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Al-Bkoor T, Ata F, Bint I Bilal A, Abdulgayoom M, Cherif H, Surchi H. Post-Thymectomy Autoimmune Flare-Up With New-Onset Type 1 Diabetes Mellitus. JCEM Case Rep 2024; 2:luae039. [PMID: 38524389 PMCID: PMC10958770 DOI: 10.1210/jcemcr/luae039] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Indexed: 03/26/2024]
Abstract
The thymus gland aids in the maturation of the immune system. An overactive or malfunctioning thymus gland, as seen in thymomas, can lead to disrupted immune systems. Thymectomy, the usual treatment, can paradoxically lead to further derangements in the immune system, leading to new autoimmune disorders. Most of these reported disorders are rheumatological. Except preclinical studies, there are no reported cases of autoimmune diabetes post-thymectomy. A 25-year-old woman who had malignant thymoma underwent chemotherapy, followed by thymectomy and radiotherapy. She developed autoimmune diabetes mellitus (AID) approximately 1 year post-thymectomy, evident from raised glycated hemoglobin, anti-glutamic acid decarboxylase (GAD) antibodies, ineffectiveness of oral glucose-lowering agents, and positive response to insulin. AID can occur after thymectomy, as evidenced by animal studies and this case report. Whether these patients would have long-term outcomes and control of diabetes differently than classic type 1 diabetes mellitus (T1D) is uncertain. Further research is needed to prove causality between thymectomy and diabetes.
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Affiliation(s)
- Tareq Al-Bkoor
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fateen Ata
- Department of Endocrinology and Metabolism, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Honar Cherif
- Department of Hematology, Hamad Medical Corporation, Doha, Qatar
| | - Haval Surchi
- Department of Endocrinology and Metabolism, Hamad Medical Corporation, Doha, Qatar
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Alfraih F, Absi A, Abuhaleeqa M, Alghamdi K, Alhuraiji A, Al‐Khabori M, Al‐Shaibani Z, Alzahrani M, Cherif H, Eldadah S, Hanbali A, Motabi IH, Salama H. Management of adult acute lymphoblastic leukemia in the Gulf Cooperation Council (GCC) countries: A consensus report from the GCC Adult ALL Working Group. Cancer Rep (Hoboken) 2024; 7:e1931. [PMID: 38083985 PMCID: PMC10849924 DOI: 10.1002/cnr2.1931] [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: 06/02/2023] [Revised: 10/22/2023] [Accepted: 11/05/2023] [Indexed: 02/12/2024] Open
Abstract
Leukemia burden is growing in the Gulf Council Cooperation (GCC) countries. Nonetheless, there is no unified protocol for managing adult acute lymphoblastic leukemia (ALL) patients in the GCC-countries. Therefore, the GCC Adult-ALL Treaters working group developed this consensus to address the adult-ALL treatment protocols in the GCC-countries and related toxicities' management. Besides, the consensus aimed to highlight the current unmet needs and treatment gaps and provide recommendations to optimize adult-ALL care and patient-centered communication. A three-step modified Delphi method to develop evidence-based recommendations through two-voting rounds and in-between virtual meetings are used in the manuscript development. A 12 experts' panel from five GCC-countries and two international experts were invited to participate in this consensus. This consensus consisted of 35-statements that highlighted the experts' recommendations to optimize ALL adults' care in the first line setting and manage pediatric or pediatric-inspired regimens-related toxicities. Besides, guidance was provided for future research direction and improve patient-centered communication. In conclusion, the adult-ALL management landscape is evolving, and the current evidence highlights better response and survival outcomes with pediatric or pediatric-inspired regiments. Therefore, protocols are needed to optimize the adult-ALL management in the GCC and tailored clinical-trials findings according to the GCC patients' characteristics and local-healthcare infrastructure.
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Affiliation(s)
- Feras Alfraih
- King Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
- Al Faisal UniversityRiyadhSaudi Arabia
| | - Ahmed Absi
- Princess Noorah Oncology CenterKing Abdulaziz Medical City, Ministry of National Guard Health AffairsJeddahSaudi Arabia
| | | | | | - Ahmad Alhuraiji
- Department of HematologyKuwait Cancer Control CenterKuwait CityKuwait
| | - Murtadha Al‐Khabori
- Department of Hematology, College of Medicine and Health SciencesSultan Qaboos UniversityMuscatOman
| | - Zeyad Al‐Shaibani
- King Faisal Specialist Hospital and Research CentreMadinahSaudi Arabia
| | - Musa Alzahrani
- Department of Medicine, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Honar Cherif
- National Center for Cancer Care and ResearchHamad Medical CooperationDohaQatar
| | - Saleem Eldadah
- Princess Noorah Oncology CenterKing Abdulaziz Medical City, Ministry of National Guard Health AffairsJeddahSaudi Arabia
| | - Amr Hanbali
- King Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | | | - Hind Salama
- King Abdulaziz‐Medical CityRiyadhSaudi Arabia
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Silfverberg T, Zjukovskaja C, Ljungman P, Nahimi A, Ahlstrand E, Dreimane A, Einarsdottir S, Fagius J, Iacobaeus E, Hägglund H, Lange N, Lenhoff S, Lycke J, Mellergård J, Piehl F, Svenningsson A, Tolf A, Cherif H, Carlson K, Burman J. Haematopoietic stem cell transplantation for treatment of relapsing-remitting multiple sclerosis in Sweden: an observational cohort study. J Neurol Neurosurg Psychiatry 2024; 95:125-133. [PMID: 37748927 PMCID: PMC10850659 DOI: 10.1136/jnnp-2023-331864] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND A growing evidence base supports the use of autologous haematopoietic stem cell transplantation (aHSCT) for treatment of relapsing-remitting multiple sclerosis (RRMS), but it has not yet been integrated into most national clinical guidelines. The objective of this study was to assess efficacy and safety when aHSCT is implemented in routine healthcare. METHODS We assessed 231 patients and the final analysis included 174 RRMS patients who were treated with aHSCT in Sweden before 1 January 2020. Efficacy was evaluated by performing a retrospective analysis of prospectively collected data from the Swedish MS registry. Procedure-related safety was assessed by analysing data from electronic patient records covering a period of 100 days following aHSCT. RESULTS With a median follow-up time of 5.5 (IQR: 3.4-7.5) years, the Kaplan-Meier estimate for no evidence of disease activity was 73% (95% CI 66% to 81%) at 5 years and 65% (95% CI 57% to 75%) at 10 years. Out of the 149 patients with baseline disability, 80 (54%) improved, 55 (37%) were stable and 14 (9%) deteriorated. The mean number of adverse events per patient was 1.7 (±SD: 1.5) for grade 3 events and 0.06 (±SD: 0.3) for grade 4 events. Febrile neutropenia was the most common adverse event, affecting 68% of patients. There was no treatment-related mortality. CONCLUSIONS Treatment with aHSCT for RRMS is associated with freedom from disease activity in a majority of patients, with acceptable adverse events. This procedure should be considered a standard of care for patients with highly active RRMS.
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Affiliation(s)
- Thomas Silfverberg
- Medical Sciences, Uppsala universitet Medicinska och farmaceutiska vetenskapsomradet, Uppsala, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
| | | | - Per Ljungman
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Adjmal Nahimi
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics, Skåne University Hospital Lund, Lund, Sweden
| | - Erik Ahlstrand
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Arta Dreimane
- Department of Hematology, Linköping University Hospital, Linkoping, Sweden
| | - Sigrun Einarsdottir
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Hematology and Coagulation, Sahlgrenska Sjukhuset, Gothenburg, Sweden
| | - Jan Fagius
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Hägglund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Niclas Lange
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Stig Lenhoff
- Department of Hematology, Oncology & Radiophysics, Skåne University Hospital Lund, Lund, Sweden
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Johan Mellergård
- Department of Neurology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Stockholm, Sweden
- Department of Neurology, Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Stockholm, Sweden
| | - Andreas Tolf
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Honar Cherif
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Kristina Carlson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Joachim Burman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Alshemmari SH, A Siddiqui M, Pandita R, Osman HY, Cherif H, O'Brien S, Marashi M, Al Farsi K. Evidence-based Management of Chronic Lymphocytic Leukemia: Consensus Statements from the Gulf Region. Acta Haematol 2023:000531675. [PMID: 37751733 DOI: 10.1159/000531675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/16/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Despite recent advances in diagnosis, prognostication, and treatment options, chronic lymphocytic leukemia (CLL) is still a largely incurable disease. New concepts on diagnosis, staging, treatment, and follow-up on CLL have been incorporated throughout recent years. The lack of regional consensus guidelines has led to varying practices in the management of patients with CLL in the region. AIM This manuscript aims to reach a consensus among expert hematologists regarding the definitions, classifications, and related practices of CLL. The experts developed a set of statements utilizing their personal experience together with the current literature on CLL management. This consensus aims to provide guidance for healthcare professionals involved in the management of CLL and serves as a step in developing regional guidelines. METHODS Eight experts responded to 50 statements regarding the diagnosis, staging, treatment, and prognosis of CLL with three potential answering alternatives ranging between agree, disagree, and abstain. This consensus adopted a modified Delphi consensus methodology. A consensus was reached when at least 75% of the agreement to the answer were reached. This manuscript presents the scientific insights of the participating attendees, panel discussions, and the supporting literature review. RESULTS Of the 50 statements, a consensus was reached on almost all statements. Statements covered CLL-related topics, including diagnostic evaluation, staging, risk assessment, different patient profiles, prognostic evaluation, treatment decision, therapy sequences, response evaluation, complications, and CLL during the COVID-19 pandemic. DISCUSSION/CONCLUSION In recent years, CLL management has progressed significantly with many diagnostic tests and several novel treatments becoming available. This consensus gathers decades of consolidated principles, novel research, and promising prospects for the management of this disease.
