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Krokos G, Kotwal T, Malaih A, Barrington S, Jackson P, Hicks RJ, Marsden PK, Fischer BM. Evaluation of manual and automated approaches for segmentation and extraction of quantitative indices from [ 18F]FDG PET-CT images. Biomed Phys Eng Express 2024; 10:025007. [PMID: 38100790 PMCID: PMC10767880 DOI: 10.1088/2057-1976/ad160e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 12/17/2023]
Abstract
Utilisation of whole organ volumes to extract anatomical and functional information from computed tomography (CT) and positron emission tomography (PET) images may provide key information for the treatment and follow-up of cancer patients. However, manual organ segmentation, is laborious and time-consuming. In this study, a CT-based deep learning method and a multi-atlas method were evaluated for segmenting the liver and spleen on CT images to extract quantitative tracer information from Fluorine-18 fluorodeoxyglucose ([18F]FDG) PET images of 50 patients with advanced Hodgkin lymphoma (HL). Manual segmentation was used as the reference method. The two automatic methods were also compared with a manually defined volume of interest (VOI) within the organ, a technique commonly performed in clinical settings. Both automatic methods provided accurate CT segmentations, with the deep learning method outperforming the multi-atlas with a DICE coefficient of 0.93 ± 0.03 (mean ± standard deviation) in liver and 0.87 ± 0.17 in spleen compared to 0.87 ± 0.05 (liver) and 0.78 ± 0.11 (spleen) for the multi-atlas. Similarly, a mean relative error of -3.2% for the liver and -3.4% for the spleen across patients was found for the mean standardized uptake value (SUVmean) using the deep learning regions while the corresponding errors for the multi-atlas method were -4.7% and -9.2%, respectively. For the maximum SUV (SUVmax), both methods resulted in higher than 20% overestimation due to the extension of organ boundaries to include neighbouring, high-uptake regions. The conservative VOI method which did not extend into neighbouring tissues, provided a more accurate SUVmaxestimate. In conclusion, the automatic, and particularly the deep learning method could be used to rapidly extract information of the SUVmeanwithin the liver and spleen. However, activity from neighbouring organs and lesions can lead to high biases in SUVmaxand current practices of manually defining a volume of interest in the organ should be considered instead.
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Affiliation(s)
- Georgios Krokos
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Tejas Kotwal
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Afnan Malaih
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Sally Barrington
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | | | - Rodney J Hicks
- Department of Medicine, St Vincent’s Hospital Medical School, the University of Melbourne, Australia
| | - Paul K Marsden
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Barbara Malene Fischer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Dept. Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark
- Dept. of Clinical Medicine, University of Copenhagen, Denmark
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Voltammetric Quantification of Anti-Cancer Antibiotic Bleomycin Using an Electrochemically Pretreated and Decorated with Lead Nanoparticles Screen-Printed Sensor. Int J Mol Sci 2022; 24:ijms24010472. [PMID: 36613924 PMCID: PMC9820353 DOI: 10.3390/ijms24010472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
In this paper, we report a highly sensitive voltammetric sensor for the determination of the anti-cancer antibiotic bleomycin (BLM) based on a screen-printed carbon sensor that is electrochemically pretreated and decorated with lead nanoparticles in the sample solution (pSPCE/PbNPs). These sensor surface manipulations contribute to significant amplification of the analytical signal and improvement of its shape and repeatability. The effect of the electrochemical behavior of BLM on the pSPCE/PbNPs was examined by electrochemical strategies. CV, EIS, and XPS were used to compare the sensor surface modifications. The effects of the type and pH of the supporting electrolyte and the procedure parameters were optimized. The features of the proposed procedure include: (a) very low limits of detection and quantification (2.8 × 10-11 and 9.3 × 10-11 M, respectively), (b) linear ranges (1.0 × 10-10-2.0 × 10-9 M and 2.0 × 10-9-2.0 × 10-8 M, and (c) a high sensitivity of 0.32 µA/nM. The electrochemical sensor was successfully applied for the determination of BLM in wastewater and reference material of human urine samples.
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Ognerubov NA, Antipova TS, Ognerubov SA. Pulmonary toxicity induced by the use of bleomycin in patients with germ cell testicular tumors. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.3.201529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction. Pulmonary toxicity induced by bleomycin is a dangerous complication of polychemotherapy in patients with germ cell tumors. It occurs with a frequency of up to 46%, and in 14% of cases it is fatal.
Aim. To present cases of pulmonary toxicity during polychemotherapy with the inclusion of bleomycin for testicular germ cell tumors.
