1
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Marcoux C, Saliba RM, Wallis W, Khazal S, Ragoonanan D, Rondon G, Tewari P, Popat U, Oran B, Olson A, Bashir Q, Qazilbash M, Alousi A, Hosing C, Nieto Y, Alatrash G, Marin D, Rezvani K, Khouri I, Srour S, Champlin R, Shpall E, Kebriaei P. Incidence and risk factors of early onset VOD/SOS differ in younger vs older adults after stem cell transplantation. Blood Adv 2024; 8:1128-1136. [PMID: 38266155 PMCID: PMC10909702 DOI: 10.1182/bloodadvances.2023011233] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024] Open
Abstract
ABSTRACT Veno-occlusive disease (VOD) is a rare but potentially life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-SCT). Although increasing awareness and modern transplant techniques have mitigated risk, the interaction of historic risk factors in the current era with posttransplant cyclophosphamide (PTCy) is unknown. We performed a retrospective single-center analysis of adult patients aged ≥18 years undergoing allo-SCT (N = 1561) using predominately PTCy as graft-versus-host disease (GVHD) prophylaxis (72%). We found a higher rate of VOD at 16.8% (20 of 119) in those aged ≤25 years compared with 3.8% (55 of 1442) in those aged >25 years, with unique predictors of VOD within each cohort. Multivariate classification and regression tree (CART) analysis confirmed age as the primary independent determinant of the rate of VOD. Among patients aged 18 to 25 years, disease risk index (DRI; 31% with high/very high DRI vs 12% low/intermediate DRI; P = .03) and prior lines of chemotherapy (24% with >1 vs 6% with ≤1; P = .03) were the strongest predictors of VOD. Incidence of VOD in patients aged >25 years of age consistently ranged between 3% and 5% across most risk factors evaluated, with only hepatic factors (baseline elevation of bilirubin, aspartate transferase, alanine aminotransferase) or gemtuzumab exposure associated with increased rates of VOD. There was no significant difference in rates of VOD in those receiving PTCy compared with those receiving alternate GVHD prophylaxis. Our data highlight the differences in incidence and predictors of VOD between younger (≤25) and older (>25) adults undergoing allo-SCT.
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Affiliation(s)
- Curtis Marcoux
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
- Division of Hematology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rima M. Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Whitney Wallis
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sajad Khazal
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
- Pediatric Hematology-Oncology, Loma Linda University, San Bernardino, CA
| | - Dristhi Ragoonanan
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priti Tewari
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amanda Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Muzaffar Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amin Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gheath Alatrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Issa Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
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2
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Maze D, Arcasoy MO, Henrie R, Cerquozzi S, Kamble R, Al-Hadidi S, Yacoub A, Singh AK, Elsawy M, Sirhan S, Smith E, Marcoux C, Viswabandya A, Daly A, Sibai H, McNamara C, Shi Y, Xu W, Lajkosz K, Foltz L, Gupta V. Upfront allogeneic transplantation versus JAK inhibitor therapy for patients with myelofibrosis: a North American collaborative study. Bone Marrow Transplant 2024; 59:196-202. [PMID: 37938736 PMCID: PMC10849956 DOI: 10.1038/s41409-023-02146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is the only curative therapy for myelofibrosis (MF) and is recommended for patients with higher risk disease. However, there is a risk of early mortality, and optimal timing is unknown. JAK inhibitor (JAKi) therapy may offer durable improvement in symptoms, splenomegaly and quality of life. The aim of this multicentre, retrospective observational study was to compare outcomes of patients aged 70 years or below with MF in chronic phase who received upfront JAKi therapy vs. upfront HCT in dynamic international prognostic scoring system (DIPSS)-stratified categories. For the whole study cohort, median overall survival (OS) was longer for patients who received a JAKi vs. upfront HCT, 69 (95% CI 57-89) vs. 42 (95% CI 20-not reached, NR) months, respectively (p = 0.01). In patients with intermediate-2 and high-risk disease, median OS was 55 (95% CI 36-73) months with JAKi vs. 36 (95% CI 20-NR) months for HCT (p = 0.27). An upfront HCT strategy was associated with early mortality and difference in median OS was not observed in any risk group by 5 years of follow-up. Within the limitations of a retrospective observational study, we did not observe any benefit of a universal upfront HCT approach for higher-risk MF.