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Lundblad K, Zjukovskaja C, Larsson A, Cherif H, Kultima K, Burman J. CSF Concentrations of CXCL13 and sCD27 Before and After Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200135. [PMID: 37311645 DOI: 10.1212/nxi.0000000000200135] [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] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/01/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES In the past decade, autologous hematopoietic stem cell transplantation (AHSCT) has emerged as a treatment for relapsing-remitting multiple sclerosis (RRMS). How this procedure affects biomarkers of B- and T-cell activation is currently unknown. The objective of this study was to investigate CXCL13 and sCD27 concentrations in CSF before and after AHSCT. METHODS This prospective cohort study was conducted at a specialized MS clinic in a university hospital. Patients with a diagnosis of RRMS, treated with AHSCT between January 1, 2011, and December 31, 2018, were evaluated for participation. Patients were included if CSF samples from baseline plus at least 1 follow-up were available on June 30, 2020. A control group of volunteers without neurologic disease was included as a reference. CSF concentrations of CXCL13 and sCD27 were measured with ELISA. RESULTS The study comprised 29 women and 16 men with RRMS, aged 19-46 years at baseline, and 15 women and 17 men, aged 18-48 years, in the control group. At baseline, patients had higher CXCL13 and sCD27 concentrations than controls, with a median (IQR) of 4 (4-19) vs 4 (4-4) pg/mL (p < 0.0001) for CXCL13 and 352 (118-530) vs 63 (63-63) pg/mL (p < 0.0001) for sCD27. After AHSCT, the CSF concentrations of CXCL13 were considerably lower at the first follow-up at 1 year than at baseline, with a median (IQR) of 4 (4-4) vs 4 (4-19) pg/mL (p < 0.0001), and then stable throughout follow-up. The CSF concentrations of sCD27 were also lower at 1 year than at baseline, with a median (IQR) of 143 (63-269) vs 354 (114-536) pg/mL (p < 0.0001). Thereafter, sCD27 concentrations continued to decrease and were lower at 2 years than at 1 year, with a median (IQR) of 120 (63-231) vs 183 (63-290) pg/mL (p = 0.017). DISCUSSION After AHSCT for RRMS, CSF concentrations of CXCL13 were rapidly normalized, whereas sCD27 decreased gradually over the course of 2 years. Thereafter, the concentrations remained stable throughout follow-up, indicating that AHSCT induced long-lasting biological changes.
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Affiliation(s)
- Katarina Lundblad
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden
| | | | - Anders Larsson
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden
| | - Honar Cherif
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden
| | - Kim Kultima
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden
| | - Joachim Burman
- From the Department of Medical Sciences, Neurology, Uppsala University, Sweden.
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6
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Ramos PM, Choi J, Campbell CD, Wang YA, Pallaud C, Dickinson M, Verma A, Mittelman M, Platzbecker U, Cherif H, Fenaux P. Next-generation sequencing of baseline genetic mutations and outcomes of eltrombopag and azacitidine therapy in patients with myelodysplastic syndromes and thrombocytopenia: Data from the SUPPORT clinical trial. EJHaem 2023; 4:876-881. [PMID: 37601870 PMCID: PMC10435669 DOI: 10.1002/jha2.694] [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] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 08/22/2023]
Abstract
Eltrombopag has been previously shown to be effective in reversing azacitidine-mediated thrombocytopenia. This was further investigated in the SUPPORT trial, a phase III study assessing the efficacy/safety of eltrombopag plus azacitidine in patients with intermediate- to high-risk myelodysplastic syndromes and thrombocytopenia. The results did not support a clinical benefit for the addition of eltrombopag to azacitidine. We investigated if the somatic mutational profiles in the patient cohort were associated with treatment outcomes. Based on the available data, we observed no imbalance in the mutational profiles between treatment arms or a clear association between identified somatic mutations and clinical outcomes.
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Affiliation(s)
| | - Jeea Choi
- Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
| | | | - Ying A. Wang
- Novartis Global Drug DevelopmentCambridgeMassachusettsUSA
- Present address:
Bayer Pharmaceuticals CorporationCambridgeMAUSA
| | | | - Michael Dickinson
- The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneAustralia
| | - Amit Verma
- Division of Medical OncologyDepartment of MedicineAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | - Moshe Mittelman
- Tel Aviv Sourasky Medical CenterTel Aviv UniversityTel AvivIsrael
| | - Uwe Platzbecker
- Medical Clinical and PoliclinicHematology and Cellular TherapyUniversity Hospital LeipzigLeipzigGermany
| | - Honar Cherif
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Pierre Fenaux
- Hôpital AvicenneAssistance Publique‐Hôpitaux de Paris/University Paris XIIIBobignyFrance
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7
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Maalej KM, Merhi M, Inchakalody VP, Mestiri S, Alam M, Maccalli C, Cherif H, Uddin S, Steinhoff M, Marincola FM, Dermime S. CAR-cell therapy in the era of solid tumor treatment: current challenges and emerging therapeutic advances. Mol Cancer 2023; 22:20. [PMID: 36717905 PMCID: PMC9885707 DOI: 10.1186/s12943-023-01723-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
In the last decade, Chimeric Antigen Receptor (CAR)-T cell therapy has emerged as a promising immunotherapeutic approach to fight cancers. This approach consists of genetically engineered immune cells expressing a surface receptor, called CAR, that specifically targets antigens expressed on the surface of tumor cells. In hematological malignancies like leukemias, myeloma, and non-Hodgkin B-cell lymphomas, adoptive CAR-T cell therapy has shown efficacy in treating chemotherapy refractory patients. However, the value of this therapy remains inconclusive in the context of solid tumors and is restrained by several obstacles including limited tumor trafficking and infiltration, the presence of an immunosuppressive tumor microenvironment, as well as adverse events associated with such therapy. Recently, CAR-Natural Killer (CAR-NK) and CAR-macrophages (CAR-M) were introduced as a complement/alternative to CAR-T cell therapy for solid tumors. CAR-NK cells could be a favorable substitute for CAR-T cells since they do not require HLA compatibility and have limited toxicity. Additionally, CAR-NK cells might be generated in large scale from several sources which would suggest them as promising off-the-shelf product. CAR-M immunotherapy with its capabilities of phagocytosis, tumor-antigen presentation, and broad tumor infiltration, is currently being investigated. Here, we discuss the emerging role of CAR-T, CAR-NK, and CAR-M cells in solid tumors. We also highlight the advantages and drawbacks of CAR-NK and CAR-M cells compared to CAR-T cells. Finally, we suggest prospective solutions such as potential combination therapies to enhance the efficacy of CAR-cells immunotherapy.
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Affiliation(s)
- Karama Makni Maalej
- grid.413548.f0000 0004 0571 546XTranslational Cancer Research Facility, National Center for Cancer Care and Research, Translational Research Institute, Hamad Medical Corporation, P.O. Box: 3050, Doha, Qatar
| | - Maysaloun Merhi
- grid.413548.f0000 0004 0571 546XTranslational Cancer Research Facility, National Center for Cancer Care and Research, Translational Research Institute, Hamad Medical Corporation, P.O. Box: 3050, Doha, Qatar
| | - Varghese P. Inchakalody
- grid.413548.f0000 0004 0571 546XTranslational Cancer Research Facility, National Center for Cancer Care and Research, Translational Research Institute, Hamad Medical Corporation, P.O. Box: 3050, Doha, Qatar
| | - Sarra Mestiri
- grid.413548.f0000 0004 0571 546XTranslational Cancer Research Facility, National Center for Cancer Care and Research, Translational Research Institute, Hamad Medical Corporation, P.O. Box: 3050, Doha, Qatar
| | - Majid Alam
- grid.413548.f0000 0004 0571 546XTranslational Research Institute, Academic Health System, Dermatology Institute, Hamad Medical Corporation, Doha, Qatar ,grid.413548.f0000 0004 0571 546XDepartment of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
| | - Cristina Maccalli
- grid.467063.00000 0004 0397 4222Laboratory of Immune and Biological Therapy, Research Department, Sidra Medicine, Doha, Qatar
| | - Honar Cherif
- grid.413548.f0000 0004 0571 546XDepartment of Hematology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Shahab Uddin
- grid.413548.f0000 0004 0571 546XTranslational Research Institute, Academic Health System, Dermatology Institute, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- grid.413548.f0000 0004 0571 546XTranslational Research Institute, Academic Health System, Dermatology Institute, Hamad Medical Corporation, Doha, Qatar ,grid.413548.f0000 0004 0571 546XDepartment of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar ,grid.416973.e0000 0004 0582 4340Department of Dermatology, Weill Cornell Medicine-Qatar, Doha, Qatar ,grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar ,grid.5386.8000000041936877XDepartment of Dermatology, Weill Cornell Medicine, New York, USA
| | - Francesco M. Marincola
- grid.418227.a0000 0004 0402 1634Global Head of Research, Kite Pharma, Santa Monica, California USA
| | - Said Dermime
- grid.413548.f0000 0004 0571 546XTranslational Cancer Research Facility, National Center for Cancer Care and Research, Translational Research Institute, Hamad Medical Corporation, P.O. Box: 3050, Doha, Qatar ,grid.452146.00000 0004 1789 3191College of Health and Life Sciences (CHLS), Hamad Bin Khalifa University, Doha, Qatar
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8
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Elamin NH, Rashid F, Afana MS, Cherif H, Yassin MA. Differentiation syndrome in patients with acute promyelocytic leukemia. Clin Case Rep 2023; 11:e6697. [PMID: 36721680 PMCID: PMC9880381 DOI: 10.1002/ccr3.6697] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/31/2022] [Accepted: 11/13/2022] [Indexed: 01/28/2023] Open
Abstract
A 48-year-old male diagnosed with acute promyelocytic leukemia (APL) started on all-trans-retinoic acid and arsenic trioxide, developed typical symptoms of differentiation syndrome, and improved dramatically on steroids. Hence, any APL patient started on chemotherapy, needs to be monitored closely for developing differentiation syndrome and to start steroid upon suspicion.