Materials and Methods. Two patients aged 43 and 33 years old with testicular germ cell tumors were under observation after orchifuniculectomy who underwent chemotherapy according to the BER scheme (bleomycin + etoposide + cisplatin) in the steady-state mode in 4 and 6 cycles respectively. Positron emission tomography combined with computer tomography (PET/CT) with 18F-fluorodeoxyglucose was performed when clinical symptoms appeared at the end of treatment.
Results. Histologically, the tumor in a 33-year-old patient was a mixed tumor seminoma, embryonal cancer with teratoid cancer elements. Abdominal spiral computed tomography revealed metastases to retroperitoneal lymph nodes. In a 43-year-old patient, the tumor had the structure of fetal cancer with multiple metastases to the lungs, mediastinal lymph nodes and retroperitoneal lymph nodes. Six and four cycles of polychemotherapy according to the BER regimen were administered, respectively. The cumulative dose of bleomycin was 540 and 360 mg in 18 and 12 injections. Treatment was accompanied by the development of febrile neutropenia with G-CSF correction. These risk factors should be considered the most significant. The appearance of respiratory symptoms during treatment should be regarded as a manifestation of pulmonary toxicity. PET/CT is the method of choice for diagnosis. The clinical picture in the observed patients, as well as changes on PET/CT, were detected 2 weeks after chemotherapy was completed.
Conclusion. Pulmonary toxicity induced by the use of bleomycin in patients with germ cell testicular tumors is a very dangerous complication, sometimes with a lethal outcome. Therefore, its early diagnosis taking into account risk factors is of great importance in clinical practice. Among medical imaging methods, a special role is played by PET/CT, which allows predicting toxicity before the clinical and radiological debut.
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Malaih AA, Dunn JT, Nygård L, Kovacs DG, Andersen FL, Barrington SF, Fischer BM. Test-retest repeatability and interobserver variation of healthy tissue metabolism using 18F-FDG PET/CT of the thorax among lung cancer patients. Nucl Med Commun 2022; 43:549-559. [PMID: 35081091 PMCID: PMC7612596 DOI: 10.1097/mnm.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to assess the test-retest repeatability and interobserver variation in healthy tissue (HT) metabolism using 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG) PET/computed tomography (PET/CT) of the thorax in lung cancer patients. METHODS A retrospective analysis was conducted in 22 patients with non-small cell lung cancer who had two PET/CT scans of the thorax performed 3 days apart with no interval treatment. The maximum, mean and peak standardized uptake values (SUVs) in different HTs were measured by a single observer for the test-retest analysis and two observers for interobserver variation. Bland-Altman plots were used to assess the repeatability and interobserver variation. Intrasubject variability was evaluated using within-subject coefficients of variation (wCV). RESULTS The wCV of test-retest SUVmean measurements in mediastinal blood pool, bone marrow, skeletal muscles and lungs was less than 20%. The left ventricle (LV) showed higher wCV (>60%) in all SUV parameters with wide limits of repeatability. High interobserver agreement was found with wCV of less than 10% in SUVmean of all HT, but up to 22% was noted in the LV. CONCLUSION HT metabolism is stable in a test-retest scenario and has high interobserver agreement. SUVmean was the most stable metric in organs with low FDG uptake and SUVpeak in HTs with moderate uptake. Test-retest measurements in LV were highly variable irrespective of the SUV parameters used for measurements.