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Affiliation(s)
- Dawn Maze
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Murat O Arcasoy
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ryan Henrie
- Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Sonia Cerquozzi
- Tom Baker Cancer Centre, Alberta Health Service Calgary Zone, University of Calgary, Calgary, AB, Canada
| | - Rammurti Kamble
- Center for Cell and Gene Therapy, Baylor College of Medicine and Houston Methodist Hospital, Houston, TX, USA
| | - Samer Al-Hadidi
- Myeloma Section, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abdulraheem Yacoub
- Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Anurag K Singh
- Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mahmoud Elsawy
- Division of Hematology, Dalhousie University, Halifax, NS, Canada
| | - Shireen Sirhan
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Elliot Smith
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Curtis Marcoux
- Division of Hematology, Dalhousie University, Halifax, NS, Canada
| | - Auro Viswabandya
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Andrew Daly
- Tom Baker Cancer Centre, Alberta Health Service Calgary Zone, University of Calgary, Calgary, AB, Canada
| | - Hassan Sibai
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Caroline McNamara
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Yuliang Shi
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lynda Foltz
- Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Vikas Gupta
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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3
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Maze D, Arcasoy MO, Henrie R, Cerquozzi S, Kamble R, Al-Hadidi S, Yacoub A, Singh AK, Elsawy M, Sirhan S, Smith E, Marcoux C, Viswabandya A, Daly A, Sibai H, McNamara C, Shi Y, Xu W, Lajkosz K, Foltz L, Gupta V. Correction: Upfront allogeneic transplantation versus JAK inhibitor therapy for patients with myelofibrosis: a North American collaborative study. Bone Marrow Transplant 2024; 59:295. [PMID: 38279008 PMCID: PMC10849954 DOI: 10.1038/s41409-023-02194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Affiliation(s)
- Dawn Maze
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Murat O Arcasoy
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ryan Henrie
- Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Sonia Cerquozzi
- Tom Baker Cancer Centre, Alberta Health Service Calgary Zone, University of Calgary, Calgary, AB, Canada
| | - Rammurti Kamble
- Center for Cell and Gene Therapy, Baylor College of Medicine and Houston Methodist Hospital, Houston, TX, USA
| | - Samer Al-Hadidi
- Myeloma Section, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abdulraheem Yacoub
- Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Anurag K Singh
- Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mahmoud Elsawy
- Division of Hematology, Dalhousie University, Halifax, NS, Canada
| | - Shireen Sirhan
- Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Elliot Smith
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Curtis Marcoux
- Division of Hematology, Dalhousie University, Halifax, NS, Canada
| | - Auro Viswabandya
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Andrew Daly
- Tom Baker Cancer Centre, Alberta Health Service Calgary Zone, University of Calgary, Calgary, AB, Canada
| | - Hassan Sibai
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Caroline McNamara
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Yuliang Shi
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lynda Foltz
- Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Vikas Gupta
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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4
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Pasvolsky O, Marcoux C, Milton DR, Tanner MR, Bashir Q, Srour S, Saini N, Lin P, Ramdial J, Nieto Y, Lee HC, Patel KK, Kebriaei P, Tewari P, Crawford-Suber L, Thomas SK, Weber DM, Orlowski RZ, Shpall EJ, Champlin RE, Qazilbash MH. Outcomes of young adults (aged ≤ 40 years) with newly diagnosed multiple myeloma after up-front autologous stem cell transplant. Br J Haematol 2023; 202:866-873. [PMID: 37376789 PMCID: PMC10527395 DOI: 10.1111/bjh.18944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Multiple myeloma (MM) primarily affects older patients. There are scarce data on the outcomes of young adults undergoing autologous transplantation (auto-HCT). In this single-centre analysis, we included 117 younger patients, with a median age of 37 years (range 22-40) at transplant. Seventeen (15%) patients had high-risk cytogenetics. Before transplant, 10% of patients achieved ≥CR and 44% achieved ≥VGPR. At best post-transplant response, 56% and 77% of patients achieved ≥CR and ≥VGPR respectively. With a median follow-up for survivors of 72.6 months (range 0.9-238.0), median PFS and OS were 43.1 months (95% CI 31.2-65.0) and 146.6 months (95% CI 100.0-208.1) respectively. Patients who underwent auto-HCT after 2010 had better median PFS (84.9 months vs. 28.2 months, p < 0.001) and OS (NR vs. 91.8 months, p < 0.001) compared with those transplanted earlier. In multi-variate analysis, achieving ≥CR as best post-transplant response was associated with improved PFS (HR [95% CI] 0.55 [0.32-0.95], p = 0.032), while achieving ≥VGPR was predictive of superior OS (0.32 [0.16-0.62], p < 0.001). Three patients (3%) developed a second primary malignancy. Younger MM patients had durable survival after auto-HCT, which further improved after the availability of novel anti-myeloma drugs in recent years. Depth of response following transplant remains a key predictor of survival.
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Affiliation(s)
- Oren Pasvolsky
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Curtis Marcoux
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Denái R. Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark R. Tanner
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeraj Saini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Lin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeremy Ramdial
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hans C. Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Krina K. Patel
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Priti Tewari
- Department of Pediatrics Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lindsay Crawford-Suber
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Sheeba K. Thomas
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donna M. Weber
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Z. Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth J. Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E. Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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5
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Mehta RS, Cao K, Saliba RM, Al-Atrash G, Alousi AM, Lontos K, Marcoux C, Carmazzi Y, Rondon G, Bashir Q, Hosing CM, Kebriaei P, Khouri I, Marin D, Nieto Y, Oran B, Popat UR, Qazilbash MH, Ramdial J, Rezvani K, Champlin RE, Shpall EJ. HLA Factors versus Non-HLA Factors for Haploidentical Donor Selection. Transplant Cell Ther 2023; 29:189-198. [PMID: 36470579 PMCID: PMC10125001 DOI: 10.1016/j.jtct.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
When multiple haploidentical donors are available for transplantation, those of younger generations are generally selected over those of older generations. However, it is unclear who is the optimal donor when selecting candidates from within a generation, such as father versus mother, son versus daughter, or brother versus sister. Although traditionally male donors are favored over female donors, particularly for male recipients, and significant associations of individual HLA mis(matches) on outcomes are being increasingly recognized, the hierarchy of factors for donor selection is indeterminate. To assess whether HLA factors take precedence over non-HLA factors and to isolate the influence of specific characteristics on outcomes, we analyzed 412 patients stratified by donor relationship: child donor (son [n = 202] versus daughter [n = 96]), parent (father [n = 28] versus mother [n = 29]), and sibling (noninherited maternal [NIMA; n = 29] versus paternal [NIPA; n = 28] mismatched). Among siblings, NIMA mismatch was associated with a lower risk of acute graft-versus-host disease (aGVHD); B-leader mismatch was associated with high nonrelapse mortality (NRM), poor progression-free survival, and a trend toward poor overall survival (OS), whereas A-mismatch was associated with lower aGVHD. Among parent donors, the relationship did not impact any outcome; B-leader mismatch was associated with higher NRM and a trend toward poor OS, whereas A-mismatch was associated with lower NRM and improved progression-free survival and OS. Among child donors, no individual HLA mismatch was predictive of any outcome, and daughter donors were not associated with any adverse outcomes in multivariate analyses. Our data suggest that certain HLA factors may be more significant in some cases and should be given priority over simply selecting a donor based on relationship/sex.
