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Jakovic L, Jovanovic J, Kurtovic NK, Fekete MD, Bogdanovic A. Primary plasma cell leukemia presented with atypical flower-like morphology. Int J Lab Hematol 2024; 46:425-426. [PMID: 38243765 DOI: 10.1111/ijlh.14229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Affiliation(s)
- Ljubomir Jakovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Jelica Jovanovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Marija Dencic Fekete
- Institute of Pathology, Medical faculty, University of Belgrade, Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
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2
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Patriquin CJ, Bogdanovic A, Griffin M, Kelly RJ, Maciejewski JP, Mulherin B, Peffault de Latour R, Röth A, Selvaratnam V, Szer J, Al-Adhami M, Horneff R, Tan L, Yeh M, Panse J. Safety and Efficacy of Pegcetacoplan in Adult Patients with Paroxysmal Nocturnal Hemoglobinuria over 48 Weeks: 307 Open-Label Extension Study. Adv Ther 2024; 41:2050-2069. [PMID: 38573482 DOI: 10.1007/s12325-024-02827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life-threatening disease characterized by complement-mediated hemolysis and thrombosis. Pegcetacoplan, the first targeted complement component 3 (C3) PNH therapy, was safe and efficacious in treatment-naive and pre-treated patients with PNH in five clinical trials. METHODS The 307 open-label extension (OLE) study (NCT03531255) is a non-randomized, multicenter extension study of long-term safety and efficacy of pegcetacoplan in adult patients with PNH who completed a pegcetacoplan parent study. All patients received pegcetacoplan. Outcomes at the 48-week data cutoff (week 48 of 307-OLE or August 27, 2021, whichever was earlier) are reported. Hemoglobin concentrations, Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scores, and transfusion avoidance were measured. Hemoglobin > 12 g/dL and sex-specific hemoglobin normalization (i.e., male, ≥ 13.6 g/dL; female, ≥ 12 g/dL) were assessed as percentage of patients with data available and no transfusions 60 days before data cutoff. Treatment-emergent adverse events, including hemolysis, were reported. RESULTS Data from 137 patients with at least one pegcetacoplan dose at data cutoff were analyzed. Mean (standard deviation [SD]) hemoglobin increased from 8.9 (1.22) g/dL at parent study baseline to 11.6 (2.17) g/dL at 307-OLE entry and 11.6 (1.94) g/dL at data cutoff. At parent study baseline, mean (SD) FACIT-Fatigue score of 34.1 (11.08) was below the general population norm of 43.6; scores improved to 42.8 (8.79) at 307-OLE entry and 42.4 (9.84) at data cutoff. In evaluable patients, hemoglobin > 12 g/dL occurred in 40.2% (43 of 107) and sex-specific hemoglobin normalization occurred in 31.8% (34 of 107) at data cutoff. Transfusion was not required for 114 of 137 patients (83.2%). Hemolysis was reported in 23 patients (16.8%). No thrombotic events or meningococcal infections occurred. CONCLUSION Pegcetacoplan sustained long-term improvements in hemoglobin concentrations, fatigue reduction, and transfusion burden. Long-term safety findings corroborate the favorable profile established for pegcetacoplan. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03531255.
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Affiliation(s)
- Christopher J Patriquin
- Hematology & Apheresis Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada.
| | - Andrija Bogdanovic
- Clinic of Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Morag Griffin
- Department of Haematology, St. James's University Hospital, Leeds, UK
| | - Richard J Kelly
- Department of Haematology, St. James's University Hospital, Leeds, UK
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian Mulherin
- Hematology Oncology of Indiana, Indianapolis, IN, USA
- Ascension St. Vincent Carmel, Carmel, IN, USA
| | - Régis Peffault de Latour
- French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Paris, France
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Université Paris Cité, Paris, France
| | - Alexander Röth
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | - Jeffrey Szer
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | - Lisa Tan
- Swedish Orphan Biovitrum AB, Stockholm, Sweden
- Lisa Tan Pharma Consulting Ltd, Cambridge, UK
| | | | - Jens Panse
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
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3
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Stojanovic M, Barac A, Miskovic R, Jovanovic D, Bolpacic J, Ljubicic J, Stevanovic G, Jovanovic S, Bogdanovic A. Myositis-specific autoantibodies in a non-traveler, patient from a non-endemic country, with Plasmodium vivax malaria. J Infect Dev Ctries 2023; 17:1497-1500. [PMID: 37956374 DOI: 10.3855/jidc.18482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Autoantibodies (AAb) are a hallmark of immune-mediated inflammatory diseases. Malaria is a parasitic disease caused by Plasmodium protozoa. Individuals with malaria may present with a wide range of symptoms. It is frequently linked to the development of different AAb. CASE DESCRIPTION A 35-year-old male presented with repeated episodes of fever, malaise, myalgia, dark urine, and yellowish sclera. Initial diagnostic workup revealed severe Coombs-positive anemia, increased C-reactive protein, and procalcitonin, pathological liver tests, high concentration of serum IgE, IgG, IgM, IgA, positive antinuclear antibodies (ANA), and positive antineutrophil cytoplasmatic antibodies (ANCA). In addition, myositis-specific antibodies directed to polymiositis-scleroderma 75 protein (PmScl75), threonyl-tRNA synthetase (PL-7), alanyl-tRNA synthetase (PL-12), Mi-2 antigen (Mi-2), Ku DNA helicase complex (Ku), signal recognition particle (SRP), and antiaminoacyl tRNA synthetase (EJ) were detected. The patient was suspected of having systemic lupus erythematosus and sent to the Clinic of Allergy and Immunology for further evaluation and treatment. A peripheral blood film examined by the hematologist during an episode of fever revealed intra-erythrocytic parasitic forms of Plasmodium vivax (P. vivax). After being diagnosed with P. vivax malaria, he was transferred to the Clinic for Infective and Tropical Diseases. The therapy consisted of artesunate/mefloquine and prednisone led to a complete clinical recovery and autoantibodies gradually disappeared. CONCLUSIONS Malaria would not normally be considered during the initial diagnostic workup in a non-traveler and a patient from a non-endemic country. However, a thorough parasitic evaluation in patients presenting with a broad range of autoantibodies might be of particular importance.
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Affiliation(s)
- Maja Stojanovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Rada Miskovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dragana Jovanovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jasna Bolpacic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Ljubicic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | | | - Snezana Jovanovic
- Department of Microbiology, University Clinical Center of Serbia, Belgrade, Serbia
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Lekovic D, Bogdanovic A, Sobas M, Arsenovic I, Smiljanic M, Ivanovic J, Bodrozic J, Cokic V, Milic N. Easily Applicable Predictive Score for Differential Diagnosis of Prefibrotic Primary Myelofibrosis from Essential Thrombocythemia. Cancers (Basel) 2023; 15:4180. [PMID: 37627208 PMCID: PMC10452817 DOI: 10.3390/cancers15164180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Essential thrombocythemia (ET) and prefibrotic primary myelofibrosis (prePMF) initially have a similar phenotypic presentation with thrombocytosis. The aim of our study was to determine significant clinical-laboratory parameters at presentation to differentiate prePMF from ET as well as to develop and validate a predictive diagnostic prePMF model. This retrospective study included 464 patients divided into ET (289 pts) and prePMF (175 pts) groups. The model was built using data from a development cohort (229 pts; 143 ET, 86 prePMF), which was then tested in an internal validation cohort (235 pts; 146 ET, 89 prePMF). The most important prePMF predictors in the multivariate logistic model were age ≥ 60 years (RR = 2.2), splenomegaly (RR = 13.2), and increased lactat-dehidrogenase (RR = 2.8). Risk scores were assigned according to derived relative risk (RR) for age ≥ 60 years (1 point), splenomegaly (2 points), and increased lactat-dehidrogenase (1 point). Positive predictive value (PPV) for pre-PMF diagnosis with a score of ≥points was 69.8%, while for a score of ≥3 it was 88.2%. Diagnostic performance had similar values in the validation cohort. In MPN patients with thrombocytosis at presentation, the application of the new model enables differentiation of pre-PMF from ET, which is clinically relevant considering that these diseases have different prognoses and treatments.
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Affiliation(s)
- Danijela Lekovic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marta Sobas
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Isidora Arsenovic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
| | - Mihailo Smiljanic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
| | - Jelena Ivanovic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
| | - Jelena Bodrozic
- Clinic of Hematology, University Clinical Center Serbia, 11000 Belgrade, Serbia or (A.B.); (I.A.); (M.S.); (J.I.); (J.B.)
| | - Vladan Cokic
- Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia;
| | - Natasa Milic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Medical Statistics & Informatics, University of Belgrade, 11000 Belgrade, Serbia
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5
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Zuvela M, Galun D, Bogdanovic A, Bidzic N, Zivanovic M, Bogdanovic M, Zuvela M, Zuvela M. P-084 OPEN PARASTOMAL HERNIA REPAIR: STOMA RELOCATION WITH CST, MODIFIED RIVES SUBLAY MESH TECHNIQUE WITH CST OR MODIFIED SUGARBAKER INTRAPERITONEAL MESH TECHNIQUE WITH CST. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To presents results of various open surgical techniques for parastomal hernia repair.
Material and Method
Between January 2014 and January 2020, 22 patients with parastomal hernias were treated by three various operative techniques: a) stoma relocation using component separation techniques (CST); b) modified Rives sublay mesh technique with CST; c) modified Sugarbaker intraperitoneal composite mesh repair with or withouth CST. Stoma relocation and CST was performed in two patients, modified Rives sublay technique and CST in 15 patients and modified Sugarbaker technique with or without CST in five patients.
Results
Hernia recurrence was developed in one of two patients treated by stoma relocation and CST and in two of 15 patients treated by modified Rives sublay mesh technique and CST. In five patients treated by modified Sugarbaker technique no complications occured. Mean follow up was 28 months.
Conclusion
Modified Rives sublay technique with CST and modified Sugarbaker technique with or withouth CST provide good results in treatment of patients with parastomal hernia.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - N Bidzic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
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6
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Zuvela M, Bogdanovic A, Galun D, Palibrk I, Velickovic J, Djukanovic M, Bidzic N, Zivanovic M, Zuvela M, Zuvela M. OC-013 INDIVIDUAL STRATEGY FOR PATIENTS WITH ABDOMINAL WALL EVENTRATION – DIFFERENT COMPONENTS SEPARATION TECHNIQUE WITH MESH AUGMENTATION. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To present individual approach for patients with abdominal wall eventration using various anterior component separation techniques (aCST) with mesh augmentation.
