1
|
Cattaneo D, Galli N, Bucelli C, Fidanza CA, Bellani V, Artuso S, Bianchi P, Consonni D, Passamonti F, Iurlo A. Red cell distribution width and prognosis in myelofibrosis patients treated with ruxolitinib. Ann Hematol 2024; 103:2787-2795. [PMID: 38864904 DOI: 10.1007/s00277-024-05801-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024]
Abstract
We evaluated RDW in a single-center series of 61 consecutive patients with primary and secondary MF at diagnosis and during treatment with ruxolitinib (RUX) and examined any possible prognostic impact. Elevated RDW values were present in all but 4 patients at diagnosis with a median RDW of 18.9%. RDW was higher in subjects with palpable splenomegaly (p = 0.02), higher ferritin, as well as among those cases who did not receive any cytoreduction before RUX (p = 0.04). Interestingly, higher RDW at diagnosis also correlated with a shorter time from MF diagnosis to RUX start (-4.1 months per one RDW unit; p = 0.03). We observed a modest increase (< 1%) in RDW during the first 6 months of RUX treatment. In a multivariable random-intercept model that considered all time points and contained the covariates time and RUX dose, we also observed a clear decrease in RDW with increasing hemoglobin (Hb) during RUX (slope: -0.4% per g/dL of Hb; p < 0.001). The median RDW at diagnosis of 18.9% was used as a cut-off to identify two subgroups of patients [Group 1: RDW 19.0-25.7%; Group 2: RDW 13.1-18.7%], showing a difference in mortality [Group 1 vs. 2: crude HR 2.88; p = 0.01]. Using continuous RDW at diagnosis, the crude HR was 1.21 per RDW unit (p = 0.002). In a Cox model adjusted for gender, age and Hb at diagnosis, the HR was 1.13 per RDW unit (p = 0.07). RDW may have prognostic significance at MF diagnosis and during RUX, helping in the rapid detection of patients with poor prognosis.
Collapse
Affiliation(s)
- Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Nicole Galli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy
| | - Cecilia Anna Fidanza
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Valentina Bellani
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy
| | - Silvia Artuso
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy
| | - Paola Bianchi
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy
| | - Dario Consonni
- Epidemiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Passamonti
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Myeloproliferative Syndromes Unit, Via Francesco Sforza 35, Milan, 20122, Italy.
| |
Collapse
|
2
|
Wiśniewski K, Zaczkowski K, Szmyd BM, Popęda M, Bieńkowski M, Posmyk B, Bobeff EJ, Jaskólski DJ. Evaluation of CSF 8-iso-prostaglandin F2α and erythrocyte anisocytosis as prognostic biomarkers for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Sci Rep 2024; 14:11302. [PMID: 38760404 PMCID: PMC11101481 DOI: 10.1038/s41598-024-61956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/12/2024] [Indexed: 05/19/2024] Open
Abstract
Delayed cerebral ischemia (DCI) is a serious, life-threatening, complication affecting patients who have survived the initial bleeding from a ruptured intracranial aneurysm. Due to the challenging diagnosis, potential DCI prognostic markers should be of value in clinical practice. According to recent reports isoprostanes and red blood cell distribution (RDW) showed to be promising in this respect. We conducted a prospective study of 27 aSAH patients and control group (n = 8). All patients from the study group were treated within the first day of the initial bleeding. We collected data regarding clinical status and results of biochemical, and radiological examinations. We measured cerebrospinal fluid (CSF) concentration of 8-iso-prostaglandin F2α (F2-IsoP) and RDW on days 1, 3, and 5. Both CSF F2-IsoP level and RDW-SD measured on day 1 were significant predictors of DCI. The receiver operating characteristics curve for DCI prediction based on the multivariate model yielded an area under the curve of 0.924 (95% CI 0.824-1.000, p < 0.001). In our study, the model based on the combination of RDW and the level of isoprostanes in CSF on the first day after the initial bleeding showed a prognostic value for DCI prediction. Further studies are required to validate this observation.