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Affiliation(s)
- Rohtesh S Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Kai Cao
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gheath Al-Atrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amin M Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Konstantinos Lontos
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Curtis Marcoux
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yudith Carmazzi
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chitra M Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issa Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeremy Ramdial
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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6
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Marcoux C, Marin D, Ramdial J, AlAtrash G, Alousi AM, Oran B, Kebriaei P, Popat UR, Rezvani K, Champlin RE, Shpall EJ, Mehta RS. Younger haploidentical donor versus older matched unrelated donor for patients with AML/MDS. Am J Hematol 2023; 98:712-719. [PMID: 36734029 DOI: 10.1002/ajh.26870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
Optimal donor selection is fundamental to successful allogeneic hematopoietic cell transplantation (HCT), and donor age influences survival after both matched unrelated donor (MUD) and haploidentical donor HCT. Though recent studies have shown similar outcomes between MUD and haploidentical HCT, it is unknown if outcomes differ following HCT with younger haploidentical donors compared to HCT with older MUDs. Therefore, we performed a retrospective analysis comparing outcomes of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) patients who underwent HCT with younger (≤35 years) haploidentical donors (n = 494) or older (>35 years) MUDs (n = 1005). Patients in the haploidentical and MUD groups received post-transplant cyclophosphamide (PTCy) and conventional graft-versus-host-disease (GVHD) prophylaxis, respectively. In multivariate analysis, use of younger haploidentical donors was associated with improved overall survival (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69-0.95, p = .01) and lower rates of grade II-IV acute GVHD (HR 0.64, 95% CI 0.53-0.77, p < .001), grade III-IV acute GVHD (HR 0.37, 95% CI 0.25-0.53, p < .001), and chronic GVHD (HR 0.49, 95% CI 0.40-0.60, p < .001). Relapse rates were similar among those who received myeloablative conditioning but were higher in patients of the younger haploidentical group who received reduced intensity conditioning (HR 1.49, 95%CI 1.18-1.88, p = .001). The younger haploidentical group had significantly lower non-relapse mortality ≥3 months post-HCT (HR 0.59, 95% CI 0.38-0.90, p = .02). Our data support the use of younger haploidentical donors with PTCy over older MUDs with conventional prophylaxis in patients with MDS or AML. Further studies on the importance of donor age in haploidentical and MUD HCT with PTCy prophylaxis are warranted.
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Affiliation(s)
- Curtis Marcoux
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeremy Ramdial
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gheath AlAtrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amin M Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rohtesh S Mehta
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Zhou S, AbdelWahab A, Horáček BM, MacInnis PJ, Warren JW, Davis JS, Elsokkari I, Lee DC, MacIntyre CJ, Parkash R, Gray CJ, Gardner MJ, Marcoux C, Choudhury R, Trayanova NA, Sapp JL. Prospective Assessment of an Automated Intraprocedural 12-Lead ECG-Based System for Localization of Early Left Ventricular Activation. Circ Arrhythm Electrophysiol 2020; 13:e008262. [PMID: 32538133 DOI: 10.1161/circep.119.008262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy. METHODS The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site. RESULTS In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm. CONCLUSIONS In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.
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Affiliation(s)
- Shijie Zhou
- Department of Biomedical Engineering (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Amir AbdelWahab
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - B Milan Horáček
- School of Biomedical Engineering (B.M.H.), Dalhousie University, Halifax, NS, Canada
| | - Paul J MacInnis
- Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada
| | - James W Warren
- Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada
| | - Jason S Davis
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ihab Elsokkari
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - David C Lee
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ciorsti J MacIntyre
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ratika Parkash
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Chris J Gray
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Martin J Gardner
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Curtis Marcoux
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Rajin Choudhury
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Natalia A Trayanova
- Department of Biomedical Engineering (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - John L Sapp
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.).,Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada.,Medicine (J.L.S.), Dalhousie University, Halifax, NS, Canada
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Pace D, Borgaonkar M, Evans B, Marcoux C, Lougheed M, Falk V, Hickey N, O'Leary M, McGrath J, Boone D. Annual colonoscopy volume and maintenance of competency for surgeons. Surg Endosc 2016; 31:2630-2635. [PMID: 27752813 DOI: 10.1007/s00464-016-5275-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/12/2016] [Accepted: 10/04/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION To determine whether the annual case volume of general surgeons (greater or less than 200 colonoscopies) is associated with quality outcomes. METHODS This retrospective cohort study involved all adults who underwent colonoscopy by a surgeon in the city of St. John's, NL, during the first 6 months of 2012. Subjects were identified through records from the health authority, and data were recorded on a standardized data sheet. Univariate analysis followed by stepwise multivariable logistic regression was performed to determine whether there was an association between quality outcomes (colonoscopy completion rate, adenoma detection rate) and predictors of these outcomes including annual colonoscopy volume, patient age, gender, indication for colonoscopy, and ASA score. A Chi-squared test was used to determine whether other outcomes were associated with annual colonoscopy volume. RESULTS Data were collected on 1060 patients. Mean age was 59.5 (sd 12.2) years with 550 females. A total of 13 surgeons were studied, of which 7 performed less than 200 annual colonoscopies over the previous 2 years (low-volume group) and 6 performed more than 200 annual colonoscopies over the previous 2 years (high-volume group). While there was a significant difference in the colonoscopy completion rate favoring the high-volume group (82.2 vs. 91.1 %, p < 0.001), no difference was noted in the adenoma detection rate between groups (16.7 vs. 17.7 %, p = 0.762). The regression model revealed that colonoscopy completion was also associated with an indication of screening or surveillance and an ASA score of 1 or 2. The adenoma detection rate was associated with older age and male gender. There was no statistically significant association between annual colonoscopy volume and other safety outcome measures. CONCLUSION Performing over 200 colonoscopies annually is associated with higher colonoscopy completion rates, but does not appear to be associated with other quality measures.
