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Vaughan J, Patel M, Suchard M, Gededzha M, Ranchod H, Howard W, Snyman T, Wiggill T. Derangements of immunological proteins in HIV-associated diffuse large B-cell lymphoma: the frequency and prognostic impact. Front Cell Infect Microbiol 2024; 14:1340096. [PMID: 38633747 PMCID: PMC11021765 DOI: 10.3389/fcimb.2024.1340096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Diffuse large B-cell lymphoma (DLBCL) is an aggressive malignancy of B-cells frequently encountered among people living with HIV. Immunological abnormalities are common in immunocompetent individuals with DLBCL, and are often associated with poorer outcomes. Currently, data on derangements of immunological proteins, such as cytokines and acute phase reactants, and their impact on outcomes in HIV-associated DLBCL (HIV-DLBCL) is lacking. This study assessed the levels and prognostic relevance of interleukin (IL)-6, IL-10 and Transforming Growth Factor Beta (TGFβ), the acute phase proteins C-reactive protein (CRP) and ferritin; serum free light chains (SFLC) (elevation of which reflects a prolonged pro-inflammatory state); and the activity of the immunosuppressive enzyme Indoleamine 2,3-dioxygenase (IDO)in South African patients with DLBCL. Methods Seventy-six patients with incident DLBCL were enrolled, and peripheral blood IL-6, IL-10, TGFβ, SFLC and IDO-activity measured in selected patients. Additional clinical and laboratory findings (including ferritin and CRP) were recorded from the hospital records. Results Sixty-one (80.3%) of the included patients were people living with HIV (median CD4-count = 148 cells/ul), and survival rates were poor (12-month survival rate 30.0%). The majority of the immunological proteins, except for TGFβ and ferritin, were significantly higher among the people living with HIV. Elevation of IL-6, SFLC and IDO-activity were not associated with survival in HIV-DLBCL, while raised IL-10, CRP, ferritin and TGFβ were. On multivariate analysis, immunological proteins associated with survival independently from the International Prognostic Index (IPI) included TGFβ, ferritin and IL-10. Conclusion Derangements of immunological proteins are common in HIV-DLBCL, and have a differential association with survival compared to that reported elsewhere. Elevation of TGFβ, IL-10 and ferritin were associated with survival independently from the IPI. In view of the poor survival rates in this cohort, investigation of the directed targeting of these cytokines would be of interest in our setting.
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Affiliation(s)
- Jenifer Vaughan
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Moosa Patel
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Clinical Haematology Unit, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Melinda Suchard
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maemu Gededzha
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Immunology, University of the Witwatersrand, Johannesburg, South Africa
| | - Heena Ranchod
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases, Centre for Vaccines and Immunology, Johannesburg, South Africa
| | - Wayne Howard
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases, Centre for Vaccines and Immunology, Johannesburg, South Africa
| | - Tracy Snyman
- National Health Laboratory Services, Johannesburg, South Africa
| | - Tracey Wiggill
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
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Bian W, Li H, Chen Y, Yu Y, Lei G, Yang X, Li S, Chen X, Li H, Yang J, Yang C, Li Y, Zhou Y. Ferroptosis mechanisms and its novel potential therapeutic targets for DLBCL. Biomed Pharmacother 2024; 173:116386. [PMID: 38492438 DOI: 10.1016/j.biopha.2024.116386] [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: 12/31/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL), a heterogeneous lymphoid malignancy, poses a significant threat to human health. The standard therapeutic regimen for patients with DLBCL is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), with a typical cure rate of 50-70%. However, some patients either relapse after complete remission (CR) or exhibit resistance to R-CHOP treatment. Therefore, novel therapeutic approaches are imperative for managing high-risk or refractory DLBCL. Ferroptosis is driven by iron-dependent phospholipid peroxidation, a process that relies on the transition metal iron, reactive oxygen species (ROS), and phospholipids containing polyunsaturated fatty acids-containing phospholipids (PUFA-PLs). Research indicates that ferroptosis is implicated in various carcinogenic and anticancer pathways. Several hematological disorders exhibit heightened sensitivity to cell death induced by ferroptosis. DLBCL cells, in particular, demonstrate an increased demand for iron and an upregulation in the expression of fatty acid synthase. Additionally, there exists a correlation between ferroptosis-associated genes and the prognosis of DLBCL. Therefore, ferroptosis may be a promising novel target for DLBCL therapy. In this review, we elucidate ferroptosis mechanisms, its role in DLBCL, and the potential therapeutic targets in DLBCL. This review offers novel insights into the application of ferroptosis in treatment strategies for DLBCL.
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Affiliation(s)
- Wenxia Bian
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Haoran Li
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuhan Chen
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yanhua Yu
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Guojie Lei
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xinyi Yang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Sainan Li
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xi Chen
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Huanjuan Li
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jing Yang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chen Yang
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Yanchun Li
- Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China.
| | - Yi Zhou
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Formica V, Riondino S, Morelli C, Guerriero S, D'Amore F, Di Grazia A, Del Vecchio Blanco G, Sica G, Arkenau HT, Monteleone G, Roselli M. HIF2α, Hepcidin and their crosstalk as tumour-promoting signalling. Br J Cancer 2023; 129:222-236. [PMID: 37081189 PMCID: PMC10338631 DOI: 10.1038/s41416-023-02266-2] [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: 10/20/2022] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
Not all aspects of the disruption of iron homeostasis in cancer have been fully elucidated. Iron accumulation in cancer cells is frequent for many solid tumours, and this is often accompanied by the contemporary rise of two key iron regulators, HIF2α and Hepcidin. This scenario is different from what happens under physiological conditions, where Hepcidin parallels systemic iron concentrations while HIF2α levels are inversely associated to Hepcidin. The present review highlights the increasing body of evidence for the pro-tumoral effect of HIF2α and Hepcidin, discusses the possible imbalance in HIF2α, Hepcidin and iron homeostasis during cancer, and explores therapeutic options relying on these pathways as anticancer strategies.
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Affiliation(s)
- Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
| | - Silvia Riondino
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
- PhD Program in Systems and Experimental Medicine (XXXV cycle), University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Simona Guerriero
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Federica D'Amore
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Antonio Di Grazia
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133, Rome, Italy
| | | | - Giuseppe Sica
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
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Potre C, Borsi E, Potre O, Ionita I, Samfireag M, Costachescu D, Secosan C, Lazar S, Ristescu AI. A Systematic Review Assessing the Impact of Vitamin D Levels on Adult Patients with Lymphoid Malignancies. Curr Oncol 2023; 30:4351-4364. [PMID: 37185444 PMCID: PMC10137018 DOI: 10.3390/curroncol30040331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Vitamin D deficiency has been correlated with various conditions, including the risk of developing lymphoid malignancies. This systematic review aimed to assess the association between vitamin D levels at diagnosis of lymphoid malignancies, patient outcomes, and survival. A systematic review was conducted, encompassing 15 studies published until January 2023, involving 4503 patients, examining the relationship between vitamin D and lymphoid cancers. The median age of the patients was 56.5 years, with a median follow-up duration of approximately 36 months across studies. The overall median vitamin D level at initial measurement was 20.4 ng/mL, while a <20 ng/mL threshold was used to define vitamin D insufficiency. The results demonstrated significant associations between vitamin D levels and patient outcomes in several lymphoid malignancies, with a pooled risk in disease progression of 1.93 and a pooled hazard ratio of 2.06 for overall survival in patients with 25-(OH)D levels below the normal threshold of 20 ng/mL. Among findings, it was demonstrated that supplemental vitamin D improves the chemosensitivity of tumors by reducing the rate of tumor growth compared with vitamin D or chemotherapy alone. Vitamin D had a protective effect for patients with DLBCL under R-CHOP treatment, while vitamin D insufficiency was associated with the impairment of rituximab treatment and showed worse clinical outcomes in chimeric antigen receptor T-cell (CAR-T) recipients. Although one study found no association between vitamin D deficiency and the cause of death, most associated vitamin D insufficiency with early clinical failure and lower survival probability. In conclusion, his systematic review highlights the importance of vitamin D levels in the prognosis and survival of patients with lymphoid malignancies. Further research is needed to better understand the underlying mechanisms and explore the potential benefits of vitamin D supplementation in managing these cancers.
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Affiliation(s)
- Cristina Potre
- Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ema Borsi
- Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Potre
- Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ioana Ionita
- Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Miruna Samfireag
- Department of Internal Medicine, Discipline of Clinical Practical Skills, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Dan Costachescu
- Department of Orthopedics-Traumatology, Urology, Radiology, and Medical Imaging, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristina Secosan
- Department of Obstetrics and Gynecology, Discipline of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Sandra Lazar
- Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Anca Irina Ristescu
- Discipline of Anesthesia and Intensive Care, School of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, University Street 16, 700115 Iasi, Romania
- Department of Anesthesia and Intensive Care, Regional Institute of Oncology, General Henri Mathias Berthelot 2-4, 700483 Iasi, Romania
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Lin F, Tuffour A, Hao G, Peprah FA, Huang A, Zhou Y, Zhang H. Distinctive modulation of hepcidin in cancer and its therapeutic relevance. Front Oncol 2023; 13:1141603. [PMID: 36895478 PMCID: PMC9989193 DOI: 10.3389/fonc.2023.1141603] [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: 01/10/2023] [Accepted: 02/08/2023] [Indexed: 02/23/2023] Open
Abstract
Hepcidin, a short peptide synthesized primarily by hepatocytes in response to increased body iron and inflammation, is a crucial iron-regulating factor. Hepcidin regulates intestinal iron absorption and releases iron from macrophages into plasma through a negative iron feedback mechanism. The discovery of hepcidin inspired a torrent of research into iron metabolism and related problems, which have radically altered our understanding of human diseases caused by an excess of iron, an iron deficiency, or an iron disparity. It is critical to decipher how tumor cells manage hepcidin expression for their metabolic requirements because iron is necessary for cell survival, particularly for highly active cells like tumor cells. Studies show that tumor and non-tumor cells express and control hepcidin differently. These variations should be explored to produce potential novel cancer treatments. The ability to regulate hepcidin expression to deprive cancer cells of iron may be a new weapon against cancer cells.