Collapse
Affiliation(s)
- Karol Wiśniewski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland.
| | - Karol Zaczkowski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Bartosz M Szmyd
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Marta Popęda
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Bieńkowski
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Bartłomiej Posmyk
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Ernest J Bobeff
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Łódź, Łódź, Poland
| | - Dariusz J Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
| |
Collapse
|
3
|
Lucijanic M, Krecak I, Soric E, Sabljic A, Galusic D, Holik H, Perisa V, Moric Peric M, Zekanovic I, Budimir J, Kusec R. Evaluation of Absolute Neutrophil, Lymphocyte and Platelet Count and Their Ratios as Predictors of Thrombotic Risk in Patients with Prefibrotic and Overt Myelofibrosis. Life (Basel) 2024; 14:523. [PMID: 38672793 PMCID: PMC11051164 DOI: 10.3390/life14040523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
AIM To investigate the prognostic contribution of absolute neutrophil (ANC), lymphocyte (ALC), platelet count and their ratios, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), to thrombotic risk in patients with prefibrotic and overt fibrotic myelofibrosis (MF). METHODS We retrospectively analyzed a cohort of 256 patients with prefibrotic (85 patients) and overt fibrotic MF (171 patients) treated in six Croatian hematological centers. RESULTS Prefibrotic compared to overt fibrotic MF patients presented with significantly higher ALC, platelet count and PLR, and experienced longer time to thrombosis (TTT). Among prefibrotic patients, ANC > 8.33 × 109/L (HR 13.08, p = 0.036), ALC > 2.58 × 109/L (HR 20.63, p = 0.049) and platelet count > 752 × 109/L (HR 10.5, p = 0.043) remained independently associated with shorter TTT. Among overt fibrotic patients, ANC > 8.8 × 109/L (HR 4.49, p = 0.004), ALC ≤ 1.43 × 109/L (HR 4.15, p = 0.003), platelet count ≤ 385 × 109/L (HR 4.68, p = 0.004) and chronic kidney disease (HR 9.07, p < 0.001) remained independently associated with shorter TTT. CONCLUSIONS Prognostic properties of ANC, ALC and platelet count are mutually independent and exceed those of NLR and PLR regarding thrombotic risk stratification. ALC and platelet count associate in opposite directions with thrombotic risk in prefibrotic and overt fibrotic MF patients.
Collapse
Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Ul. Salata 3, 10000 Zagreb, Croatia
| | - Ivan Krecak
- Department of Internal Medicine, General Hospital Sibenik, Ul. Stjepana Radica 83, 22000 Sibenik, Croatia
- School of Medicine, University of Rijeka, Ul. Brace Branchetta 20/1, 51000 Rijeka, Croatia
- Sibenik University of Applied Science, Trg Andrije Hebranga 11, 22000 Sibenik, Croatia
| | - Ena Soric
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
| | - Anica Sabljic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
| | - Davor Galusic
- Department of Hematology, University Hospital of Split, Soltanska ul. 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska ul. 2, 21000 Split, Croatia
| | - Hrvoje Holik
- Department of Internal Medicine, “Dr. Josip Bencevic” General Hospital, Ul. Andrije Stampara, 35000 Slavonski Brod, Croatia
- Faculty of Medicine, University of Osijek, Ul. Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Vlatka Perisa
- Faculty of Medicine, University of Osijek, Ul. Josipa Huttlera 4, 31000 Osijek, Croatia
- Department of Hematology, Osijek University Hospital, Ul. Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Martina Moric Peric
- Department of Internal Medicine, General Hospital Zadar, Ul. Boze Pericica 5, 23000 Zadar, Croatia
| | - Ivan Zekanovic
- Department of Internal Medicine, General Hospital Zadar, Ul. Boze Pericica 5, 23000 Zadar, Croatia
| | - Josipa Budimir
- Department of Internal Medicine, General Hospital Sibenik, Ul. Stjepana Radica 83, 22000 Sibenik, Croatia
| | - Rajko Kusec
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Ul. Salata 3, 10000 Zagreb, Croatia
| |
Collapse
|
4
|
Carlisi M, Presti RL, Plano F, Mancuso S, Siragusa S, Caimi G. Changes in RDW according to prognostic predictors in newly diagnosed multiple myeloma. Sci Rep 2024; 14:2832. [PMID: 38310176 PMCID: PMC10838310 DOI: 10.1038/s41598-024-53385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
RDW is an erythrocyte index that increase in multiple myeloma, in which it appears to have an important role in predicting outcome. For this reason, we performed a retrospective analysis to evaluate the relationships of RDW with some important prognostic predictors. Specifically, in a cohort of 190 newly diagnosed multiple myeloma patients, we have examined the behaviour of RDW and its trend in relation to the ISS stage and other prognostic factors, such as albumin, beta-2 microglobulin, LDH and bone marrow plasma cell infiltration. We performed the analysis in the entire cohort of patients and in the three different disease isotypes (Light chain, IgA, and IgG multiple myeloma). The evaluation of RDW in the different isotypes was made with the Kruskal-Wallis test, integrated by the Dunn test. The comparison between the subgroups allocated above and below the median value of each prognostic factor, was made with the Mann-Whitney test. From our analysis, we observed that RDW is higher in the IgA multiple myeloma, and it increases significantly from ISS I to III. Moreover, RDW increases in the presence of lower albumin values, higher levels of beta2-microglobulin and LDH and in the presence of a greater bone marrow plasma cell infiltrate.