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Affiliation(s)
- David Pace
- Department of Surgery, Memorial University, St. John's, Canada.
- Department of Surgery, Health Sciences Center, St. John's, NL, A1B 3V6, Canada.
| | - Mark Borgaonkar
- Department of Medicine, Memorial University, St. John's, Canada
| | - Brad Evans
- Department of Surgery, Memorial University, St. John's, Canada
| | - Curtis Marcoux
- Department of Surgery, Memorial University, St. John's, Canada
| | - Muna Lougheed
- Department of Surgery, Memorial University, St. John's, Canada
| | - Vanessa Falk
- Department of Surgery, Memorial University, St. John's, Canada
| | - Nikita Hickey
- Department of Surgery, Memorial University, St. John's, Canada
| | - Meghan O'Leary
- Department of Surgery, Memorial University, St. John's, Canada
| | - Jerry McGrath
- Department of Medicine, Memorial University, St. John's, Canada
| | - Darrel Boone
- Department of Surgery, Memorial University, St. John's, Canada
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Pace D, Borgaonkar M, Hickey N, Evans B, Lougheed M, Marcoux C, McGrath J, Boone D, O’Leary M, Smith C. Does the hands-on, technical training of residents in colonoscopy affect quality outcomes? Surg Endosc 2015; 30:1352-5. [DOI: 10.1007/s00464-015-4397-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/27/2015] [Indexed: 01/28/2023]
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Bargatin I, Myers EB, Aldridge JS, Marcoux C, Brianceau P, Duraffourg L, Colinet E, Hentz S, Andreucci P, Roukes ML. Large-scale integration of nanoelectromechanical systems for gas sensing applications. Nano Lett 2012; 12:1269-74. [PMID: 22280452 PMCID: PMC3839335 DOI: 10.1021/nl2037479] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We have developed arrays of nanomechanical systems (NEMS) by large-scale integration, comprising thousands of individual nanoresonators with densities of up to 6 million NEMS per square centimeter. The individual NEMS devices are electrically coupled using a combined series-parallel configuration that is extremely robust with respect to lithographical defects and mechanical or electrostatic-discharge damage. Given the large number of connected nanoresonators, the arrays are able to handle extremely high input powers (>1 W per array, corresponding to <1 mW per nanoresonator) without excessive heating or deterioration of resonance response. We demonstrate the utility of integrated NEMS arrays as high-performance chemical vapor sensors, detecting a part-per-billion concentration of a chemical warfare simulant within only a 2 s exposure period.
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Affiliation(s)
- I Bargatin
- Kavli Nanoscience Institute and Department of Physics, Caltech, Pasadena, CA, USA
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Koumela A, Mercier D, Dupré C, Jourdan G, Marcoux C, Ollier E, Purcell ST, Duraffourg L. Piezoresistance of top-down suspended Si nanowires. Nanotechnology 2011; 22:395701. [PMID: 21891838 DOI: 10.1088/0957-4484/22/39/395701] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Measurements of the gauge factor of suspended, top-down silicon nanowires are presented. The nanowires are fabricated with a CMOS compatible process and with doping concentrations ranging from 2 × 10(20) down to 5 × 10(17) cm(-3). The extracted gauge factors are compared with results on identical non-suspended nanowires and with state-of-the-art results. An increase of the gauge factor after suspension is demonstrated. For the low doped nanowires a value of 235 is measured. Particular attention was paid throughout the experiments to distinguishing real resistance change due to strain modulation from resistance fluctuations due to charge trapping. Furthermore, a numerical model correlating surface charge density with the gauge factor is presented. Comparison of the simulations with experimental measurements shows the validity of this approach. These results contribute to a deeper understanding of the piezoresistive effect in Si nanowires.
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Affiliation(s)
- A Koumela
- CEA-Leti, MINATEC Campus, 17 rue des Martyrs, 38054 Grenoble Cedex 9, France
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Mile E, Jourdan G, Bargatin I, Labarthe S, Marcoux C, Andreucci P, Hentz S, Kharrat C, Colinet E, Duraffourg L. In-plane nanoelectromechanical resonators based on silicon nanowire piezoresistive detection. Nanotechnology 2010; 21:165504. [PMID: 20351411 DOI: 10.1088/0957-4484/21/16/165504] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report an actuation/detection scheme with a top-down nanoelectromechanical system (NEMS) for frequency shift based sensing applications with outstanding performance. It relies on electrostatic actuation and piezoresistive nanowire gauges for in-plane motion transduction. The process fabrication is fully CMOS (complementary metal-oxide-semiconductor) compatible. The results show a very large dynamic range of more than 100 dB and an unprecedented signal to background ratio of 69 dB providing an improvement of two orders of magnitude in the detection efficiency presented in the state of the art in NEMS fields. Such a dynamic range results from both negligible 1/f noise and very low Johnson noise compared to the thermomechanical noise. This simple low power detection scheme paves the way for new class of robust mass resonant sensors.