Materials and Methods
Between January 2008 and April 2022, 194 patients with abdominal wall eventration underwent surgery by single surgeon. Surgical treatment consists: a) enlargement of the abdominal cavity using different aCST (Ramirez CST, modified CST in the presence of enterostomies, “open book” modification CST, “method of wide myofascial release” or combination of these techniques); b) mesh augmentation (sublay or onlay hernioplasty); c) prolonged muscle relaxation and mechanical respiratory support in intensive care unit.
Results
Type of abdominal wall reconstruction: 143 Ramirez CST, 35 modification CST in the presence of enterostomies, 11“open book” CST modification, 5 “method of wide myofascial release”, 159 onlay mesh hernioplasty and 35 sublay mesh hernioplasty. Mean hernia defect size was 255 cm2 (100–750). During the mean follow-up of 31 months, 78 (40%) patients had one or more complications: intraabdominal hypertension 8 (4,1%), seroma 13 (6,7%), hematoma 10 (5,1%), wound/mesh infections 21 (10,8%), skin necrosis 40 (20,6%), pain 3 (1,6%), and recurrence 5 (2,6%). There were 10 (5,1%) postoperative deaths. The cause of dead was significant comorbidity in 8 patients and postoperative compartment syndrome in two.
Conclusion
Eventration disease is a complex surgical problem and its treatment is associated with significant complications. Individual strategy for each patient based on multidisciplinary approach using different component separation techniques with mesh augmentation may improve postoperative results.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - I Palibrk
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - J Velickovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Djukanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - N Bidzic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
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7
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Zuvela M, Galun D, Bogdanovic A, Bidzic N, Zivanovic M, Zuvela M, Zuvela M. OC-051 MANAGEMENT OF EPIGASTRIC, UMBILICAL, SPIGELIAN AND SMALL INCISIONAL HERNIA AS A DAY CASE PROCEDURE: RESULTS OF LONG–TERM FOLLOW–UP AFTER OPEN PREPERITONEAL FLAT MESH TECHNIQUE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To investigate short and long-term outcome after the open preperitoneal flat mesh technique (OPPFMT) for umbilical, epigastric, spigelian, small incisional and “port-site” hernia performed as a day case procedure.
Materials and Methods
We retrospectively analyzed records of patients who underwent OPFMT for umbilical, epigastric, Spigelian, small incisional and “port-site” hernia. All patients were operated under local anesthesia in ambulatory settings. The operative technique is as follows: polypropylene flat mesh exceeding the size of the hernia defect for 2–3 cm in all directions is placed into a pre-peritoneal position above the intrabdominaly repositioned hernia sac (mesh is placed into hernia sac) and fixed by at least 8 transfascial “U” sutures.
Results
In the period from January 2004 to April 2022, 531 patients with ventral hernias (272 with umbilical, 155 with epigastric, 69 with small incisional, 17 with “port site” and 18 with Spigelian hernia) underwent surgery. During the median follow-up of 44 months, 8 (1,5%) hematomas, 2 (0,4%) seromas, 2 (0,4%), superfitial wound infections, 8 (1,5%) mesh infections and 24 (4,6%) recurrences occurred.
Conclusion
Management of epigastric, umbilical, spigelian and small incisional hernia with OPFMT under local anesthesia as a day case procedure is a safe and associated with favorable long-term outcome.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - N Bidzic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
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8
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Zuvela M, Galun D, Bogdanovic A, Palibrk I, Velickovic J, Djukanovic M, Zivanovic M, Zuvela M, Zuvela M. OC-025 STRATEGY FOR SURGICAL TREATMENT OF GIANT INGUINOSCROTAL HERNIA - SERIES OF 21 CONSECUTIVE PATIENTS DURING 15 YEARS. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
To present our strategy for surgical treatment of patients with giant inguinoscrotal hernia whose hernia defect is ≥10 cm or who have a loss of domain.
Material and methods
Between January 2006 - January 2022, 21 consecutive patients with giant inguinoscrotal hernia and high risk of postoperative intra-abdominal hypertension were managed. The hernia was repaired in the following manner: modified Rives technique performed through direct inguinal approach in 10 patients; additional procedures were needed to reduce the volume of organs returned to the abdomen in four patients; the primary abdominal cavity was enlarged by various components separation techniques with or without mesh hernioplasty in seven patients.
Results
The hernia defect size was in range 7–17 cm. In three patients the contents of the hernia sac accounted for more than 50% of the intestines: entire large bowel without the rectum, ileum, jejunum except proximal 15 cm and greater omentum). Postoperative complications occurred in eight patients were: scrotal hematoma, deep mesh infection, seroma and hydrocele. There were three postoperative deaths: 12 hours, 17 and 42 days after the surgery because ischemic enteritis, cerebrovascular stroke and heart failure, respectively.
Conclusion
Our strategy consisting of modified Rives technique performed through direct inguinal approach with or without additional procedures to reduce the volume of organs returned to the abdomen or to enlarge the primary abdominal cavity can be a good solution for giant inguinoscrotal hernias. Procedure is followed by the risk of deadly complications and requires trained team in intesive care unit.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - I Palibrk
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - J Velickovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Djukanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
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9
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Zuvela M, Galun D, Bogdanovic A, Bidzic N, Zivanovic M, Zuvela M, Zuvela M. P-073 THE MODIFIED SUBLAY TECHNIQUE FOR THE MANAGEMENT OF MAJOR SUBCOSTAL INCISIONAL HERNIA: LONG-TERM FOLLOW-UP RESULTS OF 41 CONSECUTIVE PATIENTS. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To present the concept of original technique in the management of major incisional subcostal hernias bassed on sublay position of large haevy-weight polypropylene mesh between the two myofascial layers in the anterolateral abdominal wall.
Material and methods
Between January 2010 and May 2022, 41 consecutive patients underwent the modified sublay technique for major incisional subcostal hernia (minimal defect surface100 cm2 or minimal defect width or height 10 cm). The operative technique is: a) hernia sac dissetion and reposition into the abdominal cavity; b) rectus muscle and rectus muscle stump dissection from posterior rectus sheath, rectus muscle atachement dissection from thoracic wall and external oblique muscle dissection from internal oblique muscle around hernia defect at the side of the hernia defect; c) separate posterior and anterior rectus sheaths reconstruction at the midline; d) reconstruction of the posterior miofascial layer suturing internal oblique/transversal muscle and posterior rectus sheaths; e) large haevy-weight polypropilene mesh placement between posterior and anterior miofascial layer; e) reconstruction of the anterior miofascial layer by suturing external oblique muscle and anterior rectus sheaths.
Results
A median (range) hernia defect surface was 160 (100–500) cm2. A median operative time was 120 (90–330) minutes. The morbidity rate was 19.5%. A median (range) postoperative hospital stay was 7 (2–24) days. After the median follow-up of 50 (1–124) months, two patients (4,9%) developed recurrent hernia.
Conclusions
The modified sublay technique using large heavyweight polypropylene mesh provides good results in the management of major subcostal abdominal wall defects.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - N Bidzic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
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10
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Zuvela M, Galun D, Bogdanovic A, Loncar Z, Zivanovic M, Zuvela M, Zuvela M. OC-012 THE COMBINATION OF THE THREE MODIFICATIONS OF THE COMPONENT SEPARATION TECHNIQUE IN THE MANAGEMENT OF COMPLEX SUBCOSTAL WALL DEFECT. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall defect.
Material and Methods
Between January 2010 and January 2022, seven patients with complex subcostal hernia defects compromised by infection, radiation, or chemotherapy underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the “method of wide myofascial release” at the side of the hernia defect; (b) “openbook variation” of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position.
Results
The median (range) length and width of the complex subcostal hernias were 15 cm (10–19) and 15 cm (8–24), respectively. The overall morbidity rate was 57.1% (wound infection, seroma and skin necrosis). There was no hernia recurrence during the median follow-up time of 19 (range 3–84) months.
Conclusion
The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall defect.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - Z Loncar
- Emergency Center, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
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11
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Zuvela M, Galun D, Bogdanovic A, Palibrk I, Velickovic J, Djukanovic M, Bogdanovic M, Zivanovic M, Zuvela M, Zuvela M. P-088 HOW TO REPAIR A LATERAL INCISIONAL ABDOMINAL WALL HERNIA? Br J Surg 2022. [DOI: 10.1093/bjs/znac308.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To present our original method for surgical treatment of patients with lateral incisional hernia (LIH)
Material and Method
Patients with LIH and simultaneous presence of a middle incisional hernia (MIH) were treated by our original technique based on the principles of anterior component separation technique and sublay technique: a) skin and subcutaneous tissue incision along the midline and MIH dissection; b) subcutaneous tissue dissection in the lateral direction to the Spiegel line or the LIH lateral edge on the side of the LIH; c) vertical incision of the external oblique muscle (EOM) lateral to the Spiegel line or the LIH; d) the rectus muscle (RM) dissection from its posterior sheath on the opposite side of the LIH; e) suturing the posterior rectus sheath on the opposite side of the LIH with RM on the side of the LIH; f) suturing of the internal oblique muscle with the lateral edge of the RM on the side of the LIH; g) onlay polypropylene mesh hernioplasty.
Results
Between January 2013 and May 2022, 44 consecutive patients with LIH+MIH underwent surgery. A median (range) LIH defect surface was 90 (20–270) cm2. During mean follow up of 14 months postoperative complications occured in seven (15,9%) patients: seroma in three, hematoma in two, mesh infection and hernia recurrence in one.
