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Kamperidis V, Vlachou M, Pappa Z, Pantelidou D, Karamitsos T, Papadopoulou D, Kartas A, Vlachaki E, Giannakoulas G, Karvounis H. Prediction of long-term survival in haemoglobinopathies: insights from cardiac imaging and ferritin. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.396] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims.The data on echocardiography, cardiac magnetic resonance (CMR) and ferritin predicting long-term survival in haemoglobinopathies are scarce. The current study evaluated the association of these parameters with the 10-years survival in haemoglobinopathies.
Methods.This prospective study included stable consecutive haemoglobinopathy patients .Demographics, ferritin, echocardiography and CMR parameters were prospectively collected.
Results. In total, 83 patients (mean age 38.4 ± 12.0 years, 46% male) with haemoglobinopathies were included and dichotomized based on their survival status after a follow-up of 9.8 ± 1.4 years. Patients who died were older (45.3 ± 11.6 vs 37.1 ± 11.7 years, p = 0.025), had higher ferritin levels (2498 vs 754 ng/ml, p = 0.001), higher right ventricular systolic pressure (RVSP) (41 ± 10 vs 31 ± 11mmHg, p = 0.001), more frequently elevated left ventricular (LV) end-diastolic pressure (70 vs 35%, p = 0.039) and lower CMR T2* values (23 ± 12 vs 35 ± 12ms, p = 0.007). Older age (HR: 1.053, p = 0.018), ferritin >2000ng/ml (HR: 3.517, p = 0.03), and >950ng/ml (HR: 11,135, p = 0.02), elevated LV end-diastolic pressure (HR: 3.977, p = 0.046), RVSP >34mmHg(HR: 10,134, p = 0.003), CMR T2* <20msec (HR: 4.900, p = 0.018) and <36msec (HR: 9.376, p = 0.035) were associated with increased all-cause mortality. A baseline model including age was created andit became more predictive of worse survival by adding RVSP >34mmHg than elevated LV end-diastolic pressure (C index 0.777 vs. 0.757 respectively) or ferritin >950ng/ml than >2000ng/ml (C index 0.805 vs. 0.770 respectively) or CMR T2*<36msec than <20msec (C index 0.825 vs. 0.810 respectively).
Conclusions. In haemoglobinopathy patients, RVSP >34mmHg, ferritin >2000ng/ml and CMR T2* <20ms were associated with worse long term survival.In the current era of advanced chelation therapy, aiming for ferritin <950ng/ml and CMR T2* >36ms appears to improve their prognosis.
Abstract Figure.
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Affiliation(s)
- V Kamperidis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - M Vlachou
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Z Pappa
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - D Pantelidou
- Ahepa General Hospital of Aristotle University, Thalassaemia Unit, Thessaloniki, Greece
| | - T Karamitsos
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - D Papadopoulou
- Ahepa General Hospital of Aristotle University, Thalassaemia Unit, Thessaloniki, Greece
| | - A Kartas
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - E Vlachaki
- Hippokration General Hospital of Thessloniki, Thalassaemia Unit, Thessaloniki, Greece
| | - G Giannakoulas
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - H Karvounis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
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Nemtsas P, Arnaoutoglou M, Perifanis V, Koutsouraki E, Spanos G, Arnaoutoglou N, Chalkia P, Pantelidou D, Orologas A. Polyneuropathy and myopathy in beta-thalassemia major patients. Ann Hematol 2018; 97:899-904. [PMID: 29427184 DOI: 10.1007/s00277-018-3251-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/23/2017] [Accepted: 01/18/2018] [Indexed: 12/17/2022]
Abstract
The thalassemias are the most common single gene disorder in the world. Nowadays, the average life expectancy of patients in developed countries has increased significantly, while, there was an increase of complications. We aimed to investigate peripheral neuropathy and myopathy in this patient group using a neurophysiological study. We performed nerve conduction studies and electromyography of upper and lower extremities on 36 beta-thalassemia major (β-thal) patients. The electrophysiological findings were correlated with demographic data and laboratory parameters of the disease. Patients with β-thal present polyneuropathy or myopathy at (50%). Polyneuropathy was detected in (38.9%) and myopathy in (27.8%), while polyneuropathy and myopathy were present at (16.7%) with an overlap of the diseases in 1/3 of the patients. There was not a statistically significant correlation of polyneuropathy and myopathy with age, sex, splenectomy, nor with respect to laboratory parameters, hemoglobin, and ferritin. However, there was a statistically significant correlation of polyneuropathy and myopathy with iron overload, as recorded by the magnetic resonance imaging (MRI) of the heart and the liver. Our findings suggest that iron overload plays a key role in the pathogenesis of polyneuropathy and myopathy in β-thal patients, and performing heart and liver MRI for the prediction of such lesions in an annual basis is warranted.
