1
|
Vallejo C, Rosell A, Xicoy B, García C, Albo C, Polo M, Jarque I, Esteban B, Codesido ML. A multicentre ambispective observational study into the incidence and clinical management of aplastic anaemia in Spain (IMAS study). Ann Hematol 2024; 103:705-713. [PMID: 38175253 DOI: 10.1007/s00277-023-05602-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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
Aplastic anemia (AA) is a rare, life-threatening hematological disease, with a poorly defined incidence. As the data available on AA varies substantially worldwide, a multicenter, ambispective, observational study was carried out between 2010 and 2019 to assess the incidence, clinical management and survival of AA at seven Spanish hospitals. The incidence of AA was 2.83 per million inhabitants per year, consistent with that reported previously in Europe, with a median age at diagnosis of 61 years-old (range 12-86), and a similar number of males and females. The initial diagnosis was severe or very severe AA in 55.8% of cases and 93.7% required transfusion. The most frequent first line therapy was anti-thymocyte globulin (ATG) plus cyclosporin A (CsA, 44.2%), followed by other CsA-based regimes (46.3%), with hematopoietic stem cell transplantation an infrequent 1st line therapy. The 6-month response rate was 68.2%, which then increased over a median follow-up of 3.9 years. The 5-year overall survival (5OS) was 73.6%, similar in severe (78.6%) and very severe AA patients (74.6%) but lower in moderate AA (MAA) patients (68.4%). The 5OS was 100% in 0-25 year-old patients but dropping to 58.3% in patients ≥ 60 years-old. At the last contact, 75.8% of the patients were alive. In conclusion, the incidence, characteristics and management of AA in our study are consistent with that reported previously. In terms of survival, although the global long-term OS rate was good, there is room for improvement, particularly in older patients. Finally, what appears to be a worse long-term survival of MAA patients, as reported previously, reinforces the importance of not underestimating this condition when diagnosed as MAA.
Collapse
Affiliation(s)
- Carlos Vallejo
- Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
- Hospital Universitario Donostia, San Sebastián, Spain.
- PETHEMA Cooperative Group, Madrid, Spain.
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain.
| | - Ana Rosell
- Hospital Universitario Virgen de La Victoria, Málaga, Spain
| | - Blanca Xicoy
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Carmen García
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Carmen Albo
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Marta Polo
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Brígida Esteban
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | - M Lorena Codesido
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| |
Collapse
|
2
|
Guo H, Zhao Y, Mu R, Zhang G, Chen S, Cao X, Liu K, Liu Y, Dai B, Zhou Y, Wang C, Yang J. The Protective Effect of Chronic Intermittent Hypobaric Hypoxia on Preventing the Destruction of CD34 + Haematopoietic Stem Cells in Aplastic Anaemia by Modulating the Th1/Th2 Balance. Stem Cell Rev Rep 2024; 20:301-312. [PMID: 37831395 DOI: 10.1007/s12015-023-10631-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023]
Abstract
Aplastic anaemia (AA) is a haematopoietic disorder caused by immune-mediated attack on haematopoietic stem cells (HSCs). Stem cell transplantation and immunosuppressive therapy remain the major treatment choice for AA patients but have limited benefits and undesired side effects. The aim of our study was to clarify the protective role of immunity of chronic intermittent hypobaric hypoxia (CIHH) and the underlying mechanism in AA. Our integrative analysis demonstrated that CIHH pre-treatment significantly improved haematopoiesis and survival in an AA rat model. We further confirmed that CIHH pre-treatment was closely associated with the Th1/Th2 balance and a large number of negative regulatory haematopoietic factors, such as TNF-α and IFN-γ, produced by hyperactive Th1 lymphocytes released in AA rats, which induced the death program in a large number of CD34+ HSCs by activating the Fas/FasL apoptosis pathway, while CIHH pre-treatment effectively downregulated the expression of TNF-α and IFN-γ, resulting in a reduction in Fas antigen expression in CD34+ HSCs. In summary, this study provides evidence that CIHH has good protective effect against AA by modulating immune balance in Th1/Th2 cells and may provide a new therapeutic strategy.
Collapse
Affiliation(s)
- Hui Guo
- Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou, China
- Key Laboratory of Infection and Immunity of CAS, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Yilin Zhao
- Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou, China
- Department of Pathology and Pathophysiology, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China
| | - Rui Mu
- College of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Guangdao Zhang
- Department of Prosthodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Shuxian Chen
- College of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Xinwei Cao
- College of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Kangcan Liu
- College of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Yiran Liu
- College of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Baiyun Dai
- Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou, China
- Department of Pathology and Pathophysiology, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China
| | - Yuan Zhou
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
| | - Chuan Wang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.
| | - Jing Yang
- Key Laboratory of Aging and Cancer Biology of Zhejiang Province, Hangzhou, China.
- Department of Pathology and Pathophysiology, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China.
| |
Collapse
|
3
|
Fox LC, McQuilten ZK, Firkin F, Fox V, Badoux X, Bajel A, Barbaro P, Cole-Sinclair MF, Forsyth C, Gibson J, Hiwase DK, Johnston A, Mills A, Roncolato F, Sutherland R, Szer J, Ting SB, Vilcassim S, Young L, Waters NA, Wood EM. The Australian Aplastic Anaemia and other Bone Marrow Failure Syndromes Registry. Best Pract Res Clin Haematol 2023; 36:101516. [PMID: 38092475 DOI: 10.1016/j.beha.2023.101516] [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: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 12/18/2023]
Abstract
The bone marrow failure syndromes (BMFS) are a diverse group of acquired and inherited diseases which may manifest in cytopenias, haematological malignancy and/or syndromic multisystem disease. Patients with BMFS frequently experience poor outcomes, and improved treatment strategies are needed. Collation of clinical characteristics and patient outcomes in a national disease-specific registry represents a powerful tool to identify areas of need and support clinical and research collaboration. Novel treatment strategies such as gene therapy, particularly in rare diseases, will depend on the ability to identify eligible patients alongside the molecular genetic features of their disease that may be amenable to novel therapy. The Australian Aplastic Anaemia and other Bone Marrow Failure Syndromes Registry (AAR) aims to improve outcomes for all paediatric and adult patients with BMFS in Australia by describing the demographics, treatments (including supportive care) and outcomes, and serving as a resource for research and practice improvement.