Conclusion
Our original method can be one of the good solutions for simultaneous treatment of LIH and MIH.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - I Palibrk
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - J Velickovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Djukanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia , Belgrade , Serbia
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12
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Jakovic L, Fekete MD, Virijevic M, Kurtovic NK, Todoric-Zivanovic B, Stamatovic D, Karan-Djurasevic T, Pavlovic S, Lekovic D, Bogdanovic A. De novo acute myeloid leukemia harboring concomitant t(8;21)(q22;q22);RUNX1::RUNX1T1 and BCR::ABL1 (p190 minor transcript). J Hematop 2022. [DOI: 10.1007/s12308-022-00509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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13
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Wong RSM, Pullon HWH, Amine I, Bogdanovic A, Deschatelets P, Francois CG, Ignatova K, Issaragrisil S, Niparuck P, Numbenjapon T, Roman E, Sathar J, Xu R, Al-Adhami M, Tan L, Tse E, Grossi FV. Inhibition of C3 with pegcetacoplan results in normalization of hemolysis markers in paroxysmal nocturnal hemoglobinuria. Ann Hematol 2022; 101:1971-1986. [PMID: 35869170 PMCID: PMC9375762 DOI: 10.1007/s00277-022-04903-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/18/2022] [Indexed: 11/01/2022]
Abstract
AbstractParoxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired hematologic disorder characterized by complement-mediated hemolysis. C5 inhibitors (eculizumab/ravulizumab) control intravascular hemolysis but do not prevent residual extravascular hemolysis. The newly approved complement inhibitor, pegcetacoplan, inhibits C3, upstream of C5, and has the potential to improve control of complement-mediated hemolysis. The PADDOCK and PALOMINO clinical trials assessed the safety and efficacy of pegcetacoplan in complement inhibitor-naïve adults (≥ 18 years) diagnosed with PNH. Patients in PADDOCK (phase 1b open-label, pilot trial) received daily subcutaneous pegcetacoplan (cohort 1: 180 mg up to day 28 [n = 3]; cohort 2: 270–360 mg up to day 365 [n = 20]). PALOMINO (phase 2a, open-label trial) used the same dosing protocol as PADDOCK cohort 2 (n = 4). Primary endpoints in both trials were mean change from baseline in hemoglobin, lactate dehydrogenase, haptoglobin, and the number and severity of treatment-emergent adverse events. Mean baseline hemoglobin levels were below the lower limit of normal in both trials (PADDOCK: 8.38 g/dL; PALOMINO: 7.73 g/dL; normal range: 11.90–18.00 g/dL), increased to within normal range by day 85, and were sustained through day 365 (PADDOCK: 12.14 g/dL; PALOMINO: 13.00 g/dL). In PADDOCK, 3 serious adverse events (SAE) led to study drug discontinuation, 1 of which was deemed likely related to pegcetacoplan and 1 SAE, not deemed related to study drug, led to death. No SAE led to discontinuation/death in PALOMINO. Pegcetacoplan was generally well tolerated and improved hematological parameters by controlling hemolysis, while also improving other clinical PNH indicators in both trials. These trials were registered at www.clinicaltrials.gov (NCT02588833 and NCT03593200).
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14
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Zuvela M, Galun D, Bogdanovic A, Loncar Z, Zivanovic M, Zuvela M, Zuvela M. The combination of the three modifications of the component separation technique in the management of complex subcostal abdominal wall hernia. Hernia 2022; 26:1369-1379. [PMID: 35575863 DOI: 10.1007/s10029-022-02622-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The purpose of this study is to present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall hernia. METHODS Between January 2010 and January 2020, seven patients presenting at the high-volume academic center with complex subcostal hernia underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the "method of wide myofascial release" at the side of the hernia defect; (b) "open-book variation" of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position. RESULTS The median length and width of the complex subcostal hernias were 15 cm (10-19) and 15 cm (8-24), respectively. The overall morbidity rate was 57.1% (wound infection occurred in three patients, seroma in two patients, and skin necrosis in one patient). There was no hernia recurrence during the median follow-up period of 19 months. CONCLUSION The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall hernia.
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Affiliation(s)
- M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia.,School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - D Galun
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia.,School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - A Bogdanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia. .,School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia.
| | - Z Loncar
- Emergency Center, University Clinical Center of Serbia, 11 000, Belgrade, Serbia.,School of Medicine, University of Belgrade, 11 000, Belgrade, Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
| | - M Zuvela
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Koste Todorovica 6, 11 000, Belgrade, Serbia
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15
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Dencic-Fekete M, Terzic T, Jakovic L, Djurasinovic V, Karan D, Radojkovic M, Pavlovic S, Bogdanovic A. Rapid progression to Richter’s syndrome in patient with chronic lymphocytic leukemia and near-triploid karyotype. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp211111060d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. The presence of aneuploidy in patients with chronic lymphocytic
leukemia (CLL), except trisomy 12, is quite uncommon. The frequency of
hyperdiploidy or near-tetraploidy ocurrs in 1-3% of the CLL patients and
usually confer poor prognosis. Case report. We report a patient in a
progressive phase of CLL with near-triploid karyotype. Cytogenetic analysis
was performed and complemented with molecular methods and pathohistological
examination. The complex karyotype was accompanied with the TP53, C-MYC and
IGH gene disruptions, the most probable cause of rapid evolution into
Richter's syndrome. Conclusion. Utilization of comprehensive diagnostic
techniques is highly recommended in patients with progressive phase of CLL,
primarily for the adequate choice of management strategy. The current case
confirms poor prognosis of the previously reported CLL patients with
aneuploidy.
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16
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Pravdic Z, Mitrovic M, Bogdanovic A, Virijevic M, Sabljic N, Pantic N, Vukovic NS. COVID-19 Presented with Deep Vein Thrombosis in a Patient with Paroxysmal Nocturnal Haemoglobinuria. Hamostaseologie 2021; 41:397-399. [PMID: 34544179 DOI: 10.1055/a-1554-6432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, acquired clonal haematological disease characterized by complement-mediated haemolysis, bone marrow failure and venous thrombosis. Anticomplement therapy eculizumab improves survival and reduces complications. Severe acute respiratory distress syndrome corona virus 2 (SARS-CoV-2) disease 2019 (COVID-19) is associated with high incidence of both venous and arterial thrombosis in hospitalized patients with pneumonia. Deep venous thrombosis (DVT) as the presenting symptom of COVID-19 is a rare event. We describe a well-controlled PNH patient on eculizumab for more than 5 years who presented with DVT, while on warfarin, as the first sign of COVID-19. To our knowledge, this is the first described case of DVT in a PNH patient with COVID-19.
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Affiliation(s)
- Zlatko Pravdic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Mirjana Mitrovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikica Sabljic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nikola Pantic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nada Suvajdzic Vukovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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17
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Milosevic V, Jovanovic MP, Bukumirić Z, Djordjevic V, Jovanovic J, Fekete MD, Lekovic D, Bogdanovic A. Prediction of optimal cytogenetic responses at 6 and 12 months in patients with chronic myeloid leukemia in chronic phase treated with imatinib. J BUON 2021; 26:1070-1079. [PMID: 34268974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Imatinib mesylate transformed the treatment and paradigms of chronic myeloid leukemia. European LeukemiaNet (ELN) group has defined specific treatment milestones with an optimal outcome to be achieved in patients. METHODS In a retrospective cohort study, we evaluated the impact of clinical and biological variables on achieving an optimal response at 6 and 12 months according to ELN recommendations. We included 106 patients with chronic phase chronic myeloid leukemia (CML) with appropriate bone marrow aspirate and biopsy for immunohistochemistry. RESULTS The number of white blood cells (WBC), the percentage of peripheral blast, the values of Sokal and ELTS scores and the percentage of Ki-67+ cells in the bone marrow predicted a complete cytogenetic response (CCyR) at 6 months, but only WBC and EUTOS score predicts CCyR at 12 months. We found that Sokal score below 0.775 was very sensitive to achieve of CCyR at 6 months (m) and that all patients with a value <0.550 achieved CCyR-6m. Patients with a low percentage of blast in the peripheral blood (≤1.5%) or in the bone marrow (≤5%) together with lower WBC (≤100×109/L) were likely to have significantly higher CCyR rates at 6 and 12 months respectively. Also, patients with a higher number of Ki67+ cells in the leukemic areas of the bone marrow had a significantly better outcome. Unfortunately, our investigation did not reveal that bone marrow fibrosis (MF grade), microvascular density, percentage of CD34+, CD61+ or PTCH1+ cells could have any effect on achievement of CCyR at 6 or 12 months. CONCLUSION Our investigation has shown that only a few biological characteristics in patients with CML can predict the optimal treatment outcome after imatinib.
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Affiliation(s)
- Violeta Milosevic
- 1Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
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18
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Bogdanovic A, Bulajic P, Masulovic D, Bidzic N, Zivanovic M, Galun D. Liver resection versus transarterial chemoembolization for huge hepatocellular carcinoma: a propensity score matched analysis. Sci Rep 2021; 11:4493. [PMID: 33627697 PMCID: PMC7904801 DOI: 10.1038/s41598-021-83868-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/09/2021] [Indexed: 12/13/2022] Open
Abstract
To date, it is unclear which treatment modality, liver resection (LR) or transarterial chemoembolization (TACE) is the more appropriate for patients with huge (≥ 10 cm) hepatocellular carcinoma (HCC). The study aim was to compare, using propensity score matching, short- and long-term outcomes of patients with huge HCC who underwent potentially curative LR or TACE. Patients with huge HCC who had been managed at the Clinical Center by curative-intent LR or by palliative TACE between November 2001 and December 2018 were retrospectively identified. The morbidity and mortality rates and overall survival were compared between the groups before and after the propensity score matching. Independent predictors of long-term survival were determined by multivariate analysis. A total of 103 patients with huge HCC were included; 68 were assigned to the LR group and 35 to the TACE group. The overall morbidity rate was higher in the LR group than in the TACE group before matching (64.7% vs. 37.1%, p = 0.012), while there was no difference after matching (60% vs. 30%, p = 0.055). The major morbidity and 30-days mortality were similar between the groups before and after matching. The LR group was associated with longer overall survival than the TACE group before matching (p = 0.032) and after matching (p = 0.023). Total bilirubin and TACE treatment were independent prognostic factors associated with long-term survival. In patients with huge HCC, liver resection provides better long-term survival than TACE and should be considered as the initial treatment whenever possible.