Collapse
Affiliation(s)
- Melania Carlisi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - R Lo Presti
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - F Plano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - S Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - S Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - G Caimi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| |
Collapse
|
5
|
Verachi P, Gobbo F, Martelli F, Falchi M, di Virgilio A, Sarli G, Wilke C, Bruederle A, Prahallad A, Arciprete F, Zingariello M, Migliaccio AR. Preclinical studies on the use of a P-selectin-blocking monoclonal antibody to halt progression of myelofibrosis in the Gata1 low mouse model. Exp Hematol 2023; 117:43-61. [PMID: 36191885 PMCID: PMC10450205 DOI: 10.1016/j.exphem.2022.09.004] [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: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 01/10/2023]
Abstract
The bone marrow (BM) and spleen from patients with myelofibrosis (MF), as well as those from the Gata1low mouse model of the disease contain increased number of abnormal megakaryocytes. These cells express high levels of the adhesion receptor P-selectin on their surface, which triggers a pathologic neutrophil emperipolesis, leading to increased bioavailability of transforming growth factor-β (TGF-β) in the microenvironment and disease progression. With age, Gata1low mice develop a phenotype similar to that of patients with MF, which is the most severe of the Philadelphia-negative myeloproliferative neoplasms. We previously demonstrated that Gata1low mice lacking the P-selectin gene do not develop MF. In the current study, we tested the hypothesis that pharmacologic inhibition of P-selectin may normalize the phenotype of Gata1low mice that have already developed MF. To test this hypothesis, we have investigated the phenotype expressed by aged Gata1low mice treated with the antimouse monoclonal antibody RB40.34, alone and also in combination with ruxolitinib. The results indicated that RB40.34 in combination with ruxolitinib normalizes the phenotype of Gata1low mice with limited toxicity by reducing fibrosis and the content of TGF-β and CXCL1 (two drivers of fibrosis in this model) in the BM and spleen and by restoring hematopoiesis in the BM and the architecture of the spleen. In conclusion, we provide preclinical evidence that treatment with an antibody against P-selectin in combination with ruxolitinib may be more effective than ruxolitinib alone to treat MF in patients.
Collapse
Affiliation(s)
- Paola Verachi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Francesca Gobbo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; Department of Veterinary Medical Sciences, University of Bologna, Italy
| | - Fabrizio Martelli
- National Center for Preclinical and Clinical Research and Evaluation of Pharmaceutical Drugs, Istituto Superiore di Sanità, Rome, Italy
| | - Mario Falchi
- National Center for HIV/AIDS Research, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio di Virgilio
- Center for Animal Experimentation and Well-being, Istituto Superiore di Santà, Rome, Italy
| | - Giuseppe Sarli
- Department of Veterinary Medical Sciences, University of Bologna, Italy
| | | | | | | | - Francesca Arciprete
- Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy
| | - Maria Zingariello
- Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy
| | - Anna Rita Migliaccio
- Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy; Altius Institute for Biomedical Sciences, Seattle, WA, USA.
