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Hashmi SK, Powles RC, Ma D, Muhsen IN, Aljurf M, Niederwieser D, Weisdorf DJ, Koh MBC, Greinix H. Radiation hazards of the Ukraine nuclear power plants: how can international blood and marrow stem cell transplant societies help? Ann Hematol 2024; 103:1121-1129. [PMID: 37280449 DOI: 10.1007/s00277-023-05191-9] [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: 10/09/2022] [Accepted: 12/18/2022] [Indexed: 06/08/2023]
Abstract
Any conflict in countries that process nuclear power plants raises concerns of the potential radiation injuries to the people in that region and beyond such as the current conflict in Ukraine. International healthcare organizations and societies should prepare for the potential scenarios of nuclear incidents. The Worldwide Network for Blood and Marrow Transplantation (WBMT) and its members, have recent experience preparing for this type of events such as the Fukushima incident in 2011. In this article, we discuss the risks of radiation exposure, current guidelines, and scientific evidence on hematopoietic support, including the role of hematopoietic stem cell transplant (HCT) for those exposed to nuclear radiation, and the role that the WBMT and other global BMT societies can play in triaging and managing people suffering from radiation injuries.
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Affiliation(s)
- Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Medicine, Sheikh Shakbout Medical City, Abu Dhabi, UAE.
- College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, UAE.
| | - Ray C Powles
- Cancer Centre London, 49 Parkside, Wimbledon, London, SW19 5NB, UK
| | - David Ma
- Department of Haematology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Ibrahim N Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dietger Niederwieser
- University of Leipzig, Leipzig, Germany
- Aichi Medical University, Nagakute, Japan
| | - Daniel J Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Mickey B C Koh
- Infection and Immunity Clinical Academic Group, St George's University of London, London, UK
- Department of Haematology, St George's University Hospitals, London, UK
- Cell Therapy Programme, Health Sciences Authority, Outram, Singapore
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Muhsen IN, Hill LC, Ramos CA. Chimeric Antigen Receptor T Cells in Hodgkin and T-Cell Lymphomas. Hematol Oncol Clin North Am 2023; 37:1107-1124. [PMID: 37357070 PMCID: PMC10697615 DOI: 10.1016/j.hoc.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
The authors review the current use of chimeric antigen receptor (CAR)-transduced T cells (CAR-T) in Hodgkin lymphoma (HL) and T-cell lymphomas (TCL) and discuss the data on CD30-targeting CAR-T cells, which seem to be safe and effective in HL. In addition, the authors examine the use of CAR-T cells targeting CD30, CD5, or CD7 in TCL, while highlighting the unique challenges of their use in this subset of lymphomas. Furthermore, the authors present future directions and ongoing trials investigating the use of CAR-T cells in TCL and HL.
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Affiliation(s)
- Ibrahim N Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - LaQuisa C Hill
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Carlos A Ramos
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital and Houston Methodist Hospital, Houston, TX, USA; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
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Haque E, Muhsen IN, Rasheed W, Fakih RE, Aljurf M. Parasitic infections in hematopoietic stem cell transplant recipients. Transpl Infect Dis 2023; 25 Suppl 1:e14160. [PMID: 37793057 DOI: 10.1111/tid.14160] [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: 08/24/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Hematopoietic stem cell transplantation (HSCT) is a vital treatment for various hematological disorders. However, HSCT recipients face increased risks of infectious complications due to immunosuppression. Parasitic infections are a significant concern in this vulnerable population and can lead to substantial morbidity and mortality. This review examines parasitic infections in HSCT recipients, focusing on major infections affecting different organ systems, including intestinal parasites (Giardia spp., Entamoeba histolytica, and Cryptosporidium spp.), hematologic parasites (Plasmodium spp. and Babesia spp.), and tissue/visceral parasites (Toxoplasma gondii, Leishmania spp., and Trypanosoma cruzi). METHODS A systematic search of relevant literature was conducted and included studies up to August 2023. Databases included PubMed, Google Scholar, were queried using specific keywords related to parasitic infections in HSCT patients. The epidemiology, risk factors, clinical presentation, diagnostic methods, and treatment approaches for each infection were evaluated. RESULTS AND CONCLUSION Knowing the epidemiology, risk factors, and clinical presentations are crucial for timely intervention and successful management. By emphasizing early detection, effective therapies, and the unique challenges posed by each of these infections, this review highlights the importance of tailored strategies for HSCT recipients. Future research can further refine management protocols to enhance care and outcomes for these patients.
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Affiliation(s)
- Emaan Haque
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ibrahim N Muhsen
- Department of Medicine, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Walid Rasheed
- Department of Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Riad El Fakih
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Mushtaq AH, Shafqat A, Salah HT, Hashmi SK, Muhsen IN. Machine learning applications and challenges in graft-versus-host disease: a scoping review. Curr Opin Oncol 2023; 35:594-600. [PMID: 37820094 DOI: 10.1097/cco.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW This review delves into the potential of artificial intelligence (AI), particularly machine learning (ML), in enhancing graft-versus-host disease (GVHD) risk assessment, diagnosis, and personalized treatment. RECENT FINDINGS Recent studies have demonstrated the superiority of ML algorithms over traditional multivariate statistical models in donor selection for allogeneic hematopoietic stem cell transplantation. ML has recently enabled dynamic risk assessment by modeling time-series data, an upgrade from the static, "snapshot" assessment of patients that conventional statistical models and older ML algorithms offer. Regarding diagnosis, a deep learning model, a subset of ML, can accurately identify skin segments affected with chronic GVHD with satisfactory results. ML methods such as Q-learning and deep reinforcement learning have been utilized to develop adaptive treatment strategies (ATS) for the personalized prevention and treatment of acute and chronic GVHD. SUMMARY To capitalize on these promising advancements, there is a need for large-scale, multicenter collaborations to develop generalizable ML models. Furthermore, addressing pertinent issues such as the implementation of stringent ethical guidelines is crucial before the widespread introduction of AI into GVHD care.