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Affiliation(s)
- A Bogdanovic
- Clinic for Digestive Surgery, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia. .,School of Medicine, University of Belgrade, Belgrade, 11000, Serbia.
| | - P Bulajic
- Clinic for Digestive Surgery, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia
| | - D Masulovic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Belgrade, 11000, Serbia.,School of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - N Bidzic
- Clinic for Digestive Surgery, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia.,School of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - M Zivanovic
- Clinic for Digestive Surgery, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia
| | - D Galun
- Clinic for Digestive Surgery, Clinical Center of Serbia, Koste Todorovica 6, Belgrade, 11000, Serbia.,School of Medicine, University of Belgrade, Belgrade, 11000, Serbia
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19
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Pfirrmann M, Clark RE, Prejzner W, Lauseker M, Baccarani M, Saussele S, Guilhot F, Heibl S, Hehlmann R, Faber E, Turkina A, Ossenkoppele G, Höglund M, Zaritskey A, Griskevicius L, Olsson-Strömberg U, Everaus H, Koskenvesa P, Labar B, Sacha T, Zackova D, Cervantes F, Colita A, Zupan I, Bogdanovic A, Castagnetti F, Guilhot J, Hasford J, Hochhaus A, Hoffmann VS. The EUTOS long-term survival (ELTS) score is superior to the Sokal score for predicting survival in chronic myeloid leukemia. Leukemia 2020; 34:2138-2149. [PMID: 32601376 PMCID: PMC7387299 DOI: 10.1038/s41375-020-0931-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/20/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022]
Abstract
Prognostic scores support clinicians in selecting risk-adjusted treatments and in comparatively assessing different results. For patients with chronic-phase chronic myeloid leukemia (CML), four baseline prognostic scores are commonly used. Our aim was to compare the prognostic performance of the scores and to arrive at an evidence-based score recommendation. In 2949 patients not involved in any score development, higher hazard ratios and concordance indices in any comparison demonstrated the best discrimination of long-term survival with the ELTS score. In a second step, of 5154 patients analyzed to investigate risk group classification differences, 23% (n = 1197) were allocated to high-risk by the Sokal score. Of the 1197 Sokal high-risk patients, 56% were non-high-risk according to the ELTS score and had a significantly more favorable long-term survival prognosis than the 526 high-risk patients according to both scores. The Sokal score identified too many patients as high-risk and relatively few (40%) as low-risk (versus 60% with the ELTS score). Inappropriate risk classification jeopardizes optimal treatment selection. The ELTS score outperformed the Sokal score, the Euro, and the EUTOS score regarding risk group discrimination. The recent recommendation of the European LeukemiaNet for preferred use of the ELTS score was supported with significant statistical evidence.
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Affiliation(s)
- Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Ludwig-Maximilians Universität, Munich, Germany.
| | - Richard E Clark
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Michael Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Ludwig-Maximilians Universität, Munich, Germany
| | - Michele Baccarani
- Clinical Department of Hematology and Oncology L. and A. Seragnoli, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Susanne Saussele
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - François Guilhot
- Clinical Investigation Centre, INSERM CIC 1402, CHU Poitiers, Poitiers, France
| | - Sonja Heibl
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Rüdiger Hehlmann
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
- ELN Foundation, Weinheim, Germany
| | - Edgar Faber
- Department of Hemato-Oncology, Faculty Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Anna Turkina
- National Research Center for Hematology, Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Gert Ossenkoppele
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Martin Höglund
- Institution of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Andrey Zaritskey
- Almazov Medical Reseach Centre, Institute of Oncology and Hematology, St Petersburg, Russian Federation
| | | | - Ulla Olsson-Strömberg
- Department of Medical Sciences, University of Uppsala and Section of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Perttu Koskenvesa
- Hematology Research Unit Helsinki, University of Helsinki and Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Boris Labar
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomasz Sacha
- Department of Hematology, Jagiellonian Unversity Medical College, Kraków, Poland
| | - Daniela Zackova
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | | | - Adriana Colita
- Romanian Academy of Medical Sciences and Medical University, Bucharest, Romania
| | - Irena Zupan
- Department of Hematology, University Medical Centre, Ljubljana, Slovenia
| | - Andrija Bogdanovic
- Clinic of Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Fausto Castagnetti
- Clinical Department of Hematology and Oncology L. and A. Seragnoli, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Joëlle Guilhot
- Clinical Investigation Centre, INSERM CIC 1402, CHU Poitiers, Poitiers, France
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Ludwig-Maximilians Universität, Munich, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Verena S Hoffmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie - IBE, Ludwig-Maximilians Universität, Munich, Germany
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20
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Lauseker M, Bachl K, Turkina A, Faber E, Prejzner W, Olsson‐Strömberg U, Baccarani M, Lomaia E, Zackova D, Ossenkoppele G, Griskevicius L, Schubert‐Fritschle G, Sacha T, Heibl S, Koskenvesa P, Bogdanovic A, Clark RE, Guilhot J, Hoffmann VS, Hasford J, Hochhaus A, Pfirrmann M. Prognosis of patients with chronic myeloid leukemia presenting in advanced phase is defined mainly by blast count, but also by age, chromosomal aberrations and hemoglobin. Am J Hematol 2019; 94:1236-1243. [PMID: 31456269 DOI: 10.1002/ajh.25628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
Abstract
Chronic myeloid leukemia (CML) is usually diagnosed in chronic phase, yet there is a small percentage of patients that is diagnosed in accelerated phase or blast crisis. Due to this rarity, little is known about the prognosis of these patients. Our aim was to identify prognostic factors for this cohort. We identified 283 patients in the EUTOS population-based and out-study registries that were diagnosed in advanced phase. Nearly all patients were treated with tyrosine kinase inhibitors. Median survival in this heterogeneous cohort was 8.2 years. When comparing patients with more than 30% blasts to those with 20-29% blasts, the hazard ratio (HR) was 1.32 (95%-confidence interval (CI): [0.7-2.6]). Patients with 20-29% blasts had a significantly higher risk than patients with less than 20% blasts (HR: 2.24, 95%-CI: [1.2-4.0], P = .008). We found that the blast count was the most important prognostic factor; however, age, hemoglobin, basophils and other chromosomal aberrations should be considered as well. The ELTS score was able to define two groups (high risk vs non-high risk) with an HR of 3.01 (95%-CI: [1.81-5.00], P < .001). Regarding the contrasting definitions of blast crisis, our data clearly supported the 20% cut-off over the 30% cut-off in this cohort. Based on our results, we conclude that a one-phase rather than a two-phase categorization of de novo advanced phase CML patients is appropriate.
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Affiliation(s)
- Michael Lauseker
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig‐Maximilians‐Universität München Munich Germany
| | - Katharina Bachl
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig‐Maximilians‐Universität München Munich Germany
| | - Anna Turkina
- National Research Center for Hematology Moscow Russia
| | - Edgar Faber
- Department of Hematology‐OncologyUniversity Hospital, Palacky University Olomouc Czech Republic
| | - Witold Prejzner
- Department of HematologyMedical University of Gdansk Gdansk Poland
| | - Ulla Olsson‐Strömberg
- Department of Internal Medicine, Department of Medical Science and Division of HematologyUniversity Hospital Uppsala Sweden
| | - Michele Baccarani
- Department of Hematology and Oncology L. and AUniversity of Bologna Bologna Italy
| | - Elza Lomaia
- Clinical oncology ‐ Research department of oncology and hematologyAlmazov Medical Research Center St Petersburg Russian Federation
| | - Daniela Zackova
- Department of Internal Medicine, Hematology and OncologyUniversity Hospital Brno and Masaryk University Brno Czech Republic
| | - Gert Ossenkoppele
- Department of HematologyAmsterdam University Medical Center, location VUmc Amsterdam The Netherlands
| | - Laimonas Griskevicius
- Vilnius University Hospital Santaros Klinikos and Institute of Clinical MedicineVilnius University Vilnius Lithuania
| | | | - Tomasz Sacha
- Chair and Department of HematologyJagiellonian University Hospital Kraków Poland
| | - Sonja Heibl
- Department for Internal Medicine IVKlinikum Wels‐Grieskirchen Wels Austria
| | - Perttu Koskenvesa
- Helsinki University Hospital Cancer Center and Hematology Research UnitHelsinki University Helsinki Finland
| | - Andrija Bogdanovic
- Clinic of Hematology CCS and Faculty of MedicineUniversity of Belgrade Belgrade Serbia
| | - Richard E. Clark
- Institute of Translational MedicineUniversity of Liverpool Liverpool UK
| | - Joelle Guilhot
- Clinical Investigation Center, INSERM CIC 1402, CHU Poitiers Poitiers France
| | - Verena S. Hoffmann
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig‐Maximilians‐Universität München Munich Germany
| | - Joerg Hasford
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig‐Maximilians‐Universität München Munich Germany
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin IIUniversitätsklinikum Jena Jena Germany
| | - Markus Pfirrmann
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig‐Maximilians‐Universität München Munich Germany
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Colovic N, Marisavljevic D, Kraguljac-Kurtovic N, Bogdanovic A, Gotic M. CD56-Positive Acute Myeloid Leukemia Following Treatment of Hairy Cell Leukemia with Cladribine - Report of 2 Cases and Review of the Literature. Arch Iran Med 2019; 22:269-271. [PMID: 31256601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 04/07/2019] [Indexed: 06/09/2023]
Abstract
Treatment of hairy cell leukemia (HCL) with alfa-interferon and purine analogs significantly prolongs survival in these patients. However, with life prolongation, an increased risk of secondary malignancies has been reported. Acute myeloid leukemia (AML), as a second malignancy after HCL treatment is extremely rare and has been reported in only 12 cases so far. We here report additional 2 cases of CD56+ AML developed after sustained clinical remission of HCL achieved with cladribine (2 and 6 years after, respectively). The first patient refused chemotherapy and shortly thereafter died. The second patient responded to chemotherapy and was successfully allo-transplanted. Three years later, the patient is in stable clinical remission, which is a unique case in the literature. In conclusion, it is not clear whether development of AML in HCL patients is caused by mutagenic potential of the applied chemotherapy or by immune suppression/ perturbations as a characteristic of the underlying disease.
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Affiliation(s)
- Natasa Colovic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Dragomir Marisavljevic
- Faculty of Medicine, University of Belgrade, Serbia
- Department of Hematology, Medical Center Bezanijska Kosa, Belgrade, Serbia
| | | | - Andrija Bogdanovic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Mirjana Gotic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
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22
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Djikic D, Markovic D, Bogdanovic A, Mitrovic-Ajtic O, Suboticki T, Diklic M, Beleslin-Cokic B, Bjelica S, Kovacic M, P Cokic V. Oxidative and nitrosative stress in myeloproliferative neoplasms: the impact on the AKT / mTOR signaling pathway. J BUON 2018; 23:1481-1491. [PMID: 30570876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE A common feature of malignancies is increased reactive oxygen species (ROS) and reactive nitrogen species (RNS). We analyzed the influence of oxidative and nitrosative stress on the activation of AKT/mTOR signaling pathway in myeloproliferative neoplasms (MPN). METHODS Oxidative stress-induced gene expression in circulatory CD34+ cells of MPN patients was studied by microarray analysis. Biomarkers of oxidative and nitrosative stress were determined using spectrophotometry in plasma and erythrocyte lysate. The levels of nitrotyrosine, inducible NO synthase (iNOS) and AKT/mTOR/p70S6K phosphorylation were determined by immunocytochemistry and immunoblotting in granulocytes of MPN patients. RESULTS Antioxidants superoxide dismutase 2 (SOD2) and glutathione peroxidase 1 (GPx1) gene expression were increased in circulatory CD34+ cells, while SOD1 and GPx enzymes were reduced in the erythrocytes of MPN. Plasma malonyl-dialdehyde and protein carbonyl levels were elevated in MPN. The total antioxidant capacity in plasma and erythrocyte catalase (CT) activities was the most prominent in primary myelofibrosis (PMF) with JAK2V617F heterozygosity. The total nitrite/nitrate (NOx) level was augmented in the plasma of PMF patients (p<0.001), while nitrotyrosine and iNOS were generally increased in the granulocytes of MPN patients. Activation of AKT/mTOR signaling was the most significant in PMF (p<0.01), but demonstrated JAK2V617F dependence and consequent p70S6K phosphorylation in the granulocytes of essential thrombocytemia (ET) and polycythemia vera (PV) patients. Hydrogen peroxide stimulated mTOR pathway, iNOS and nitrotyrosine quantities, the last one prevented by the antioxidant n-acetyl-cysteine (NAC) in the granulocytes of MPN. CONCLUSION Our study showed increased levels of oxidative and nitrosative stress parameters in MPN with JAK2V617F dependence. The ROS enhanced the constitutive activation of AKT/mTOR signaling and nitrosative parameters in MPN.