| |
Collapse
|
6
|
Leiva O, Hobbs G, Ravid K, Libby P. Cardiovascular Disease in Myeloproliferative Neoplasms: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2022; 4:166-182. [PMID: 35818539 PMCID: PMC9270630 DOI: 10.1016/j.jaccao.2022.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Myeloproliferative neoplasms are associated with increased risk for thrombotic complications. These conditions most commonly involve somatic mutations in genes that lead to constitutive activation of the Janus-associated kinase signaling pathway (eg, Janus kinase 2, calreticulin, myeloproliferative leukemia protein). Acquired gain-of-function mutations in these genes, particularly Janus kinase 2, can cause a spectrum of disorders, ranging from clonal hematopoiesis of indeterminate potential, a recently recognized age-related promoter of cardiovascular disease, to frank hematologic malignancy. Beyond thrombosis, patients with myeloproliferative neoplasms can develop other cardiovascular conditions, including heart failure and pulmonary hypertension. The authors review the pathophysiologic mechanisms of cardiovascular complications of myeloproliferative neoplasms, which involve inflammation, prothrombotic and profibrotic factors (including transforming growth factor-beta and lysyl oxidase), and abnormal function of circulating clones of mutated leukocytes and platelets from affected individuals. Anti-inflammatory therapies may provide cardiovascular benefit in patients with myeloproliferative neoplasms, a hypothesis that requires rigorous evaluation in clinical trials.
Collapse
Key Words
- ASXL1, additional sex Combs-like 1
- CHIP, clonal hematopoiesis of indeterminate potential
- DNMT3a, DNA methyltransferase 3 alpha
- IL, interleukin
- JAK, Janus-associated kinase
- JAK2, Janus kinase 2
- LOX, lysyl oxidase
- MPL, myeloproliferative leukemia protein
- MPN, myeloproliferative neoplasm
- STAT, signal transducer and activator of transcription
- TET2, tet methylcytosine dioxygenase 2
- TGF, transforming growth factor
- atherosclerosis
- cardiovascular complications
- clonal hematopoiesis
- myeloproliferative neoplasms
- thrombosis
Collapse
Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriela Hobbs
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Katya Ravid
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Lucijanic M, Krecak I, Verstovsek S, Soric E, Galusic D, Holik H, Perisa V, Peric MM, Zekanovic I, Kusec R. Higher red blood cell distribution width predicts thrombosis risk in primary and secondary myelofibrosis. Ann Hematol 2021; 101:1355-1357. [PMID: 34825960 DOI: 10.1007/s00277-021-04724-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia. .,University of Zagreb School of Medicine, Ul. Salata 3, 10000, Zagreb, Croatia.
| | - Ivan Krecak
- Department of Internal Medicine, General Hospital Sibenik, Ul. Stjepana Radica 83, 22000, Sibenik, Croatia
| | - Srdan Verstovsek
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ena Soric
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| | - Davor Galusic
- Department of Hematology, University Hospital of Split, Soltanska ul. 1, 21000, Split, Croatia.,School of Medicine, University of Split, Soltanska ul. 2, 21000, Split, Croatia
| | - Hrvoje Holik
- Department of Internal Medicine, Josip Bencevic" General Hospital, Ul. Andrije Štampara, "Dr, 35000, Slavonski Brod, Croatia.,Faculty of Medicine, University of Osijek, Ul. Josipa Huttlera 4, 31000, Osijek, Croatia
| | - Vlatka Perisa
- Faculty of Medicine, University of Osijek, Ul. Josipa Huttlera 4, 31000, Osijek, Croatia.,Department of Hematology, Osijek University Hospital, Ul. Josipa Huttlera 4, 31000, Osijek, Croatia
| | - Martina Moric Peric
- Department of Internal Medicine, General Hospital Zadar, Ul. Boze Pericica 5, 23000, Zadar, Croatia
| | - Ivan Zekanovic
- Department of Internal Medicine, General Hospital Zadar, Ul. Boze Pericica 5, 23000, Zadar, Croatia
| | - Rajko Kusec
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia.,University of Zagreb School of Medicine, Ul. Salata 3, 10000, Zagreb, Croatia
| |
Collapse
|
8
|
Hematocrit to hemoglobin ratio as a prognostic marker in polycythemia vera. Wien Klin Wochenschr 2021; 134:110-117. [PMID: 34738212 DOI: 10.1007/s00508-021-01967-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The hematocrit to hemoglobin ratio (HHR) is frequently used in everyday practice to measure hemoconcentration; however, clinical associations of HHR in the context of polycythemia vera (PV) have not been investigated so far. PATIENTS AND METHODS We retrospectively assessed HHR at the time of diagnosis in 107 PV and 40 secondary polycythemia (SP) patients from three community hospitals. RESULTS Median HHR was higher in PV than in SP patients (3.131 vs. 2.975, p = 0.041). Among PV patients, higher HHR correlated with splenomegaly, higher total leukocyte and absolute granulocyte counts, higher red blood cell counts, lower hemoglobin, higher red blood cell distribution width, lower mean corpuscular hemoglobin and lower ferritin levels, whereas in SP patients higher HHR correlated with older age, female sex and lower hemoglobin (p < 0.050 for all analyses). Using the receiver operating curve analysis-defined cut-off points, higher HHR in PV was associated with a shorter time to thrombosis (hazard ratio-HR 5.20, p = 0.022) independently of high-risk disease status (HR 4.48, p = 0.034) and shorter overall survival (HR 6.69, p = 0.009) independently of leukocytosis (HR 4.48, P = 0.034) and the absence of aspirin use (HR 15.53, p < 0.001). CONCLUSION Higher HHR may represent iron deficiency and a stronger clonal myeloproliferation in PV and could provide additional prognostic information to the classical risk assessment.