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Affiliation(s)
- Nusiba H. Elamin
- Department of Internal MedicineHamad General Hospital, Hamad Medical CorporationDohaQatar
| | - Farah Rashid
- Department of Internal MedicineHamad General Hospital, Hamad Medical CorporationDohaQatar
| | - Muhammad S. Afana
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care and ResearchHamad Medical CorporationDohaQatar
| | - Honar Cherif
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care and ResearchHamad Medical CorporationDohaQatar
| | - Mohamed A. Yassin
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care and ResearchHamad Medical CorporationDohaQatar
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9
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Mohamed S, Ibrahim F, Alasafar MN, Alshurafa A, Akiki S, Soliman D, Kohla S, Amer A, Qasim H, Cherif H. Recurrent sideroblastic anemia during pregnancy. Clin Case Rep 2023; 11:e6814. [PMID: 36644616 PMCID: PMC9834147 DOI: 10.1002/ccr3.6814] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 11/01/2022] [Accepted: 12/14/2022] [Indexed: 01/15/2023] Open
Abstract
Sideroblastic anemia is a heterogeneous group of disorders typified by the presence of ring sideroblasts in the bone marrow and has congenital and acquired types. Sideroblastic anemia is a rare event in pregnancy. We report a case of a 32-year-old female patient, gravida 4 para 3, 27th weeks pregnant, who presented to the emergency department complaining of palpitation and generalized weakness for 2 weeks. She was found to have severe normochromic normocytic anemia, with hemoglobin of 4.2 g/dl, and low reticulocytes count of 13 × 103/μl. She gave a history of recurrent anemia, which had only occurred during pregnancy. Her bone marrow aspirate showed many ring sideroblasts concluding the diagnosis of sideroblastic anemia (SA). Further investigation revealed a significantly low pyridoxine level (vitamin B6) of (8 nmol/L). The Hb level improved with vitamin B6 replacement, without any transfusion support.
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Affiliation(s)
- Shehab Mohamed
- Department of HematologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Firyal Ibrahim
- Department of Laboratory Medicine and PathologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | | | - Awni Alshurafa
- Department of HematologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Susanna Akiki
- Department of Laboratory Medicine and PathologyHamad Medical CorporationDohaQatar,Weill Cornell Medicine‐QatarDohaQatar
| | - Dina Soliman
- Department of Laboratory Medicine and PathologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Samah Kohla
- Department of Laboratory Medicine and PathologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Aliaa Amer
- Department of Laboratory Medicine and PathologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Hana Qasim
- Department of HematologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Honar Cherif
- Department of HematologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
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Yacoub A, Ayadi A, Ayed W, Ayari S, Chebbi S, Magroun I, Ben Afia L, Mersni M, Mechergui N, Brahim D, Ben Said H, Bahri G, Youssef I, Ladhari N, Mziou N, Grassa A, M'rad M, Khessairi N, Krir A, Chihaoui M, Mahjoub S, Bahlous A, Jridi M, Cherif Y, Derbal S, Chebbi D, Hentati O, Ben Dahmen F, Abdallah M, Hamdi I, Sahli F, Ouerdani Y, Mnekbi Y, Abaza H, Ajmi M, Guedria A, Randaline A, Ben Abid H, Gaddour N, Maatouk A, Zemni I, Gara A, Kacem M, Maatouk I, Ben Fredj M, Abroug H, Ben Nasrallah C, Dhouib W, Bouanene I, Sriha A, Mahmoudi M, Gharbi G, Khsiba A, Azouz M, Ben Mohamed A, Yakoubi M, Medhioub M, Hamzaoui L, Azouz M, Ben Attig Y, Hamdi S, Essid R, Ben Jemia E, Rezgui B, Boudaya MS, Hassine H, Dabbabi H, Fradi Y, Cherif D, Lassoued I, Yacoub H, Kchir H, Maamouri N, Khairi W, Ben Ammar H, Abaza H, Chelbi E, Merhaben S, Neffati W, Ajmi M, Tarchalla S, Boughzala S, Gazzeh M, Gara S, Labidi A, Touati H, Nefzi AM, Ben Mustpha N, Fekih M, Serghini M, Boubaker J, Zouiten L, Driss A, Meddeb N, Driss I, Walha S, Ben Said H, Bel Hadj Mabrouk E, Zaimi Y, Mensi A, Trad N, Ayadi S, Said Y, Mouelhi L, Dabbèche R, Belfkih H, Bani M, Moussa A, Souissi S, Trabelsi Werchfeni B, Chelly S, Ezzi O, Ammar A, Besbes M, Njah M, Mahjoub M, Ghali H, Neffati A, Bhiri S, Bannour R, Ayadi S, Khouya FE, Kamel A, Hariz E, Aidani S, Kefacha S, Ben Cheikh A, Said H, Dogui S, Atig A, Gara A, Ezzar S, Ben Fradj M, Bouanène I, M'kadmi H, Farhati M, Dakhli N, Nalouti K, Chanoufi MB, Abouda SH, Louati C, Zaaimi Y, Dabbeche R, Hermi A, Saadi A, Mokaddem S, Boussaffa H, Bellali M, Zaghbib S, Ayed H, Bouzouita A, Derouiche A, Allouche M, Chakroun M, Ben Slama R, Gannoun N, Kacem I, Tlili G, Kahloul M, Belhadj Chabbah N, Douma F, Bouhoula M, Chouchene A, Aloui A, Maoua M, Brahem A, Kalboussi H, El Maalel O, Chatti S, Jaidane M, Naija W, Mrizek N, Sellami I, Feki A, Hrairi A, Kotti N, Baklouti S, Jmal Hammami K, Masmoudi ML, Hajjaji M, Naaroura A, Ben Amar J, Ouertani H, Ben Moussa O, Zaibi H, Aouina H, Ben Jemaa S, Gassara Z, Ezzeddine M, Kallel MH, Fourati H, Akrout R, Kallel H, Ayari M, Chehaider A, Souli F, Abdelaali I, Ziedi H, Boughzala C, Haouari W, Chelli M, Soltani M, Trabelsi H, Sahli H, Hamdaoui R, Masmoudi Y, Halouani A, Triki A, Ben Amor A, Makni C, Eloillaf M, Riahi S, Tlili R, Jmal L, Belhaj Ammar L, Nsibi S, Jmal A, Boukhzar R, Somai M, Daoud F, Rachdi I, Ben Dhaou B, Aydi Z, Boussema F, Frikha H, Hammami R, Ben Cheikh S, Chourabi S, Bokri E, Elloumi D, Hasni N, Hamza S, Berriche O, Dalhoum M, Jamoussi H, Kallel L, Mtira A, Sghaier Z, Ghezal MA, Fitouri S, Rhimi S, Omri N, Rouiss S, Soua A, Ben Slimene D, Mjendel I, Ferchichi I, Zmerli R, Belhadj Mabrouk E, Debbeche R, Makhloufi M, Chouchane A, Sridi C, Chelly F, Gaddour A, Kacem I, Chatti S, Mrizak N, Elloumi H, Debbabi H, Ben Azouz S, Marouani R, Cheikh I, Ben Said M, Kallel M, Amdouni A, Rejaibi N, Aouadi L, Zaouche K, Khouya FE, Aidani S, Khefacha S, Jelleli N, Sakly A, Zakhama W, Binous MY, Ben Said H, Bouallegue E, Jemmali S, Abcha S, Wahab H, Hmida A, Mabrouk I, Mabrouk M, Elleuch M, Mrad M, Ben Safta N, Medhioub A, Ghanem M, Boughoula K, Ben Slimane B, Ben Abdallah H, Bouali R, Bizid S, Abdelli MN, Ben Nejma Y, Bellakhal S, Antit S, Bourguiba R, Zakhama L, Douggui MH, Bahloul E, Dhouib F, Turki H, Sabbah M, Baghdadi S, Trad D, Bellil N, Bibani N, Elloumi H, Gargouri D, Ben Said M, Hamdaoui R, Chokri R, Kacem M, Ben Rejeb M, Miladi A, Kooli J, Touati S, Trabelsi S, Klila M, Rejeb H, Kammoun H, Akrout I, Greb D, Ben Abdelghaffar H, Hassene H, Fekih L, Smadhi H, Megdiche MA, Ksouri J, Kasdalli H, Hayder A, Gattoussi M, Chérif L, Ben Saida F, Gueldich M, Ben Jemaa H, Dammak A, Frikha I, Saidani A, Ben Amar J, Aissi W, Chatti AB, Naceur I, Ben Achour T, Said F, Khanfir M, Lamloum M, Ben Ghorbel I, Houman M, Cherif T, Ben Mansour A, Daghfous H, Slim A, Ben Saad S, Tritar F, Naffeti W, Abdellatif J, Ben Fredj M, Selmi M, Kbir GH, Maatouk M, Jedidi L, Taamallah F, Ben Moussa M, Halouani L, Rejeb S, Khalffalah N, Ben Ammar J, Hedhli S, Azouz MM, Chatti S, Athimni Z, Bouhoula M, Elmaalel O, Mrizak N, Maalej M, Kammoun R, Gargouri F, Sallemi S, Haddar A, Masmoudi K, Oussaifi A, Sahli A, Bhouri M, Hmaissi R, Friha M, Cherif H, Baya C, Triki M, Yangui F, Charfi MR, Ben Hamida HY, Karoui S, Aouini F, Hajlaoui A, Jlassi H, Sabbah M, Fendri MN, Kammoun N, Fehri S, Nouagui H, Harzalli A, Snène H, Belakhal S, Ben Hassine L, Labbene I, Jouini M, Kalboussi S, Ayedi Y, Harizi C, Skhiri A, Fakhfakh R, Jelleli B, Belkahla A, Fejjeri M, Zeddini M, Mahjoub S, Nouira M, Frih N, Debiche S, Blibech H, Belhaj S, Mehiri N, Ben Salah N, Louzir B, Kooli J, Bahri R, Chaka A, Abdenneji S, Majdoub Fehri S, Hammadi J, Dorgham D, Hriz N, Kwas H, Issaoui N, Jaafoura S, Bellali H, Shimi M, Belhaj Mabrouk E, Sellami R, Ketata I, Medi W, Mahjoub M, Ben Yacoub S, Ben Chaabene A, Touil E, Ben Ayed H, Ben Miled S, El Zine E, Khouni H, Ben Kadhi S, Maatoug J, Boulma R, Rezgui R, Boudokhane M, Jomni T, Chamekh S, Aissa S, Touhiri E, Jlaiel N, Oueslati B, Maaroufi N, Aouadi S, Belkhir S, Daghfous H, Merhaben S, Dhaouadi N, Ounaes Y, Chaker K, Yaich S, Marrak