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Affiliation(s)
- Dragoslava Djikic
- Deparment of Molecular Biology, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
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Saglio G, Sharf G, Almeida A, Bogdanovic A, Bombaci F, Čugurović J, Deekes N, Garcia-Gutiérrez V, de Jong J, Narbutas Š, Westerweel P, Zackova D. Considerations for Treatment-free Remission in Patients With Chronic Myeloid Leukemia: A Joint Patient-Physician Perspective. Clin Lymphoma Myeloma Leuk 2018; 18:375-379. [PMID: 29753691 DOI: 10.1016/j.clml.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
Treatment-free remission (TFR) after discontinuation of tyrosine kinase inhibitor therapy is now an emerging treatment goal for patients with chronic myeloid leukemia, who have achieved a deep and stable response to treatment. Although guidance is now available, patients' questions regarding this progressive concept have yet to be addressed. The overall aim of this European Steering Group is a patient-centered approach that educates patients on their treatment options, including TFR, facilitates better patient-physician relationships, and meets patients' emotional and psychological needs. The present report outlines 5 key topic areas on discontinuing tyrosine kinase therapy and the implications of TFR for patient-physician consideration: what TFR is; when TFR is appropriate; which patients might and might not be eligible for TFR; and patients' considerations for discontinuing therapy, such as tyrosine kinase withdrawal syndrome, potential psychological implications, molecular recurrence, and repeat treatment. This Steering Group advocates that patients with chronic myeloid leukemia should have access to high-quality, frequent molecular monitoring and be treated in a specialist center with appropriate medical and psychological support. As patient concerns with attempting TFR become forefront in patient-physician discussions, a greater number of eligible patients might be willing to discontinue therapy.
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Affiliation(s)
- Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
| | | | | | - Andrija Bogdanovic
- Clinical Centre of Serbia, University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Felice Bombaci
- Gruppo AIL Pazienti Leucemia Mieloide Cronica, Rome, Italy
| | | | | | | | - Jan de Jong
- Hematon Foundation, Utrecht, The Netherlands
| | | | | | - Daniela Zackova
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
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Lekovic D, Gotic M, Milic N, Zivojinovic B, Jovanovic J, Colovic N, Milosevic V, Bogdanovic A. Predictive parameters for imatinib failure in patients with chronic myeloid leukemia. Hematology 2017; 22:460-466. [PMID: 28327053 DOI: 10.1080/10245332.2017.1302179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Until recently, imatinib was the standard first-line treatment in chronic myeloid leukemia (CML). The inclusion of nilotinib and dasatinib as first-line options in CML raised a debate on treatment selection. The aim of our study was to analyze predictive parameters for imatinib response as the first-line treatment of CML patients. METHODS The study included 168 consecutive patients with chronic phase Philadelphia-positive CML who were diagnosed and treated with Imatinib 400 mg once daily at a single university hospital. Numerous parameters were analyzed in terms of imatinib response including comorbidities as well as occurrence of second malignancies. RESULTS After the median follow-up of 87 months in 61 patients (36.3%), the imatinib failure was verified. Cox regression analysis identified hepatomegaly (p = 0.001), leukocytosis ≥ 100 × 109/l (p = 0.001), blood blasts ≥ 1% (p = 0.002), and the presence of additional cytogenetic aberrations (p = 0.002) as predictors of Imatinib failure. Based on these findings, a new prognostic model was developed according to which imatinib failure had 17% (8/47) of patients in low risk, 34.9% (30/86) of patients in intermediate risk, and 76.7% (23/30) of patients in high-risk group (HR = 3.973, 95% CI for HR 2.237-7.053, p < 0.001). CONCLUSION The new score allows better selection of patients who are suitable for treatment with imatinib and may guideline the clinical decision for front-line treatment of CML.
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Affiliation(s)
- Danijela Lekovic
- a Clinic for Hematology , Clinical Center of Serbia , Belgrade , Serbia.,b Medical Faculty , University of Belgrade , Belgrade , Serbia
| | - Mirjana Gotic
- a Clinic for Hematology , Clinical Center of Serbia , Belgrade , Serbia.,b Medical Faculty , University of Belgrade , Belgrade , Serbia
| | - Natasa Milic
- b Medical Faculty , University of Belgrade , Belgrade , Serbia.,c Institute for Medical Statistics , University of Belgrade , Belgrade , Serbia
| | | | - Jelica Jovanovic
- a Clinic for Hematology , Clinical Center of Serbia , Belgrade , Serbia
| | - Natasa Colovic
- a Clinic for Hematology , Clinical Center of Serbia , Belgrade , Serbia.,b Medical Faculty , University of Belgrade , Belgrade , Serbia
| | - Violeta Milosevic
- a Clinic for Hematology , Clinical Center of Serbia , Belgrade , Serbia
| | - Andrija Bogdanovic
- a Clinic for Hematology , Clinical Center of Serbia , Belgrade , Serbia.,b Medical Faculty , University of Belgrade , Belgrade , Serbia
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Vilimanovich U, Bosnjak M, Bogdanovic A, Markovic I, Isakovic A, Kravic-Stevovic T, Mircic A, Trajkovic V, Bumbasirevic V. Statin-mediated inhibition of cholesterol synthesis induces cytoprotective autophagy in human leukemic cells. Eur J Pharmacol 2015; 765:415-28. [PMID: 26358205 DOI: 10.1016/j.ejphar.2015.09.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 12/11/2022]
Abstract
Statins exhibit anti-leukemic properties due to suppression of the mevalonate pathway by the inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase, and subsequent depletion of cholesterol, farnesylpyrophosphate, and geranylgeranylpyrophosphate. We investigated the role of autophagy, a controlled intracellular self-digestion, in the anti-leukemic action of statins. Treatment with low concentrations (≤6 µM) of statins, cholesterol depletion, and specific inhibition of cholesterol synthesis and protein farnesylation or geranylgeranylation, all inhibited proliferation of leukemic cell lines and primary leukemic cells without inducing overt cell death. Statins and agents that selectively reduce intracellular cholesterol levels, but not the inhibition of protein farnesylation or geranylgeranylation, induced autophagy in leukemic cells. The observed autophagic response was associated with the reduction of phosphorylated Akt levels in the lipid rafts, accompanied by a decrease in the activation of the main autophagy suppressor mammalian target of rapamycin (mTOR) and its substrate ribosomal p70S6 kinase (p70S6K). No significant autophagy induction and downregulation of mTOR/p70S6K activation were observed in normal leukocytes. Autophagy suppression by bafilomycin A1 or RNA interference-mediated knockdown of beclin-1 and microtubule-associated protein 1 light chain 3B induced apoptotic death in statin-treated leukemic cells, an effect attenuated by the addition of mevalonate or squalene, but not farnesylpyrophosphate or geranylgeranylpyrophosphate. Therefore, while the inhibition of cholesterol synthesis, protein farnesylation, and geranylgeranylation all contributed to anti-leukemic effects of statins, the inhibition of cholesterol synthesis was solely responsible for the induction of cytoprotective autophagy. These data indicate that combined treatment with statins and autophagy inhibitors might be potentially useful in anti-leukemic therapy.
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Affiliation(s)
- Urosh Vilimanovich
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
| | - Mihajlo Bosnjak
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic of Hematology, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivanka Markovic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Isakovic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara Kravic-Stevovic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
| | - Aleksandar Mircic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
| | - Vladimir Trajkovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, 11000 Belgrade, Serbia.
| | - Vladimir Bumbasirevic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia.
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Lekovic D, Bogdanovic A, Perunicic-Jovanovic M, Jankovic G, Gotic M, Elezovic I. Diagnostic challenges during pretreatment long-term follow-up in a patient with FIP1L1-PDGFRA-positive eosinophilia. Intern Med 2015; 54:637-42. [PMID: 25786456 DOI: 10.2169/internalmedicine.54.2258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Obtaining a precise characterization of eosinophilia is crucial, as successful treatment relies on the underlying etiology of the disease. Platelet-derived growth factor receptor alpha-related disorders were first specified in 2008 as a distinct group of clonal eosinophilic disorders with exceptional responsiveness to imatinib. We herein present the case of a man with myeloid neoplasm and eosinophilia in whom a definitive diagnosis could not be adequately made based on histopathological features who was ultimately diagnosed only after extensive molecular analyses and successfully treated with imatinib. In addition, we discuss the diagnostic and therapeutic approaches to treating patients presenting with eosinophilia.
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Antic D, Bogdanovic A, Perunicic Jovanovic M, Jovanovic J, Elezovic I. Myeloid sarcoma of the skin in a patient with myelodysplastic syndrome. Acta Dermatovenerol Croat 2015; 23:134-137. [PMID: 26228825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report the case of a 76-year-old woman who presented with asymptomatic extensive erythematous. Firm plaques were noted over the right cheek. Complete blood count was normal, as was a peripheral smear. An excision biopsy taken from the cheek showed infiltration of the dermis and hypodermis with atypical cells which were strongly positive for human leukocyte antigen (HLA-DR) and lysozyme and were moderately myeloperoxidase (MPO) enzyme. The results of immunohistochemical staining for CD34, CD117, CD3, CD4, CD8, CD20, CD23, CD56, and ALK-1 were negative. Bone marrow analysis indicated myelodysplastic syndrome RAEB 1 while cytogenetic finding showed tetrasomy 8. It was recommended that the patient undergo local radiotherapy of skin lesions, but she refused and was lost to follow-up.