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Affiliation(s)
- Feng Lin
- Key Laboratory of Healthy Freshwater Aquaculture, Ministry of Agriculture, Zhejiang Institute of Freshwater Fisheries, Huzhou, China
| | - Alex Tuffour
- School of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu, China.,State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, China
| | - Guijie Hao
- Key Laboratory of Healthy Freshwater Aquaculture, Ministry of Agriculture, Zhejiang Institute of Freshwater Fisheries, Huzhou, China
| | | | - Aixia Huang
- Key Laboratory of Healthy Freshwater Aquaculture, Ministry of Agriculture, Zhejiang Institute of Freshwater Fisheries, Huzhou, China
| | - Yang Zhou
- School of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Haiqi Zhang
- Key Laboratory of Healthy Freshwater Aquaculture, Ministry of Agriculture, Zhejiang Institute of Freshwater Fisheries, Huzhou, China
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Foda AAM, Atia T, Sakr HI, Abd Elaziz Ahmed Elnaghi K, Abdelhay WM, Enan ET. Clinicopathological Characteristics and Prognosis of Diffuse Large B-Cell Lymphoma in Relation to CA-125 and CA 19-9 Expression. J Evid Based Integr Med 2023; 28:2515690X231198315. [PMID: 37654084 PMCID: PMC10475264 DOI: 10.1177/2515690x231198315] [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: 02/14/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Background: Some epithelial tumors express the carbohydrate antigen 125 (Cancer antigen-125, CA-125) and CA 19-9, especially ovarian and pancreatic tumors. Patients with non-Hodgkin lymphoma (NHL) were reported to have a close association between serum CA-125 levels and adverse prognostic factors with worse survival. We aimed to investigate CA-125 and 19-9 expression in nodal diffuse large B-cell lymphoma, not otherwise specified (DLBCL NOS) tissues using immunohistochemistry (IHC) and their relations to clinicopathological manifestations and patients' survival. Methods: 65 cases of DLBCL NOS were examined. A modified mechanical pencil tip was used to construct Manual Tissue Micro-array (TMA) blocks. Immunohistochemical staining for CA-125 and CA 19-9 was performed and scored semi-quantitatively. All relations were analyzed using established statistical methodologies. Results: Aberrant expression of CA 19-9 was detected in 12% of cases without any expression of CA-125. Moreover, 75% of the CA 19-9 positive cases were statistically significantly associated with anemia and performance status 1. Also, 75% of the CA 19-9 positive cases were females. Conclusions: CA 19-9 was aberrantly expressed in 12% of nodal DLBCL NOS cases and significantly related to anaemia and performance status but not to survival. In cases of DLBCL NOS, CA 19-9 expression cannot be considered an independent prognostic factor. CA-125 was not expressed in nodal DLBCL NOS tissues, necessitating re-evaluation studies. Therefore, it is advised to conduct more research to clarify the potential correlation between serum and tissue CA 19-9 levels and other clinic-pathological characteristics of nodal and extranodal DLBCL NOS patients.
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Affiliation(s)
- Abd AlRahman Mohammad Foda
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Pathology Department, General Medicine Practice, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Tarek Atia
- Department of Histology and Cytology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hader I. Sakr
- Department of Medical Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Medical Physiology, Medicine Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Khaled Abd Elaziz Ahmed Elnaghi
- Oncology Centre, Medical Oncology unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Medical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Wagih M. Abdelhay
- Department of Histology and Cytology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Eman T. Enan
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Taniguchi T, Nakayama S, Tanaka H, Rai S, Hirase C, Morita Y, Tatsumi Y, Ashida T, Matsuda M, Hashimoto S, Matsumura I. Novel prognostic predictor of haemoglobin-platelet index in diffuse large B-cell lymphoma, not otherwise specified: Anaemia and thrombocytopenia are associated with IL-6 production in lymphoma cells. Br J Haematol 2022; 198:360-372. [PMID: 35451502 DOI: 10.1111/bjh.18208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
We previously reported that a novel haemoglobin-platelet index (HPI) based on anaemia and thrombocytopenia was useful to predict the prognosis of patients with diffuse large B-cell lymphoma not otherwise specified (DLBCL NOS). Here, we analyse the utility of HPI in a new validation cohort with DLBCL NOS (n = 94). As a result, we confirm that HPI was effective for differentiating progression-free survival (PFS) and overall survival in this validation cohort. So, we further compare the utility of HPI with previously reported prognostic markers such as the National Comprehensive Center Network-International Prognostic Index (NCCN-IPI), Glasgow prognostic score (GPS), and platelet-albumin (PA) score, using a larger number of 160 patients consisting of the derivation cohort (n = 66) and a validation cohort (n = 94). As a result, the patients with a higher HPI score had significantly worse outcomes, and HPI predicted the prognosis of DLBCL NOS independently of NCCN-IPI. HPI was more sensitive than GPS and almost the same as PA score in predicting PFS. Moreover, the patients whose lymphoma cells were positive for interleukin-6 (IL-6) (75/111 cases) judged by immunohistochemical staining had significantly lower haemoglobin levels and platelet counts than IL-6-negative cases (36/111 cases), suggesting the involvement of IL-6 produced by lymphoma cells in anaemia and thrombocytopenia in DLBCL NOS patients.
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Affiliation(s)
- Takahide Taniguchi
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Shoko Nakayama
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Hirokazu Tanaka
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Shinya Rai
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Chikara Hirase
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Yasuyoshi Morita
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Yoichi Tatsumi
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Takashi Ashida
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
| | - Mitsuhiro Matsuda
- Department of Hematology, Perfect Liberty General Hospital, Tondabayashi-shi, Osaka, Japan
| | - Shigeo Hashimoto
- Department of Pathology, Perfect Liberty General Hospital, Tondabayashi-shi, Osaka, Japan
| | - Itaru Matsumura
- Division of Hematology and Rheumatology, Faculty of Medicine, Kindai University Hospital, Osakasayama-shi, Osaka, Japan
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Vlatka P, Marko L, Stefan M, Dorian L. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel prognostic factor for patients with diffuse large B-cell lymphoma. J Cancer Res Ther 2022; 18:725-732. [DOI: 10.4103/jcrt.jcrt_174_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cha RR, Baek DH, Lee GW, Park SJ, Lee JH, Park JH, Kim TO, Lee SH, Kim HW, Kim HJ. Clinical Features and Prognosis of Patients with Primary Intestinal B-cell Lymphoma Treated with Chemotherapy with or without Surgery. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 78:320-327. [DOI: 10.4166/kjg.2021.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/01/2021] [Accepted: 09/06/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Ra Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gyeong Won Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jong Hoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jong Ha Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Heon Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
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Luo Q, Yang C, Fu C, Wu W, Wei Y, Zou L. Prognostic Role of Blood Markers in Primary Central Nervous System Lymphoma Patients Treated With High-Dose Methotrexate-Based Therapy. Front Oncol 2021; 11:639644. [PMID: 33996552 PMCID: PMC8117413 DOI: 10.3389/fonc.2021.639644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/15/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: Primary central nervous system lymphoma (PCNSL) is a rare type of extra-nodal non-Hodgkin lymphoma, but the prognostic value of blood parameters indicating systemic inflammation and nutritional status remains unknown. We aim to explore the prognostic role of blood parameters in PCNSL. Methods: All PCNSL patients diagnosed at West China Hospital between February 2011 and February 2020 were retrospectively screened. For patients who were initially treated with high-dose methotrexate (HD-MTX)-based therapy, clinical data were collected. Survival analyses were performed using the Kaplan–Meier method and multivariable Cox proportional regression. The accuracies of different multivariate models were assessed by Harrell's C statistical analysis (C-index). Results: Sixty patients were included. Median overall survival (OS) was 4.8 ± 3.7 years, and median progression-free survival (PFS) was 1.9 ± 1.3 years. In the multivariate analysis, hemoglobin (Hb) (HR 3.940, p = 0.013), neutrophil–lymphocyte ratio (NLR) (HR 10.548, p = 0.034), and total bilirubin (TBIL) (HR 3.429, p = 0.004) had independent prognostic values for PFS, while lymphocyte–monocyte ratio (LMR) (HR 6.195, p = 0.039), systemic immune-inflammation index (SII) (HR 5.144, p = 0.012), and TBIL (HR 3.892, p = 0.009) were independently related to OS. The C-index of the Memorial Sloan-Kettering Cancer Center (MSKCC) score increased from 0.57 to 0.72 when SII and TBIL were combined. Conclusions: Our study indicated that pretreatment Hb, NLR, SII, LMR, and TBIL were convenient prognostic factors in PCNSL. Adding SII and TBIL to the MSKCC score can better predict the survival of PCNSL based on HD-MTX regimens.