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Affiliation(s)
- E Mile
- CEA/LETI MINATEC, 17 rue des Martyrs, 38054 Grenoble Cedex 9, France
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Marcoux C, Tremblay M, Fredenrich A, Davignon J, Cohn JS. Lipoprotein distribution of apolipoprotein C-III and its relationship to the presence in plasma of triglyceride-rich remnant lipoproteins. Metabolism 2001; 50:112-9. [PMID: 11172484 DOI: 10.1053/meta.2001.19452] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [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: 11/11/2022]
Abstract
The distribution of apolipoprotein C-III (apoC-III) between high-density lipoprotein (HDL) and apoB-containing lipoproteins has been used in lipid-lowering angiographic trials to establish a link between impaired triglyceride (TG)-rich lipoprotein (TRL) metabolism and the progression of coronary artery disease. To investigate the extent to which plasma lipoprotein apoC-III levels reflect the presence in plasma of potentially atherogenic remnant lipoproteins, we studied 4 groups of subjects: (1) normolipidemic (NL, n = 10), (2) hypercholesterolemic (HC, type IIa, low-density lipoprotein cholesterol [LDL-C] > 3.4 mmol/L, n = 10), (3) hypertriglyceridemic (HTG, type IV, TG > 2.3 mmol/L, n = 10), and (4) combined hyperlipidemic (CHL, type IIb, TG > 2.3 mmol/L, LDL-C > 3.4 mmol/L, n = 10). The apoC-III level was measured in plasma lipoproteins separated either by density (ultracentrifugation) or by size (fast protein liquid chromatography [FPLC]), and was compared with 4 parameters reflecting remnant lipoprotein levels (ie, very-low-density lipoprotein cholesterol [VLDL-C], intermediate-density lipoprotein cholesterol [IDL-C], remnant-like particle cholesterol [RLP-C], and intermediate-sized lipoprotein [ISL] apoE). Our results demonstrate that (1) increased amounts of apoC-III associated with plasma VLDL, TRL, or apoB-containing lipoproteins (LpB), as well as increased levels of TRL remnant lipoproteins, are a characteristic of HTG patients rather than patients with increased LDL, and (2) plasma levels of apoC-III in VLDL, TRL, or LpB, as well as the HDL apoC-III to LpB apoC-III ratios, are strongly correlated with circulating levels of TRL, although these apoC-II parameters more closely reflect the balance between TRL TG production and lipolysis than the extent of plasma TRL remnant accumulation.
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Affiliation(s)
- C Marcoux
- Hyperlipidemia and Atherosclerosis Research Group, Clinical Research Institute of Montreal, Quebec, Canada
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Marcoux C, Hopkins PN, Wang T, Leary ET, Nakajima K, Davignon J, Cohn JS. Remnant-like particle cholesterol and triglyceride levels of hypertriglyceridemic patients in the fed and fasted state. J Lipid Res 2000; 41:1428-36. [PMID: 10974050] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Potentially atherogenic triglyceride-rich lipoprotein (TRL) remnants can be isolated and quantitated as remnant-like particles (RLP), using an immunoaffinity gel containing specific anti-human apolipoprotein A-I (apoA-I) and apoB-100 monoclonal antibodies. The aim of the present study was to determine the relationship between postprandial changes in RLP levels and changes in total serum triglyceride (TG) in patients with different forms of hypertriglyceridemia (HTG). Three groups of patients were selected, having similarly elevated serum TG levels: a) HTG with TRL remnant accumulation (i.e., type III patients, n = 15, TG: 3.8 +/- 0.2 mm), b) HTG with increased LDL (i.e., type IIb patients, n = 15, TG: 3.7 +/- 0.2 mm), and c) HTG without evidence of remnant or LDL accumulation (i.e., type IV patients, n = 15, TG: 3.9 +/- 0.3 mm). Ingestion of a 45-g fat meal caused a significant increase in serum TG (30;-50%) in all patients. Mean serum TG levels of the three groups were not significantly different at 4 or 6 h after the meal. RLP cholesterol (C) and TG levels increased after the meal in all patients, but these postprandial increases were also not significantly different among groups. Type III patients had significantly higher (P < 0.01) levels of RLP-C and RLP-apoE in the fasted and fed state, and also had significantly higher RLP-C-to-serum TG ratios (P < 0.001) compared with the other groups. These results indicate that 1) RLP-C and RLP-TG levels are significantly increased in the fed versus fasted state in patients with elevated fasting TG levels; 2) patients with different forms of HTG, but similar TG levels, have similar postprandial increases in RLP-C and RLP-TG; and 3) type III patients have significantly elevated levels of RLP-C and RLP-apoE in both the fed and fasted state.
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Affiliation(s)
- C Marcoux
- Hyperlipidemia and Atherosclerosis Research Group, Clinical Research Institute of Montreal, Quebec, Canada H2W 1R7
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Cohn JS, Marcoux C, Davignon J. Detection, quantification, and characterization of potentially atherogenic triglyceride-rich remnant lipoproteins. Arterioscler Thromb Vasc Biol 1999; 19:2474-86. [PMID: 10521378 DOI: 10.1161/01.atv.19.10.2474] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Triglyceride-rich lipoprotein (TRL) remnants are formed in the circulation when apolipoprotein (apo) B-48-containing chylomicrons of intestinal origin or apoB-100-containing VLDL of hepatic origin are converted by lipoprotein lipase, and to a lesser extent by hepatic lipase, into smaller and more dense particles. Compared with their nascent precursors, TRL remnants are depleted of triglyceride, phospholipid, and C apolipoproteins and are enriched in cholesteryl esters and apoE. They can thus be identified, separated, and/or quantified in plasma according to their density, charge, size, specific lipid components, apolipoprotein composition, and/or apolipoprotein immunospecificity. Each of these approaches has contributed to our current understanding of the compositional characteristics of TRL remnants and their potential to promote atherosclerosis. An ongoing search is nevertheless under way for more accurate and clinically applicable remnant lipoprotein assays that will be able to better define coronary artery disease risk in patients with hypertriglyceridemia.