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Affiliation(s)
- Darko Antic
- Darko Antic, MD, Clinic for Hematology, Clinical Center Serbia, Koste Todorovića 2, 11000 Belgrade, Serbia;
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Mitrovic M, Suvajdzic N, Elezovic I, Bogdanovic A, Djordjevic V, Miljic P, Djunic I, Gvozdenov M, Colovic N, Virijevic M, Lekovic D, Vidovic A, Tomin D. Thrombotic events in acute promyelocytic leukemia. Thromb Res 2014; 135:588-93. [PMID: 25528069 DOI: 10.1016/j.thromres.2014.11.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/24/2014] [Accepted: 11/30/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Thrombotic events (TE) appear to be more common in acute promyelocytic leukemia (APL) than in other acute leukemias, with reported prevalence ranging from 2 to 10-15%. MATERIALS AND METHODS We retrospectively analyzed the data on TE appearance in 63 APL patients. RESULTS TE occured in 13 (20.6%) cases, four arterial (6.3%) and nine venous (14.3%). TE were more frequently diagnosed after initiation of weekly D-dimer monitoring (7 TE during 20 months vs 6 during 76 months, P=0.032). Patients with and without venous thrombosis were significantly different regarding female/male ratio (P=0.046), PT (P=0.022), aPTT (P=0.044), ISTH DIC score (P=0.001), bcr3 (P=0.02) and FLT3-ITD (P=0.028) mutation. The most significant risk factor for venous TE occurrence in multivariate analysis was FLT3-ITD mutation (P=0.034). PAI-1 4G/4G polymorphism was five times more frequent in patients with venous TE than without it (P=0.05). Regarding risk factors for arterial TE we failed to identify any. CONCLUSIONS We have demonstrated that APL-related TE rate is higher than previously reported and that weekly D-dimer monitoring might help to identify patients with silent thrombosis. Moreover, our study suggests a possible relationship between venous TE occurrence and several laboratory findings (PT, aPTT, ISTH DIC score, bcr3 isoform, FLT3-ITD mutation and PAI 4G/4G). Prophylactic use of heparin might be considered in patients with ISTH DIC score<5, bcr3 isoform, FLT3-ITD mutation and PAI 4G/4G.
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Affiliation(s)
| | - Nada Suvajdzic
- Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia
| | - Ivo Elezovic
- Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia
| | - Valentina Djordjevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444aBelgrade, Serbia
| | - Predrag Miljic
- Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia
| | - Irena Djunic
- Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia
| | - Maja Gvozdenov
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444aBelgrade, Serbia
| | - Natasa Colovic
- Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia
| | | | | | - Ana Vidovic
- Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia
| | - Dragica Tomin
- Clinic of Hematology CCS, Belgrade, Koste Todorovica 2 Serbia; Faculty of Medicine, University of Belgrade, Dr Subotica 8 Belgrade, Serbia
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Ristic B, Bosnjak M, Arsikin K, Mircic A, Suzin-Zivkovic V, Bogdanovic A, Perovic V, Martinovic T, Kravic-Stevovic T, Bumbasirevic V, Trajkovic V, Harhaji-Trajkovic L. Idarubicin induces mTOR-dependent cytotoxic autophagy in leukemic cells. Exp Cell Res 2014; 326:90-102. [PMID: 24907655 DOI: 10.1016/j.yexcr.2014.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023]
Abstract
We investigated if the antileukemic drug idarubicin induces autophagy, a process of programmed cellular self-digestion, in leukemic cell lines and primary leukemic cells. Transmission electron microscopy and acridine orange staining demonstrated the presence of autophagic vesicles and intracellular acidification, respectively, in idarubicin-treated REH leukemic cell line. Idarubicin increased punctuation/aggregation of microtubule-associated light chain 3B (LC3B), enhanced the conversion of LC3B-I to autophagosome-associated LC3B-II in the presence of proteolysis inhibitors, and promoted the degradation of the selective autophagic target p62, thus indicating the increase in autophagic flux. Idarubicin inhibited the phosphorylation of the main autophagy repressor mammalian target of rapamycin (mTOR) and its downstream target p70S6 kinase. The treatment with the mTOR activator leucine prevented idarubicin-mediated autophagy induction. Idarubicin-induced mTOR repression was associated with the activation of the mTOR inhibitor AMP-activated protein kinase and down-regulation of the mTOR activator Akt. The suppression of autophagy by pharmacological inhibitors or LC3B and beclin-1 genetic knockdown rescued REH cells from idarubicin-mediated oxidative stress, mitochondrial depolarization, caspase activation and apoptotic DNA fragmentation. Idarubicin also caused mTOR inhibition and cytotoxic autophagy in K562 leukemic cell line and leukocytes from chronic myeloid leukemia patients, but not healthy controls. By demonstrating mTOR-dependent cytotoxic autophagy in idarubicin-treated leukemic cells, our results warrant caution when considering combining idarubicin with autophagy inhibitors in leukemia therapy.
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Affiliation(s)
- Biljana Ristic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, 11000 Belgrade, Serbia
| | - Mihajlo Bosnjak
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Arsikin
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, 11000 Belgrade, Serbia
| | - Aleksandar Mircic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Violeta Suzin-Zivkovic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic for Hematology, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Perovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, 11000 Belgrade, Serbia
| | - Tamara Martinovic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara Kravic-Stevovic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Bumbasirevic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Trajkovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, 11000 Belgrade, Serbia.
| | - Ljubica Harhaji-Trajkovic
- Institute for Biological Research, University of Belgrade, Belgrade, Despot Stefan Blvd. 142, 11000 Belgrade, Serbia.
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Andjelic B, Antic D, Jakovic L, Todorovic M, Bogdanovic A, Djurasinovic V, Bila J, Mihaljevic B. A single institution experience on 314 newly diagnosed advanced Hodgkin lymphoma patients: the role of ABVD in daily practice. Eur J Haematol 2014; 93:392-9. [DOI: 10.1111/ejh.12364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Bosko Andjelic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia
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Mitrovic M, Suvajdzic N, Elezovic I, Bogdanovic A, Dordevic V, Djunic I, Gvozdenov M, Colovic N, Virijevic M, Vidovic A, Tomin D. C0321: Risk Factors for Thrombosis in Acute Promyelocytic Leukemia. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bosnjak M, Ristic B, Arsikin K, Mircic A, Suzin-Zivkovic V, Perovic V, Bogdanovic A, Paunovic V, Markovic I, Bumbasirevic V, Trajkovic V, Harhaji-Trajkovic L. Inhibition of mTOR-dependent autophagy sensitizes leukemic cells to cytarabine-induced apoptotic death. PLoS One 2014; 9:e94374. [PMID: 24714637 PMCID: PMC3979773 DOI: 10.1371/journal.pone.0094374] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 03/14/2014] [Indexed: 02/01/2023] Open
Abstract
The present study investigated the role of autophagy, a cellular self-digestion process, in the cytotoxicity of antileukemic drug cytarabine towards human leukemic cell lines (REH, HL-60, MOLT-4) and peripheral blood mononuclear cells from leukemic patients. The induction of autophagy was confirmed by acridine orange staining of intracellular acidic vesicles, electron microscopy visualization of autophagic vacuoles, as well as by the increase in autophagic proteolysis and autophagic flux, demonstrated by immunoblot analysis of p62 downregulation and LC3-I conversion to autophagosome-associated LC3-II in the presence of proteolysis inhibitors, respectively. Moreover, the expression of autophagy-related genes Atg4, Atg5 and Atg7 was stimulated by cytarabine in REH cells. Cytarabine reduced the phosphorylation of the major negative regulator of autophagy, mammalian target of rapamycin (mTOR), and its downstream target p70S6 kinase in REH cells, which was associated with downregulation of mTOR activator Akt and activation of extracellular signal- regulated kinase. Cytarabine had no effect on the activation of mTOR inhibitor AMP-activated protein kinase. Leucine, an mTOR activator, reduced both cytarabine-induced autophagy and cytotoxicity. Accordingly, pharmacological downregulation of autophagy with bafilomycin A1 and chloroquine, or RNA interference-mediated knockdown of LC3β or p62, markedly increased oxidative stress, mitochondrial depolarization, caspase activation and subsequent DNA fragmentation and apoptotic death in cytarabine-treated REH cells. Cytarabine also induced mTOR-dependent cytoprotective autophagy in HL-60 and MOLT-4 leukemic cell lines, as well as primary leukemic cells, but not normal leukocytes. These data suggest that the therapeutic efficiency of cytarabine in leukemic patients could be increased by the inhibition of the mTOR-dependent autophagic response.
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Affiliation(s)
- Mihajlo Bosnjak
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Biljana Ristic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, Belgrade, Serbia
| | - Katarina Arsikin
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, Belgrade, Serbia
| | - Aleksandar Mircic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Violeta Suzin-Zivkovic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Perovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic of Hematology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Verica Paunovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, Belgrade, Serbia
| | - Ivanka Markovic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Bumbasirevic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Trajkovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Dr. Subotica 1, Belgrade, Serbia
- * E-mail: (VT); (LHT)
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Smiljanic M, Milosevic R, Antic D, Andjelic B, Djurasinovic V, Todorovic M, Bila J, Bogdanovic A, Mihaljevic B. Orbital and ocular adnexal Mucosa-Associated Lymphoid Tissue (MALT) lymphomas: a single-center 10-year experience. Med Oncol 2013; 30:722. [PMID: 24026660 DOI: 10.1007/s12032-013-0722-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/28/2013] [Indexed: 11/29/2022]
Abstract
Orbital and ocular andexal Mucosa-Associated Lymphoid Tissue Lymphoma (MALT) or ocular adnexal MALT lymphoma (OAML) is the most common of all eye non-Hodgkin lymphomas. Autoimmune inflammatory disorders and chronic infections are important etiological factors and CD5 and CD43 (sialophorin) tumor markers are significant negative prognostic factors. Disease signs and symptoms can occur a long time before diagnosis. Varieties of treatment options are available. The aim of this retrospective analysis was to compare the efficiency of different treatment options and to investigate disease outcome. Twenty OAML patients, diagnosed in the Clinic of Hematology, Clinical Centre of Serbia, between 2003 and 2013, were enrolled. In most cases, OAML developed in the eighth decade with greater incidence in the male population. Median age was 67.5 years. The median period between the appearance of local signs and symptoms and diagnosis was 7 months. The dominant sign at presentation was swelling of involved tissue (40%). The most common was orbital involvement (55%). All patients had localized disease. Observed laboratory parameters on presentation showed low disease activity. Sialophorin prognostic significance was not registered. Our patients were initially treated differently but there was no significant difference in progression-free survival (PFS) due to initial treatment option (p = 0.2957). Median PFS was 22 months (3-89), and 5-year PFS was 60%. Median overall survival (OS) was 43 months (1-105) and 5-year OS 95%. Eight patients (40%) relapsed and one patient died due to non-hematological complications. In our experience, most modern induction treatment options appear to result in the same, favorable outcome.