Collapse
Affiliation(s)
- Lucy C Fox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Austin Health, Melbourne, Australia
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia
| | | | - Vanessa Fox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia
| | | | - Merrole F Cole-Sinclair
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; St Vincent's Hospital, Melbourne, Australia
| | | | - John Gibson
- Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | | | | | - Robyn Sutherland
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeff Szer
- Peter MacCallum Cancer Centre, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia
| | - Stephen B Ting
- Eastern Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Shahla Vilcassim
- Monash Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Lauren Young
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Neil A Waters
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Monash Health, Melbourne, Australia.
| |
Collapse
|
4
|
Iqbal A, Phukan A, Sharma C. Indigenous antithymocyte globulin-equine to treat aplastic anaemia in adults: a case series from two centres in northeast India. Hematol Transfus Cell Ther 2023:S2531-1379(23)02540-3. [PMID: 38302378 DOI: 10.1016/j.htct.2023.08.005] [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: 09/14/2021] [Revised: 10/11/2022] [Accepted: 08/09/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Immunosuppressive therapy is the standard management of adults with aplastic anaemia. Antithymocyte globulin is used as first-line treatment of patients not eligible for bone marrow transplantation. This being a rare disease, available evidence in India is scarce. This study aimed to present experience in treating adult aplastic anaemia patients by immunosuppressive therapy using antithymocyte globulin-equine (Thymogam) in two tertiary care centres of northeast India. METHODS This case series was conducted at the Health city hospital, Guwahati, and Excel Care Hospital, Guwahati from 2018 to 2020. Eighteen adult aplastic anaemia patients who were treated by immunosuppressive therapy with antithymocyte globulin-equine (Thymogam) and followed up for two years were included. Treatment response and relapse are described. RESULTS All the 18 patients, (14 severe, four very severe) were uniformly treated with immunosuppressive therapy (Thymogam 40 mg/kg/d for four days with oral Cyclosporine from Day-1). Cyclosporin A was used as a concomitant drug in 94.44 % of the patients. At two years of follow up, 66.7 % showed a response and the mortality rate was 11.1 %. CONCLUSION The results of this case series substantiate the effectiveness of immunosuppressive therapy with a low-cost preparation of horse antithymocyte globulin (Thymogam) along with cyclosporin A in the management of aplastic anaemia patients not suitable for bone marrow transplantation.
Collapse
Affiliation(s)
- Asif Iqbal
- Department of Medical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India.
| | - Abhijit Phukan
- Department of Haematology and Bone Marrow Transplant, Excel Care Hospitals, Guwahati, India
| | - Chandana Sharma
- Department of Internal Medicine and Critical care, Health City Hospital, Guwahati, India
| |
Collapse
|
5
|
Singh A, Prasad P, Singh A. A case of strongyloidiasis with aplastic anaemia: A common disease with an uncommon presentation. IDCases 2023; 33:e01883. [PMID: 37663134 PMCID: PMC10474063 DOI: 10.1016/j.idcr.2023.e01883] [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: 07/29/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
Strongyloidiasis is an opportunistic infection caused by the nematode helminth Strongyloides stercoralis and transmitted mostly via soil. The disease is usually asymptomatic, limited, and long-standing. Herein, we report a case of strongyloidiasis in a patient who seemed to be immunocompetent despite his malnourished appearance. He was presented with pancytopenia and aplastic anaemia and well responded to albendazole therapy with complete resolution of symptoms within three months. We recommend, prior to beginning of immunosuppressive regimens, it may be prudent to examine all patients presenting with abdominal discomfort along with pancytopenia for a possible worm infestation. Bone marrow suppression induced by worm infestation is an extremely rare but potentially comorbid condition that can lead to pancytopenia and severe aplastic anaemia.
Collapse
Affiliation(s)
- Alka Singh
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Pallavi Prasad
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anurag Singh
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
6
|
Hill A, de Latour RP, Kulasekararaj AG, Griffin M, Brodsky RA, Maciejewski JP, Marantz JL, Gustovic P, Schrezenmeier H. Concomitant Immunosuppressive Therapy and Eculizumab Use in Patients with Paroxysmal Nocturnal Hemoglobinuria: An International PNH Registry Analysis. Acta Haematol 2023; 146:1-13. [PMID: 36108594 DOI: 10.1159/000526979] [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: 01/28/2022] [Accepted: 09/03/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Complement C5 inhibitor eculizumab is the first approved treatment for paroxysmal nocturnal hemoglobinuria (PNH), a rare hematologic disorder caused by uncontrolled terminal complement activation. Approximately 50% of patients with aplastic anemia (AA) have PNH cells. Limited data are available for patients with AA-PNH taking concomitant immunosuppressive therapy (IST) and eculizumab. METHODS Data from the International PNH Registry (NCT01374360) were used to evaluate the safety and effectiveness of eculizumab and IST in patients taking IST followed by concomitant eculizumab (IST + c-Ecu) or eculizumab followed by concomitant IST (Ecu + c-IST). RESULTS As of January 1, 2018, 181 Registry-enrolled patients were included in the eculizumab effectiveness analyses (n = 138, IST + c-Ecu; n = 43, Ecu + c-IST); 87 additional patients received IST alone. Reductions from baseline with eculizumab were observed in the least squares mean lactate dehydrogenase ratio (IST + c-Ecu, -3.4; Ecu + c-IST, -3.5); thrombotic event incidence rates were similar between groups (IST + c-Ecu, 1.3; Ecu + c-IST, 0.7). Red blood cell transfusion rate ratios decreased from baseline for IST + c-Ecu (0.7) and increased for Ecu + c-IST (1.2); there were none for IST alone. Hematological parameters generally improved for IST + c-Ecu and IST alone, and changed minimally or worsened for Ecu + c-IST. Safety signals were generally consistent with those previously described for the respective therapies. DISCUSSION/CONCLUSION Although some intergroup differences were seen, concomitant eculizumab and IST were safe and effective regardless of treatment sequence.
Collapse
Affiliation(s)
- Anita Hill
- Department of Haematology, Leeds Teaching Hospitals, Leeds, UK
| | | | | | - Morag Griffin
- Department of Haematology, St. James University Hospital, Leeds, UK
| | - Robert A Brodsky
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jing L Marantz
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | | | - Hubert Schrezenmeier
- Institute of Transfusion Medicine, University of Ulm, and Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, Ulm, Germany
| |
Collapse
|
7
|
Gale R, Hinterberger W, Young NS, Gennery A, Dvorak C, Hebert K, Heim M, Broglie L, Eapen M. What Causes Aplastic Anaemia: Results of Transplants from Genetically-Identical Twins. Res Sq 2023:rs.3.rs-2540187. [PMID: 36778326 PMCID: PMC9915784 DOI: 10.21203/rs.3.rs-2540187/v1] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Aplastic anaemia has diverse aetiologies. Distinguishing between these is, in part, testable by analyzing results of haematopoietic cells transplants between genetically-identical twins one of whom has aplastic anaemia. Objective Describe outcomes of genetically-identical twin transplants for aplastic anaemia with and without pretransplant conditioning. Methods We interrogated data from an observational database of 59 consecutive recipients of genetically-identical twin transplants for aplastic anaemia reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) 2000-2019. Results 38 subjects were male. Median age was 18 years (Interquartile Range [IQR], 11-32 years). Median interval from diagnosis to transplant was 2 months (IQR 1-3 months). 11 subjects received a 1st transplant without pretransplant conditioning. 2 of recovered normal bone marrow function. The other 9 received a 2nd transplant with pretransplant conditioning 7 of whom recovered. 48 subjects received pretransplant conditioning before a 1st or 2nd transplant all of whom recovered. Conclusion Only some genetically-identical twins with aplastic anaemia recover normal bone marrow function after a 1st haematopoietic cell transplant without pretransplant conditioning whereas most subjects recover when a transplant is preceded by pretransplant conditioning. These data are consistent with an immune-mediated aetiology of aplastic anaemia in most cases.