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Affiliation(s)
- Afnan A Malaih
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, PET Imaging Centre, St Thomas Hospital, King's College London, London, UK
| | - Joel T Dunn
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, PET Imaging Centre, St Thomas Hospital, King's College London, London, UK
| | - Lotte Nygård
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital
| | - David G Kovacs
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Flemming L Andersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sally F Barrington
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, PET Imaging Centre, St Thomas Hospital, King's College London, London, UK
| | - Barbara M Fischer
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, PET Imaging Centre, St Thomas Hospital, King's College London, London, UK
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Jennane S, Ababou M, El Haddad M, Ait Sahel O, Mahtat EM, El Maaroufi H, Doudouh A, Doghmi K. Bleomycin-Induced Lung Toxicity in Hodgkin's Lymphoma: Risk Factors in the Positron Emission Tomography Era. Cureus 2022; 14:e23993. [PMID: 35419251 PMCID: PMC8994685 DOI: 10.7759/cureus.23993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Bleomycin is a major antimitotic agent in the first-line treatment for Hodgkin's lymphoma. The main limitation of its use is its pulmonary toxicity. The objectives of this study are to find out the risk factors for the occurrence of bleomycin-induced lung toxicity in patients with Hodgkin's lymphoma and, on the other hand, to determine if positron emission tomography scan is a reliable means of early detection of this toxicity. Methods This is a retrospective study conducted in the clinical Hematology Department of Mohammed V Military Instruction Hospital, Rabat, Morocco. All patients with Hodgkin's lymphoma and treated with a bleomycin-based chemotherapy were included. The impact of different clinical and biological factors on the risk of bleomycin-induced lung toxicity occurrence was assessed using univariate and multivariate logistic regression. The benefit of positron emission tomography, usually performed as part of the re-assessment of Hodgkin’s lymphoma after two and four cycles, has been evaluated in the detection of bleomycin-induced lung toxicity. Results Among 124 patients included in the study, 18 (14.5%) patients experienced bleomycin-induced lung toxicity. On multivariate analysis, smoking (p = 0.038) and the use of the ABVD regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine) compared to the escalated BEACOPPe regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) (p = 0.018) were statistically significant risk factors. After two and four courses of therapy, the positron emission tomography was able to predict the occurrence of bleomycin-induced lung toxicity before the appearance of clinical symptoms only in 36.4 % and 12.5% of patients, respectively. Conclusion Studies to identify risk factors for the development of bleomycin-induced lung toxicity are crucial to reduce toxicity in the treatment of Hodgkin's lymphoma. However, two- and four-cycle positron emission tomography scans cannot be considered as a reliable means of early detection of this toxicity.
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The Role of Hypertension and Renin-angiotensin-aldosterone System Inhibitors in Bleomycin-induced Lung Injury. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e321-e327. [PMID: 33127326 DOI: 10.1016/j.clml.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The risk factors for bleomycin-induced lung injury (BLI), a fatal complication of cancer chemotherapy, are not well-established. The renin-angiotensin-aldosterone system (RAAS) has recently been suggested to play a role in the development of lung injury. This study clarified the impact of hypertension (HTN) and the administration of RAAS inhibitors on BLI occurrence in patients treated with bleomycin-containing regimens. PATIENTS AND METHODS We retrospectively analyzed the data of 190 patients treated with a bleomycin-containing regimen for Hodgkin lymphoma or germ cell tumors at our institutions from 2004 to 2018. RESULTS Overall, 190 patients received bleomycin, and symptomatic BLI occurred in 21 (11.1%) cases. In the multivariate analysis, age ≥ 65 years (odd ratio, 10.90; 95% confidence interval, 3.72-32.20; P < .001) and history of HTN (odds ratio, 3.32; 95% confidence interval, 1.07-10.30; P = .04) were found to be significant risk factors for BLI onset. BLI occurred in 3.6% (n = 5) of patients with no risk, 11.8% (n = 2) of those whose only risk factor was HTN, 31.6% (n = 6) of those whose only risk factor was age ≥ 65 years, and 57.1% (n = 8) of those with both risk factors (P < .001). BLI-induced mortality rates in each group were 0.0% (n = 0), 5.9% (n = 1), 10.5% (n = 2), and 42.9% (n = 6) (P < .001), respectively. Among 31 patients with HTN, BLI incidence was 12.5% in patients who were administered RAAS inhibitors and 53.3% in those who were not (P = .02). CONCLUSION Older age and history of HTN were independent risk factors for the development of BLI, and the administration of RAAS inhibitors might reduce the onset of BLI.