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Affiliation(s)
- M Smiljanic
- Clinic of Hematology, Clinical Centre of Serbia, Belgrade, Serbia,
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Mitrovic M, Suvajdzic N, Bogdanovic A, Kurtovic NK, Sretenovic A, Elezovic I, Tomin D. International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation ≥6: a new predictor of hemorrhagic early death in acute promyelocytic leukemia. Med Oncol 2013; 30:478. [DOI: 10.1007/s12032-013-0478-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/20/2013] [Indexed: 11/28/2022]
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Mitrovic M, Sumarac Z, Antic D, Bogdanovic A, Elezovic I, Vukosavljevic D, Ignjatovic S, Majkic-Singh N, Suvajdzic N. Markers of coagulation activation and enhanced fibrinolysis in Gaucher type 1 patient: Effects of enzyme replacement therapy. Blood Cells Mol Dis 2012; 49:58-9. [DOI: 10.1016/j.bcmd.2012.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 12/04/2011] [Accepted: 02/25/2012] [Indexed: 11/30/2022]
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Petzer AL, Fong D, Lion T, Dyagil I, Masliak Z, Bogdanovic A, Griskevicius L, Lejniece S, Goranov S, Gercheva L, Stojanovic A, Peytchev D, Tzvetkov N, Griniute R, Stanchev A, Grubinger T, Kwakkelstein M, Schuld P, Gastl G, Wolf D. High-dose imatinib induction followed by standard-dose maintenance in pre-treated chronic phase chronic myeloid leukemia patients--final analysis of a randomized, multicenter, phase III trial. Haematologica 2012; 97:1562-9. [PMID: 22511495 DOI: 10.3324/haematol.2011.060087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Previous data suggest that the response of chronic myeloid leukemia cells to imatinib is dose-dependent. The potential benefit of initial dose intensification of imatinib in pre-treated patients with chronic phase chronic myeloid leukemia remains unknown. DESIGN AND METHODS Two hundred and twenty-seven pre-treated patients with chronic myeloid leukemia in chronic phase were randomly assigned to continuous treatment with a standard dose of imatinib (400 mg/day; n=113) or to 6 months of high-dose induction with imatinib (800 mg/day) followed by a standard dose of imatinib as maintenance therapy (n=114). RESULTS The rates of major and complete cytogenetic responses were significantly higher in the high-dose arm than in the standard-dose arm at both 3 and 6 months (major cytogenetic responses: 36.8% versus 21.2%, P=0.01 and 50.0% versus 34.5%, P=0.018; complete cytogenetic responses: 22.8% versus 6.2%, P<0.001 and 40.4% versus 16.8%, P<0.001) on the basis of an intention-to-treat analysis. At 12 months, the difference between treatment arms remained statistically significant for complete cytogenetic responses (40.4% versus 24.8%, P=0.012) but not for major cytogenetic responses (49.1% versus 44.2%, P=0.462). The rate of major molecular responses was also significantly better at 3 and 6 months in the high-dose arm (month 3: 14.9% versus 3.5%, P=0.003; month 6: 32.5% versus 8.8%, P<0.001). Overall and progression-free survival rates were comparable between arms, but event-free survival was significantly worse in the high-dose arm (P=0.014). CONCLUSIONS Standard-dose imatinib remains the standard of care for pre-treated patients with chronic phase chronic myeloid leukemia (Clinicaltrials.gov identifier: NCT00327262).
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Affiliation(s)
- Andreas L Petzer
- Central European Leukemia Study Group, Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.
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Misirlic Dencic S, Poljarevic J, Vilimanovich U, Bogdanovic A, Isakovic AJ, Kravic Stevovic T, Dulovic M, Zogovic N, Isakovic AM, Grguric-Sipka S, Bumbasirevic V, Sabo T, Trajkovic V, Markovic I. Cyclohexyl Analogues of Ethylenediamine Dipropanoic Acid Induce Caspase-Independent Mitochondrial Apoptosis in Human Leukemic Cells. Chem Res Toxicol 2012; 25:931-9. [DOI: 10.1021/tx3000329] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Sonja Misirlic Dencic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Urosh Vilimanovich
- Institute of Histology and Embryology,
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrija Bogdanovic
- Clinic
of Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra J. Isakovic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara Kravic Stevovic
- Institute of Histology and Embryology,
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Dulovic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nevena Zogovic
- Institute for Biological Research
“Sinisa Stankovic”, University of Belgrade, Belgrade, Serbia
| | - Andjelka M. Isakovic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Vladimir Bumbasirevic
- Institute of Histology and Embryology,
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tibor Sabo
- Faculty of Chemistry, University of Belgrade, Belgrade, Serbia,
| | - Vladimir Trajkovic
- Institute
of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivanka Markovic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Colovic M, Colovic N, Jankovic G, Kraguljac Kurtovic N, Vidovic A, Djordjevic V, Bogdanovic A. Mixed phenotype acute leukemia of T/myeloid type with a prominent cellular heterogeneity and unique karyotypic aberration 45,XY, dic(11;17). Int J Lab Hematol 2012; 34:290-4. [PMID: 22212154 DOI: 10.1111/j.1751-553x.2011.01393.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A 26-yr-old male patient with mixed phenotype acute leukemia of T/myeloid type with prominent leukemic cell heterogeneity, and the presence of a so far unreported karyotype aberration in this type of acute leukemia 45,XY, dic(11;17)(11qter→11p11.2::17p11.2→17qter) is presented. METHODS Flow immunocytometry was performed by direct multicolor immunofluorescent technique on bone marrow aspirates. Cytogenetic analyses were performed using G-banding method by direct preparation of unstimulated bone marrow cells and following 24 hours of culture in RPMI 1540 culture medium with 25% fetal calf serum at 37°C RESULTS: The flow immunocytometry of bone marrow nucleated cells revealed the existance of three distinct blast cell populations with overlapping immunophenotypes. Predominant blast cell population had an early myeloid phenotype and aberrant expression of CD7 antigen (HLA-DR(+), CD34(+), anti-MPO(+), CD117(+), CD33(+), CD13(+), CD7(+low), cyCD3(-), TdT(-)). The other two blast cell populations, smaller in cell diameter and less sizable in cell proportion, both shared the T-lymphoid features. The patient was treated with ADE protocol (etoposide, cytarabine and doxorubicine). A complete remission was achieved and lasted 5 months. CONCLUSION A case of MPAL with complex biological features, 45,XY, dic(11;17)(11qter→11p11.2::17p11.2→17qter) karyotype and an aggressive, therapy-resistant clinical course, is presented.
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Affiliation(s)
- M Colovic
- Clinic for Hematology, Clinical Center of Serbia, Dr. Koste Todorovica 2, Belgrade, Serbia.
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Todoric-Zivanovic B, Strnad M, Stamatovic D, Tukic L, Krtolica K, Tatomirovic Z, Djordjevic V, Bogdanovic A, Jankovic G, Magic Z. Frequency of BCR-ABL fusion transcripts in Serbian patients with chronic myeloid leukemia. J BUON 2011; 16:104-107. [PMID: 21674858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of this study was to analyze the occurrence of the most frequent BCR-ABL transcript variants (b3a2, b2a2 and e1a2) in Serbian patients with chronic myeloid leukemia (CML) and compare it with the occurrence reported in other populations. METHODS We analyzed peripheral blood and bone marrow samples of 136 Serbian patients with CML by RT-PCR and cytogenetic methods. RESULTS In 100 patients (73.5%) the b3a2 and in 34 (25%) the b2a2 forms of BCR-ABL were detected. One (0.75%) patient was BCR-ABL negative, but in lymphoblastic transformation he expressed the e1a2 [corrected] transcript of BCR-ABL. One (0.75%) patient displayed both b2a2 and b3a2 forms of BCR-ABL. Analysis of this group according to karyotype showed b3a2 predominance (79%) in patients with classic t(9;22); b2a2 was found in 20% and both b2a2 and b3a2 forms in 1%. In variant translocations b3a2 in 65% and b2a2 in 35% of the patients were detected. In contrast, the subgroup with normal karyotype expressed slight predominance of the b2a2 form (50%); b3a2 was found in 43% of the patients and one patient (7%) displayed e1a2. CONCLUSION Predominance of the b3a2 form in Serbian patients with CML is in concordance with other relevant investigations, conducted mostly on Caucasian ethnic groups, but in contrast to the study performed on the Mestizo ethnic group in Ecuador. Slight predominance of the b2a2 form was also noticed among the patients with normal karyotype.
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Trifunovic D, Vujisic-Tesic B, Vuckovic M, Ostojic M, Ristic A, Bogdanovic A, Mihaljevic B, Andjelic B, Perunicic-Jovanovic M, Antonic Z. Multimodality imaging in the assessment of cardiac lymphoma presented as new-onset atrial fibrillation. Echocardiography 2010; 27:332-6. [PMID: 20486963 DOI: 10.1111/j.1540-8175.2009.01074.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cardiac involvement by non-Hodgkin's lymphoma is not uncommon, however rarely diagnosed during life due to nonspecific clinical presentation. We report a case of secondary cardiac lymphoma in patient who presented with new-onset atrial fibrillation. Cardiac lymphoma was in a form of bulky right atrial mass, infiltrating the atrial septum and cavo-atrial junction with concomitant mild pericardial effusion. In the present case, we illustrate complementary role of transthoracic, transesophageal echocardiography and multislice CT scan with three-dimensional reconstruction, in detection and evaluation of secondary cardiac tumor. Usefulness of echocardiography to follow up the effects of chemotherapy is also shown.
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Affiliation(s)
- Danijela Trifunovic
- Institute of Cardiovascular Disease, University Clinical Centre of Serbia, Ul. Koste Todorovica 8, 11000, Belgrade, Serbia.