Collapse
Affiliation(s)
| | | | | | | | | | - Kyle Hebert
- CIBMTR Statistical Center, Medical College of Wisconsin
| | - Michael Heim
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin
| | - Larisa Broglie
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin
| | | |
Collapse
|
8
|
Yang W, Zhao X, Liu X, Xiong Y, Fan H, Zhang L, Li J, Ye L, Zhou K, Li Y, Yang Y, Peng G, Jing L, Zhang F. Hetrombopag plus porcine ATG and cyclosporine for the treatment of aplastic anaemia: early outcomes of a prospective pilot study. Exp Hematol Oncol 2023; 12:16. [PMID: 36726169 PMCID: PMC9890734 DOI: 10.1186/s40164-023-00377-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
Hetrombopag, a small molecular thrombopoietin-receptor agonist, has shown encouraging efficiency in immunosuppressive therapy refractory or relapsed severe aplastic anaemia. To investigate the response rate of hetrombopag combined with IST as first-line treatment, we designed a prospective pilot study including 32 patients with SAA treated with anti-human T lymphocyte porcine immunoglobulin (p-ATG), cyclosporine, and hetrombopag. In addition, 96 patients with SAA treated with p-ATG and cyclosporine alone were matched as controls. In total, 21.9% of patients treated with hetrombopag achieved complete response (CR) at 3 months, while 5.2% of patients achieved CR in the control group (P = 0.005). At 6 months, the CR rates were 34.4% in the hetrombopag group and 14.6% in the control group (P = 0.015). The overall response rates at 6 months were 68.7% and 50.0% in the hetrombopag and control groups, respectively. The median time to haematologic response was 56 days and 77 days, and to CR was 96 days and 214 days in the hetrombopag and control groups, respectively. In conclusion, adding hetrombopag to IST as first-line treatment resulted in faster and better haematologic response in SAA.
Collapse
Affiliation(s)
- Wenrui Yang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Xin Zhao
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Xu Liu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Youzhen Xiong
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Huihui Fan
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Li Zhang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Jianping Li
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Lei Ye
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Kang Zhou
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Yuan Li
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Yang Yang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Guangxin Peng
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Liping Jing
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| | - Fengkui Zhang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020 China
| |
Collapse
|
9
|
Khan M, Iftikhar R, Chaudhry QU, Mehmood SK, Faraz T, Ghafoor T, Shahbaz N, Khan MA, Shamshad GU, Khattak TA. Response To Immunosuppressive Therapy In Patients Of Acquired Aplastic Anaemia: A Single Center Experience From A Developing Country. J Ayub Med Coll Abbottabad 2022; 34(Suppl 1):S969-73. [PMID: 36550655 DOI: 10.55519/JAMC-04-S4-9885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Aplastic Anaemia (AA) is characterized by pancytopenia and hypocellular marrow. Immunosuppressive therapy (IST) SHOWS impressive haematological response; however, risk of relapse and clonal evolution persists. The objective of the study is to assess response to IST in patients with aplastic anaemia. Methods A retrospective single centre study at AFBMTC / NIBMT for patients of acquired AA was conducted from January 2005 to December 2019.Inclusion criteria included diagnosed cases of acquired AA receiving IST for at least 12 weeks and age >2 years. IST included cyclosporine (CsA) alone, CsA + androgens, CsA + rabbit anti thymocyte globulin (rATG), CsA + horse anti thymocyte globulin (hATG). Primary outcome measure was response to IST; secondary outcome measure was overall survival (OS). Results A total of 513 patients received IST. Median age was 23 years (range 2-97 years). In study cohort, 155 (30.2%) patients responded to the IST, 63 (12.3%) achieved complete response (CR) while 92 (17.9%) achieved partial response (PR). The ORR of CsA in NSAA, SAA and VSAA was 52.6%, 28.10% and 10% respectively; whereas ORR of CsA + rATG in NSAA, SAA and VSAA was 50%, 35.1% and 22.5% respectively. OS was 38% at a median follow up of 36 months. There was a significant difference in the survival distributions of different treatment modalities (p=0.016). Median survival time 60 months (CsA), 9 months (CsA+ androgens) and 39 months (CsA+ rATG/hATG.) . Conclusion In resource constrained settings, single agent CsA remains a reasonable alternative with modest activity and acceptable side effect profile.
Collapse
|
10
|
Hwang YY, Chan TSY, Chan FHY, Lau CWP, Luk YY, Lau GWN, Chan KP, Leung KH, Kho B, Lau JSM, Lau CK, Mak V, Yip SF, Lin SY, Sim JPY, Kwong YL. Eltrombopag as frontline treatment of aplastic anaemia in routine practice: implications on cost and efficacy. Ann Hematol 2022. [PMID: 35412083 DOI: 10.1007/s00277-022-04780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/29/2022] [Indexed: 11/01/2022]
Abstract
The thrombopoietin mimetic eltrombopag (EPAG) is efficacious in clinical trials of newly diagnosed moderate (M), severe (S) and very severe (vS) aplastic anaemia (AA). Its use in routine practice and resource-constrained settings is not well described. Twenty-five men and 38 women at a median age of 54 (18-86) years with newly diagnosed AA treated consecutively in a 7-year period with EPAG (N = 6), EPAG/cyclosporine (CsA) (N = 33) and EPAG/CsA/anti-thymocyte globulin (ATG) (N = 24) were analyzed. Because EPAG was not reimbursed, peak doses ranged from 25 to 200 mg/day depending on affordability. EPAG/CsA-treated patients were older (median age: 61 years) with less severe AA (MAA, N = 15; SAA, N = 14; vSAA, N = 4), whereas EPAG/CsA/ATG-treated patients were younger (median age: 44 years) with more severe AA (MAA, N = 2; SAA, N = 12, vSAA, N = 10). The overall/trilineage response rates were 83%/50% for EPAG-treated patients; 79%/42% for EPAG/CsA-treated patients and 75%/63% for EPAG/CsA/ATG-treated patients. Adverse events included grade 1 liver derangement (N = 7) and grade 1 dyspepsia (N = 3). The 5-year overall survivals/failure-free survivals were 62%/80% for the entire cohort; 55%/75% for EPAG/CsA-treated patients and 82%/78% for EPAG/CsA/ATG-treated patients. EPAG showed robust efficacy in AA in routine practice. However, EPAG dosage and combinations remain to be optimized for AA of different severities.