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Affiliation(s)
- J S Cohn
- Hyperlipidemia and Atherosclerosis Research Group, Clinical Research Institute of Montreal, Montreal, Quebec, Canada.
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Marcoux C, Tremblay M, Nakajima K, Davignon J, Cohn JS. Characterization of remnant-like particles isolated by immunoaffinity gel from the plasma of type III and type IV hyperlipoproteinemic patients. J Lipid Res 1999; 40:636-47. [PMID: 10191287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Previous studies have investigated the potential atherogenicity and thrombogenicity of triglyceride-rich lipoprotein (TRL) remnants by isolating them from plasma within a remnant-like particle (RLP) fraction, using an immunoaffinity gel containing specific anti-apoB-100 and anti-apoA-I antibodies. In order to characterize lipoproteins in this RLP fraction and to determine to what extent their composition varies from one individual to another, we have used automated gel filtration chromatography to determine the size heterogeneity of RLP isolated from normolipidemic control subjects (n = 8), and from type III (n = 6) and type IV (n = 9) hyperlipoproteinemic patients, who by selection had similarly elevated levels of plasma triglyceride (406 +/- 43 and 397 +/- 35 mg/dl, respectively). Plasma RLP triglyceride, cholesterol, apoB, apoC-III, and apoE concentrations were elevated 2- to 6-fold (P < 0. 05) in hyperlipoproteinemic patients compared to controls. RLP fractions of type III patients were enriched in cholesterol and apoE compared to those of type IV patients, and RLP of type IV patients were enriched in triglyceride and apoC-III relative to those of normolipidemic subjects. In normolipidemic subjects, the majority of RLP had a size similar to LDL or HDL. The RLP of hyperlipoproteinemic patients were, however, larger and were similar in size to TRL, or were intermediate in size (i.e., ISL) between that of TRL and LDL. Compared to controls, ISL in the RLP fraction of type III patients were enriched in apoE relative to apoC-III, whereas in type IV patients they were enriched in apoC-III relative to apoE. These results demonstrate that: 1) RLP are heterogeneous in size and composition in both normolipidemic and hypertriglyceridemic subjects, and 2) the apoE and apoC-III composition of RLP is different in type III compared to type IV hyperlipoproteinemic patients.
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Affiliation(s)
- C Marcoux
- Hyperlipidemia and Atherosclerosis Research Group, Clinical Research Institute of Montreal, Montreal, Quebec, Canada, H2W 1R7
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Marcoux C, Tremblay M, Fredenrich A, Jacques H, Krimbou L, Nakajima K, Davignon J, Cohn JS. Plasma remnant-like particle lipid and apolipoprotein levels in normolipidemic and hyperlipidemic subjects. Atherosclerosis 1998; 139:161-71. [PMID: 9699904 DOI: 10.1016/s0021-9150(98)00042-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [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: 11/28/2022]
Abstract
Remnant-like particle (RLP) lipid and apolipoprotein (apo) levels were determined in the plasma of normolipidemic and hyperlipidemic subjects, in order to investigate the relationship between RLP levels and the concentration of other plasma lipoprotein parameters. Plasma RLP fractions were isolated with the use of an immunoaffinity gel (RLP-Cholesterol Jimro II, Japan Immunoresearch Lab.), containing specific anti-apoB-100 and anti-apoA-I antibodies. Four groups of human subjects were selected, who had either matching or significantly different levels of plasma triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C): (1) normolipidemic control (NC) subjects (n = 10), (2) patients with elevated levels of LDL-C (type IIa, LDL-C (mean +/- S.E.), 4.65 +/- 0.09 mmol/l, n = 10), (3) hypertriglyceridemic (HTG) patients with elevated LDL-C (type IIb, TG: 3.86 +/- 0.36; LDL-C: 4.67 +/- 0.21 mmol/l, n = 10), and (4) HTG patients with normal LDL-C (type IV, TG: 3.71 +/- 0.39 mmol/l, n = 10). NC subjects (RLP-C: 0.22 +/- 0.01; RLP-TG: 0.24 +/- 0.03 mmol/l) had RLP apoB, apoC-III and apoE levels of 3.2 +/- 0.3, 1.8 +/- 0.3, and 1.4 +/- 0.1 mg/dl, representing 3.2 +/- 0.4, 14.5 +/- 1.4 and 32.1 +/- 2.1% of total plasma levels, respectively. RLP lipid and apolipoprotein concentrations were significantly higher in HTG groups (type IIb and IV) compared to NTG groups (NC and type IIa) (e.g. RLP-C: 0.50 +/- 0.07 and 0.58 +/- 0.11 vs. 0.22 +/- 0.01 and 0.21 +/- 0.01 mmol/l, respectively (P < 0.01); RLP apoB: 8.4 +/- 1.6 and 8.2 +/- 0.9 vs. 3.2 +/- 0.3 and 3.4 +/- 0.2 mg/dl, respectively (P < 0.01)). No significant difference in RLP levels was observed between groups having different LDL levels, and thus no correlation existed between RLP-C and LDL-C levels (r = 0.24, n.s.). RLP-C and RLP apoB levels were, however, correlated with VLDL-C and VLDL apoB (r = 0.86, P < 0.001 and r = 0.70, P < 0.001, respectively). These results demonstrate that elevated levels of both RLP lipids and apolipoproteins are characteristic of patients with increased levels of plasma triglyceride, and not patients with increased levels of LDL.