M, Bibi M, Mrad Dali K, Sellami A, Nouira Y, Sellami S, Anane I, Trabelsi H, Ennaifer R, Benzarti Z, Bouchabou B, Hemdani N, Nakhli A, Cherif Y, Abdelkef M, Derbel K, Barkous B, Yahiaoui A, Sayhi A, Guezguez F, Rouatbi S, Racil H, Ksouri C, Znegui T, Maazaoui S, Touil A, Habibech S, Chaouech N, Ben Hmid O, Ismail S, Chouaieb H, Chatti M, Guediri N, Belhadj Mohamed M, Bennasrallah C, Bouzid Y, Zaouali F, Toumia M, El Khemiri N, El Khemiri A, Sfar H, Farhati S, Ben Chehida F, Yamoun R, Braham N, Hamdi Y, Ben Mansour A, Mtir M, Ayari M, Toumia M, Rouis S, Sakly H, Nakhli R, Ben Garouia H, Chebil D, Hannachi H, Merzougui L, Samet S, Hrairi A, Mnif I, Hentati O, Bouzgarrou L, Souissi D, Boujdaria R, Kadoussi R, Rejeb H, Ben Limem I, Ben Salah I, Greb D, Ben Abdelghaffar H, Smadhi H, Laatiri H, Manoubi SA, Gharbaoui M, Hmandi O, Zhioua M, Taboubi F, Hamza Y, Hannach W, Jaziri H, Gharbi R, Hammami A, Dahmani W, Ben Ameur W, Ksiaa M, Ben Slama A, Brahem A, Elleuch N, Jmaa A, Kort I, Jlass S, Benabderrahim S, Turki E, Belhaj A, Kebsi D, Ben Khelil M, Rmadi N, Gamaoun H, Alaya Youzbechi F, Brahim T, Boujnah S, Abid N, Gader N, Kalboussi S, Ben Sassi S, Loukil M, Ghrairi H, Ben Said N, Mrad O, Ferjaoui M, Hedhli L, Ben Kaab B, Berriche A, Charfi R, Mourali O, Smichi I, Bel Haj Kacem L, Ksentini M, Aloui R, Ferchichi L, Nasraoui H, Maoua M, Chérif F, Belil Y, Ayed MA, Alloulou Y, Belhadj S, Daghfous J, Mehiri N, Louzir B, Abbes A, Ghrab A, Chermiti A, Akacha A, Mejri O, Debbiche A, Yahiaoui C, Binous M, Tissaoui A, Mekni K, El Fekih C, Said MA, Chtioui S, Mestiri S, Smaoui H, Ben Hamida S, Haddar A, Mrizek N, Gares N, Zaibi A, Bouazizi N, Gallas S, Lachhab A, Belhadj M, Hadj Salem N, Garrouch A, Mezgar Z, Khrouf M, Abbassi H, Souissi D, Hamra I, Ben Mustapha N, Abessi I, Boubaker F, Bouchareb S, ElOmma Mrabet H, Touil I, Boussoffara L, Knani J, Boudawara N, Alaya W, Sfar MH, Fekih S, Snène H, Boudawara N, Gargouri I, Benzarti W, Knaz A, Abdelghani A, Aissa S, Hayouni A, Mejri I, Kacem M, Mhamdi S, Daboussi S, Aichaouia C, Moatemri Z, Chaachou A, Fsili R, Ben Ghezala H, Ben Jazia A, Brahmi N. 2022 TUNISIAN NATIONAL CONGRESS OF MEDICINE ABSTRACTS. Tunis Med 2023; 101:62-64. [PMID: 37682263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Indexed: 09/09/2023]
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Hamad A, Elazzazy S, Bujassoum S, Rasul K, Gaziev J, Cherif H, Al-Boloshi Z, Hanssens Y, Saleh A, Rasheed HA, Al-Badriyeh D, Babiker A, Hmaidan AA, Al-Hail M. Applying value-based strategies to accelerate access to novel cancer medications: guidance from the Oncology Health Economics Expert Panel in Qatar (Q-OHEP). BMC Health Serv Res 2023; 23:15. [PMID: 36609388 PMCID: PMC9816531 DOI: 10.1186/s12913-022-08981-5] [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: 06/24/2022] [Accepted: 12/16/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In line with global trends, cancer incidence and mortality may have decreased for specific types of cancer in Qatar. However, the cancer-related burden on patients, healthcare systems, and the economy is expected to expand; thus, cancer remains a significant public healthcare issue in Qatar. Qatar's free access to cancer care represents a considerable economic burden. Ensuring the best utilization of financial resources in the healthcare sector is important to provide unified and fair access to cancer care for all patients. Experts from the Qatar Oncology Health Economics Expert Panel (Q-OHEP) aimed to establish a consistent and robust base for evaluating oncology/hematology medications; involve patients' insights to accelerate access to cutting-edge medications; increase the value of cancer care; and reach a consensus for using cost-effective strategies and efficient methodologies in cancer treatment. METHODS The Q-OHEP convened on 30 November 2021 for a 3-hour meeting to discuss cancer management, therapeutics, and health economics in Qatar, focusing on four domains: (1) regulatory, (2) procurement, (3) treatment, and (4) patients. Discussions, guided by a moderator, focused on a list of suggested open-ended questions. RESULTS Some of the salient recommendations included the development of a formal, fast-track, preliminary approval pathway for drugs needed by patients with severe disease or in critical condition; and encouraging and promoting the conduct of local clinical trials and real-world observational studies using existing registry data. The Q-OHEP also recommended implementing a forecast system using treatment center data based on the supply/demand of formulary oncology drugs to detect treatment patterns, estimate needs, expedite procurement, and prevent shortages/delays. Furthermore, the panel discussed the needs to define value concerning cancer treatment in Qatar, implement value-based models for reimbursement decision-making such as health technology assessment and multiple-criteria decision analysis, and promote patient education and involvement/feedback in developing and implementing cancer management guidelines. CONCLUSION Herein, we summarize the first Q-OHEP consensus recommendations, which aim to provide a solid basis for evaluating, registering, and approving new cancer medications to accelerate patient access to novel cancer treatments in Qatar; promote/facilitate the adoption and collection of patient-reported outcomes; and implement value-based cancer care in Qatar.
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Affiliation(s)
- Anas Hamad
- grid.413548.f0000 0004 0571 546XPharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Shereen Elazzazy
- grid.413548.f0000 0004 0571 546XPharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Salha Bujassoum
- grid.466917.b0000 0004 0637 4417Medical Oncology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Kakil Rasul
- grid.466917.b0000 0004 0637 4417Medical Oncology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Javid Gaziev
- grid.413548.f0000 0004 0571 546XHematology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Honar Cherif
- grid.413548.f0000 0004 0571 546XHematology Department, National Center for Cancer Care & Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Zakiya Al-Boloshi
- grid.413548.f0000 0004 0571 546XDrug Supply Department, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Yolande Hanssens
- grid.413548.f0000 0004 0571 546XPharmacy Executive Office, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ayman Saleh
- grid.467063.00000 0004 0397 4222Division of Pediatric Hematology/Oncology, Sidra Medicine, PO Box 26999, Doha, Qatar
| | - Hadi Abu Rasheed
- Professional Development & Scientific Research Department, Qatar Cancer Society, PO Box 22944, Doha, Qatar
| | - Daoud Al-Badriyeh
- grid.412603.20000 0004 0634 1084College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Ahmed Babiker
- grid.498619.bRegistration & Drugs Pricing Section, Pharmacy & Drug Control Department, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Amid Abu Hmaidan
- grid.498619.bNational Cancer Program, Directorate of Policy, Ministry of Public Health, PO Box 42, Doha, Qatar
| | - Moza Al-Hail
- grid.413548.f0000 0004 0571 546XPharmacy Executive Office, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Alnajjar M, Mudawi D, Cherif H, Hashim SM, Zaqout A, Bougaila A, Jibril FI, Mohamed SF. Central catheter-related Gordonia bronchialis bacteremia in an immunocompromised patient: A case report, and literature review. IDCases 2023; 32:e01738. [PMID: 36938335 PMCID: PMC10014288 DOI: 10.1016/j.idcr.2023.e01738] [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: 01/28/2023] [Revised: 03/04/2023] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
Gordonia is a rarely reported organism causing central line-associated bloodstream infection (CLABSI). This article reports an acute myeloid leukemia (AML) case in which the patient developed febrile neutropenia and was later found to have Gordonia bronchialis (G. bronchialis) CLABSI. The patient received a two-week ceftriaxone regimen, based on susceptibility. The microbiologic diagnosis of this organism is considered challenging due to its resemblance with other organisms; however, more sophisticated methods of diagnosis (such as gene sequencing) can aid in differentiation.