Collapse
|
11
|
Patel BA, Giudice V, Young NS. Immunologic effects on the haematopoietic stem cell in marrow failure. Best Pract Res Clin Haematol 2021; 34:101276. [PMID: 34404528 DOI: 10.1016/j.beha.2021.101276] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
Acquired bone marrow failure (BMF) syndromes comprise a diverse group of diseases with variable clinical manifestations but overlapping features of immune activation, resulting in haematopoietic stem and progenitor cells (HSPC) damage and destruction. This review focuses on clinical presentation, pathophysiology, and treatment of four BMF: acquired aplastic anaemia, large granular lymphocytic leukaemia, paroxysmal nocturnal haemoglobinuria, and hypoplastic myelodysplastic syndrome. Autoantigens are speculated to be the inciting event that result in immune activation in all of these diseases, but specific pathogenic antigens have not been identified. Oligoclonal cytotoxic T cell expansion and an active role of proinflammatory cytokines, primarily interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α), are two main contributors to HSPC growth inhibition and apoptosis in BMF. Emerging evidence also suggests involvement of the innate immune system.
Collapse
|
12
|
Mania A, Mazur-Melewska K, Lubarski K, Kuczma-Napierała J, Mazurek J, Jończyk-Potoczna K, Służewski W, Figlerowicz M. Wide spectrum of clinical picture of COVID-19 in children - From mild to severe disease. J Infect Public Health 2021; 14:374-379. [PMID: 33621800 PMCID: PMC7833883 DOI: 10.1016/j.jiph.2020.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/30/2020] [Accepted: 12/20/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Children account for a relatively small proportion of laboratory-confirmed SARS-CoV-2 infections. In children, COVID-19 usually has a relatively mild course. However, in rare cases, severe disorders can be observed, and clinical manifestations may differ from adults. PURPOSE The aim of this study is to analyse the frequency, clinical picture and outcome of COVID-19 in children based on the experience from the tertiary care centre and regional sanitary-epidemiological office. METHODS We report a study regarding 106 cases of confirmed SARS-CoV-2 infection cases in PCR from a nasopharyngeal swab (age range 1-month - 17-years). In all cases, history was taken. In children who required hospital admission, physical examination and laboratory test were performed according to clinical indications. RESULTS Twelve of the patients required admission to the hospital. The most common symptoms were anosmia and dysgeusia (75%) and headaches (49%) in outpatients and fever in hospitalised children (75%). Three children from the hospitalised group developed a severe course with increased inflammatory indexes. The clinical picture was more severe in younger children from the hospitalised group. Treatment options were regarded individually in all cases. CONCLUSION Our study is the first tour knowledge regarding the clinical course of COVID-19 in Polish children. In general, the clinical course of COVID-19 was mild with anosmia and dysgeusia as the most common symptoms. However, in hospitalised children, a severe progression of the disease and less typical signs as aplastic anaemia may be developed.
Collapse
Affiliation(s)
- Anna Mania
- Department of Infectious Diseases and Child Neurology, University of Medical Sciences in Poznań, Poland.
| | - Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, University of Medical Sciences in Poznań, Poland
| | - Karol Lubarski
- Department of Infectious Diseases and Child Neurology, University of Medical Sciences in Poznań, Poland
| | | | - Justyna Mazurek
- Regional Sanitary-Epidemiological Station in Poznan (WSSE), Poland
| | | | - Wojciech Służewski
- Department of Infectious Diseases and Child Neurology, University of Medical Sciences in Poznań, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, University of Medical Sciences in Poznań, Poland
| |
Collapse
|
13
|
Skibenes ST, Clausen I, Raaschou-Jensen K. Next-generation sequencing in hypoplastic bone marrow failure: What difference does it make? Eur J Haematol 2020; 106:3-13. [PMID: 32888355 DOI: 10.1111/ejh.13513] [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: 05/02/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
Hypoplastic bone marrow failure is a diagnostic feature of multiple haematological disorders, which also share a substantial overlap of clinical symptoms. Hence, discrimination of underlying disorders in patients presenting with hypoplastic bone marrow failure remains a major challenge in the clinic. Recent next-generation sequencing (NGS) studies have broadened our understanding of the varying molecular mechanisms and advanced diagnostics of disorders exhibiting hypoplastic bone marrow failure. In this article, we present a literature review of NGS studies of haematological disorders associated with hypoplastic bone marrow failure and highlight the relevance of NGS for improved clinical diagnostics and decision-making.
Collapse
Affiliation(s)
- Sofie T Skibenes
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Ida Clausen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
14
|
Abstract
INTRODUCTION Temozolomide (TMZ) is an oral alkylating agent principally indicated for neurological malignancies including glioblastoma (GBM) and astrocytoma. Most common side effects are mild to moderate, and include fatigue, nausea, vomiting, thrombocytopenia and neutropenia. Severe or prolonged myelosuppression, causing delayed treatment or discontinuation, is uncommon. Major haematological adverse effects such as myelodysplastic syndrome or aplastic anaemia (AA) have rarely been reported. CASE REPORT We report a 68-year old female with GBM treated at a tertiary hospital with short-course radiotherapy and concurrent temozolomide following craniotomy. On treatment completion she was transferred to our hospital for rehabilitation. She was thrombocytopenic on admission. Platelets continued falling with significant pancytopenia developing over the next two weeks. Blood parameters and a markedly hypocellular bone marrow confirmed the diagnosis of very severe AA, probably due to TMZ. MANAGEMENT AND OUTCOME Treatment consisted of repeated platelet transfusions, intravenous antibiotics, antiviral and antifungal prophylaxis, and G-CSF 300 mcg daily. Platelet and neutrophil counts had returned to normal at 38 days following the completion of TMZ treatment. DISCUSSION Whilst most cases of AA are idiopathic, a careful drug, occupational exposure and family history should be obtained, as acquired AA may result from viruses, chemical exposure, radiation and medications. Temozolomide-induced AA is well documented, though only 12 cases have been described in detail. Other potential causes were eliminated in our patient. Physicians should be aware of this rare and potentially fatal toxicity when prescribing. Frequent blood tests should be performed, during and following TMZ treatment, to enable early detection.