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Affiliation(s)
- Qian Luo
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunli Yang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunxi Fu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wanchun Wu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wei
- Department of Central Medical Transportation, West China Hospital, Sichuan University, Chengdu, China
| | - Liqun Zou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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11
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Liang X, Guo L, Hu X, Li S, Wen S. Analysis of clinical characteristics and prognosis of patients with peripheral T-cell lymphoma. Medicine (Baltimore) 2021; 100:e25194. [PMID: 33787601 PMCID: PMC8021354 DOI: 10.1097/md.0000000000025194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to explore the clinical characteristics, therapeutic efficacy and prognostic factors of peripheral T-cell lymphoma (PTCL). METHODS The clinical data of 119 PTCL patients who were admitted to the Xinjiang Medical University Affiliated Tumor Hospital from January 2010 to December 2017 were retrospectively analyzed, including the clinical characteristics, therapeutic efficacy, prognosis-related factors and treatments. Among the patients, 98 patients received antharcyclines-based therapeutic protocols, including Cyclophosphamide, Pirarubicin, Vincristine, Prednisone (CHOP) protocol and Cyclophosphamide, Pirarubicin, Vincristine, Prednisone, Etoposide (CHOPE) protocol, with median follow-up time of 32.5 months (2-166 months). The patients' clinical characteristics were analyzed, and COX ratio risk regression model was adopted to analyze the prognostic factors related with the survival rate of PTCL patients. RESULTS The 5-year overall survival (OS) rate was 46.4% and progression-free survival (PFS) rate was 42.7% in the 98 patients, and there were insignificant differences between patients with CHOP protocol and those with CHOPE protocol in the 5-year OS and PFS rates (OS: P = 0.197, PFS: P = 0.663). The univariate analysis results showed that different pathological types, Ann Arbor stage, Eastern Cooperative Oncology Group (ECOG) score ≥ 2, the number of extranodal lymphomas involved, Lactic dehydrogenase (LDH) level, presence/absence of bone marrow involved, international prognostic index (IPI) score, β2 microglobulin (β2-MG) level and hemoglobin (Hb) level were poor prognosis factors influencing patients' OS and PFS rates (P all < .05). Multivariate analysis demonstrated that different pathological types, Ann Arbor stage, presence/absence of bone marrow involved and Hb level were independent prognostic indicators influencing patients' OS and PFS rates (P all < .05). CONCLUSION PTCL is poor in therapeutic efficacy and prognosis, and different pathological types, Ann Arbor stage, presence/absence of bone marrow involved and Hb level are related with the prognosis of PTCL patients. Anemia occurring before the treatment is an important predictive indicator influencing the prognosis of PTCL patients and patients who experience anemia will be poor in prognosis.
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12
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Iron Dysregulation in Human Cancer: Altered Metabolism, Biomarkers for Diagnosis, Prognosis, Monitoring and Rationale for Therapy. Cancers (Basel) 2020; 12:cancers12123524. [PMID: 33255972 PMCID: PMC7761132 DOI: 10.3390/cancers12123524] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Iron is the more abundant metal ion in humans. It is essential for life as it has a role in various cellular processes involved, for instance, in cell metabolism and DNA synthesis. These functions are crucial for cell proliferation, and it is therefore not surprising that iron is accumulated in tumors. In this review, we describe normal and altered iron homeostasis mechanisms. We also provide a vision of iron-related proteins with altered expression in cancers and discuss their potential as diagnostic and/or prognostic biomarkers. Finally, we give an overview of therapeutic strategies acting on iron metabolism to fight against cancers. Abstract Iron (Fe) is a trace element that plays essential roles in various biological processes such as DNA synthesis and repair, as well as cellular energy production and oxygen transport, and it is currently widely recognized that iron homeostasis is dysregulated in many cancers. Indeed, several iron homeostasis proteins may be responsible for malignant tumor initiation, proliferation, and for the metastatic spread of tumors. A large number of studies demonstrated the potential clinical value of utilizing these deregulated proteins as prognostic and/or predictive biomarkers of malignancy and/or response to anticancer treatments. Additionally, the iron present in cancer cells and the importance of iron in ferroptosis cell death signaling pathways prompted the development of therapeutic strategies against advanced stage or resistant cancers. In this review, we select relevant and promising studies in the field of iron metabolism in cancer research and clinical oncology. Besides this, we discuss some co-existing discrepant findings. We also present and discuss the latest lines of research related to targeting iron, or its regulatory pathways, as potential promising anticancer strategies for human therapy. Iron chelators, such as deferoxamine or iron-oxide-based nanoparticles, which are already tested in clinical trials, alone or in combination with chemotherapy, are also reported.
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13
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Jiang M, Qiao M, Zhao C, Deng J, Li X, Zhou C. Targeting ferroptosis for cancer therapy: exploring novel strategies from its mechanisms and role in cancers. Transl Lung Cancer Res 2020; 9:1569-1584. [PMID: 32953528 PMCID: PMC7481593 DOI: 10.21037/tlcr-20-341] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ferroptosis is a novel form of non-apoptotic regulated cell death (RCD), with distinct characteristics and functions in physical conditions and multiple diseases such as cancers. Unlike apoptosis and autophagy, this new RCD is an iron-dependent cell death with features of lethal accumulation of reactive oxygen species (ROS) and over production of lipid peroxidation. Excessive iron from aberrant iron metabolisms or the maladjustment of the two main redox systems thiols and lipid peroxidation role as the major causes of ROS generation, and the redox-acrive ferrous (intracellular labile iron) is a crucial factor for the lipid peroxidation. Regulation of ferrroptosis also involves different pathways such as mevalonate pathway, P53 pathway and p62-Keap1-Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway. Ferroptosis roles as a double-edged sword either suppressing or promoting tumor progression with the release of multiple signaling molecules in the tumor microenvironment. Emerging evidence suggests ferroptosis as a potential target for cancer therapy and ferroptosis inducers including small molecules and nanomaterials have been developed. The application of ferroptosis inducers also relates to overcoming drug resistance and preventing tumor metastasis, and may become a promising strategy combined with other anti-cancer therapies. Here, we summarize the ferroptosis characters from its underlying basis and role in cancer, followed by its possible applications in cancer therapies and challenges maintained.
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Affiliation(s)
- Minlin Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Meng Qiao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Chuanliang Zhao
- Department of Otolaryngology, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Juan Deng
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China.,Tongji University, Shanghai, China
| | - Xuefei Li
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
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14
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Maiolo E, Alma E, Napodano C, Gulli F, Bellesi S, Cuccaro A, Pocino K, D’Alo’ F, Iachini M, Martini M, Larocca LM, De Stefano V, Basile U, Hohaus S. The prognostic impact of monoclonal immune globulin and free light chain secretion in diffuse large B cell lymphoma (DLBCL). Leuk Lymphoma 2019; 61:1133-1139. [DOI: 10.1080/10428194.2019.1706731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Elena Maiolo
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Eleonora Alma
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Cecilia Napodano
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesca Gulli
- Dipartimento di Medicina di Laboratorio, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Silvia Bellesi
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Annarosa Cuccaro
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Krizia Pocino
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco D’Alo’
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Iachini
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Martini
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Maria Larocca
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Basile
- Area di Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stefan Hohaus
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Clausen MR, Maurer MJ, Ulrichsen SP, Larsen TS, Himmelstrup B, Rønnov-Jessen D, Link BK, Feldman AL, Slager SL, Nowakowski GS, Thompson CA, Pedersen PT, Madsen J, Pedersen RS, Gørløv JS, Cerhan JR, Nørgaard M, D'Amore F. Pretreatment Hemoglobin Adds Prognostic Information To The NCCN-IPI In Patients With Diffuse Large B-Cell Lymphoma Treated With Anthracycline-Containing Chemotherapy. Clin Epidemiol 2019; 11:987-996. [PMID: 31814771 PMCID: PMC6861518 DOI: 10.2147/clep.s219595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background Hemoglobin (Hgb) concentration at diagnosis is associated with outcome in cancer. In a recently reported simplified 3-factor prognostic score in Hodgkin lymphoma, Hgb, along with age and clinical stage, outperformed the classical International Prognostic Score with seven parameters. Methods In the present study, we investigated if pretherapeutic Hgb concentration added prognostic information to the NCCN-IPI in diffuse large B-cell lymphoma. We included patients from the Danish Lymphoma Registry (LYFO; N = 3499) and from the Molecular Epidemiology Resource (MER; N = 1225), Mayo Clinic and University of Iowa. Four sex-specific Hgb groups were defined: below transfusion threshold, from transfusion threshold to below lower limit of normal, from lower limit of normal to the population mean, and above the mean. We used multivariable Cox regression to estimate the hazard rate ratios (HR) and 95% CIs for overall survival (OS) and event-free survival (EFS), adjusting for sex, NCCN-IPI, comorbidity, and rituximab treatment. Results Approximately half of the patients had Hgb levels below the lower limit of normal. Compared to patients with Hgb levels above the mean, an inferior OS was directly correlated with lower pretreatment Hgb within the predefined groups (HR=1.23, HR=1.51, and HR=2.05, respectively). These findings were validated in the MER. Conclusion Based on multivariable analysis, lower pretreatment Hgb, even within the normal range but below the mean, added prognostic information to established indices such as the NCCN-IPI and the Charlson comorbidity index.