Collapse
|
9
|
Holik H, Krečak I, Gverić-Krečak V, Vučinić Ljubičić I, Coha B. Higher red blood cell distribution width might differentiate primary from secondary polycythemia: A pilot study. Int J Lab Hematol 2020; 43:e68-e71. [PMID: 33108020 DOI: 10.1111/ijlh.13373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hrvoje Holik
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia.,School of Medicine, University of Osijek, Osijek, Croatia
| | - Ivan Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
| | - Velka Gverić-Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
| | - Ivana Vučinić Ljubičić
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Božena Coha
- Department of Internal Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| |
Collapse
|
10
|
High red blood cell distribution width might predict thrombosis in essential thrombocythemia and polycythemia vera. Blood Cells Mol Dis 2020; 80:102368. [DOI: 10.1016/j.bcmd.2019.102368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 01/16/2023]
|
11
|
Ćatić J, Jurin I, Lucijanić M, Jerkić H, Blažeković R. High red cell distribution width at the time of ST segment elevation myocardial infarction is better at predicting diastolic than systolic left ventricular dysfunction: A single-center prospective cohort study. Medicine (Baltimore) 2018; 97:e0601. [PMID: 29718862 PMCID: PMC6393031 DOI: 10.1097/md.0000000000010601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Multiple studies have demonstrated the association of red cell distribution width (RDW) with the ultrasound parameters of both systolic and diastolic heart dysfunction. We aimed to further investigate the clinical associations of RDW in the setting of ST-elevation myocardial infarction (STEMI) and to comparatively evaluate its predictive properties regarding systolic and diastolic dysfunction.A total of 89 patients with STEMI were prospectively analyzed. RDW was obtained at the time of STEMI and compared to the parameters of systolic and diastolic dysfunction obtained by transthoracic heart ultrasound on the 5th through 7th day post-STEMI.The median RDW was 13.9%, and among other factors, RDW was significantly associated with older age (P < .001), arterial hypertension (P = .017), hyperlipoproteinemia 2, nonsmoking (P = .027), increased thrombolysis in myocardial infarction score (P = .004), and multivessel disease (P = .007). A higher RDW was observed in patients with parameters that indicated systolic and diastolic dysfunction (ejection fraction of the left ventricle < 50% [P = .009], early/late diastolic filling wave ratio [E/A] < 1 [P = .001], ratio of peak early transmitral velocity and early diastolic annular velocity [E/E'] >10 [P < .001], and combined E/A < 1 and E/E' > 10 [P < .001]). The best discriminatory properties were observed for combined E/A < 1 and E/E' > 10. RDW remained significantly associated with the aforementioned parameters in a series of multivariate regression models.Elevated RDW is significantly associated with the parameters of systolic and diastolic dysfunction even after adjusting for several confounding factors in the setting of STEMI and subsequent percutaneous coronary intervention. RDW seems to be better at discriminating patients with diastolic rather than systolic dysfunction.