Collapse
Affiliation(s)
- Peter J Gilbar
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Khageshwor Pokharel
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Hilda M Mangos
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia
| |
Collapse
|
15
|
Wei Y, Zhang L, Chi Y, Ren X, Gao Y, Song B, Li C, Han Z, Zhang L, Han Z. High-efficient generation of VCAM-1 + mesenchymal stem cells with multidimensional superiorities in signatures and efficacy on aplastic anaemia mice. Cell Prolif 2020; 53:e12862. [PMID: 32597552 PMCID: PMC7445411 DOI: 10.1111/cpr.12862] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 03/16/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Longitudinal studies have indicated VCAM-1+ mesenchymal stem/stromal cells (MSCs) as promising resources in regenerative medicine, yet the abundance in gene expression is far from adequate in the advantaged and "discarded" hUC-MSCs. Thus, high-efficient preparation and systematic dissection of the signatures and biofunctions of the subpopulation is the prerequisite for large-scale clinical applications. MATERIALS AND METHODS We primarily took advantage of a cytokine-based programming strategy for large-scale VCAM-1+ hUC-MSC generation (III-MSCs). Thereafter, we conducted multifaceted analyses including cytomorphology, immunophenotype, cell vitality, multilineage differentiation, whole-genome analysis, tube formation and Matrigel plug assay, lymphocyte activation and differentiation, and systemic transplantation for aplastic anaemia (AA) treatment. RESULTS III-MSCs with high-proportioned VCAM-1 expression were obtained by combining IL-1β, IL-4 with IFN-γ, which exhibited comparable immunophenotype with untreated hUC-MSCs (NT-MSCs) but revealed multidimensional superiorities both at the cellular and molecular levels. Simultaneously, systemic infusion of III-MSCs could significantly ameliorate clinicopathological features and finally help facilitate haematopoietic reconstruction and immunoregulation in AA mice. CONCLUSIONS We have established a high-efficient procedure for large-scale generation of III-MSCs with preferable signatures and efficacy upon aplastic anaemia in mice. Our findings suggested that III-MSCs were advantageous sources with multifaceted characteristics for regenerative medicine.
Collapse
Affiliation(s)
- Yimeng Wei
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Leisheng Zhang
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.,The Postdoctoral Research Station, School of Medicine, Nankai University, Tianjin, China.,The Enterprise Postdoctoral Working Station, Tianjin Chase Sun Pharmaceutical Co., Ltd., Tianjin, China.,Precision Medicine Division, Health-Biotech (Tianjin) Stem Cell Research Institute Co., Ltd., Tianjin, China
| | - Ying Chi
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Xiang Ren
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yuchen Gao
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Baoquan Song
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chengwen Li
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zhibo Han
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zhongchao Han
- State Key Laboratory of Experimental Hematology & National Clinical Research Center for Blood Disease, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.,Precision Medicine Division, Health-Biotech (Tianjin) Stem Cell Research Institute Co., Ltd., Tianjin, China
| |
Collapse
|
16
|
Michot JM, Lazarovici J, Tieu A, Champiat S, Voisin AL, Ebbo M, Godeau B, Michel M, Ribrag V, Lambotte O. Haematological immune-related adverse events with immune checkpoint inhibitors, how to manage? Eur J Cancer 2019; 122:72-90. [PMID: 31634647 DOI: 10.1016/j.ejca.2019.07.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [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: 06/30/2019] [Revised: 07/21/2019] [Accepted: 07/23/2019] [Indexed: 01/06/2023]
Abstract
Immune checkpoint inhibitors (ICIs) are changing the treatments of many patients with cancer. These immunotherapies are generally better tolerated than chemotherapy, and their adverse events are immune-related mimicking autoimmune or inflammatory conditions. Although these immune-related adverse events mainly affect the skin, endocrine glands, digestive tract, joints, liver or lungs, all the organs can be theoretically affected, and the haematopoietic system is not spared. This review of the literature will focus on the haematological immune-related adverse events (Haem-irAEs). By reviewing the largest clinical trials of ICIs, we estimate the frequency of Haem-irAEs at 3.6% for all grades and 0.7% for grades III-IV. Frequency of Haem-irAEs of all grades was found to be higher with anti-programmed cell death 1 (4.1%) or anti-programmed cell death ligand 1 (4.7%) than with anti-cytotoxic T-lymphocyte-associated protein 4 (0.5%) (p < 0.0001). From the 63 cases with Haem-irAEs reported in the literature, the mean time to the onset was found to be 10 weeks after ICI initiation, and the large range for occurrence (1-84 weeks) and the regular incidence suggest that Haem-irAEs could occur at any time after ICI therapy. Among the 63 reported cases with Haem-irAEs, the distribution was immune thrombocytopenia (n = 18, 29%), pancytopenia or immune aplastic anaemia (n = 12, 19%), neutropenia (n = 11, 17%), haemolytic anaemia (n = 10, 16%), cytokine release syndrome with haemophagocytic syndrome (n = 7, 11%) and other Haem-irAEs including bicytopenia or pure red cell aplasia (n = 5, 8%). Haem-irAEs are generally highly severe adverse reactions with a mortality rate of Haem-irAEs reported to be 14% (9 deaths among the 63 cases reported). The more severe and life-threatening Haem-irAEs were both cytokine release syndrome with haemophagocytic syndrome and pancytopenia or aplastic anaemia. Haem-irAEs induced by ICIs are potentially life-threatening. By discussing their pathophysiological aspects and clinical picture, we propose in this review clinical guidelines for management.
Collapse
Affiliation(s)
- J M Michot
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, F-94805, France; Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, F-94275, France.
| | - J Lazarovici
- Gustave Roussy, Université Paris-Saclay, Département D'Hématologie, Villejuif, F-94805, France
| | - A Tieu
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, F-94275, France
| | - S Champiat
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, F-94805, France
| | - A L Voisin
- Gustave Roussy, Université Paris-Saclay, Unité de Pharmacovigilance, Villejuif, F-94805, France
| | - M Ebbo
- Assistance Publique - Hôpitaux de Marseille, Hôpital de La Timone, Médecine Interne, Marseille, F-13005, France
| | - B Godeau
- Assistance Publique - Hôpitaux de Paris, Hôpital Henri Mondor, Médecine Interne, Centre de Référence des Cytopénies Auto-immunes de L'Adulte, Université Paris-Est Créteil, Créteil, F-94010, France
| | - M Michel
- Assistance Publique - Hôpitaux de Paris, Hôpital Henri Mondor, Médecine Interne, Centre de Référence des Cytopénies Auto-immunes de L'Adulte, Université Paris-Est Créteil, Créteil, F-94010, France
| | - V Ribrag
- Gustave Roussy, Université Paris-Saclay, Département des Innovations Thérapeutiques et Essais Précoces, Villejuif, F-94805, France; Gustave Roussy, Université Paris-Saclay, Département D'Hématologie, Villejuif, F-94805, France
| | - O Lambotte
- Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, F-94275, France; INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, F-94276, France; Université Paris Sud, UMR 1184, Le Kremlin-Bicêtre, F-94276, France; CEA, DSV/iMETI, IDMIT, Fontenay-aux-Roses, F-92265, France
| |
Collapse
|
17
|
Dutta B, Dolai TK, Mandal PK, Baul S, De R, Senthil K, Chakrabarti P. Response to Immunosuppressive Therapy in Acquired Aplastic Anaemia: Experience of a Tertiary Care Centre from Eastern India. Indian J Hematol Blood Transfus 2019; 37:197-203. [PMID: 33867724 DOI: 10.1007/s12288-019-01158-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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022] Open
Abstract
The current study was conducted to assess response to immunosuppressive therapy (IST) in acquired aplastic anaemia (AA). It was a retrospective and prospective observational study. Patients were diagnosed as per standard international guidelines and IST was started as per standard protocol. Patients were followed up at 3 months and 6 months for assessment of response as per published standard guidelines. Total 76 cases were included in the study. The median age of the study population was 36 years with a range of 6-66 years with a male to female ratio of 2.04:1. Most common clinical presentation was pallor followed by bleeding. Commonest type of disease in the study group was severe AA. Among total 76 patients, 32 patients received Atgam and 44 patients received Thymogam. Within 3 months of ATG administration, 4 patients died and 1 patient was lost to follow up. At 3 months, 2 (2.63%) patients were on complete response (CR), 32 (42.10%) patients were in partial response (PR) and 37 (48.68%) patients were on no response (NR). Overall response (OR) at 3 months was 44.73%. At 6 months 5 (6.57%) patients were in CR, 43 (56.57%) patients in PR and 23 (30.26%) patients in NR; the OR was 63.14%. Overall response at 3 months was 44.73% and overall response at 6 months was 63.14%. The study revealed better overall survival for patients with ATGAM treatment than THYMOGAM treatment arm.