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Affiliation(s)
- Michael R Clausen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas S Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Bodil Himmelstrup
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Brian K Link
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Jakob Madsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mette Nørgaard
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Francesco D'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
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16
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Shimono J, Takahashi S, Takemura R, Kakinoki Y. Useful prognostic tools based on complete blood cell counts in diffuse large B-cell lymphoma. Int J Lab Hematol 2019; 41:754-761. [PMID: 31529774 DOI: 10.1111/ijlh.13106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/12/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is the most frequent lymphoma. Three prognostic factors are widely used in DLBCL: International Prognostic Index (IPI), Revised-IPI (R-IPI), and National Comprehensive Cancer Network-IPI (NCCN-IPI). METHOD We established a prognostic model using peripheral blood absolute lymphocyte/absolute monocyte counts ratio (LMR), hemoglobin, and platelet counts obtained from complete blood cell counts (CBC) data at diagnosis based on 214 cases of DLBCL who received more than one course of R-CHOP therapy at a single institution. RESULTS The cutoff values for using the receiver operating characteristics (ROC) curve for LMR, hemoglobin, and platelet counts were 1.6, 100 g/L, and 150 × 109 /L, respectively. Stratification was performed using the three factors (LMR < 1.6, hemoglobin < 100 g/L, and platelet counts < 150 × 109 /L). CBC Group 1 (none of the 3 factors) included 92 cases, CBC Group 2 (1 or 2 of these factors) included 108 cases, and CBC Group 3 (all 3 factors) included 11 cases. The 5-year OS rates were 78.2%, 60.9%, and 10.1%, respectively. In multivariate analysis, CBC Group 3 (hazard ratio, 2.9760; 95% confidence interval, 1.2670-6.991; P = .01) were prognostic factors for OS. CBC Group 3 had factors based on which the further stratification of the poor prognosis group into IPI high-risk and R-IPI poor-risk groups (P = .01, <.0001, respectively) was possible. CONCLUSIONS In DLBCL, combination of three CBC parameters has the potential to be a useful prognostic tool.
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Affiliation(s)
- Joji Shimono
- Department of Hematology, Asahikawa city hospital, Asahikawa, Japan.,Department of Hematology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shogo Takahashi
- Department of Hematology, Asahikawa city hospital, Asahikawa, Japan
| | - Ryo Takemura
- Department of Hematology, Asahikawa city hospital, Asahikawa, Japan
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17
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Le M, Garcilazo Y, Ibáñez-Juliá MJ, Younan N, Royer-Perron L, Benazra M, Mokhtari K, Houillier C, Hoang-Xuan K, Alentorn A. Pretreatment Hemoglobin as an Independent Prognostic Factor in Primary Central Nervous System Lymphomas. Oncologist 2019; 24:e898-e904. [PMID: 30867243 DOI: 10.1634/theoncologist.2018-0629] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal lymphoma. Despite established clinical prognostic scoring such as that of the Memorial Sloan Kettering Cancer Center (MSKCC) and the International Extranodal Lymphoma Study Group, outcome prediction needs to be improved. Several studies have indicated an association between changes in hematologic laboratory parameters with patient outcomes in PCNSL. We sought to assess the association between hematological parameters and overall survival (OS) in patients with PCNSL. METHODS Pretreatment blood tests were analyzed in patients with newly diagnosed PCNSL (n = 182), and we divided the analysis into two cohorts (A and B, both n = 91). OS was evaluated using the Cox proportional hazards models and log-rank test. Furthermore, the accuracy of the different multivariate models was assessed by Harrell's concordance index (C-index). RESULTS Using prechemotherapy blood tests, anemia was found in 38 patients (41.8%) in cohort A and 34 patients (37.4%) in cohort B. In univariate analysis, anemia (<12 g/dL in women and <13 g/dL in men) was significantly associated with OS. None of the other blood tests parameters (neutrophils, lymphocyte, or platelets counts) or their ratios (neutrophil-to-lymphocyte ratio and neutrophil-to-platelets ratio) were associated with OS. In multivariate analysis, after adjusting by MSKCC score, anemia remained an independent prognostic factor. Interestingly, the prediction accuracy of OS using Harrell's C-index was similar using anemia or MSKCC (mean C-index, 0.6) and was increased to 0.67 when combining anemia and MSKCC. CONCLUSION The presence of anemia was associated with poor prognosis in both cohorts of PCNSL. Validation of these results and biologic role of hemoglobin levels in PCNSL requires further investigation. IMPLICATIONS FOR PRACTICE The prediction of the outcome of primary central nervous system lymphoma (PCNSL) using the most frequently used scores (i.e., Memorial Sloan Kettering Cancer Center [MSKCC] or International Extranodal Lymphoma Study Group) needs to be improved. We analyzed a large cohort of PCNSL to dissect the potential prognostic value of blood tests in this rare entity. We found anemia as an independent predictor for overall survival in PCNSL. Interestingly, the accuracy to predict PCNSL outcome was improved using hemoglobin level. This improvement was additional to the currently used clinical score (i.e., MSKCC). Finally, none of the other blood tests parameters or their ratios had a prognostic impact in this study.
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Affiliation(s)
- My Le
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Ytel Garcilazo
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Maria-José Ibáñez-Juliá
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Nadia Younan
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
| | - Louis Royer-Perron
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marion Benazra
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
| | - Karima Mokhtari
- Laboratory Escourolle, Department of Neuropathology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Onconeurotek Tumour Bank, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
| | - Caroline Houillier
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Lymphome Oculo-Cérébral (LOC) Network, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Lymphome Oculo-Cérébral (LOC) Network, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
| | - Agusti Alentorn
- Department of Neurology-2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Unité Mixte de Recherche (UMR) 1127, INSERM U1127, Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne University-Pitié-Salpêtrière University Hospital-Centre National de la Recherche (CNRS), Paris, France
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18
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Abstract
Objective: Purpose of this study was to find out frequency of anemia and its causes in newly diagnosed treatment naive lymphoma patients. Methods: We retrospectively studied all lymphoma patients (> 18 years age) diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, from January 2016 till January 2017. The data was collected from electronic Hospital Information System. Descriptive statistics were done by using summary measures for categorical variables as well as continuous variables. Results: Out of a total 408 patients, 272 were males and 136 females. Median age of patients was 33 years (18-76). Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL) were the diagnosis in 201 and 134 patients respectively; rest of the patients had low grade lymphomas. Anemia was present in 184 (45%) patients. Anemia of chronic disease was the commonest cause of anemia and was present in 61 (33.1%) patients. Remaining patients had anemia secondary to marrow involvement 50(27.17%); iron deficiency anemia, Vitamin B-12 deficiency anemia and hemolytic anemia were the causes in 7.6, 1.6%, % and 0.54% respectively. Conclusion: Anemia is a common feature in newly diagnosed lymphoma patients with anemia of chronic disease as the commonest cause. It is more frequent in patients with higher stages of lymphoma especially when bone marrow is involved by lymphoma. Since anemia is an important adverse prognostic factor for the outcome of lymphoma patients, work up for anemia prior to initiation of chemotherapy should be done in every lymphoma patient in order to help improve the management of these patients.
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Affiliation(s)
- Tahira Yasmeen
- Dr. Tahira Yasmeen, FCPS (Medicine), Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Jamshed Ali
- Dr. Jamshed Ali, FCPS (Medicine) FCPS (Medical Oncology), Senior Instructor, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Khadeeja Khan
- Dr. Khadeeja Khan, MBBS, Medical Officer, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Neelam Siddiqui
- Dr. Neelam Siddiqui, MRCP, FRCP, CCST (Medical Oncology), Consultant Oncologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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19
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Dong D, Zhang G, Yang J, Zhao B, Wang S, Wang L, Zhang G, Shang P. The role of iron metabolism in cancer therapy focusing on tumor-associated macrophages. J Cell Physiol 2018; 234:8028-8039. [PMID: 30362549 DOI: 10.1002/jcp.27569] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/17/2018] [Indexed: 12/11/2022]
Abstract
Iron is an essential micronutrient in mammalian cells for basic processes such as DNA synthesis, cell cycle progression, and mitochondrial activity. Macrophages play a vital role in iron metabolism, which is tightly linked to their phagocytosis of senescent and death erythrocytes. It is now recognized that the polarization process of macrophages determines the expression profile of genes associated with iron metabolism. Although iron metabolism is strictly controlled by physiology, cancer has recently been connected with disordered iron metabolism. Moreover, in the environment of cancer, tumor-associated macrophages (TAMs) exhibit an iron release phenotype, which stimulates tumor cell survival and growth. Usually, the abundance of TAMs in the tumor is implicated in poor disease prognosis. Therefore, important attention has been drawn toward the development of tumor immunotherapies targeting these TAMs focussing on iron metabolism and reprogramming polarized phenotypes. Although further systematic research is still required, these efforts are almost certainly valuable in the search for new and effective cancer treatments.