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Affiliation(s)
- Mohammed Alnajjar
- Division of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
- Correspondence to: Division of Internal Medicine, Hamad Medical Corporation, 950 Al-Qawafel Street, Alsadd Area, Doha, Qatar.
| | - Deena Mudawi
- Division of Hematology, National Center for Cancer Care and Research (NCCCR), Doha, Qatar
| | - Honar Cherif
- Division of Hematology, National Center for Cancer Care and Research (NCCCR), Doha, Qatar
| | - Samar Mahmoud Hashim
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Zaqout
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | - Amina Bougaila
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Shehab Fareed Mohamed
- Division of Hematology, National Center for Cancer Care and Research (NCCCR), Doha, Qatar
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Zjukovskaja C, Larsson A, Cherif H, Kultima K, Burman J. Biomarkers of demyelination and axonal damage are decreased after autologous hematopoietic stem cell transplantation for multiple sclerosis. Mult Scler Relat Disord 2022; 68:104210. [PMID: 36257151 DOI: 10.1016/j.msard.2022.104210] [Citation(s) in RCA: 2] [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: 06/20/2022] [Revised: 09/13/2022] [Accepted: 10/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplantation (aHSCT) has seen increased use for relapsing-remitting multiple sclerosis (RRMS) in recent years. It is considered one of the most effective treatments for RRMS and has been associated with improvement in disability and prolonged remission. This suggests that the tissue-injuring disease process may have been altered by aHSCT. To assess whether this hypothesis is correct, we performed a study of three commonly used cerebrospinal fluid biomarkers of tissue damage. METHODS In this single center study, 63 patients treated with aHSCT at Uppsala University Hospital between January 1st 2012 and January 31st 2019 were screened for participation. A control group consisting of volunteers without neurologic disease were included as a reference. Cerebrospinal fluid concentrations of neurofilament light (NFL), myelin basic protein (MBP) and glial acidic fibrillary protein (GFAp) were determined using ELISA and a multiplex proteomics platform from Meso Scale Discovery. RESULTS Forty-three patients with a mean age of 31 and a median follow-up time of 3.9 years were included. Their median baseline expanded disability status scale (EDSS) score was 3.5 and the annualized relapse rate in the year preceding aHSCT was 1.6. At baseline the proportion of patients with values above the upper limit of normal was 67% for NFL, 63% for MBP and 16% for GFAp. At 5-year follow-up, the proportion of patients with values above the upper limit of normal was 12% for NFL, 12% for MBP and 25% for GFAp. The mean concentration of NFL decreased from 920 pg/mL at baseline to 270 pg/mL at 5-year follow-up (p < 0.001); MBP decreased from 1500 to 680 pg/mL (p < 0.001); whereas the mean concentration of GFAp was unchanged. CONCLUSION In a majority of patients, biomarkers of demyelination and axonal damage reached normal values within five years from treatment with aHSCT.
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Affiliation(s)
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala SE-751 85, Sweden
| | - Honar Cherif
- Department of Medical Sciences, Uppsala University, Uppsala SE-751 85, Sweden
| | - Kim Kultima
- Department of Medical Sciences, Uppsala University, Uppsala SE-751 85, Sweden
| | - Joachim Burman
- Department of Medical Sciences, Uppsala University, Uppsala SE-751 85, Sweden.
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Silfverberg T, Cherif H, Carlson K, Wahlin B. P1610: IMPACT OF COVID-19 ON PATIENTS TREATED WITH AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION - A RETROSPECTIVE COHORT STUDY. Hemasphere 2022. [PMCID: PMC9431100 DOI: 10.1097/01.hs9.0000849296.87853.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Silfverberg T, Wahlin B, Carlson K, Cherif H. Impact of COVID-19 on patients treated with autologous hematopoietic stem cell transplantation: A retrospective cohort study. Ups J Med Sci 2022; 127:8611. [PMID: 36120088 PMCID: PMC9447418 DOI: 10.48101/ujms.v127.8611] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/23/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe how coronavirus disease 2019 (COVID-19) affects patients with hematological malignancies treated with autologous hematopoietic stem cell transplantation (ASCT). METHODS This retrospective observational cohort study includes all patients with hematological malignancies treated with ASCT in Sweden from 1 January 2020 to 31 December 2020. Patients who subsequently tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) until 31 March 2021 were analyzed for morbidity, mortality, need for supportive care, and risk factors related to COVID-19. RESULTS This study identified 442 patients who underwent ASCT in Sweden in 2020, among whom 20 (4.5%) subsequently tested positive for COVID-19. The overall mortality was 15%, and the COVID-19-related mortality was 10% among the patients who contracted COVID-19. Six (35%) patients were hospitalized, of which four (24%) needed supplementary oxygen and two (12%) needed intensive care. The absolute risk of COVID-19-related mortality was 0.45%. CONCLUSIONS ASCT patients have a higher risk of severe outcome of COVID-19 compared to the normal population. However, the risks of death, inpatient care, oxygen therapy, and intensive care seem lower in this study compared to previous studies, possibly due to fewer mildly ill patients in other studies. The risk of contracting SARS-CoV-2 appears to be comparable to that in the general population. This study suggests that the COVID-19 pandemic is not a strong argument for refraining from ASCT in the case of hematological malignancy.
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Affiliation(s)
- Thomas Silfverberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Björn Wahlin
- Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Carlson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Honar Cherif
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Zhukovsky C, Sandgren S, Silfverberg T, Einarsdottir S, Tolf A, Landtblom AM, Novakova L, Axelsson M, Malmestrom C, Cherif H, Carlson K, Lycke J, Burman J. Autologous haematopoietic stem cell transplantation compared with alemtuzumab for relapsing-remitting multiple sclerosis: an observational study. J Neurol Neurosurg Psychiatry 2021; 92:189-194. [PMID: 33106366 PMCID: PMC7841472 DOI: 10.1136/jnnp-2020-323992] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare outcomes after treatment with autologous haematopoietic stem cell transplantation (AHSCT) and alemtuzumab (ALZ) in patients with relapsing-remitting multiple sclerosis. METHODS Patients treated with AHSCT (n=69) received a conditioning regimen of cyclophosphamide (200 mg/kg) and rabbit anti-thymocyte globulinerG (6.0 mg/kg). Patients treated with ALZ (n=75) received a dose of 60 mg over 5 days, a repeated dose of 36 mg over 3 days after 1 year and then as needed. Follow-up visits with assessment of the expanded disability status scale score, adverse events and MR investigations were made at least yearly. RESULTS The Kaplan-Meier estimates of the primary outcome measure 'no evidence of disease activity' was 88% for AHSCT and 37% for ALZ at 3 years, p<0.0001. The secondary endpoint of annualised relapse rate was 0.04 for AHSCT and 0.1 for ALZ, p=0.03. At last follow-up, the proportions of patients who improved, were stable or worsened were 57%/41%/1% (AHSCT) and 45%/43%/12% (ALZ), p=0.06 Adverse events grade three or higher were present in 48/69 patients treated with AHSCT and 0/75 treated with ALZ in the first 100 days after treatment initiation. The most common long-term adverse event was thyroid disease with Kaplan-Meier estimates at 3 years of 21% for AHSCT and 46% for ALZ, p=0.005. CONCLUSIONS In this observational cohort study, treatment with AHSCT was associated with a higher likelihood of maintaining 'no evidence of disease activity'. Adverse events were more frequent with AHSCT in the first 100 days, but thereafter more common in patients treated with ALZ.
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Affiliation(s)
| | - Sofia Sandgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Thomas Silfverberg
- Department of of Medical Sciences, Uppsala University, Uppsala, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Sigrun Einarsdottir
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Tolf
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Lenka Novakova
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Clas Malmestrom
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Honar Cherif
- Department of of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Kristina Carlson
- Department of of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Joachim Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Ekstrand C, Bahmanyar S, Cherif H, Kieler H, Linder M. Cancer risk in patients with primary immune thrombocytopenia - A Swedish nationwide register study. Cancer Epidemiol 2020; 69:101806. [PMID: 32947155 DOI: 10.1016/j.canep.2020.101806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/20/2020] [Revised: 08/04/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is an autoimmune disease treated with immunosuppressive agents, thrombopoietin receptor agonists, immunomodulation drugs and/or splenectomy. Patients with ITP have been found to have increased risk ofhematological malignancies. Studies investigating stomach/liver cancer are contradictory and the risk of developing other solid tumors is largely unknown. We aimed at estimating risk of overall and organ-specific cancers in patients with primary ITP. METHODS The study population was Swedish patients with at least one ITP diagnosis recorded in the National Patient Register and a 1:10 matched comparison cohort from the population. The study period covers 1997-2016. The Cancer Register and the Cause of Death Register provided data on malignancies and deaths, respectively. Primary ITP was identified using an established algorithm. We used time-split Cox models to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs), adjusted for age, sex, index-year, county, income, education, Charlson score and number of in- and outpatient contacts. RESULTS In total 66,134 individuals were included in the study. Patients with ITP had higher risk of gastro-intestinal, skin (all morphologies), lymphoid and hematological cancers. Adjusted HR (95 % CI) for cancer was 1.37 (1.27-1.48), with highest risk during the first year, but with increased risk remaining for up to 20 years for men. For women, the overall risk was increased during the first year, HR (95 % CI) 2.00 (1.55-2.60). A significantly increased liver cancer risk was seen up to 9 years after diagnosis. CONCLUSION Patients with primary ITP have higher risk of cancer than the population. The observed increased risk does not seem to be solely due to surveillance bias, but might be associated with ITP or its treatments. Treating hematologists need to have high index of suspicion for cancer.