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Willemsen AECAB, Tol J, van Erp NP, Jonker MA, de Boer M, Meek B, de Jong PC, van Moorsel C, Gerritsen WR, Grutters JC, van Herpen CML. Prospective Study of Drug-induced Interstitial Lung Disease in Advanced Breast Cancer Patients Receiving Everolimus Plus Exemestane. Target Oncol 2020; 14:441-451. [PMID: 31325105 PMCID: PMC6684805 DOI: 10.1007/s11523-019-00656-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Everolimus-related interstitial lung disease (ILD) (also: pneumonitis) poses a difficulty for physicians, as it is hard to discriminate ILD from other causes of respiratory symptoms and to decide on safe treatment continuation. OBJECTIVE We investigated the capability of pulmonary function tests (PFT), plasma biomarkers, everolimus pharmacokinetics, and FDG-PET to discriminate between everolimus-related ILD and other causes of respiratory problems and to predict the severity of ILD. PATIENTS AND METHODS Women starting treatment with everolimus plus exemestane for advanced breast cancer were included. At baseline and during the first 3 months, respiratory symptoms, PFT with diffusion capacity of the lungs for carbon monoxide corrected for hemoglobin (DLCOc) and forced vital capacity, serum plasma biomarkers (including SP-D and YKL-40), everolimus trough concentration, and 18F-FDG-PET were prospectively recorded. RESULTS Twenty-seven (out of 29 included) patients were evaluable for analysis. Fifteen patients (56%) developed everolimus-related respiratory signs or symptoms and four patients (15%) needed everolimus discontinuation and received corticosteroids. Change in DLCOc differentiated ILD from alternative diagnoses with 0.91 sensitivity and 0.78 specificity. Decrease in DLCOc (non-significant) was greatest in patients who needed everolimus discontinuation. Serum SP-D and YKL-40 could differentiate ILD from alternative diagnoses with 0.83 and 0.83 sensitivity, and 0.85 and 0.62 specificity, respectively. 18F-FDG-PET abnormalities did not precede clinical symptoms. No relationship between ILD and everolimus trough concentration was found. CONCLUSIONS This study shows that everolimus-related ILD occurs frequently. Prospective monitoring of DLCOc in combination with measurement of serum SP-D and YKL-40 appear useful to discriminate ILD from other causes of respiratory symptoms. Clinicaltrials.gov identifier: NCT01978171.
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Affiliation(s)
- Annelieke E C A B Willemsen
- Department of Medical Oncology, Radboud university medical center, route 452, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jolien Tol
- Department of Medical Oncology, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 's Hertogenbosch, The Netherlands
| | - Nielka P van Erp
- Department of Pharmacy, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marianne A Jonker
- Department for Health Evidence, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maaike de Boer
- Division of Medical Oncology Department of Internal Medicine, GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bob Meek
- Department of Pulmonology, St. Antonius Hospital, Centre of Interstitial Lung Diseases, Nieuwegein, The Netherlands
| | - Paul C de Jong
- Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Coline van Moorsel
- Department of Pulmonology, St. Antonius Hospital, Centre of Interstitial Lung Diseases, Nieuwegein, The Netherlands.,Division Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud university medical center, route 452, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan C Grutters
- Department of Pulmonology, St. Antonius Hospital, Centre of Interstitial Lung Diseases, Nieuwegein, The Netherlands.,Division Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud university medical center, route 452, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Beyhan Sagmen S, Comert S, Turan Erkek E, Küçüköz Uzun A, Doğan C, Yılmaz G, Kıral N, Fidan A, Yılmaz Haksal Ç, Torun Parmaksız E. Can We Predict Bleomycin Toxicity with PET-CT? Acta Haematol 2019; 142:171-175. [PMID: 31454795 DOI: 10.1159/000502374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/26/2019] [Indexed: 01/30/2023]
Abstract
AIM Bleomycin is an antitumor antibiotic used successfully to treat a variety of malignancies, predominantly germ cell tumors and Hodgkin's lymphoma (HL). The major limitation of bleomycin therapy is the potential for life-threatening interstitial pulmonary fibrosis. Early identification of asymptomatic patients who may develop toxicity is important. We aimed to evaluate fluorodeoxyglucose positron-emission tomography (FDG-PET/CT) findings to predict bleomycin toxicity (BT) early after chemotherapy with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy before clinical symptoms and radiological changes occur. MATERIALS AND METHODS HL patients who were treated with ABVD were evaluated. SUVmax values of lung parenchyma were analyzed in FDG-PET/CT at diagnosis and after 4 cycles of chemotherapy in all patients. At the end of the chemotherapy cycles, lung parenchymal SUVmax values of patients with BT and without BT were compared statistically. RESULTS Twenty (66.7%) male and 10 (33.3%) female patients with HL were included. Five (16.7%) HL patients developed BT. In 3 HL patients, BT was determined after 5 cycles and in 2 patients, BT was seen after 6 cycles. In all 5 of these patients with BT, FDG uptake in PET-CT was increased after 4 cycles of chemotherapy and BT was predicted before clinical and radiological findings by FDG-PET/CT. After 4 cycles of chemotherapy, lung parenchymal SUVmax of patients with BT (3.24 ± 0.76) was significantly higher than in patients without toxicity (1.84 ± 0.52) (p < 0.001). In patients with BT, a significant increase was established in lung parenchymal SUVmax after 4 cycles of chemotherapy when compared to the time of diagnosis (p = 0.043). CONCLUSION BT can be fatal. Early detection of BT is essential in clinical practice. FDG-PET/CT can predict BT before clinical and radiological findings occur.