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Affiliation(s)
- Dandan Dong
- School of Life Sciences, Northwestern Polytechnical University, Xi'an Shanxi, China.,Key Laboratory for Space Biosciences and Biotechnology, Xi'an Shanxi, China
| | - Gejing Zhang
- School of Life Sciences, Northwestern Polytechnical University, Xi'an Shanxi, China.,Key Laboratory for Space Biosciences and Biotechnology, Xi'an Shanxi, China
| | - Jiancheng Yang
- School of Life Sciences, Northwestern Polytechnical University, Xi'an Shanxi, China.,Key Laboratory for Space Biosciences and Biotechnology, Xi'an Shanxi, China
| | - Bin Zhao
- School of Life Sciences, Northwestern Polytechnical University, Xi'an Shanxi, China.,Key Laboratory for Space Biosciences and Biotechnology, Xi'an Shanxi, China
| | - Shenghang Wang
- School of Life Sciences, Northwestern Polytechnical University, Xi'an Shanxi, China.,Key Laboratory for Space Biosciences and Biotechnology, Xi'an Shanxi, China
| | - Luyao Wang
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University (HKBU), Hong Kong, China
| | - Ge Zhang
- Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University (HKBU), Hong Kong, China
| | - Peng Shang
- Research & Development Institute in Shenzhen, Northwestern Polytechnical University, Shenzhen, China.,Key Laboratory for Space Biosciences and Biotechnology, Xi'an Shanxi, China
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20
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Nakayama S, Matsuda M, Adachi T, Sueda S, Ohashi Y, Awaji S, Hashimoto S, Matsumura I. Novel prognostic index based on hemoglobin level and platelet count for diffuse large B-cell lymphoma, not otherwise specified in the R-CHOP era. Platelets 2018; 30:637-645. [DOI: 10.1080/09537104.2018.1499889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Shoko Nakayama
- Department of Hematology, PL General Hospital, Tondabayashi City, Osaka, Japan
- Division of Hematology and Rheumatology, Kinki University Faculty of Medicine, Osakasayama City, Osaka, Japan
| | - Mitsuhiro Matsuda
- Department of Hematology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Tatsuya Adachi
- Department of Hematology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Sanae Sueda
- Department of Hematology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Yuka Ohashi
- Department of Pathology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Sumie Awaji
- Department of Pathology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Shigeo Hashimoto
- Department of Pathology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Itaru Matsumura
- Division of Hematology and Rheumatology, Kinki University Faculty of Medicine, Osakasayama City, Osaka, Japan
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Yang J, Xu T, Gomez DR, Yuan X, Nguyen Q, Jeter M, Song Y, Komaki R, Hu Y, Hahn SM, Liao Z. Nomograms incorporating genetic variants in BMP/Smad4/Hamp pathway to predict disease outcomes after definitive radiotherapy for non-small cell lung cancer. Cancer Med 2018; 7:2247-2255. [PMID: 29745043 PMCID: PMC6010922 DOI: 10.1002/cam4.1349] [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] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 12/20/2022] Open
Abstract
Hepcidin is crucial in regulating iron metabolism, and increased serum levels were strongly linked with poor outcomes in various malignancies. Thus, we investigated if genetic variants in the BMP/Smad4/Hamp hepcidin-regulating pathway were associated with outcomes in patients receiving definitive radiotherapy for NSCLC. Subjects were 664 NSCLC patients who received ≥60 Gy radiotherapy for NSCLC retrospectively identified from a single-institution database. Potentially, functional and tagging single nucleotide polymorphisms (SNPs) of BMP2 (rs170986, rs1979855, rs1980499, rs235768, and rs3178250), BMP4 (rs17563, rs4898820, and rs762642), Smad4 (rs12456284), and Hamp (rs1882694, rs10402233, rs10421768, and rs12971321) were genotyped by TaqMan real-time polymerase chain reaction. Cox proportional hazard's analyses were used to assess potential influences of SNPs on overall survival (OS), local-regional progression-free survival (LRPFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). Nomogram of each endpoint model was developed using R project. The median patient age was 66 years. Most (488 [73.2%]) had stage III NSCLC. Age, disease stage, receipt of concurrent chemotherapy, and gross tumor volume were independent factors of OS. Hamp rs1882694 AC/CC genotypes were associated with poor OS, LRPFS, PFS, and DMFS in multivariate analyses. Besides, BMP2 rs1979855, rs3178250, and rs1980499 associated with PFS; Hamp rs10402233 and BMP2 rs1979855 associated with LRPFS; BMP2 rs3178250 associated with DMFS after adjustment for clinical factors. After adding SNPs to each model, all the likelihood ratios were increased; the nomograms were improved significantly to predict LRPFS (P < 0.001) and PFS (P < 0.001), and marginally to predict OS (P = 0.056) and DM (P = 0.057). Our nomograms incorporating significant SNPs in the BMP/Smad4/Hamp hepcidin-regulating pathway could improve the prediction of outcomes in patients given definitive radiotherapy for NSCLC. Intensified follow-ups would be recommended for patients with unfavorable outcomes identified in nomograms. Due to the rapid developments of targeted therapies and immunotherapies for NSCLC, it is necessary to further validate our findings in patients receiving such treatments.
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Affiliation(s)
- Ju Yang
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas77030
- The Comprehensive Cancer Centre of Drum Tower HospitalMedical School of Nanjing University & Clinical Cancer Institute of Nanjing UniversityNanjing210008China
| | - Ting Xu
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas77030
| | - Daniel R. Gomez
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas77030
| | - Xianglin Yuan
- Department of OncologyTongji HospitalHuazhong University of Science and TechnologyWuhanHubei430030China
| | - Quynh‐Nhu Nguyen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas77030
| | - Melenda Jeter
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas77030
| | - Yipeng Song
- Department of Radiation OncologyYuhuangding HospitalZhifu, YantaiShandong264000China
| | - Ritsuko Komaki
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas77030
| | - Ye Hu
- Arizona State UniversityMesaArizona85212
| | - Stephen M. Hahn
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas77030
| | - Zhongxing Liao
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas77030
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Matsumoto K, Fujisawa S, Ando T, Koyama M, Koyama S, Ishii Y, Numata A, Yamamoto W, Motohashi K, Hagihara M, Nakajima H. Anemia Associated with Worse Outcome in Diffuse Large B-Cell Lymphoma Patients: A Single-Center Retrospective Study. Turk J Haematol 2018; 35:181-184. [PMID: 29589833 PMCID: PMC6110437 DOI: 10.4274/tjh.2017.0437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective Useful prognostic biomarkers for diffuse large B-cell lymphoma (DLBCL) patients have been reported. To determine the prognostic value of hemoglobin (Hb) level in DLBCL patients, we performed a retrospective study. Materials and Methods We evaluated disease outcome, progression-free survival (PFS), overall survival as the endpoint, and clinical and laboratory factors affecting the outcome of 185 DLBCL patients who had received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy during 2004-2014. Results The study group included 121 men and 64 women with a median age of 66 years minimum-maximum: 21-83 years. In univariate analysis, factors independently associated with worse PFS were Eastern Cooperative Oncology Group performance status ≥2, Ann Arbor stage III or IV, anemia with Hb levels of <10 g/dL, and serum albumin of <3.5 g/dL. In multivariate analysis, anemia with Hb levels of <10 g/dL and Ann Arbor stage III or IV were found to be international index-independent prognostic factors (hazard ratio: 2.4; p=0.04). Conclusion Anemia is an independent prognostic marker of poor outcome in DLBCL patients. Hb can be an easily available prognostic marker for risk stratification in these patients.
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Affiliation(s)
- Kenji Matsumoto
- Yokohama City University Faculty of Medicine, Department of Hematology and Clinical Immunology, Yokohama, Japan
| | - Shin Fujisawa
- Yokohama City University Faculty of Medicine, Department of Hematology, Yokohama, Japan
| | - Taiki Ando
- Yokohama City University Faculty of Medicine, Department of Hematology, Yokohama, Japan
| | - Megumi Koyama
- Kanagawa Cancer Center, Clinic of Medical Oncology, Yokohama, Japan
| | - Satoshi Koyama
- Kanagawa Cancer Center, Clinic of Hematology, Yokohama, Japan
| | - Yoshimi Ishii
- Yokohama City University Faculty of Medicine, Department of Hematology, Yokohama, Japan
| | - Ayumi Numata
- Kanagawa Cancer Center, Clinic of Medical Oncology, Yokohama, Japan
| | - Wataru Yamamoto
- Kanagawa Cancer Center, Clinic of Medical Oncology, Yokohama, Japan
| | - Kenji Motohashi
- Yokohama City University Faculty of Medicine, Department of Hematology, Yokohama, Japan
| | - Maki Hagihara
- Yokohama City University Faculty of Medicine, Department of Hematology and Clinical Immunology, Yokohama, Japan
| | - Hideaki Nakajima
- Yokohama City University Faculty of Medicine, Department of Hematology and Clinical Immunology, Yokohama, Japan
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Dignass A, Farrag K, Stein J. Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions. Int J Chronic Dis 2018; 2018:9394060. [PMID: 29744352 PMCID: PMC5878890 DOI: 10.1155/2018/9394060] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/09/2018] [Accepted: 02/06/2018] [Indexed: 12/16/2022] Open
Abstract
Patients with inflammatory conditions such as inflammatory bowel disease (IBD), chronic heart failure (CHF), and chronic kidney disease (CKD) have high rates of iron deficiency with adverse clinical consequences. Under normal circumstances, serum ferritin levels are a sensitive marker for iron status but ferritin is an acute-phase reactant that becomes elevated in response to inflammation, complicating the diagnosis. Proinflammatory cytokines also trigger an increase in hepcidin, which restricts uptake of dietary iron and promotes sequestration of iron by ferritin within storage sites. Patients with inflammatory conditions may thus have restricted availability of iron for erythropoiesis and other cell functions due to increased hepcidin expression, despite normal or high levels of serum ferritin. The standard threshold for iron deficiency (<30 μg/L) therefore does not apply and transferrin saturation (TSAT), a marker of iron availability, should also be assessed. A serum ferritin threshold of <100 μg/L or TSAT < 20% can be considered diagnostic for iron deficiency in CHF, CKD, and IBD. If serum ferritin is 100-300 μg/L, TSAT < 20% is required to confirm iron deficiency. Routine surveillance of serum ferritin and TSAT in these at-risk groups is advisable so that iron deficiency can be detected and managed.
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Affiliation(s)
- Axel Dignass
- Department of Medicine 1, Agaplesion Markus Hospital, Goethe University, 60431 Frankfurt am Main, Germany
- Interdisciplinary Crohn Colitis Center Rhein-Main, 60594 Frankfurt am Main, Germany
| | - Karima Farrag
- Interdisciplinary Crohn Colitis Center Rhein-Main, 60594 Frankfurt am Main, Germany
- Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, 60594 Frankfurt am Main, Germany
| | - Jürgen Stein
- Interdisciplinary Crohn Colitis Center Rhein-Main, 60594 Frankfurt am Main, Germany
- Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, 60594 Frankfurt am Main, Germany
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Differential regulation of hepcidin in cancer and non-cancer tissues and its clinical implications. Exp Mol Med 2018; 50:e436. [PMID: 29391539 PMCID: PMC5903825 DOI: 10.1038/emm.2017.273] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/29/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
Hepcidin is a crucial peptide for regulating cellular iron efflux. Because iron is essential for cell survival, especially for highly active cells, such as tumor cells, it is imperative to understand how tumor cells manipulate hepcidin expression for their own metabolic needs. Studies suggest that hepcidin expression and regulation in tumor cells show important differences in comparison with those in non-tumorous cells. These differences should be investigated to develop new strategies to fight cancer cells. Manipulating hepcidin expression to starve cancer cells for iron may prove to be a new therapy in the anticancer arsenal.