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Petzer AL, Wolf D, Fong D, Lion T, Dyagil I, Masliak Z, Bogdanovic A, Griskevicius L, Lejniece S, Goranov S, Gercheva L, Stojanovic A, Peytchev D, Tzvetkov N, Griniute R, Oucheva R, Ulmer H, Kwakkelstein M, Rancati F, Gastl G. High-dose imatinib improves cytogenetic and molecular remissions in patients with pretreated Philadelphia-positive, BCR-ABL-positive chronic phase chronic myeloid leukemia: first results from the randomized CELSG phase III CML 11 "ISTAHIT" study. Haematologica 2010; 95:908-13. [PMID: 20145273 DOI: 10.3324/haematol.2009.013979] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Imatinib 400 mg/day is the standard treatment for patients with chronic phase chronic myeloid leukemia. Recent reports suggested higher and more rapid cytogenetic and molecular responses with higher doses of imatinib. DESIGN AND METHODS In this prospective international, multicenter phase III study, 227 patients with pre-treated Philadelphia chromosome-positive, BCR-ABL-positive chronic myeloid leukemia were randomized to a standard-dose imatinib arm (400 mg/day) or a high-dose imatinib arm (800 mg/day for 6 months followed by 400 mg/day as maintenance therapy). In this planned interim analysis hematologic, cytogenetic and molecular responses as well as toxicity were evaluated. RESULTS Compared to the standard-dose, high-dose imatinib led to higher rates of major and complete cytogenetic responses at both 3 months (major: 21% versus 37%, P=0.01; complete: 6% versus 25%, P<0.001) and 6 months (major: 34% versus 54%, P=0.009; complete: 20% versus 44%, P<0.001). This was paralleled by a significantly higher major molecular response rate at 6 months in the high-dose imatinib arm (11.8% versus 30.4%; P=0.003). At 12 months, the rates of major cytogenetic response (the primary end-point) were comparable between the two arms (57% versus 59%). In contrast to non-hematologic toxicities, grade 3/4 hematologic toxicities were more common in the high-dose arm. Cumulative complete cytogenetic response rates were higher in patients without dose reduction in the high-dose arm (61%) than in the patients with no dose reduction in the standard-dose arm (36%) (P=0.014). CONCLUSIONS This is the first randomized phase III trial in patients with pre-treated chronic phase chronic myeloid leukemia demonstrating improvements in major cytogenetic response, complete cytogenetic response and major molecular response rates with high-dose imatinib therapy (ClinicalTrials.gov Identifier: NCT00327262).
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Affiliation(s)
- Andreas L Petzer
- Central European Leukemia Study Group, Internal Medicine V, Haematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.
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Kravic-Stevovic T, Bogdanovic A, Boskovic D, Bumbasirevic V. Ribosome-lamella complexes in the peripheral blood of patients with chronic lymphocytic leukemia are associated with serological immune deficiency. Ultrastruct Pathol 2010; 34:31-4. [PMID: 20070151 DOI: 10.3109/01913120903419492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The ribosome-lamella complex (RLC) is a cylindrical structure composed of different numbers of circular lamellae with associated particles, regarded as ribosomes, around a central core. Structures resembling RLC, but lacking the typical mature appearance of RLC, have been called pre-RLC. The authors have found RLCs and pre-RLCs in peripheral lymphocytes of 3 patients with chronic lymphocytic leukemia (CLL). The fact that CLL patients with RLCs were in early Rai clinical stages, had good clinical prognostic factors, and did not require immediate therapy indicates that RLCs occurred in the early course of some cases of CLL. Moreover, the presence of RLC was associated with hypogammaglobulinemia M.
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Affiliation(s)
- Tamara Kravic-Stevovic
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, Visegradska 26, Belgrade, Serbia.
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Abstract
Myeloid sarcoma (MS) is a rare disease that presents as an extramedullary tumor of myeloid cells. Most patients subsequently develop acute myelogenous leukemia (AML), and their prognosis is poor. Here, we report the case of a 28-year-old woman with a primary isolated myeloid sarcoma which originated in the gastrointestinal (GI) tract. Two months after initial presentation, bone marrow tests led to a diagnosis of AML. This case is noteworthy because GI tract infiltration with leukemic cells is very rare, and it is even more rare as an occurrence preceding the development of systemic leukemia.
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Affiliation(s)
- Darko Antic
- Institute of Hematology, Clinical Center Serbia, Belgrade.
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45
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46
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Sretenovic A, Mihaljevic B, Bogdanovic A, Jankovic S, Colovic M, Perunicic M, Jakovic L, Bosko A, Petrovic M. P039 The clinical outcome in patients with T-cell chronic lymphocytic leukemia. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bogunovic M, Bogdanovic A, Kraguljac N, Djordjevic V, Lazarevic V, Colovic G, Jankovic M, Gotic M. P066 Biphenotypic and bilineal acute leukemia: report of 14 cases. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70144-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Djordjevic V, Dencic-Fekete M, Jovanovic J, Bizic S, Jankovic G, Bogdanovic A, Cemerikic-Martinovic V, Gotic M. Cytogenetics of agnogenic myeloid metaplasia: a study of 61 patients. ACTA ACUST UNITED AC 2007; 173:57-62. [PMID: 17284371 DOI: 10.1016/j.cancergencyto.2006.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 09/15/2006] [Accepted: 09/27/2006] [Indexed: 11/18/2022]
Abstract
Agnogenic myeloid metaplasia (AMM) or idiopathic myelofibrosis is a chronic myeloproliferative disorder characterized by fibrotic bone marrow, extramedullar haematopoiesis, and a leukoerythroblastic picture in circulating blood. The cytogenetic data on AMM are scanty and no recurring chromosome abnormality has been associated with the natural course of this disease. Trisomy 1q, del(13q), del(20q), and trisomy 8, appear in about two thirds of patients with demonstrable chromosome aberrations. We report on the cytogenetic analyses of 61 consecutive patients with AMM studied at diagnosis. The metaphases could not be found in 10/61 (16.4%) patients, and chromosome studies were successful in 51 patients. Twenty-one patients (41%) had an abnormal clone, whereas 30 (59%) patients had a normal karyotype. Most frequent pathological findings included trisomy 8 (either alone or within a complex karyotype) in five patients, aberrations of chromosome 12 (translocation in two, monosomy in two, and trisomy in one patient), and aberrations of chromosome 20 (interstitial deletion in two, monosomy in two, and trisomy in one patient). We also detected aberrations of chromosome 13 (translocation in two and an interstitial deletion and trisomy in one patient each) and chromosome 18 (derivative 18 in two patients and a monosomy and deletion in one patient each). Three patients exhibited complex aberrations involving several chromosomes, sometimes with a mosaicisam. A near-tetraploid karyotype was observed in a single patient. Balanced translocations [t(2;16)(q31;q24), t(5;13)(q13;q32), t(12;13)(p12;q13), and t(12;16)(q24;q24)] were present in four patients. While the series of patients studied displayed chromosomal aberrations that are frequently observed in AMM, we found some new abnormalities (balanced translocations and polyploidy) that are rarely observed in AMM.
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Affiliation(s)
- Vesna Djordjevic
- Institute of Hematology, Clinical Center of Serbia, Koste Todorovića 2, 11000 Belgrade, Serbia.
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Pekmezovic T, Suvajdzic Vukovic N, Kisic D, Grgurevic A, Bogdanovic A, Gotic M, Bakrac M, Brkic N. A case-control study of myelodysplastic syndromes in Belgrade (Serbia Montenegro). Ann Hematol 2006; 85:514-9. [PMID: PMID: 16691397 DOI: 10.1007/s00277-006-0128-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 04/06/2006] [Indexed: 10/24/2022]
Abstract
The objective of the study was to investigate factors related to the occurrence of myelodysplatic syndromes (MDS) in the population of Belgrade (Serbia Montenegro). The case-control study was conducted during the period 2000-2003. The study group consisted of 80 newly diagnosed MDS patients and 160 sex- and age-matched hospital controls with nonmalignant and noninfectious diseases. The disease categories in the control group were circulatory (51 patients, 32%), gastrointestinal (53 patients, 33%), and ophthalmological (56 patients, 35%) disorders. Conditional univariate and multivariate logistic regression analyses were applied. Multivariate analysis showed the following factors to be significantly related to MDS: exposure to chemicals (OR = 10.8, 95%CI 3.2-36.2, p = 0.0001), viral upper respiratory tract infections (twice a year or more, OR = 5.8, 95%CI 2.5-13.6, p = 0.0001), exposure to insecticides, pesticides and herbicides (OR = 5.2, 95%CI 1.8-15.1, p = 0.003), coffee (OR = 5.1, 95%CI 1.9-13.7, p = 0.001), and alcohol consumption (OR = 2.2, 95%CI 1.1-4.6, p = 0.033). The findings support the hypotheses that exposure to chemical agents, pesticides, insecticides, and herbicides, certain lifestyle factors (alcohol and coffee consumption), and frequent viral infections may be involved in the etiology of MDS, but these results should be confirmed by further investigations.
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Affiliation(s)
- Tatjana Pekmezovic
- Institute of Epidemiology, School of Medicine, University of Belgrade, Visegradska 26A, Belgrade 11000, Serbia Montenegro.
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Gojnic M, Fazlagic A, Likic I, Stefanovic A, Vidakovic S, Pervulov M, Petkovic S, Mostic T, Miljic P, Bogdanovic A. New approach of the treatment of von Willebrand’s disease during pregnancy. Arch Gynecol Obstet 2005; 273:35-8. [PMID: 16172853 DOI: 10.1007/s00404-005-0739-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
AIM The aim of the study was to analyze the effectiveness of the application of DDAVP (desmopressin) and Hemate P with cryoprecipitate pre- and postpartum in patients with von Willebrand disease. METHODS We monitored 32 patients with von Willebrand disease during the study period 1993-2003. DDAVP was applied in the 36th/37th week of gestation and cryoprecipitate and fresh frozen plasma were applied 1 day before and 3 days after delivery. DDAVP treatment continued for 4 weeks. Factor VIII (Hemate P) at the day of delivery RESULTS No complications occurred in the studied population. CONCLUSION Precipitation of DDAVP, Hemate P, and cryoprecipitate may help in the treatment of pregnant women with von Willebrand disease.
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Affiliation(s)
- Miroslava Gojnic
- Medical Faculty Belgrade, Institute of Gynecology and Obstetrics, Clinical Center of Serbia, University of Belgrade, 38 Milesevska Street, 11000, Belgrade, Serbia and Montenegro.
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