Collapse
Affiliation(s)
- Jasmina Ćatić
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
| | - Ivana Jurin
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
| | | | - Helena Jerkić
- Department of Cardiology, Clinical Hospital “Merkur”
| | - Robert Blažeković
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
- Department of Cardiac and Transplant Surgery, Clinical Hospital “Dubrava”, Zagreb, Croatia
| |
Collapse
|
12
|
Lucijanic M, Prka Z, Pejsa V, Stoos-Veic T, Lucijanic J, Kusec R. Prognostic implications of low transferrin saturation in patients with primary myelofibrosis. Leuk Res 2018; 66:89-95. [PMID: 29407589 DOI: 10.1016/j.leukres.2018.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Transferrin saturation (TSAT) 20% or less is considered to represent functional iron deficiency in the context of malignant disease, phenomenon mediated through inflammatory changes of iron homeostasis. We aimed to investigate clinical and prognostic significance of low TSAT in patients with primary (PMF) and secondary myelofibrosis (SMF), malignant diseases characterized by strong inflammatory milieu. METHODS We retrospectively analyzed 87 patients with myelofibrosis and compared TSAT with disease specific parameters. RESULTS One-third of patients had TSAT ≤20%. Lower TSAT was significantly associated with Janus-kinase-2 (JAK2) mutation (P = 0.007), transfusion independency (P = 0.003), higher platelets (P = 0.004), lower mean-corpuscular-volume (P < 0.001), lower ferritin (P < 0.001), higher absolute-neutrophil-count (P = 0.027), lower absolute-lymphocyte-count (P = 0.041) and lower albumin (P = 0.018). PMF patients presenting with low TSAT (≤20%) experienced significantly shorter overall-survival (OS) (HR = 2.43; P = 0.017), whereas TSAT did not affect OS of SMF patients (HR = 1.48; P = 0.623). Low TSAT remained significantly associated with inferior OS in PMF in a series of multivariate Cox regression models comparing its properties to anemia, transfusion dependency, ferritin and Dynamic-International-Prognostic-System (DIPSS). CONCLUSIONS Low TSAT has detrimental effect on survival of PMF patients. This effect is independent of anemia and of ferritin levels that seem to be better at representing iron overload in PMF patients.
Collapse
Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia.
| | - Zeljko Prka
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia
| | - Vlatko Pejsa
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia
| | - Tajana Stoos-Veic
- Department of Clinical Cytology and Cytometry, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia; Faculty of Medicine, University of Osijek, Ul. Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Jelena Lucijanic
- Health Care Center Zagreb-West, Prilaz baruna Filipovica 11, 10000 Zagreb, Croatia
| | - Rajko Kusec
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; Divison of Molecular Diagnosis and Genetics, Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
| |
Collapse
|
13
|
Lucijanic M, Mitrovic Z, Cicic D, Prka Z, Pejsa V, Livun A, Stoos-Veic T, Romic Z, Zivkovic M, Lucijanic I, Fabris Z, Kusec R. Increased mean platelet volume (MPV) is an independent predictor of inferior survival in patients with primary and secondary myelofibrosis. Int J Hematol 2017; 107:166-172. [PMID: 29022201 DOI: 10.1007/s12185-017-2348-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 11/28/2022]
Abstract
Neoplastic megakaryopoiesis is a dominant feature of Philadelphia-chromosome-negative myeloproliferative neoplasms (Ph- MPNs), and elevated mean-platelet-volume (MPV) is a common finding in these diseases. The clinical and prognostic significances of MPV in patients with primary (PMF) and secondary myelofibrosis (SMF) have not been reported. We retrospectively analyzed 87 patients with myelofibrosis (66 with PMF, 21 with SMF) treated at our institution. MPV was recorded in addition to other hematological and clinical parameters. MPV was elevated in both PMF and SMF patients in comparison to controls, whereas there was no statistically significant difference between PMF and SMF. Elevated MPV was associated with lower platelets (P = 0.016), higher white blood cells (P = 0.015), higher percentage of circulatory blasts (P = 0.009), higher lactate dehydrogenase (P = 0.011), larger spleen size (P = 0.014) and higher Dynamic International Prognostic score category (P = 0.027), while there was no statistically significant association with driver mutations or degree of bone marrow fibrosis. Higher MPV was univariately associated with inferior overall survival in the whole cohort (HR = 3.82, P = 0.006), PMF (HR = 4.35, P = 0.007) and SMF patients (HR = 7.22, P = 0.034). These associations remained significant in multivariate analyses adjusted for DIPSS. Higher MPV is associated with more aggressive disease features and exhibits powerful independent prognostic properties in both PMF and SMF settings.