Collapse
Affiliation(s)
- Bijita Dutta
- Department of Hematology, NRS Medical College, Kolkata, 700014 India
| | | | - Prakas Kumar Mandal
- Department of Hematology, NRS Medical College, Kolkata, 700014 India.,Kolkata, India
| | - ShuvraNeel Baul
- Department of Hematology, NRS Medical College, Kolkata, 700014 India
| | - Rajib De
- Department of Hematology, NRS Medical College, Kolkata, 700014 India
| | - Karthika Senthil
- Department of Hematology, NRS Medical College, Kolkata, 700014 India
| | | |
Collapse
|
18
|
Niedeggen C, Singer S, Groth M, Petermann-Meyer A, Röth A, Schrezenmeier H, Höchsmann B, Brümmendorf TH, Panse J. Design and development of a disease-specific quality of life tool for patients with aplastic anaemia and/or paroxysmal nocturnal haemoglobinuria (QLQ-AA/PNH)-a report on phase III. Ann Hematol 2019; 98:1547-59. [PMID: 31115593 DOI: 10.1007/s00277-019-03681-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 03/28/2019] [Indexed: 12/20/2022]
Abstract
To date, instruments to measure quality of life (QoL) specifically for patients with acquired aplastic anaemia (AA) and paroxysmal nocturnal haemoglobinuria (PNH) are lacking altogether. As a consequence, this issue is either underevaluated or alternatively, instruments originally designed for cancer patients are being used. We therefore started to systematically develop a AA/PNH-specific QoL (QLQ-AA/PNH) instrument in these ultra-rare diseases according to European Organisation for Research and Treatment of Cancer (EORTC) guidelines. While phases I and II of the process have previously been published, we now report on the resulting instrument (phase III of this process). As part of the phase III of the evaluation process, we approached patients through physicians, patient support groups, and patient conferences. After participants completed the preliminary questionnaire and reported socio-demographic data, they were interviewed in person or via phone with a debriefing interview to find out whether the items were relevant, easy to understand, and acceptable to patients and whether there was anything missing in the questionnaire. We hypothesised what items could be combined into a scale and calculated Cronbach’s alpha to define its preliminary internal consistency. After definition of a priori criteria to keep or delete items, a group of six experts met in person, discussed the results, and decided on in- or exclusion. A total of 48 patients were enrolled, 21 of those suffered from AA (44%), 13 from PNH (27%), and 14 from AA/PNH syndrome (29%). The median time to complete the 69 items was 10 min (range 5–20), mean time 11 min. The compliance criterion (> 95% completion) was fulfilled by 57 items. Twenty-three items were mentioned as especially relevant by ≥ 2% of the patients. Cronbach’s alpha of the hypothesised scales ranged from 0.63 (social support) to 0.92 (fear of progression and illness intrusiveness). Finally, 47 items were kept; 16 were deleted, and 5 were changed, while 1 item expanded. This resulted in 54 items in total. As no issues were mentioned to lacking by a minimum of five patients, no items were added to the questionnaire. After completion, the AA/PNH-QoL tool (QLQ-AA/PNH) was translated according to EORTC guidelines into English, French, and Italian. For patients with PNH and AA until now, the standard assessment for QoL was to use the EORTC Quality of Life Questionnaire (QLQ-C30) or the Functional Assessment of Chronic Illness Therapy Fatigue Instrument (FACIT-Fatigue). We herewith present a new instrument aimed to be better tailored to the needs of PNH and AA patients. The anticipated fourth development phase will be performed for psychometric validation; however, we already explored the internal consistency of the hypothesised scales and found the results to be very good. Hence, the new QLQ-AA/PNH with 54 items can be used in trials and clinical studies from now on, according to EORTC strategy even if the scoring algorithm at this point is preliminary and the QLQ-AA/PNH might change slightly after phase IV. This is important, as there are no other disease-specific instruments available for AA/PNH patients right now.
Collapse
|
19
|
Adhikari S, Mandal P. Integrated analysis of global gene and microRNA expression profiling associated with aplastic anaemia. Life Sci 2019; 228:47-52. [PMID: 31028805 DOI: 10.1016/j.lfs.2019.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
Abstract
AIMS Aplastic anaemia is a rare disorder characterized by peripheral pancytopenia and hypocellular bone marrow. Recent advancement of miRNA technologies, new promising therapy using small molecule inhibitors was suggested as efficient treatment option. Therefore, the study was undertaken to identify the significantly altered miRNA (miR-1202-upregulation) among aplastic anaemia patients compared to healthy controls by global miRNA expression profiling of bone marrow. MATERIALS AND METHODS miRNA and gene expression profiles for all the categories of aplastic anaemia patients and healthy controls were generated using Affymetrix probes. KEY FINDINGS The study was based on freely available miRNA and host gene expression in NCBI GEO dataset. Microarray based gene expression profiling (GSE3807) revealed that RAPGEF5 and MANEA genes were significantly downregulated among aplastic anaemia patients compared to healthy controls and the expression of these genes were again upregulated after application of therapy among those patients compared to pre-therapy condition. RAPGEF5 was involved in Rap1 and Ras signaling pathways those were significantly enriched among aplastic anaemia patients and could be relevant for that phenotype. Microarray based miRNA expression profiling (GSE82095) also identified that miR-1202 was significantly upregulated among aplastic anaemia patients compared to controls and can potentially target RAPGEF5 and MANEA genes based on target prediction of miRNAs. SIGNIFICANCE Thus synthetic miRNA inhibitors of miR-1202 can be used as a possible therapeutic agent to target miR-1202 and this inhibition can lead to its corresponding target gene upregulation for reversal of disease phenotype.