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Affiliation(s)
- P Nemtsas
- First Department of Neurology, University General Hospital of Thessaloniki AHEPA, St.Kiriakidis 1, P.O, 546 36, Thessaloniki, Greece.
| | - M Arnaoutoglou
- First Department of Neurology, University General Hospital of Thessaloniki AHEPA, St.Kiriakidis 1, P.O, 546 36, Thessaloniki, Greece
| | - V Perifanis
- First Propedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - E Koutsouraki
- First Department of Neurology, University General Hospital of Thessaloniki AHEPA, St.Kiriakidis 1, P.O, 546 36, Thessaloniki, Greece
| | - G Spanos
- Tomographia Diagnostic Center, Thessaloniki, Greece
| | - N Arnaoutoglou
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - P Chalkia
- Thalassemia Unit, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - D Pantelidou
- Thalassemia Unit, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Orologas
- First Department of Neurology, University General Hospital of Thessaloniki AHEPA, St.Kiriakidis 1, P.O, 546 36, Thessaloniki, Greece
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Diamantidis MD, Chatzileontiadou S, Pantelidou D, Papaioannou M. Prolonged complete remission in a primary MALT lymphoma of the lung after rituximab monotherapy. Hippokratia 2017; 21:108-110. [PMID: 30455566 PMCID: PMC6239084] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Primary pulmonary non-Hodgkin lymphoma (NHL) is a rare entity. Despite its favorable prognosis, an optimal treatment approach has not been established until today, as there are few debated heterogeneous data in the literature. Many therapeutic options such as surgery, radiotherapy, chemotherapy alone or in combination, immunotherapy and/or immunochemotherapy all with similar results, have been reported. CASE DESCRIPTION We report the case of a 68-year-old man diagnosed with a primary marginal zone B-cell pulmonary NHL, with a durable complete response to rituximab monotherapy. CONCLUSION We support the therapeutic application of rituximab monotherapy as an attractive option for this malignancy. This effective approach exhibits significant antitumor activity leading to long-term complete remission and minimal hematological toxicity in contrast to other intensive chemotherapies and/or radiotherapy, which might have serious side effects. HIPPOKRATIA 2017, 21(2): 108-110.
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Affiliation(s)
- M D Diamantidis
- Division of Hematology, 1 Department of Internal Medicine, Aristotle University of Thessaloniki (AUTH), AHEPA General Hospital, Thessaloniki, Greece
| | - S Chatzileontiadou
- Division of Hematology, 1 Department of Internal Medicine, Aristotle University of Thessaloniki (AUTH), AHEPA General Hospital, Thessaloniki, Greece
| | - D Pantelidou
- Division of Hematology, 1 Department of Internal Medicine, Aristotle University of Thessaloniki (AUTH), AHEPA General Hospital, Thessaloniki, Greece
| | - M Papaioannou
- Division of Hematology, 1 Department of Internal Medicine, Aristotle University of Thessaloniki (AUTH), AHEPA General Hospital, Thessaloniki, Greece
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Vadikolia CM, Tsatalas C, Anagnostopoulos K, Trypsianis G, Pantelidou D, Bazdiara I, Anastasiadis A, Spanoudakis E, Kotsianidis I, Margaritis D, Kortsaris A, Bourikas G. Proteolytic matrix metallopeptidases and inhibitors in BCR-ABL1-negative myeloproliferative neoplasms: correlation with JAK2 mutation status. Acta Haematol 2011; 126:54-62. [PMID: 21474922 DOI: 10.1159/000324436] [Citation(s) in RCA: 2] [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: 11/10/2010] [Accepted: 01/17/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) share the same acquired lesion JAK2(V617F) and may exhibit substantial overlap. Variability in JAK activation and allele burden, complemented by host, genetic and non-genetic modifiers, determine the phenotype. The aim of this study was to investigate the presence of the JAK2 mutation in association with the ratio of metallopeptidases inhibitors (TIMPs) to tissue metallopeptidases (MMPs) in MPNs, where inhibitory rather than proteolytic activity in marrow microenvironment appears to predominate. METHODS 94 patients with polycythemia vera, essential thrombocythemia and primary myelofibrosis, and 102 healthy individuals were evaluated. Allele-specific PCR and RFLP were used to detect JAK2 and genomic status. Serum concentrations of MMP and TIMP were measured by ELISA. The parameters were assessed with covariance analysis, and adjusted for gender, age and co-morbidity. RESULTS Mutation frequency was 81.91%. Abnormal TIMP/MMP ratios were identified in all three diseases. JAK2 mutation was correlated with significant changes in TIMP concentrations. CONCLUSIONS Identification of an abnormal TIMP/MMP ratio in all three diseases, regardless of the JAK2 status, indicates invariable marrow remodeling. In this particular group of patients, presence of a JAK2(V617F) mutation, being associated with even higher ratios, appears to be a concurring participant in bone marrow-reforming processes. Additional research may delineate correlates with the JAK2 allelic burden.