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Hohaus S, Tisi MC, Bellesi S, Maiolo E, Alma E, Tartaglia G, Corrente F, Cuccaro A, D'Alo' F, Basile U, Larocca LM, De Stefano V. Vitamin D deficiency and supplementation in patients with aggressive B-cell lymphomas treated with immunochemotherapy. Cancer Med 2017; 7:270-281. [PMID: 29271084 PMCID: PMC5773978 DOI: 10.1002/cam4.1166] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022] Open
Abstract
Vitamin D deficiency has been reported to be a negative prognostic factor in elderly patients with aggressive B‐cell lymphomas. In vitro data suggest that vitamin D supplementation may enhance rituximab‐mediated cytotoxicity. We prospectively assessed 25‐hydroxyvitamin D [25(OH)D] levels at diagnosis in a cohort of 155 patients with aggressive B‐cell lymphomas of whom 128 had diffuse large B‐cell lymphoma (DLBCL) not otherwise specified. 25(OH)D levels were deficient (<20 ng/mL) in 105 (67%), insufficient (20–29 ng/mL) in 32 (21%), and normal (≥30 ng/mL) in 18 (12%) patients with a seasonal variation. Patient characteristics associated with lower 25(OH)D levels were poor performance status, overweight, B‐symptoms, elevated LDH, lower albumin and hemoglobin levels. As a result of a change in practice pattern, 116 patients received vitamin D3 (cholecalciferol) supplementation that included a loading phase with daily replacement and subsequent maintenance phase with a weekly dose of 25,000 IU until end of treatment. This resulted in a significant increase in 25(OH)D levels, with normalization in 56% of patients. We analyzed the impact of 25(OH)D levels on event‐free survival in patients treated with Rituximab‐CHOP. 25(OH)D levels below 20 ng/mL at diagnosis and IPI were independently associated with inferior EFS. Moreover, patients with normalized 25(OH)D levels following supplementation showed better EFS than patients with persistently deficient/insufficient 25(OH)D levels. Our study provides the first evidence that achievement of normal 25(OH)D levels after vitamin D3 supplementation is associated with improved outcome in patients with DLBCL and deficient/insufficient 25(OH)D levels when receiving rituximab‐based treatment.
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Affiliation(s)
- Stefan Hohaus
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Chiara Tisi
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Bellesi
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Maiolo
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Alma
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Germana Tartaglia
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Corrente
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annarosa Cuccaro
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco D'Alo'
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Basile
- Department of Laboratory Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Maria Larocca
- Institute of Pathological Anatomy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
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Cottereau AS, Mulé S, Lin C, Belhadj K, Vignaud A, Copie-Bergman C, Boyez A, Zerbib P, Tacher V, Scherman E, Haioun C, Luciani A, Itti E, Rahmouni A. Whole-Body Diffusion-weighted MR Imaging of Iron Deposits in Hodgkin, Follicular, and Diffuse Large B-Cell Lymphoma. Radiology 2017; 286:560-567. [PMID: 28985135 DOI: 10.1148/radiol.2017170599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Purpose To analyze the frequency and distribution of low-signal-intensity regions (LSIRs) in lymphoma lesions and to compare these to fluorodeoxyglucose (FDG) uptake and biologic markers of inflammation. Materials and Methods The authors analyzed 61 untreated patients with a bulky lymphoma (at least one tumor mass ≥7 cm in diameter). When a LSIR within tumor lesions was detected on diffusion-weighted images obtained with a b value of 50 sec/mm2, a T2-weighted gradient-echo (GRE) sequence was performed and calcifications were searched for with computed tomography (CT). In two patients, Perls staining was performed on tissue samples from the LSIR. LSIRs were compared with biologic inflammatory parameters and baseline FDG positon emission tomography (PET)/CT parameters (maximum standardized uptake value [SUVmax], total metabolic tumor volume [TMTV]). Results LSIRs were detected in 22 patients and corresponded to signal void on GRE images; one LSIR was due to calcifications, and three LSIRS were due to a recent biopsy. In 18 patients, LSIRs appeared to be related to focal iron deposits; this was proven with Perls staining in two patients. The LSIRs presumed to be due to iron deposits were found mostly in patients with aggressive lymphoma (nine of 26 patients with Hodgkin lymphoma and eight of 20 patients with diffuse large B-cell lymphoma vs one of 15 patients with follicular lymphoma; P = .047) and with advanced stage disease (15 of 18 patients). LSIRS were observed in spleen (n = 14), liver (n = 3), and nodal (n = 8) lesions and corresponded to foci FDG uptake, with mean SUVmax of 9.8, 6.7, and 16.2, respectively. These patients had significantly higher serum levels of C-reactive protein, α1-globulin, and α2-globulin and more frequently had microcytic anemia than those without such deposits (P = .0072, P = .003, P = .0068, and P < .0001, respectively). They also had a significantly higher TMTV (P = .0055) and higher levels of spleen involvement (P < .0001). Conclusion LSIRs due to focal iron deposits are detected in lymphoma lesions and are associated with a more pronounced biologic inflammatory syndrome. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Anne-Ségolène Cottereau
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Sébastien Mulé
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Chieh Lin
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Karim Belhadj
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Alexandre Vignaud
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Christiane Copie-Bergman
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Alice Boyez
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Pierre Zerbib
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Vania Tacher
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Elodie Scherman
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Corinne Haioun
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Alain Luciani
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Emmanuel Itti
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
| | - Alain Rahmouni
- From the Department of Nuclear Medicine (A.S.C., E.I.), Department of Medical Imaging (A.S.C., S.M., P.Z., V.T., A.L., A.R.), Lymphoid Malignancies Unit (K.B., E.S., C.H.), and Department of Pathology (C.C.B., A.B.), AP-HP, Groupe Henri Mondor Albert Chenevier, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, Université Paris Est Créteil, 94010 Creteil, France; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); NeuroSpin, Gif-sur-Yvette, France (A.V.); INSERM IMRB U955 Equipe 18, Paris, France (V.T., A.L.); and UPEC, Paris, France (V.T., A.L., A.R.)
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Cao J, Lan S, Shen L, Si H, Xiao H, Yuan Q, Li X, Li H, Guo R. Hemoglobin level, a prognostic factor for nasal extranodal natural killer/T-cell lymphoma patients from stage I to IV: A validated prognostic nomogram. Sci Rep 2017; 7:10982. [PMID: 28887511 PMCID: PMC5591293 DOI: 10.1038/s41598-017-11137-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/14/2017] [Indexed: 01/08/2023] Open
Abstract
Although nasal extranodal natural killer/T-cell lymphoma (nasal ENKL) shares some prognostic factors with other lymphomas, seldom studies had explored the prognostic value of hemoglobin. The ENKL cases in stage I–IV during 2000 to 2015 were collected from two medical centers (group A, n = 192), and were randomly divided into the group B (n = 155) and C (n = 37). Although the significant factors identified by the univariate analysis differed between the group A and B, the multivariate Cox regression indicated the same factors. C-index of the model was slightly better than Yang’s, but its integrated Brier score (IBS) was obviously lower than Yang’s both in the group A and B. Additionally, minimal depth of random survival forest (RSF) classifier confirmed that the prognostic ability of hemoglobin was better than age both in the group A and B. In the calibration of the nomogram, the predicted 3-year or 5-year OS of our nomogram well agreed with the corresponding actual OS. In conclusion, Hemoglobin is a prognostic factor for nasal ENKL patients in stage I - IV, and integrating it into a validated prognostic nomogram, whose generalization error is the smallest among the evaluated models, can be used to predict the patients’ outcome.
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Affiliation(s)
- Jianzhong Cao
- Department of Radiotherapy, Shanxi Cancer Hospital and Institute, Affiliated Hospital of Shanxi Medical University, Shanxi, 030013, China
| | - Shengmin Lan
- Department of Radiotherapy, Shanxi Cancer Hospital and Institute, Affiliated Hospital of Shanxi Medical University, Shanxi, 030013, China
| | - Liuhai Shen
- Department of Nuclear Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, China
| | - Hongwei Si
- Department of Nuclear Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, China.
| | - Huan Xiao
- Department of Nuclear Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, China
| | - Qiang Yuan
- Department of Radiotherapy, Shanxi Cancer Hospital and Institute, Affiliated Hospital of Shanxi Medical University, Shanxi, 030013, China
| | - Xue Li
- Department of Radiotherapy, Shanxi Cancer Hospital and Institute, Affiliated Hospital of Shanxi Medical University, Shanxi, 030013, China
| | - Hongwei Li
- Department of Radiotherapy, Shanxi Cancer Hospital and Institute, Affiliated Hospital of Shanxi Medical University, Shanxi, 030013, China
| | - Ruyuan Guo
- Department of Radiotherapy, Shanxi Cancer Hospital and Institute, Affiliated Hospital of Shanxi Medical University, Shanxi, 030013, China
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Deak AT, Troppan K, Rosenkranz AR. Anemia management in cancer patients with chronic kidney disease. Eur J Intern Med 2016; 36:13-19. [PMID: 27640913 DOI: 10.1016/j.ejim.2016.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/06/2016] [Accepted: 08/19/2016] [Indexed: 12/27/2022]
Abstract
Anemia is a common complication of cancer and chronic kidney disease (CKD) associated with decreased physical performance as well as poor prognosis for life expectancy. Renal and cancer-induced anemia share common features regarding pathogenesis and therapeutic strategies. It is typically treated with iron substitution, erythropoiesis-stimulating agents (ESA) and in refractory cases with red blood cell transfusions. However, studies of the past few years unveiled numerous setbacks in the use of ESAs. These included a higher risk of cerebrovascular events and increased mortality without the improvement of cardiovascular outcomes in patients with CKD. Moreover, particularly negative results were observed in patients with previous cancer history under ESA therapy. These unfavorable findings have forced the clinicians to reevaluate the management of renal anemia. This led to decrease of ESA usage, while iron substitution and alternative therapeutic options gained more significance. Iron supplementation is also accompanied with certain risks ranging from gastrointestinal complications to severe allergic reactions and increased rate of infections. Furthermore, the evaluation of the long-term safety of excessive iron therapy is still lacking, especially in CKD patients with cancer. In the absence of these clinical studies, this review aims to summarize the currently available therapeutic strategies in anemia management of CKD patients with concomitant cancer.