Collapse
Affiliation(s)
- Sarmistha Adhikari
- Biomedical Genetics Laboratory, Department of Zoology, The University of Burdwan, West Bengal, India
| | - Paramita Mandal
- Biomedical Genetics Laboratory, Department of Zoology, The University of Burdwan, West Bengal, India.
| |
Collapse
|
20
|
Luo S, Chen Y, Zhao L, Qi X, Miao X, Zhou H, Jia L. Effect of nutritional supplement on bone marrow-derived mesenchymal stem cells from aplastic anaemia. Br J Nutr 2018; 119:748-58. [PMID: 29569543 DOI: 10.1017/S0007114518000399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aplastic anaemia (AA) is characterised by pancytopenia resulting from a marked reduction in haemopoietic stem cells (HSC). The regulation of haemopoiesis depends on the interaction between HSC and various cells of the bone marrow (BM) microenvironment, including BM-derived mesenchymal stromal cells (BMSC). The purpose of this study was to analyse the biological effect of nutritional supplement (NS), a dietary supplement consisting of thirty-six compounds: amino acids, nucleotides, vitamins and micronutrients on the BMSC of AA rats. The AA rat model was established by irradiating X-ray (2·5 Gy) and intraperitoneal injections of cyclophosphamide (35 mg/kg; Sigma) and chloramphenicol (35 mg/kg; Sigma). Then AA rats were fed with NS in a dose-dependent manner (2266·95, 1511·3, 1057·91 mg/kg d) by intragastric administration. The effect of NS on the BMSC of AA rats was analysed. As compared with AA rats, NS treatment significantly improved these peripheral blood parameters and stimulated the proliferation of total femoral nucleated cells. NS treatment affected proliferative behaviour of BMSC and suppressed BMSC differentiation to adipocytes. Furthermore, NS treatment of AA rats accelerated osteogenic differentiation of BMSC and enhanced bone mineral density. Co-incubation of HSC with mesenchymal stromal cells and serum from AA rats subjected to high-dose NS markedly improved the yield of CD34+cells. Protein microarray analysis revealed that there were eleven differentially expressed proteins in the NS group compared with the AA rat group. The identified specific NS might be implicated in rehabilitation of BMSC in AA rats, suggesting their potential of nutritional support in AA treatment.
Collapse
|
21
|
Michot JM, Vargaftig J, Leduc C, Quere G, Burroni B, Lazarovici J, Champiat S, Ribrag V, Lambotte O. Immune-related bone marrow failure following anti-PD1 therapy. Eur J Cancer 2017; 80:1-4. [PMID: 28527392 DOI: 10.1016/j.ejca.2017.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
|
22
|
John CO, Korubo K, Ogu R, Mmom CF, Mba AG, Chidiadi EA, Akani C. Management of aplastic anaemia in pregnancy in a resource poor centre. Pan Afr Med J 2016; 24:277. [PMID: 28154632 PMCID: PMC5267852 DOI: 10.11604/pamj.2016.24.277.9880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/22/2016] [Accepted: 06/10/2016] [Indexed: 11/11/2022] Open
Abstract
Aplastic anaemia occurring in pregnancy is a rare event with life threatening challenges for both mother and child. We present a successful fetomaternal outcome despite the challenges in the management of this rare condition in a tertiary but resource poor centre. This is case of a 37 year old Nigerian woman G6P0+5managed with repeated blood transfusions from 28 weeks of gestation for bone marrow biopsy confirmed aplastic anaemia following presentation with weakness and gingival bleeds. She had a cesarean section at 37 weeks for pre-eclampsia and oligohydraminous with good feto-maternal outcome. She was managed entirely with fresh whole blood and received 21 units. Aplastic Anaemia in Pregnancy is a rare event with poor feto maternal prognosis. Successful management is possible with good multi-disciplinary approach and availability of supportive comprehensive obstetric care.
Collapse
Affiliation(s)
- Celestine Osita John
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Kaladada Korubo
- Department of Haematology & Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Rosemary Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Chigozirim Faith Mmom
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Alpheus Gogo Mba
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ezenwa-Ahanene Chidiadi
- Department of Haematology & Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Chris Akani
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| |
Collapse
|
23
|
Raut SS, Shah SA, Patel KA, Shah KM, Anand AS, Talati SS, Panchal HP, Patel AA, Parikh SK, Parekh BB, Shukla SN. Improving Outcome of Aplastic Anaemia with HLA-Matched Sibling Donor Hematopoietic Stem Cell Transplantation: An Experience of Gujarat Cancer and Research Institute (GCRI). Indian J Hematol Blood Transfus 2015; 31:1-8. [PMID: 25548437 PMCID: PMC4275516 DOI: 10.1007/s12288-014-0397-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/05/2013] [Accepted: 04/21/2014] [Indexed: 11/26/2022] Open
Abstract
Fifteen patients, with a median age of 19 years having severe aplastic anaemia (SAA) underwent human leucocyte antigen (HLA) identical sibling donor hematopoietic stem cell transplantation (HSCT) using conditioning regimens containing cyclophosphamide with antithymocyte globulin (ATG) or a combination of fludarabine and cyclophosphamide with or without ATG during December 2007 to May 2013. Cyclosporine and mini methotrexate were used as graft versus host disease (GVHD) prophylaxis. Graft source included peripheral blood stem cells in 11, bone marrow in 3 and both in 1. One patient had primary graft failure while 14 patients were engrafted with a median neutrophil and platelet engraftment time of 13.5 days. One patient had secondary graft rejection. Acute GVHD occurred in 3 patients and chronic GVHD in 4. One year death rate in engrafted patients was 14.28 %. At a mean follow-up of 21.2 months, 12 (80 %) are alive and well. One of the donors was a patient of haemophilia but the disease did not occur in the recipient. The graft was successful and the recipient is alive till date.
Collapse
Affiliation(s)
- Shreeniwas S. Raut
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Sandip A. Shah
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Kinnari A. Patel
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Kamlesh M. Shah
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Asha S. Anand
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Shailesh S. Talati
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Harsha P. Panchal
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Apurva A. Patel
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Sonia K. Parikh
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Bhavesh B. Parekh
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| | - Shilin N. Shukla
- Civil Hospital, GCRI, Room No. 35, P.G. Hostel, GCRI Campus, Ahmedabad, 380016 Gujarat India
| |
Collapse
|
24
|
Pajpani M, Webb R. Lingual necrosis caused by mucormycosis in a patient with aplastic anaemia: case report. Br J Oral Maxillofac Surg 2014; 52:e144-6. [PMID: 25300888 DOI: 10.1016/j.bjoms.2014.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 09/16/2014] [Indexed: 11/20/2022]
Abstract
Mucormycosis is a rare but aggressive fungal infection that predominantly affects immunocompromised patients. We report a case that highlights the importance of knowledge to enable prompt diagnosis and management of an otherwise fatal phenomenon.