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Affiliation(s)
- C M Vadikolia
- Department of Hematology, Democritus University Medical School, Alexandroupolis, Greece
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Christoforidou A, Pantelidou D, Anastasiadis A, Goutzouvelidis A, Margaritis D, Kotsianidis I, Spanoudakis E, Kaloutsi V, Bourikas G, Tsatalas C. Hydroxyurea and anagrelide combination therapy in patients with chronic myeloproliferative diseases resistant or intolerant to monotherapy. Acta Haematol 2009; 120:195-8. [PMID: 19129692 DOI: 10.1159/000189381] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 11/05/2008] [Indexed: 11/19/2022]
Affiliation(s)
- A Christoforidou
- Department of Haematology, Democritus University of Thrace, Alexandroupolis, Greece.
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Spanoudakis E, Margaritis D, Kotsianidis I, Georgiou G, Tripsianis G, Anastasiadis A, Karakolios A, Pantelidou D, Panayiotidis P, Bourikas G, Tsatalas C. Long-term bone marrow cultures (LTBMC) from essential thrombocythemia (ET) patients with or without JAK2617V>F mutation. Leuk Res 2008; 32:1593-6. [DOI: 10.1016/j.leukres.2008.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 01/15/2008] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
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Symeonidis A, Kouraklis-Symeonidis A, Zikos P, Galanopoulos A, Psyllaki M, Aktypi A, Michalopoulou S, Michali E, Protopapa M, Pantelidou D, Papadaki E, Anagnostopoulos N, Zoumbos N. P140 Factors predicting for a favorable response among patients with myelodysplastic syndromes treated with erythropoietin ± G-CSF. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70210-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pantelidou D, Tsatalas C, Margaritis D, Anastasiadis AG, Kaloutsi V, Argyropoulou P, Prassopoulos P, Bourikas G. Successful treatment of lymph node extramedullary plasmacytoma with bortezomib. Ann Hematol 2006; 85:188-90. [PMID: 16397787 DOI: 10.1007/s00277-005-0052-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 11/12/2005] [Indexed: 12/28/2022]
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Pantelidou D, Tsatalas C, Margaritis D, Karayiannakis AJ, Kaloutsi V, Spanoudakis E, Katsilieris I, Chatzipaschalis E, Sivridis E, Bourikas G. Extramedullary plasmacytoma: report of two cases with uncommon presentation. Ann Hematol 2004; 84:188-91. [PMID: 15042315 DOI: 10.1007/s00277-004-0854-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/18/2003] [Accepted: 01/20/2004] [Indexed: 11/24/2022]
Abstract
Lymph node infiltration by monoclonal plasma cells can occur either in aggressive forms of myeloma or may represent regional extension of extramedullary plasmacytomas, whereas lymph node plasmacytoma presenting as a solitary extramedullary plasmacytoma is very unusual. We report two cases of lymph node plasmacytomas without systemic disease diagnosed after surgical excision. Clinical remission was achieved after local radiotherapy although one patient relapsed with multifocal extramedullary plasmacytomas 20 months after radiotherapy.
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Affiliation(s)
- D Pantelidou
- Hematology Department, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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