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Affiliation(s)
- Seda Beyhan Sagmen
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey,
| | - Sevda Comert
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Esra Turan Erkek
- Hematology, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Aysun Küçüköz Uzun
- Nuclear Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Coşkun Doğan
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Guven Yılmaz
- Hematology, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Nesrin Kıral
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Ali Fidan
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Çağla Yılmaz Haksal
- Nuclear Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Elif Torun Parmaksız
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
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Ozyigit LP, Aktas EC, Senbas ZA, Ozturk AB, Ozturk E, Ergonul MO, Tabak L, Ferhanoglu B, Cetiner M, Deniz G. The role of atopy in the pathogenesis of bleomycin pulmonary toxicity. Respir Med 2019; 155:1-5. [PMID: 31255902 DOI: 10.1016/j.rmed.2019.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/26/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Bleomycin pulmonary toxicity (BPT) is a potentially life-threatening consequence of bleomycin usage in patients. An overproduction of epithelium-derived cytokines, habitually linked to allergic inflammation, has been recently revealed in experimental models of BPT. METHODS We assessed retrospectively our cohort of patients with Hodgkin Lymphoma treated with bleomycin between 2014 and 2016 for their demographic, clinical features, including BPT development, atopy status and risk factors for BPT. Then they were invited for allergy testing and blood sample collection. The samples were stimulated with different stimuli (Bleomycin, IL-33, TSLP) for 24 h on cell culture. The culture supernatants were analysed for TGF-β, Galectin3, Arginin, Amphiregulin, Eotaxin, IFNγ, TNFα, IL1β, 4, 5, 6, 10, 13, 17, MIP-1α, and bleomycin hydrolase (BLH) levels. RESULTS The cohort consisted of 51 patients showed that atopy was the only significant risk factor for BPT occurrence (OR: 7.2, p = 0.007). Fourteen subjects were included for blood analysis. The analysis of supernatants at the unstimulated condition revealed that BLH and Amphiregulin were significantly lower in patients who had BPT than controls. The BLH cut-off that best identified a history of BPT was 175.31 (Sensitivity: 62.5%, specificity: 100%). Following the stimulation, BLH reduced compared to the unstimulated condition and the difference between groups remained significant (p < 0.05). CONCLUSION Our study is the first to report that low levels of bleomycin hydrolase in allergic individuals may be predisposing to a possible pathway of fibrosis.
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Affiliation(s)
- Leyla Pur Ozyigit
- Koç University, School of Medicine, Department of Allergy and Immunology, Istanbul, Turkey.
| | - Esin Cetin Aktas
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul, Turkey
| | - Zarif Asucan Senbas
- Koç University, School of Medicine, Department of Allergy and Immunology, Istanbul, Turkey
| | - Ayse Bilge Ozturk
- Koç University Hospital, Department of Allergy and Immunology, Istanbul, Turkey
| | - Erman Ozturk
- Koç University Hospital, Department of Haematology, Istanbul, Turkey
| | - Mehmet Onder Ergonul
- Koç University, School of Medicine, Department of Infectious Diseases, Istanbul, Turkey
| | - Levent Tabak
- Koç University, School of Medicine, Department of Respiratory Medicine, Istanbul, Turkey
| | - Burhan Ferhanoglu
- Koç University, School of Medicine, Department of Haematology, Istanbul, Turkey
| | - Mustafa Cetiner
- Koç University, School of Medicine, Department of Haematology, Istanbul, Turkey
| | - Gunnur Deniz
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul, Turkey
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Zhao M, Zhang W. Early detection value of 18F-FDG-PET/CT for drug-induced lung injury in lymphoma. Ann Hematol 2018; 98:909-914. [PMID: 30460376 DOI: 10.1007/s00277-018-3558-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Meixin Zhao
- Department of Nuclear Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Weifang Zhang
- Department of Nuclear Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Dickinson M, Irving L, Hofman M. Early warning signs: FDG-PET to diagnose bleomycin toxicity. Leuk Lymphoma 2017; 58:1016-1018. [PMID: 28185528 DOI: 10.1080/10428194.2016.1277387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michael Dickinson
- a Peter MacCallum Cancer Centre , Melbourne , Australia.,b Royal Melbourne Hospital , Parkville , Australia.,c Sir Peter MacCallum Department of Oncology , University of Melbourne , Parkville , Australia
| | - Lou Irving
- a Peter MacCallum Cancer Centre , Melbourne , Australia.,b Royal Melbourne Hospital , Parkville , Australia
| | - Michael Hofman
- a Peter MacCallum Cancer Centre , Melbourne , Australia.,c Sir Peter MacCallum Department of Oncology , University of Melbourne , Parkville , Australia
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