Collapse
|
25
|
Schcolnik-Cabrera A, Labastida-Mercado N, Galindo-Becerra LS, Gomez-Almaguer D, Herrera-Rojas MA, Ruiz-Delgado GJ, Ruiz-Arguelles GJ. Reduced-intensity stem cell allografting for PNH patients in the eculizumab era: The Mexican experience. ACTA ACUST UNITED AC 2014; 20:263-6. [PMID: 25148373 DOI: 10.1179/1607845414y.0000000195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background Paroxysmal nocturnal haemoglobinuria (PNH) presents as two major entities: the classical form, predominantly haemolytic and a secondary type with marrow failure and resultant aplastic anaemia (AA-PNH). Currently, the treatment of choice of the haemolytic variant is eculizumab; however, the most frequent form of PNH in México is AA-PNH. Patients and methods Six consecutive AA-PNH patients with HLA-identical siblings were allografted in two institutions in México, employing a reduced-intensity conditioning regimen for stem cell transplantation (RIST) conducted on an outpatient basis. Results Median age of the patients was 37 years (range 25-48). The patients were given a median of 5.4 × 10(6)/kg allogeneic CD34(+) cells, using 1-3 apheresis procedures. Median time to achieve above 0.5 × 10(9)/l granulocytes was 21 days, whereas median time to achieve above 20 × 10(9)/l platelets was 17 days. Five patients are alive for 330-3150 days (median 1437) after the allograft. The 3150-day overall survival is 83.3%, whereas median survival has not been reached, being above 3150 days. Conclusion We have shown that hypoplastic PNH patients can be allografted safely using RIST and that the long-term results are adequate, the cost-benefit ratio of this treatment being reasonable. Additional studies are needed to confirm the usefulness of RIST in the treatment of AA-PNH.
Collapse
|
26
|
Priya P P, A R S. Role of absolute reticulocyte count in evaluation of pancytopenia-a hospital based study. J Clin Diagn Res 2014; 8:FC01-3. [PMID: 25302197 DOI: 10.7860/jcdr/2014/8949.4704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 06/10/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pancytopenia is a common hematological entity encountered in our laboratory practice. Evaluating the causes of pancytopenia is essential for the diagnostic as well as therapeutic management of the patients. Absolute Reticulocyte count (ARC) plays a pivotal role in identifying the cause of pancytopenia in most of the cases but it has grossly been overlooked. Hence, we attempted to identify the significance of ARC as a deciding parameter in evaluating the causes of pancytopenia. MATERIALS AND METHODS The study was conducted in a tertiary health care hospital, Chennai, India. A cross-sectional descriptive study was conducted over a period of two years (2011-2013). Patients who satisfied the criteria for pancytopenia were evaluated with clinical details. Pancytopenia work-up including Peripheral blood picture, Complete blood counts, Reticulocyte count, Serum Ferritin, B12, Folate and Bone marrow aspirate was carried out. ARC was calculated and an algorithm to approach the cases of pancytopenia was derived considering ARC as the key factor. RESULTS A total of 429 cases of pancytopenia were evaluated and based on our algorithm results were tabulated. ARC was found to be <25x10^(9)/L for cases of Aplastic anaemia; 25-50x10^(9)/L for Nutritional anaemia; and, >100x10^(9)/L in Marrow infiltrative disorders and in cases of sepsis and malaria. CONCLUSION We found that ARC plays an important role in differentiating various causes of pancytopenia and hence should be routinely included in pancytopenia work up in order to avoid unnecessary bone marrow aspirations in pancytopenic patients.
Collapse
Affiliation(s)
- Poorana Priya P
- Postgraduate, Department of Pathology, Sree Balaji Medical College & Hospital , Bharath University, Chrompet, Chennai, India
| | - Subhashree A R
- Professor, Department of Pathology, Sree Balaji Medical College & Hospital , Bharath University, Chrompet, Chennai, India
| |
Collapse
|
27
|
Arewa OP, Akinola NO. Survival in primary a plastic anaemia; experience with 20 cases from a tertiary hospital in Nigeria. Afr Health Sci 2009; 9:290-293. [PMID: 21503184 PMCID: PMC3074392] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Aplastic anaemia is a condition characterized by pancytopenia and unexplained bone marrow hypocellularity. Without treatment, it is invariably fatal. However with the currently available treatment options, patient survival is improving in the developed countries. METHODS The study is a retrospective study. We reviewed the cases of primary aplastic anaemia managed in our hospital over a period of fifteen years. RESULTS A total of twenty five cases were seen; out of which twenty had complete analyzable data. Management consisted of transfusion support with packed red cells, platelet concentrates and freshly collected unbanked blood; immunosuppressive therapy was with methyl prednisolone. None of the patients had the benefit of bone marrow/stem cell transplantation. Overall median survival was 6.5 weeks. CONCLUSIONS There is a clear need to ensure the availability of proven therapeutic options for patients such as bone marrow/stem cell transplantation and drugs such as cyclosporine and antithymocyte globulin to improve on the present situation.
Collapse
Affiliation(s)
- O P Arewa
- Department of Haematology & Blood Transfusion, Obafemi Awolowo University Teaching Hospital Ile-Ife, Osun State.
| | | |
Collapse
|
28
|
Abstract
Prior to the availability of specific treatment for aplastic anaemia (AA) with antithymocyte globulin (ATG) and cyclosporin or bone marrow transplantation (BMT), most patients died within 6 months of presentation, but the survival of patients with severe AA has improved dramatically over the last two decades and many patients now survive long term. Nevertheless, AA still remains a potentially life threatening disease. Because response to treatment with ATG and cyclosporin is delayed for two to three months and sometimes longer, patients usually need intensive transfusional support and careful attention to infection prophylaxis and treatment, particularly fungal infection. It is important to adopt a careful transfusional policy at diagnosis, in particular to help prevent HLA alloimmunisation which results in refractoriness to platelet transfusions, and sensitisation to minor histocompatibility antigens which is thought to mediate graft rejection between HLA identical siblings. The indications for immunosuppressive therapy or HLA identical sibling BMT are fairly clear, but transplantation from volunteer unrelated donors remains a highly controversial and high risk procedure in patients with AA. The effects of haemopoietic growth factors in AA patients have been perhaps not surprisingly disappointing, and not without significant toxicity, with the exception of granulocyte colony stimulating factor (G-CSF) which is well tolerated clinically. G-CSF may be useful in the treatment of severe resistant infections and it may be of benefit when used after treatment with ATG and cyclosporin.
Collapse
Affiliation(s)
- J C Marsh
- a Division of Haematology, Department of Cellular and Molecular Sciences , St George's Hospital Medical School , London , UK
| |
Collapse
|