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Affiliation(s)
- C Marcoux
- Hyperlipidemia and Atherosclerosis Research Group, Clinical Research Institute of Montreal, Quebec, Canada
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Marcoux C, Tremblay M, Jacques H, Fredenrich A, Nakajima K, Davignon J, Cohn J. 4.P.241 Plasma remnant-like particle (RLP) lipid and apolipoprotein levels in normolipidemic and hyperlipidemic subjects. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)89769-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Marcoux C, Lussier-Cacan S, Davignon J, Cohn JS. Association of Lp(a) rather than integrally-bound apo(a) with triglyceride-rich lipoproteins of human subjects. Biochim Biophys Acta 1997; 1346:261-74. [PMID: 9219911 DOI: 10.1016/s0005-2760(97)00049-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The majority of apolipoprotein (a) [apo(a)] in plasma is characteristically associated with Lipoprotein (a) [Lp(a)], having a buoyant density (1.05-1.08 g/ml) intermediate between low density lipoproteins (LDL) and high density lipoproteins (HDL). In the fed (postprandial) state or in the presence of fasting (endogenous) hypertriglyceridemia, a small proportion of plasma apo(a) is found in the density < 1.006 g/ml fraction of plasma, associated with larger and less dense triglyceride-rich lipoproteins (TRL). In order to further characterize the presence of apo(a) in ultracentrifugally-separated TRL (UTC-TRL), this lipoprotein fraction was isolated from plasma obtained in the fed state (three hours after an oral fat load) from healthy normolipidemic subjects (Lp(a): 38 +/- 8 mg/dl (mean +/- S.E.), n = 4) and also from plasma obtained after an overnight fast from hypertriglyceridemic patients (plasma TG: 8.16 +/- 2.00 mmol/l, Lp(a): 41 +/- 3 mg/dl, n = 18). Apo(a) in 3 h-postprandial UTC-TRL (5 +/- 2% of total plasma apo(a)) and in hypertriglyceridemic UTC-TRL (8 +/- 2% total apo(a)) was separable by electrophoresis and/or gel chromatography (FPLC) from the majority of UTC-TRL lipid. Apo(a) in UTC-TRL fractions had slow pre-beta electrophoretic mobility and was isolated in a lipoprotein size-range smaller than VLDL and larger than LDL, consistent with it being Lp(a). Recentrifugation of UTC-TRL resulted in the majority of apo(a) being recovered in the density > 1.006 g/ml fraction. Addition of proline to plasma samples before ultracentrifugation (final concentration: 0.1 M) substantially reduced the amount of Lp(a) in UTC-TRL. TRL separated from plasma by FPLC contained less apo(a) (2-5% of total plasma apo(a)), but this apo(a) was also readily dissociable from TRL lipid, had slow pre-beta electrophoretic mobility, and was associated with a lipoprotein with the size of Lp(a). Our data suggest that apo(a) in the TRL fraction of subjects with postprandial triglyceridemia or endogenous hypertriglyceridemia is not an integral component of plasma VLDL or chylomicrons, but represents the presence of non-covalently bound Lp(a).
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Affiliation(s)
- C Marcoux
- Hyperlipidemia and Atherosclerosis Research Group, Clinical Research Institute of Montreal, Quebec, Canada
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Des Rosiers C, Di Donato L, Comte B, Laplante A, Marcoux C, David F, Fernandez CA, Brunengraber H. Isotopomer analysis of citric acid cycle and gluconeogenesis in rat liver. Reversibility of isocitrate dehydrogenase and involvement of ATP-citrate lyase in gluconeogenesis. J Biol Chem 1995; 270:10027-36. [PMID: 7730304 DOI: 10.1074/jbc.270.17.10027] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We conducted an extensive mass isotopomer analysis of citric acid cycle and gluconeogenic metabolites isolated from livers of overnight fasted rats perfused with 4 mM glucose, 0.2 mM octanoate, 1 mM [U-13C3]lactate, and 0.2 mM [U-13C3]pyruvate, in the anterograde or retrograde mode. In both perfusion modes, two distinct isotopomer patterns were observed: (i) those of phosphoenolpyruvate, glucose, malate, and aspartate and (ii) those of citrate, alpha-ketoglutarate, glutamate, and glutamine. Key citric acid cycle parameters and, hence, rates of gluconeogenesis, calculated (Lee, W.-N.P. (1989) J. Biol. Chem. 264, 13002-13004 and Lee, W.-N.P. (1993) J. Biol. Chem. 268, 25522-25526) from our mass isotopomer data did not only vary, but lead to conclusions inconsistent with Lee's citric acid cycle model. Compared to lactate and pyruvate uptake, which sets an upper limit to glucose production, rates of gluconeogenesis calculated (i) with the phosphoenolpyruvate and citrate data were similar, but those calculated (ii) with the glutamate data amounted to only 60%, which is unlikely. All these conclusions are independent of the perfusion modes. We provide evidence that the following processes contribute to the observed labeling discrepancy: (i) the reversibility of the isocitrate dehydrogenase reaction and (ii) an active citrate cleavage pathway for the transfer of the oxaloacetate carbon skeleton from mitochondria to the cytosol. Also, a good fit of our labeling data was obtained with a model of citric acid cycle and gluconeogenesis which we developed to incorporate the above reactions (Fernandez, C.A., and Des Rosiers, C. (1995) J. Biol. Chem. 270, 10037-10042). The following conclusions can be drawn from the calculated reaction rates: (i) about half of the lactate conversion to glucose occurs via the citrate cleavage pathway, (ii) the flux through the reversal of the isocitrate dehydrogenase reaction is almost as fast as that through the citrate synthase reaction, and (iii) the flux through citrate synthase and alpha-ketoglutarate dehydrogenase is 1.6- and 3.2-fold that through pyruvate carboxylase, respectively.