Collapse
Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia.
| | - Zdravko Mitrovic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - David Cicic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| | - Zeljko Prka
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia
| | - Vlatko Pejsa
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Livun
- Division of Molecular Diagnosis and Genetics, Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Tajana Stoos-Veic
- Department of Clinical Cytology and Cytometry, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - Zeljko Romic
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Marcela Zivkovic
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Iva Lucijanic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zrinka Fabris
- Radiology Department, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - Rajko Kusec
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000, Zagreb, Croatia.,Division of Molecular Diagnosis and Genetics, Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
14
|
Lucijanic M, Livun A, Stoos-Veic T, Pejsa V, Jaksic O, Cicic D, Lucijanic J, Romic Z, Orehovec B, Aralica G, Miletic M, Kusec R. High absolute basophil count is a powerful independent predictor of inferior overall survival in patients with primary myelofibrosis. Hematology 2017; 23:201-207. [PMID: 28906207 DOI: 10.1080/10245332.2017.1376843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Ana Livun
- Divison of Molecular Diagnosis and Genetics, Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Tajana Stoos-Veic
- Department of Clinical Cytology and Cytometry, University Hospital Dubrava, Zagreb, Croatia
- Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - Vlatko Pejsa
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ozren Jaksic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - David Cicic
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | | | - Zeljko Romic
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Biserka Orehovec
- Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
| | - Gorana Aralica
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Pathology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Marko Miletic
- Radiology Department, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - Rajko Kusec
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
- Divison of Molecular Diagnosis and Genetics, Clinical Department of Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
15
|
Kust D, Lucijanic M, Urch K, Samija I, Celap I, Kruljac I, Prpic M, Lucijanic I, Matesa N, Bolanca A. Clinical and prognostic significance of anisocytosis measured as a red cell distribution width in patients with colorectal cancer. QJM 2017; 110:361-367. [PMID: 28069908 DOI: 10.1093/qjmed/hcw223] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 01/13/2023] Open
Abstract
PURPOSE : colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, and detection of new prognostic markers is mandatory for patients to receive optimal oncological treatment. The aim of the study was to assess clinical and prognostic value of red cell distribution width (RDW) in patients with CRC. METHODS : RDW values in 90 patients with CRC undergoing surgery for primary disease were analyzed in pre- and postoperative setting, and correlated with clinical and hematological parameters. RESULTS : Both pre- and postoperative RDW measurements were found to be associated with features of iron deficiency anemia, inflammatory response to tumor, advanced age and depth of tumor invasion. Optimal cutoff points were calculated to be 14% for preoperative and 13.6% for postoperative RDW measurements. Elevations in both pre- and postoperative RDW values had significant effects on survival in univariate and multivariate analyses. Effects were found to be independent of tumor related features, stage of the disease, development of anemia and aberrant inflammatory response to tumor. CONCLUSIONS : RDW is an integrative parameter reflecting tumor specific features and shows significant association with overall survival in patients with CRC. This is especially important in patients with stage 2 disease where elevation in preoperative RDW values can contribute to recognition of higher risk patients.
Collapse
Affiliation(s)
- Davor Kust
- From the Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, Zagreb 10000, Croatia
| | - Marko Lucijanic
- Department of Hematology, Clinical Hospital "Dubrava", Avenija Gojka Šuška 6, Zagreb 10000, Croatia
| | - Kristina Urch
- From the Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, Zagreb 10000, Croatia
| | - Ivan Samija
- From the Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, Zagreb 10000, Croatia
| | - Ivana Celap
- Department of Chemistry, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, Zagreb 10000, Croatia
| | - Ivan Kruljac
- Deparment of Internal Medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, Zagreb 10000, Croatia
| | - Marin Prpic
- From the Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, Zagreb 10000, Croatia
| | - Ivica Lucijanic
- Department of Orthopedics and Traumatology, General Hospital "Karlovac", Andrije Štampara 3, 47000 Karlovac
| | - Neven Matesa
- From the Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, Zagreb 10000, Croatia
| | - Ante Bolanca
- From the Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Vinogradska cesta 29, Zagreb 10000, Croatia
| |
Collapse
|
16
|
Uz B. Anisocytosis: A Classical Marker of Inflammation or a New Predictive Marker in Patients with Primary Myelofibrosis. Acta Haematol 2016; 136:191-2. [PMID: 27623285 DOI: 10.1159/000449276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/21/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Burak Uz
- Division of Adult Hematology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|