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Affiliation(s)
- Charlotta Ekstrand
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Honar Cherif
- Department of Medical Science Haematology, Uppsala University, Uppsala, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden; Department of Laboratory Medicine, Huddinge, Karolinska Institutet, Sweden
| | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Sweden.
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Cherif H, Dhahri B, Abderrahmani S, Ben Ammar J, Zaaibi H, Aouina H. Pneumothorax spontané : des complications du traitement aux traitements des complications. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.534] [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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Cherif H, Boudaya M, Dhahri B, Ben Safta Y, Daldoul S, Ben Moussa M. Coût des résections majeures pour cancer pulmonaire dans un centre public tunisien. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.456] [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: 11/16/2022]
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20
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Saidane A, Dhahri B, Cherif H, Aouina H. Profil clinique, thérapeutique et évolutif d’un pneumothorax spontané : à propos de 239 cas. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.535] [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: 10/27/2022]
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21
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Cherif H, Dhahri B, Saidane A, Abderrahmani S, Ben Ammar J, Zaibi H, Aouina H. Les variations saisonnières d’Incidence du pneumothorax spontané : à propos d’une étude menée dans un pays méditerranéen. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.333] [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: 10/27/2022]
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22
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Karlsson T, Cherif H. Mutations in the ENG, ACVRL1, and SMAD4 genes and clinical manifestations of hereditary haemorrhagic telangiectasia: experience from the Center for Osler's Disease, Uppsala University Hospital. Ups J Med Sci 2018; 123:153-157. [PMID: 30251589 PMCID: PMC6198721 DOI: 10.1080/03009734.2018.1483452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM The aim of this retrospective single-centre study was to evaluate whether mutations in the ENG, ACVRL1, and SMAD4 genes were associated with different phenotypes in hereditary haemorrhagic telangiectasia (HHT). METHODS The case records of 21 HHT patients with verified mutations in ENG, ACVRL1, or SMAD4 genes were reviewed. The numbers of HHT diagnostic criteria fulfilled for the three genotypes were compared, as was the prevalence of complications such as iron deficiency anaemia, gastrointestinal haemorrhage, stroke, and cerebral abscess. RESULTS Our results indicate that mutations in the ENG (HHT1), ACVRL1 (HHT2), and SMAD4 genes result in different HHT phenotypes. Epistaxis debuts earlier and may be more severe in HHT1 than in HHT2. The prevalence of pulmonary arteriovenous malformations (AVM) is higher in HHT type 1, whereas hepatic AVMs are more common in HHT2. One patient with mutations in both ENG and ACVRL1 genes was identified, as were two SMAD4-mutated patients suffering from the overlapping juvenile polyposis-HHT syndrome. Nearly one in five patients in our HHT population has been diagnosed with stroke or cerebral abscess, indicating a high prevalence of cerebral complications. CONCLUSION Our results showing that ENG and ACVRL1 gene mutations result in different HHT phenotypes confirm the results from other HHT centres worldwide. Cerebral complications of HHT are common, underscoring the importance of regular screening for pulmonary AVMs and early intervention against such AVMs. We have identified an HHT patient with simultaneous mutations in the ENG and ACVRL1 genes. Surprisingly, this patient has had a mild course of the disease.
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Affiliation(s)
- Torbjörn Karlsson
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
- Center for Osler’s Disease, Uppsala University Hospital, Uppsala, Sweden
- Department of Medicine, Västmanlands Hospital, Västerås, Sweden
- CONTACT Torbjörn Karlsson Department of Haematology, Uppsala University Hospital, 751 85Uppsala, Sweden
| | - Honar Cherif
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
- Center for Osler’s Disease, Uppsala University Hospital, Uppsala, Sweden
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Svensson T, Kättström M, Hammarlund Y, Roth D, Andersson PO, Svensson M, Nilsson I, Rombo L, Cherif H, Kimby E. Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group. Vaccine 2018; 36:3701-3707. [PMID: 29748028 DOI: 10.1016/j.vaccine.2018.05.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 11/10/2017] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
AIM To determine if patients with untreated chronic lymphocytic leukemia (CLL) benefit from vaccination with a 13-valent pneumococcal conjugated vaccine (PCV13), Prevenar13®, compared to a 23-valent pneumococcal polysaccharide vaccine (PPSV23), Pneumovax®, in terms of immune response. BACKGROUND Streptococcus pneumoniae causes substantial morbidity in patients with CLL, a group known to respond poorly to polysaccharide vaccines. Comparative studies with conjugated vaccines are lacking. METHODS 128 treatment naïve CLL patients from eight hematology clinics in Sweden were randomized to vaccination with PCV13 (n = 63) or PPSV23 (n = 65) after stratification by IgG level and CLL clinical stage (Rai). Blood samples for evaluation of immune response were obtained at baseline, and at one and six months after vaccination. Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay (OPA) and enzyme-linked immunosorbent assay (ELISA). RESULTS PCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination, measured as OPA geometric mean titers (GMTs). Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA, were higher than those elicited by PPSV23 in half of the common serotypes, both after one and six months. PPSV23 did not trigger a better immune response than PCV13 for any of the serotypes, regardless of analysis method or time point of analysis. Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration. Both vaccines were well tolerated. CONCLUSIONS In patients with previously untreated CLL, the efficacy of PCV13 in terms of immune response is superior to PPSV23 for most serotypes common for the two vaccines. We therefore propose that PCV13 should be included in vaccination programs against Streptococcus pneumoniae for CLL patients and administered as early as possible during the course of the disease.
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Affiliation(s)
- Tobias Svensson
- Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden.
| | - Magdalena Kättström
- Department of Medicine, Section of Hematology, Örebro University Hospital, Örebro, Sweden
| | | | - Daniel Roth
- Institution of Clinical Sciences, Faculty of Medicine, Lund University Hospital, Lund, Sweden
| | - P-O Andersson
- Department of Medicine, Section of Hematology, South Älvsborg Hospital, Borås, Sweden
| | - Magnus Svensson
- Department of Medicine, Eskilstuna Hospital, Eskilstuna, Sweden
| | - Ingmar Nilsson
- Department of Medicine, Karlstad Hospital, Karlstad, Sweden
| | - Lars Rombo
- Department of Medicine, Eskilstuna Hospital, Eskilstuna, Sweden
| | - Honar Cherif
- Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Eva Kimby
- Department of Medicine, Unit of Hematology, Karolinska Institute and Karolinska University Hospital, Huddinge, Sweden
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Berlin G, Cherif H, Knutson F, Mattsson J, Axdorph Nygell U. [Not Available]. Lakartidningen 2018; 115:E6CC. [PMID: 29634070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Gösta Berlin
- Universitetssjukhuset i Linkoping - Klinisk immunlogi och transfusionsmedicin Linkoping, Sweden Universitetssjukhuset i Linkoping - Klinisk immunlogi och transfusionsmedicin Linkoping, Sweden
| | - Honar Cherif
- Akademiska sjukhuset - Hematologiska kliniken Uppsala, Sweden Akademiska sjukhuset - Hematologiska kliniken Uppsala, Sweden
| | - Folke Knutson
- Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden
| | - Jonas Mattsson
- Karolinska Universitetssjukhuset - Centrum för allogen stamcellstransplantation Stockholm, Sweden Karolinska Universitetssjukhuset - Centrum för allogen stamcellstransplantation Stockholm, Sweden
| | - Ulla Axdorph Nygell
- Karolinska Universitetssjukhuset - Klinisk immunologi och transfusionsmedicin Stockholm, Sweden Karolinska Universitetssjukhuset - Klinisk immunologi och transfusionsmedicin Stockholm, Sweden
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25
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Berlin G, Cherif H, Knutson F, Mattsson J, Axdorph Nygell U. [Granulocyte transfusion – when and how should it be used?]. Lakartidningen 2018; 115:EXUU. [PMID: 29558012] [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: 06/08/2023]
Abstract
There are no randomized controlled trials proving the clinical benefit of granulocyte transfusions. However, clinical experience and a number of case studies suggest that granulocyte transfusions may be life-saving in certain situations. In our opinion granulocyte transfusions should be considered for patients with profound neutropenia and severe, life-threatening infection not responding to antibiotic or antifungal therapy. Since the clinical effect seems to be dose-dependent, the granulocyte concentrate should contain a large number of cells, which usually means that the donor should be mobilized with steroids and G-CSF. Regular blood donors as well as relatives to the patient can be used for granulocyte donations with apheresis technique after information of the process. Granulocyte transfusion should be given daily as long as the indication remains. The clinical efficacy of the transfusions should be evaluated daily.