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Affiliation(s)
- Andras T Deak
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 27, 8036 Graz, Austria
| | - Katharina Troppan
- Clinical Division of Haematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 27, 8036 Graz, Austria.
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Iron deficiency or anemia of inflammation? : Differential diagnosis and mechanisms of anemia of inflammation. Wien Med Wochenschr 2016; 166:411-423. [PMID: 27557596 PMCID: PMC5065583 DOI: 10.1007/s10354-016-0505-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/30/2016] [Indexed: 02/08/2023]
Abstract
Iron deficiency and immune activation are the two most frequent causes of anemia, both of which are based on disturbances of iron homeostasis. Iron deficiency anemia results from a reduction of the body’s iron content due to blood loss, inadequate dietary iron intake, its malabsorption, or increased iron demand. Immune activation drives a diversion of iron fluxes from the erythropoietic bone marrow, where hemoglobinization takes place, to storage sites, particularly the mononuclear phagocytes system in liver and spleen. This results in iron-limited erythropoiesis and anemia. This review summarizes current diagnostic and pathophysiological concepts of iron deficiency anemia and anemia of inflammation, as well as combined conditions, and provides a brief outlook on novel therapeutic options.
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Wang J, Zhou M, Wang X, Xu J, Chen B, Ouyang J. Pretreatment C-reactive protein was an independent prognostic factor for patients with diffuse large B-cell lymphoma treated with RCHOP. Clin Chim Acta 2016; 459:150-154. [DOI: 10.1016/j.cca.2016.05.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 12/21/2022]
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Manz DH, Blanchette NL, Paul BT, Torti FM, Torti SV. Iron and cancer: recent insights. Ann N Y Acad Sci 2016; 1368:149-61. [PMID: 26890363 DOI: 10.1111/nyas.13008] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/22/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023]
Abstract
Iron is an essential dietary element. However, the ability of iron to cycle between oxidized and reduced forms also renders it capable of contributing to free radical formation, which can have deleterious effects, including promutagenic effects that can potentiate tumor formation. Dysregulation of iron metabolism can increase cancer risk and promote tumor growth. Cancer cells exhibit an enhanced dependence on iron relative to their normal counterparts, a phenomenon we have termed iron addiction. Work conducted in the past few years has revealed new cellular processes and mechanisms that deepen our understanding of the link between iron and cancer. Control of iron efflux through the combined action of ferroportin, an iron efflux pump, and its regulator hepcidin appears to play an important role in tumorigenesis. Ferroptosis is a form of iron-dependent cell death involving the production of reactive oxygen species. Specific mechanisms involved in ferroptosis, including depletion of glutathione and inhibition of glutathione peroxidase 4, have been uncovered. Ferritinophagy is a newly identified mechanism for degradation of the iron storage protein ferritin. Perturbations of mechanisms that control transcripts encoding proteins that regulate iron have been observed in cancer cells, including differences in miRNA, methylation, and acetylation. These new insights may ultimately provide new therapeutic opportunities for treating cancer.
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Affiliation(s)
- David H Manz
- Department of Molecular Biology and Biophysics.,School of Dental Medicine
| | | | | | - Frank M Torti
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut
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Miseta A, Nagy J, Nagy T, Poór VS, Fekete Z, Sipos K. Hepcidin and its potential clinical utility. Cell Biol Int 2015; 39:1191-202. [PMID: 26109250 DOI: 10.1002/cbin.10505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/12/2015] [Indexed: 02/06/2023]
Abstract
A number of pathophysiological conditions are related to iron metabolism disturbances. Some of them are well known, others are newly discovered or special. Hepcidin is a newly identified iron metabolism regulating hormone, which could be a promising biomarker for many disorders. In this review, we provide background information about mammalian iron metabolism, cellular iron trafficking, and the regulation of expression of hepcidin. Beside these molecular biological processes, we summarize the methods that have been used to determine blood and urine hepcidin levels and present those pathological conditions (cancer, inflammation, neurological disorders) when hepcidin measurement may have clinical relevance.
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Affiliation(s)
- Attila Miseta
- Department of Laboratory Medicine, Faculty of Medical Sciences, University of Pécs, 7624 Ifjusag Street 13. Pecs, Hungary
| | - Judit Nagy
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences, University of Pécs, 7624 Ifjusag Street 13. Pecs, Hungary
| | - Tamas Nagy
- Department of Laboratory Medicine, Faculty of Medical Sciences, University of Pécs, 7624 Ifjusag Street 13. Pecs, Hungary
| | - Viktor Soma Poór
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Pécs, 7624 Szigeti Street 12. Pecs, Hungary
| | - Zsuzsanna Fekete
- Department of Medical Biology, Faculty of Medical Sciences, University of Pécs, 7624 Szigeti Street 12. Pecs, Hungary
| | - Katalin Sipos
- Department of Pharmaceutical Biology, Faculty of Medical Sciences, University of Pécs, 7624 Rokus Street 2. Pecs, Hungary
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Adams HJA, de Klerk JMH, Fijnheer R, Heggelman BGF, Dubois SV, Nievelstein RAJ, Kwee TC. Prognostic Value of Anemia and C-Reactive Protein Levels in Diffuse Large B-Cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:671-9. [PMID: 26361646 DOI: 10.1016/j.clml.2015.07.639] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/09/2015] [Accepted: 07/28/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the prognostic value of pretreatment anemia, pretreatment elevated C-reactive protein (CRP) levels, and 6-month posttreatment anemia in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisolone (R-CHOP). PATIENTS AND METHODS A total of 104 patients with newly diagnosed DLBCL were retrospectively included. Pretreatment hemoglobin and CRP levels and 6-month posttreatment hemoglobin levels were measured. Cox regression analyses were used to determine the associations of laboratory assessments and National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) risk groups with progression-free survival (PFS) and overall survival (OS). RESULTS Pretreatment anemia, elevated pretreatment CRP levels, and higher risk NCCN-IPI groups were significantly associated with reduced PFS and OS (P = .001 and P = .003 for pretreatment anemia, P = .035 and P = .029 for elevated CRP, and P < .001 and P < .001 for higher risk NCCN-IPI groups). On multivariate Cox regression analysis, only the NCCN-IPI risk group remained as an independent significant predictor for PFS (P < .001) and OS (P < .001). In the subgroup of patients in complete remission 6 months after chemotherapy (n = 80), 6-month posttreatment anemia was significantly associated with reduced PFS (P = .046) but not OS (P = .062), and higher risk NCCN-IPI groups were significantly associated with both reduced PFS (P = .008) and OS (P = .017). On multivariate Cox regression analysis, only the NCCN-IPI group remained an independent significant predictor for PFS (P = .008) and OS (P = .017). CONCLUSION Pretreatment anemia, pretreatment CRP levels, and 6-month posttreatment anemia are significantly associated with poor outcome, but were not proven to be of additional prognostic value to the current risk stratification index for DLBCL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anemia/diagnosis
- Anemia/etiology
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers
- C-Reactive Protein
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Female
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Male
- Middle Aged
- Prednisone/therapeutic use
- Prognosis
- Proportional Hazards Models
- Retrospective Studies
- Rituximab
- Treatment Outcome
- Vincristine/therapeutic use
- Young Adult
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - John M H de Klerk
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Rob Fijnheer
- Department of Hematology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ben G F Heggelman
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Stefan V Dubois
- Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands
| | - Rutger A J Nievelstein
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Epstein-Barr virus (EBV) positive diffuse large B-cell lymphoma (DLBCL) of the elderly is defined as patients older than 50 years alone. However, recent studies showed young patients with sound immune status could also be affected. In this study, we investigated the clinical features and outcomes of patients with EBV positive DLBCL in the different age groups using different EBER cut-off values. The prevalence of EBV positive DLBCL was 14.0% (35/250) and 10.4% (26/250) for EBER cut-off of 20% and 50%, respectively. With both EBER cut-off values, patients with EBV DLBCL shared many unfavorable prognostic characteristics, regardless of age. EBV positive patients, both in the elderly and young groups, showed significantly worse overall survival and progression-free survival than negative cases. Moreover, no significant differences of outcomes were identified between different age groups with EBV positive DLBCL. In conclusion, EBV positive DLBCL patients, regardless of age, shared similar poor prognostic features and showed worse outcome than negative cases. We suggest that the age criterion of EBV positive DLBCL of the elderly, and possibly the name itself, be modified in future.