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Affiliation(s)
- C Des Rosiers
- Department of Nutrition, University of Montréal, Québec, Canada
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Abstract
A 61-year-old man consulted for two long-standing ulcerations on the scalp and one on the nose, following an acute vascular disorder of the brain stem (Wallenberg's syndrome). The aetiology and pathogenesis of neurotrophic ulcers are briefly discussed.
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Affiliation(s)
- C Marcoux
- Department of Dermatology, Catholic University of Louvain, Brussels, Belgium
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Abstract
The ultrastructural aspects of nucleus and cytoplasm of tumor cells and the interstitial material of dermatofibrosarcoma protuberans are described in detail, especially the very peculiar labyrinthic nucleus. Opinions about its development are reviewed; some, such as melanocytic, neural, histiocytic and smooth muscle proliferation, might be discarded. The myofibroblast appears as the most probable stem cell.
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Affiliation(s)
- A Bourlond
- Department of Dermatology, Catholic University of Louvain, Belgium
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Marcoux C, Fisher S, Wong D. Central venous access devices in children. Pediatr Nurs 1990; 16:123-33. [PMID: 2359637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Central venous access devices are used with increasing frequency in children with chronic illnesses that require long-term parenteral treatment. Nurses are often responsible for taking care of the device and teaching the family home maintenance.
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Zizic TM, Lewis CG, Marcoux C, Hungerford DS. The predictive value of hemodynamic studies in preclinical ischemic necrosis of bone. J Rheumatol 1989; 16:1559-64. [PMID: 2625687] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study evaluated the predictive value of bone marrow pressures and intraosseous venography in joints at risk for developing ischemic necrosis of bone. Forty-two patients with ischemic necrosis of bone had hemodynamic studies performed on their contralateral, asymptomatic joint. A followup evaluation of symptoms and radiographs was obtained to establish the prevalence of clinical ischemic necrosis in the index joints. Thirty-six of 48 joints had increased bone marrow pressure and of these, 15 (42%) developed histologically or radiographically confirmed ischemic necrosis of bone. In none of the 12 bones with normal bone marrow pressure did ischemic necrosis of bone occur (p = 0.005). Venography was also significantly predictive for ischemic necrosis of bone, both alone and in conjunction with bone marrow pressure. Our study reaffirms the risk of developing bilateral ischemic necrosis of bone (31% at a mean followup of 47 months) once the diagnosis has been made on one side. Bone pressure measurements are of predictive value in establishing those joints which require close clinical followup so that detection of disease may be in the precollapse stage of ischemic necrosis of bone.
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Affiliation(s)
- T M Zizic
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
A case of Gottron’s syndrome or symmetrical progressive erythrokeratoderma is presented. Typical, symmetrical erythematosquamous lesions are limited to the limbs and face; the disease appeared at 4 months and stabilized at 3 years. The histological study discovers only nonspecific granular layer alterations.The ultrastructural investigation reveals an important intercellular edema and a moderate cytoplasmic vacuolization in the basal and prickle cell layer and in the stratum corneum; wandering lymphocytes are also observed. The association with neuropsychological and sensorial troubles as well as facial dysmorphy and kidney abnormalities is underlined.
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Abstract
One hundred sixty-nine patients with radiographic or histologic evidence of ischemic necrosis of bone (INB) were evaluated. Ninety-nine (59%) of the 169 patients had multiple sites of INB, with 310 bones affected. Two hundred sixty-three (85%) of the 310 ischemic bones were symptomatic. Routine radiography produced negative findings in 58 (20%) of the bones with histologically confirmed INB. Results of hemodynamic studies, including baseline bone marrow pressure, saline stress test, and/or intraosseous venography, were abnormal in 243 (94%) of 259 ischemic bones so evaluated. Most importantly, hemodynamic studies detected 51 (93%) of the 55 bones that were radiographically normal but had histologically confirmed INB.
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Abstract
In this prospective study, 28 (52 percent) of 54 patients with systemic lupus erythematosus (SLE) had ischemic necrosis of bone in 93 sites. All but two of the patients had multiple sites of involvement, with hips, knees, and shoulders affected in decreasing order of frequency. Demographic, clinical, and laboratory features were comparable in patients with and without ischemic necrosis of bone except for cushingoid changes in 24 (86 percent) of the 28 patients with ischemic necrosis of bone versus four (15 percent) of the 26 patients without ischemic necrosis of bone (p less than 0.0001). The duration of steroid therapy, total cumulative steroid dose, and the mean daily prednisone dose for the first one, three, six, and 12 months of therapy were not significantly different between the two groups. Mean daily prednisone dose for the highest single month as well as the highest consecutive three, six, and 12 months of therapy was significantly higher in patients with ischemic necrosis of bone. The mean daily dose of prednisone for the highest month of therapy was greater than 40 mg per day in 93 percent and greater than 20 mg per day in all patients with ischemic necrosis of bone. In patients with ischemic necrosis of bone, there was a statistically significant correlation between higher mean prednisone dose at all time intervals and increased number of bony sites involved. A lower mean dose of prednisone was required to produce ischemic necrosis of bone in patients with Raynaud's phenomenon.
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