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Affiliation(s)
- Gösta Berlin
- Universitetssjukhuset i Linkoping - Klinisk immunlogi och transfusionsmedicin Linkoping, Sweden Universitetssjukhuset i Linkoping - Klinisk immunlogi och transfusionsmedicin Linkoping, Sweden
| | - Honar Cherif
- Akademiska sjukhuset - Hematologiska kliniken Uppsala, Sweden Akademiska sjukhuset - Hematologiska kliniken Uppsala, Sweden
| | - Folke Knutson
- Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden
| | - Jonas Mattsson
- Karolinska Universitetssjukhuset - Centrum för allogen stamcellstransplantation Stockholm, Sweden Karolinska Universitetssjukhuset - Centrum för allogen stamcellstransplantation Stockholm, Sweden
| | - Ulla Axdorph Nygell
- Karolinska Universitetssjukhuset - Klinisk immunologi och transfusionsmedicin Stockholm, Sweden Karolinska Universitetssjukhuset - Klinisk immunologi och transfusionsmedicin Stockholm, Sweden
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Cherif H, Boudaya M, Haboureya C, Zaibi H, Ben Ammar J, Dhahri B, Aouina H. Les résections élargies pour cancer pulmonaire dans un centre public tunisien. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.479] [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: 10/18/2022]
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Cherif H, Dhahri B, Haboureya C, Ben Ammar J, Aouina H. Coût direct de prise en charge du pneumothorax spontané primitif dans un service de médecine dans un hôpital public. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.355] [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: 10/18/2022]
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28
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Cherif H, Ben Ammar J, Dhahri B, Zaibi H, Baccar M, Azzabi S, Aouina H. Prise en charge du pneumothorax : étiologies et adhésion aux recommandations internationales. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.357] [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: 10/18/2022]
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29
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Cherif H, Bacha S, Habibech S, Moussa I, Agerbi S, Racil H, Chabbou A, Chaouch N. Évènements osseux dans le cancer du poumon non à petites cellules avec métastases osseuses. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.483] [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: 11/27/2022]
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30
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Cherif H, Bacha S, Habibech S, Moussa I, Agerbi S, Racil H, Chabbou A, Chaouch N. Anémie chimio-induite au cours des cancers bronchopulmonaires non à petites cellules. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.484] [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: 11/27/2022]
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31
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Habouria C, Boudaya M, Cherif H, Zaibi H, Ben Ammar J, Dhahri B, Aouina H. Résultats de la chirurgie dans le traitement palliatif des pleurésies néoplasiques. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.340] [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: 10/18/2022]
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Löfling L, Linder M, Ekstrand C, Cherif H, Kieler H, Bahmanyar S. Pharmacological agents preceding a diagnosis of immune thrombocytopenia in adult patients developing the chronic form: A Swedish national register study. Thromb Res 2017; 160:27-31. [PMID: 29091809 DOI: 10.1016/j.thromres.2017.10.014] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/15/2017] [Accepted: 10/19/2017] [Indexed: 02/02/2023]
Abstract
Patients with primary chronic immune thrombocytopenia (cITP) have been reported to use more anti-infective medications, even before diagnosis of immune thrombocytopenia (ITP). The more common use of anti-infective medications may be due to general health problems, requiring medication in the early stages of cITP and before the diagnosis is set, rather than infections preceding the disease. Accordingly, cITP may not only be associated with use of anti-infective medications but also with medications for more general symptoms. OBJECTIVE To investigate use of medications for general symptoms, such as analgesics and vitamin supplements in patients with ITP developing the chronic form, the year preceding their first primary diagnosis in comparison with such use in the general population. METHOD Swedish Health Registers were used to identify adult patients (n=1087) with primary cITP during 2006-2012 and data on medications. Standardized Incidence Ratios (SIRs) and 95% confidence intervals (CI), were estimated as a measure of relative risk. RESULTS The association for overall studied medications was SIR=1.36 (95% CI 1.32-1.41). A majority of the point estimates were above unity. CONCLUSION In patients with cITP, prescription fills for medications used to treat pain conditions and vitamin deficiencies are more common in the year preceding their first diagnosis as compared with prescription fills in the general population. Our results suggest that patients later diagnosed with cITP receive treatment due to symptoms that could be signs of an early ITP. Accordingly, in investigations for unspecific pain symptoms and vitamin deficiencies, cITP should be considered as a differential diagnosis.
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Affiliation(s)
- Lukas Löfling
- Centre for Pharmacoepidemiology, Department of Medicine - Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine - Solna, Karolinska Institutet, Stockholm, Sweden
| | - Charlotta Ekstrand
- Centre for Pharmacoepidemiology, Department of Medicine - Solna, Karolinska Institutet, Stockholm, Sweden
| | - Honar Cherif
- Department of Medical Science, Haematology, Uppsala University, Uppsala, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine - Solna, Karolinska Institutet, Stockholm, Sweden
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Department of Medicine - Solna, Karolinska Institutet, Stockholm, Sweden
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Bacha S, Cherif H, Habibech S, Cheikhrouhou S, Racil H, Chaouech N, Ladab M, Chabbou A. Sarcoïdose avec arthrite chronique du genou et exposition à la silice : à propos d’un cas. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.273] [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: 11/30/2022]
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Svensson T, Lundström KL, Höglund M, Cherif H. Utility of bronchoalveolar lavage in diagnosing respiratory tract infections in patients with hematological malignancies: are invasive diagnostics still needed? Ups J Med Sci 2017; 122:56-60. [PMID: 27739337 PMCID: PMC5361433 DOI: 10.1080/03009734.2016.1237595] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients treated for hematological malignancies have an increased risk of serious infections. Diagnosis and prompt initiation of therapy are essential. Bronchoalveolar lavage (BAL) is a well-established investigation for identifying the cause of pulmonary infiltrates in immunocompromised patients. The aim of the study was to determine the diagnostic yield of BAL in patients treated for hematological malignancies and how often it contributed to a modification of the anti-infectious therapy. METHODS We reviewed records from 151 consecutive BAL procedures in 133 adult patients with hematological malignancies, treated at a tertiary hematology unit from 2004 to 2013. Extensive microbiological work-ups on BAL samples had been performed according to a standardized protocol. RESULTS A microbiological finding causing the infectious episode could be identified in 59 (39%) cases. In 44 (29%) of the cases, results from BAL had an impact on clinical management either by contributing to a specific diagnosis (25%) or by leading to cessation of ongoing microbiological therapy. The most common diagnoses were invasive pulmonary aspergillosis (IPA) and Pneumocystis jirovecii pneumonia (PJP). Diagnoses of IPA and PJP were based on results from BAL in 65% and 93% of cases, respectively. Several microbiological tests on BAL samples rendered no positive results. Complications were few and mainly mild. CONCLUSION BAL is still important for either verifying or excluding some of the most important respiratory tract pathogens in patients with hematological malignancies, particularly IPA and PJP. Standardized procedures for BAL sampling should be continually revised to exclude unnecessary microbiological tests.
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Affiliation(s)
- Tobias Svensson
- Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden
- CONTACT Tobias Svensson Department of Medical Sciences, Section of Hematology, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
| | | | - Martin Höglund
- Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Honar Cherif
- Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden
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Zaibi H, Maazaoui S, Dhahri B, Missaoui L, Cherif H, Ben Jemai E, Baccar M, Azzabi S, Ben Amar J, Aouina H. L’antibiothérapie au cours des exacerbations aiguës de DDB. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.624] [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: 11/30/2022]
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Bessam B, Menacer A, Boumehraz M, Cherif H. Detection of broken rotor bar faults in induction motor at low load using neural network. ISA Trans 2016; 64:241-246. [PMID: 27329853 DOI: 10.1016/j.isatra.2016.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 01/11/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
The knowledge of the broken rotor bars characteristic frequencies and amplitudes has a great importance for all related diagnostic methods. The monitoring of motor faults requires a high resolution spectrum to separate different frequency components. The Discrete Fourier Transform (DFT) has been widely used to achieve these requirements. However, at low slip this technique cannot give good results. As a solution for these problems, this paper proposes an efficient technique based on a neural network approach and Hilbert transform (HT) for broken rotor bar diagnosis in induction machines at low load. The Hilbert transform is used to extract the stator current envelope (SCE). Two features are selected from the (SCE) spectrum (the amplitude and frequency of the harmonic). These features will be used as input for neural network. The results obtained are astonishing and it is capable to detect the correct number of broken rotor bars under different load conditions.
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Affiliation(s)
- B Bessam
- LMSE Laboratory, Department of Electrical Engineering, University of Biskra, Algeria.
| | - A Menacer
- LGEB Laboratory, Department of Electrical Engineering, University of Biskra, Algeria.
| | - M Boumehraz
- LMSE Laboratory, Department of Electrical Engineering, University of Biskra, Algeria.
| | - H Cherif
- LGEB Laboratory, Department of Electrical Engineering, University El-Oued, Algeria.
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Ekstrand C, Linder M, Cherif H, Kieler H, Bahmanyar S. Increased susceptibility to infections before the diagnosis of immune thrombocytopenia. J Thromb Haemost 2016; 14:807-14. [PMID: 26792007 DOI: 10.1111/jth.13267] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 10/02/2015] [Accepted: 01/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infections after diagnosis of primary chronic immune thrombocytopenia (cITP) have mostly been connected to the immunomodulation treatment. Infections may trigger autoimmune diseases and may be a complication of an already impaired immune system. OBJECTIVES To investigate the association of cITP with infection before diagnosis. We also estimated the incidence of cITP based on the new definition by the International ITP Working Group. METHODS We identified 1087 adults with primary cITP between 2006 and 2012 using the Swedish Patient Register. Data on infections not already associated with secondary ITP were also retrieved from the register. The standardized incidence ratios (SIRs), using the rates from the general population, and 95% confidence intervals (CIs) were estimated as a measure of relative risk. We used data from the Prescribed Drug Register to estimate SIR for anti-infective treatment. RESULTS The incidence of cITP was 2.30 per 100 000 person-years (95% CI, 2.15-2.45). cITP was associated with an increased risk of serious infections requiring inpatient or outpatient care within 5 years before cITP diagnosis (SIR = 8.74; 95% CI, 7.47-10.18). Higher magnitude SIRs were observed for candidiasis, viral infection at an unspecified site and acute upper respiratory infections. For anti-infective drugs the SIR was 1.37 (1.25-1.50) and the highest SIRs were observed for amoxicillin, macrolides, nitrofurantoin and antivirals. CONCLUSION Patients with cITP have increased risks of infection and anti-infective treatments before their cITP diagnosis, with a more marked risk for candidiasis and viral infections. The findings indicate that infection is not only related to the immunomodulation treatment but also to the disease itself.