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Gloghini A, Bongarzone I. Cell-secreted signals shape lymphoma identity. Semin Cancer Biol 2015; 34:81-91. [PMID: 25837156 DOI: 10.1016/j.semcancer.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 12/12/2022]
Abstract
Sequencing data show that both specific genes and a number of signaling pathways are recurrently mutated in various types of lymphoma. DNA sequencing analyses of lymphoma have identified several aberrations that might affect the interaction between malignant cells and the tumor microenvironment. Microenvironmental functions are essential to lymphoma; they provide survival and proliferation signals and license immune evasion. It is plausible that interventions that aim to destroy tumor-microenvironment interactions may improve responses to therapeutics. Accordingly, the identification of extrinsic factors and their downstream intracellular signaling targets has led to much progress in understanding tumor-microenvironment interactions. Lymphoma cells are differently influenced by cells' interactions with components of their microenvironment; these cell extrinsic factors include soluble and immobilized factors, the extracellular matrix, and signals presented by neighboring cells. Soluble factors, which are often cell-secreted autocrine and paracrine factors, comprise a significant fraction of targetable molecules. To begin to understand how intercellular communication is conducted in lymphoma, a first order of study is deciphering the soluble factors secreted by malignant cells and microenvironmental cells. These soluble factors are shed into the interstitial fluid in lymphoma and can be conveniently explored using mass spectrometry. Protein components can be detected and quantified, thus enabling the routine navigation of the soluble part of the microenvironment. Elucidating functional and signaling states affords a new paradigm for understanding cancer biology and devising new therapies. This review summarizes knowledge in this field and discusses the utility of studying tumor-secreted factors.
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Affiliation(s)
- Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Italia Bongarzone
- Proteomics Laboratory, Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
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Troppan KT, Melchardt T, Deutsch A, Schlick K, Stojakovic T, Bullock MD, Reitz D, Beham-Schmid C, Weiss L, Neureiter D, Wenzl K, Greil R, Neumeister P, Egle A, Pichler M. The significance of pretreatment anemia in the era of R-IPI and NCCN-IPI prognostic risk assessment tools: a dual-center study in diffuse large B-cell lymphoma patients. Eur J Haematol 2015; 95:538-44. [PMID: 25677782 DOI: 10.1111/ejh.12529] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anemia is frequently identified at the time of diagnosis in patients with diffuse large B-cell lymphoma (DLBCL); however, studies addressing the prognostic significance of this important clinical parameter are lacking. METHODS In this dual-center study of patients with DLBCL (n = 556) treated with rituximab-containing regimens, we evaluated the prognostic relevance of anemia at diagnosis in a training set (n = 211) and validated our findings in a second independent patient cohort (n = 345). Using Kaplan-Meier curves as well as univariate and multivariate Cox regression models, we analyzed the impact of anemia on 5-year overall survival (OS) and 5-year disease-free survival (DFS) alongside established prognostic indicators including age, tumor stage, the revised International Prognostic Index (R-IPI), and the recently published NCCN-IPI. The influence of anemia on the predictive accuracy of IPI, R-IPI, and NCCN-IPI prognosis scores was subsequently determined using the Harrell's concordance index. RESULTS Anemia was an independent predictor of impaired OS and DFS at 5 years in both DLBCL patient cohorts (P < 0.001, log-rank test). In multivariate analysis, hemoglobin level was also a strong and independent prognostic indicator in patients stratified according to R-IPI or NCCN-IPI score. In survival analysis, the estimated concordance index, using IPI, R-IPI, and NCCN-IPI stratification measures (0.69, 0.64, and 0.70, respectively), improved to 0.70, 0.68, and 0.73, respectively, when anemia was also considered. CONCLUSION In this study, we have demonstrated that anemia at the time of diagnosis is an independent predictor of impaired clinical outcome in DLBCL. Furthermore, consideration of hemoglobin levels may improve the accuracy of recently established prognostic tools in lymphoma. Our data encourage further evaluation of the prognostic utility of this readily accessible biological parameter in prospective clinical trials.
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Affiliation(s)
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Deutsch
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz (MUG), Graz, Austria
| | - Marc D Bullock
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Reitz
- Division of Oncology, Medical University of Graz (MUG), Graz, Austria
| | | | - Lukas Weiss
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Kerstin Wenzl
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Richard Greil
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Martin Pichler
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Oncology, Medical University of Graz (MUG), Graz, Austria
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Hara M, Ando M, Tsuchiya K, Nitta K. Serum hepcidin-25 level linked with high mortality in patients with non-Hodgkin lymphoma. Ann Hematol 2014; 94:603-8. [PMID: 25465232 DOI: 10.1007/s00277-014-2255-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 11/08/2014] [Indexed: 12/12/2022]
Abstract
Hepatic hepcidin-25 production is stimulated by systemic inflammation, and it interferes with the body's utilization of iron, leading to anemia. A 1-year prospective study was conducted to elucidate an association of serum hepcidin-25 concentration with mortality in anemic patients with non-Hodgkin lymphoma (NHL). Serum hepcidin-25 levels were measured in 50 NHL patients using liquid chromatography-tandem mass spectrometry. The patients were stratified into a high- and a low-hepcidin-25 group according to the median of serum hepcidin-25 concentrations. Factors associated with hemoglobin (Hb) were determined by multivariate regression analysis, incorporating serum hepcidin-25 and inflammatory markers including ferritin and interleukin-6 (IL-6) as covariates. The association between serum hepcidin-25 and mortality was analyzed using both the Kaplan-Meier method and a multivariate proportional hazards regression model. The median of serum hepcidin-25 concentrations was 49.8 (0.6-269) ng/mL, a level approximately nine times greater than the reference value for healthy individuals. Hb level was significantly lower in the high than in the low-hepcidin-25 group. Serum hepcidin-25 was extracted as the significant factor associated with Hb, but neither ferritin nor IL-6 was. The cumulative mortality was significantly greater in the high than in the low-hepcidin-25 group (56.0 vs. 24.0 %; P = 0.0222). The mortality risk for the presence of high hepcidin-25 was four times greater (hazard ratio [95 % confidence interval]: 3.66 [1.12-16.4]). In conclusion, serum hepcidin-25 levels are elevated in anemic NHL patients, and in this study, the group with higher hepcidin-25 levels manifested advanced anemia and poor survival.
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Affiliation(s)
- Masaki Hara
- Department IV of Internal Medicine, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku-Ku, Tokyo, 162-0054, Japan
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Hong J, Woo HS, Kim H, Ahn HK, Sym SJ, Park J, Ahn JY, Cho EK, Shin DB, Lee JH. Anemia as a useful biomarker in patients with diffuse large B-cell lymphoma treated with R-CHOP immunochemotherapy. Cancer Sci 2014; 105:1569-75. [PMID: 25263825 PMCID: PMC4317957 DOI: 10.1111/cas.12544] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 12/27/2022] Open
Abstract
The aim of the current study is to evaluate the prognostic value of anemia, an easily estimable parameter in patients with diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) immunochemotherapy. A total of 157 patients with newly diagnosed diffuse large B-cell lymphoma treated with ≥1 cycle of R-CHOP were included. Hemoglobin level without red cell transfusion within 7 days of initiation of treatment was chosen as a parameter of baseline cancer-induced anemia. To investigate the clinical significance of chemotherapy-induced anemia and its recovery after completion of treatment, 87 patients in complete remission for ≥6 months from the time of the last cycle of R-CHOP were grouped and analyzed separately. Patients with a cancer-induced anemia of hemoglobin <10 g/dL showed inferior event-free and disease-free survival compared to those with hemoglobin ≥10 g/dL. This finding was observed irrespective of the status of pre-treatment bone marrow involvement. In multivariate analysis, hemoglobin <10 g/dL was found to be an international prognostic index-independent prognostic factor. Risk of relapse was significantly higher for patients who were still anemic at 6 months after R-CHOP, compared to those who achieved complete recovery from chemotherapy-induced anemia within 6 months.
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Affiliation(s)
- Junshik Hong
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
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Yamazaki E, Tomita N, Koyama S, Ogusa E, Ishii Y, Takahashi H, Miyashita K, Matsuura S, Tachibana T, Takasaki H, Takemura S, Fujimaki K, Sakai R, Fujisawa S, Ishigatsubo Y. Serum ferritin level is prognostic of patient outcome in extranodal NK/T cell lymphoma, nasal type. Med Oncol 2014; 31:149. [PMID: 25108598 DOI: 10.1007/s12032-014-0149-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/26/2014] [Indexed: 11/26/2022]
Abstract
The objective of the current study was to assess the prognostic factors in patients with extranodal natural killer (NK)/T cell lymphoma, nasal type (ENKL). We retrospectively analyzed 35 patients who were diagnosed with ENKL between 1998 and 2011. The median patient age was 63 years, and the male/female ratio was 22:13; twenty patients had localized ENKL, and 26 had a good Eastern Cooperative Oncology Group performance status (score 0 or 1). B symptoms were present in 17 patients. Twenty-five patients presented with nasal or paranasal lesions, or both. With a median follow-up duration among patients still alive at their last follow-up of 47 months (range 8-93 months), the 3-year overall survival (OS) rate was 44.5 %. Multivariate analysis revealed that advanced disease stage (P = 0.002), the presence of extranasal disease (P = 0.013), and serum ferritin levels greater than 300 ng/ml (P < 0.001) were significant and independent (negative) prognostic factors. High serum ferritin levels were associated with the presence of B symptoms, elevated lactate dehydrogenase levels, and high soluble interleukin-2 receptor levels, but not with clinical stage. Patients with high ferritin levels had a remarkably low remission rate (23 %) and a short OS time (median: 4 months). Serum ferritin level at the time of diagnosis of ENKL was a useful prognostic factor.
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Affiliation(s)
- Etsuko Yamazaki
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura Kanazawa-ku, Yokohama, 2360004, Japan,
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