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Affiliation(s)
- C Ekstrand
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - M Linder
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - H Cherif
- Department of Medical Science Hematology, Uppsala Universitet, Uppsala, Sweden
| | - H Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - S Bahmanyar
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
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Karlsson T, Cherif H. Effect of Intravenous Iron Supplementation on Iron Stores in Non-Anemic Iron-Deficient Patients with Hereditary Hemorrhagic Telangiectasia. Hematol Rep 2016; 8:6348. [PMID: 27103980 PMCID: PMC4815949 DOI: 10.4081/hr.2016.6348] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/05/2016] [Accepted: 03/08/2016] [Indexed: 01/01/2023] Open
Abstract
In hereditary hemorrhagic telangiectasia (HHT), frequent episodes of nasal and gastrointestinal bleeding commonly lead to iron-deficiency with or without anemia. In the retrospective study presented here we assessed the iron stores, as determined by analysis of plasma ferritin, during oral and intravenous iron supplementation, respectively, in a population of iron-deficient non-anemic HHT patients who were inadequately iron-repleted by oral supplementation. A switch from oral to intravenous iron supplementation was associated with a significant increase in ferritin in this patient population.
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Affiliation(s)
- Torbjörn Karlsson
- Department of Hematology and Center for Osler's Disease, Uppsala University Hospital , Uppsala, Sweden
| | - Honar Cherif
- Department of Hematology and Center for Osler's Disease, Uppsala University Hospital , Uppsala, Sweden
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Bacha S, Khemiri M, Majdoub S, Chaouch N, Cherif H, Racil H, Cheikhrouhou S, Megdiche M, Chabbou A. Réactions paradoxales au traitement antituberculeux chez le sujet immunocompétent : cinq nouvelles observations. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.304] [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: 11/30/2022]
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Bacha S, Majdoub S, El Oueslati S, Khemiri M, Chaouch N, Cherif H, Racil H, Cheikhrouhou S, Megdiche M, Chabbou A. Chimiothérapies en fin de vie chez les patients pris en charge pour cancer pulmonaire : analyse des pratiques. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.180] [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: 11/24/2022]
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Bacha S, Khemiri M, Majdoub S, Chaouch N, Cherif H, Cheikhrouhou S, Racil H, Megdiche M, Chabbou A. Évaluation de l’association entre la dépendance tabagique et les symptômes de sevrage. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.624] [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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Bessam B, Menacer A, Boumehraz M, Cherif H. DWT and Hilbert Transform for Broken Rotor Bar Fault Diagnosis in Induction Machine at Low Load. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.egypro.2015.07.769] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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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Hafaied S, Hamdi B, Berraies A, Cherif H, Ammar J, Hamzaoui A. Localisations rares de tuberculose chez l’enfant : à propos de 8 cas. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.377] [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: 12/01/2022]
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Cherif H, Hamdi B, Berraies A, Hfaiedh S, Ammar J, Hamzaoui A. Profil étiologique des pleurésies séro-fibrineuses. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.282] [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: 10/24/2022]
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45
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Hafaied S, Berraies A, Hamdi B, Cherif H, Ammar J, Hamzaoui A. Dégression de la corticothérapie inhalée chez les enfants asthmatiques. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.11.033] [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: 10/24/2022]
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Cherif H, Karlsson T. Combination treatment with an erythropoiesis-stimulating agent and intravenous iron alleviates anaemia in patients with hereditary haemorrhagic telangiectasia. Ups J Med Sci 2014; 119:350-3. [PMID: 25188751 PMCID: PMC4248076 DOI: 10.3109/03009734.2014.955619] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with hereditary haemorrhagic telangiectasia (HHT) suffer from recurrent epistaxis and bleeding from gastrointestinal telangiectasias that occur despite otherwise normal haemostasis and result in iron deficiency anaemia with increasing severity. In advanced disease, anaemia may be severe, be irresponsive to iron supplementation, and may lead to red blood cell transfusion dependency. METHODS We conducted a retrospective study at our Centre for Osler's Disease to evaluate the effectiveness of adding an erythropoiesis-stimulating agent (ESA) to intravenous iron supplementation in the management of anaemic HHT patients. Blood values and treatment parameters were collected for nine months before combination therapy (iron supplementation only) and 12 months during combination therapy (iron supplementation plus ESA). RESULTS Four patients received intravenous iron and an ESA with mean weekly doses of 126 mg and 17,300 units (U), respectively. Mean haemoglobin improved significantly during combination therapy, from 106 g/L to 119 g/L (p < 0.001). CONCLUSION Anaemia can be alleviated in patients with HHT who are irresponsive to intravenous iron supplementation, by addition of an ESA. The proposed mechanism behind the iron irresponsiveness is that the anaemia is caused by a combination of recurrent haemorrhage and anaemia of chronic disease.
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Affiliation(s)
- Honar Cherif
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
- Centre for Osler’s Disease, Uppsala University Hospital, Uppsala, Sweden
| | - Torbjörn Karlsson
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
- Centre for Osler’s Disease, Uppsala University Hospital, Uppsala, Sweden
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Svensson T, Chowdhury O, Garelius H, Lorenz F, Saft L, Jacobsen SE, Hellström-Lindberg E, Cherif H. A pilot phase I dose finding safety study of the thrombopoietin-receptor agonist, eltrombopag, in patients with myelodysplastic syndrome treated with azacitidine. Eur J Haematol 2014; 93:439-45. [DOI: 10.1111/ejh.12383] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Tobias Svensson
- Department of Medical Sciences; Section of Hematology; Uppsala University Hospital; Uppsala Sweden
| | - Onima Chowdhury
- Haematopoietic Stem Cell Laboratory and MRC Molecular Haematology Unit; Weatherall Institute of Molecular Medicine; Oxford University; Oxford UK
| | - Hege Garelius
- Department of Medicine; Section of Hematology and Coagulation; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Fryderyk Lorenz
- Department of Hematology; Umeå University Hospital; Umeå Sweden
| | - Leonie Saft
- Department of Pathology; Division of Hematopathology; Karolinska University Hospital; Solna Sweden
| | - Sten-Eirik Jacobsen
- Haematopoietic Stem Cell Laboratory and MRC Molecular Haematology Unit; Weatherall Institute of Molecular Medicine; Oxford University; Oxford UK
| | - Eva Hellström-Lindberg
- Center for Hematology and Regenerative Medicine; Karolinska Institutet; Karolinska University Hospital; Huddinge Sweden
| | - Honar Cherif
- Department of Medical Sciences; Section of Hematology; Uppsala University Hospital; Uppsala Sweden
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Cherif H, Höglund M, Pauksens K. Adjuvanted influenza a (H1N1) 2009 vaccine in patients with hematological diseases: good safety and immunogenicity even in chemotherapy-treated patients. Eur J Haematol 2013; 90:413-9. [DOI: 10.1111/ejh.12094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Honar Cherif
- Department of Medical Sciences; Section of Hematology; Uppsala University Hospital; Uppsala; Sweden
| | - Martin Höglund
- Department of Medical Sciences; Section of Hematology; Uppsala University Hospital; Uppsala; Sweden
| | - Karlis Pauksens
- Department of Infectious Diseases; Uppsala University Hospital; Uppsala; Sweden
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Svensson T, Höglund M, Cherif H. Clinical significance of serum immunoglobulin G subclass deficiency in patients with chronic lymphocytic leukemia. ACTA ACUST UNITED AC 2013; 45:537-42. [PMID: 23427875 DOI: 10.3109/00365548.2013.769279] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) and hypogammaglobulinemia who suffer from recurrent infections can be offered prophylactic intravenous immunoglobulin (Ig) substitution. Our aim was to assess the prevalence of pure IgG subclass deficiency (with normal Ig levels), its correlation to risk of infection, and the clinical value of routine measurement of serum IgG subclass levels in patients with CLL. METHODS Serum levels of Ig and IgG subclasses were determined in patients with CLL at Uppsala University Hospital. Clinical data were collected through patient records and questionnaires. RESULTS Hypogammaglobulinemia occurred in 52.3% out of 111 patients. These patients did not have a higher annual risk of infection than patients without hypogammaglobulinemia (79.5% vs 79.1%, p = 0.706 for all infections; 13.4% vs 11.2%, p = 0.394 for severe infection; and 1.7% vs 3.4%, p = 0.083 for sepsis). Pure subclass deficiency was uncommon and occurred in 6 patients (5.4%). The annual overall risk of infection, of severe infection, and of sepsis for these patients did not differ as compared to patients with no hypogammaglobulinemia and no subclass deficiency (70.8% vs 80.7%, p = 0.334; 11.8% vs 11.1%, p = 0.497; and 8.9% vs 2.3%, p = 0.067, respectively). CONCLUSIONS Pure IgG subclass deficiency is rare in patients with CLL. In this heterogeneous cohort of patients, neither hypogammaglobulinemia nor pure IgG subclass deficiency were significant risk factors for infectious complications. Measurement of serum levels of Ig may be justified in patients with recurrent severe infections, but routine analysis of IgG subclass levels in patients with CLL is probably not warranted.
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Affiliation(s)
- Tobias Svensson
- Department of Medical Sciences, Section of Hematology, Uppsala University Hospital, Uppsala, Sweden.
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