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Affiliation(s)
- Ali Hassan Mushtaq
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Haneen T Salah
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, Sheikh Shakbout Medical City
- Medical Affairs, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ibrahim N Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Yang EH, Muhsen IN, Samarkandi H, El Fakih R, Aljurf M, Hanbali A. Role of Anti-CD38 Monoclonal Antibodies in the Treatment of Adult Immune Hematological Diseases. Hematol Oncol Stem Cell Ther 2023; 17:4-12. [PMID: 37581463 DOI: 10.56875/2589-0646.1108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 08/16/2023] Open
Abstract
Daratumumab is a first-in-class human anti-CD38 IgG1 monoclonal antibody approved for treating newly diagnosed and relapsed refractory multiple myeloma. Pre-clinical data supported daratumumab's ability to deplete autoantibodies producing plasma cells, B-cells, and NK cells. Those reports showed promising results on using daratumumab in autoimmune disorders that are refractory to multiple lines of therapies, which encouraged using daratumumab in various autoimmune conditions that are refractory to standard therapies. This review aims to summarize the literature reporting experience using anti-CD38 antibodies in hematological autoimmune diseases, focusing on the most common autoimmune hematological diseases, including autoimmune hemolytic anemia, immune thrombocytopenia, post-transplant cytopenia, and pure red blood cell aplasia.
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Affiliation(s)
- Erin H Yang
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ibrahim N Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hadeel Samarkandi
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Riad El Fakih
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amr Hanbali
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Gurnari C, Spadea M, Muratori R, Jimenez V, Radici V, Torrado S, Desai N, Ropero J, Muhsen IN, Ibrahimova A, Du Toit J, Hendricks CL, Gagelmann N, Horga C. Inequalities in the career pathway for paediatric HSCT and cellular therapy physicians. Lancet Haematol 2023; 10:e492-e494. [PMID: 37414023 DOI: 10.1016/s2352-3026(23)00180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Manuela Spadea
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy; Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Rafaella Muratori
- Pediatric Blood and Marrow Transplantation Division and Pele Pequeno Principe Research Institute, Hospital Pequeno Principe, Curitiba, Brazil
| | - Valentine Jimenez
- Hematology, Facultad de Medicina y Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Vera Radici
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Sheila Torrado
- Paediatric Haematopoietic Stem Cell Transplant Unit, Hospital Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Nihar Desai
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, India
| | - Julio Ropero
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ibrahim N Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Azada Ibrahimova
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Justin Du Toit
- Cellular and Immunotherapy Centre, Wits Donald Gordon Medical Centre, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice Laverne Hendricks
- Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; SAMRC Extramural Unit for Stem Cell Research and Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claire Horga
- Department of Paediatric Bone Marrow Transplant, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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Muhsen IN, Galeano S, Niederwieser D, Koh MBC, Ljungman P, Machado CM, Kharfan-Dabaja MA, de la Camara R, Kodera Y, Szer J, Rasheed W, Cesaro S, Hashmi SK, Seber A, Atsuta Y, Saleh MFM, Srivastava A, Styczynski J, Alrajhi A, Almaghrabi R, Abid MB, Chemaly RF, Gergis U, Brissot E, El Fakih R, Riches M, Mikulska M, Worel N, Weisdorf D, Greinix H, Cordonnier C, Aljurf M. Endemic or regionally limited bacterial and viral infections in haematopoietic stem-cell transplantation recipients: a Worldwide Network for Blood and Marrow Transplantation (WBMT) Review. The Lancet Haematology 2023; 10:e284-e294. [PMID: 36990623 DOI: 10.1016/s2352-3026(23)00032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/04/2022] [Accepted: 01/18/2023] [Indexed: 03/29/2023]
Abstract
Literature discussing endemic and regionally limited infections in recipients of haematopoietic stem-cell transplantation (HSCT) outside western Europe and North America is scarce. This Worldwide Network for Blood and Marrow Transplantation (WBMT) article is part one of two papers aiming to provide guidance to transplantation centres around the globe regarding infection prevention and treatment, and considerations for transplantation based on current evidence and expert opinion. These recommendations were initially formulated by a core writing team from the WBMT and subsequently underwent multiple revisions by infectious disease experts and HSCT experts. In this paper, we summarise the data and provide recommendations on several endemic and regionally limited viral and bacterial infections, many of which are listed by WHO as neglected tropical diseases, including Dengue, Zika, yellow fever, chikungunya, rabies, brucellosis, melioidosis, and leptospirosis.
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Muhsen IN, Galeano S, Niederwieser D, Koh MBC, Ljungman P, Machado CM, Kharfan-Dabaja MA, de la Camara R, Kodera Y, Szer J, Rasheed W, Cesaro S, Hashmi SK, Seber A, Atsuta Y, Saleh MFM, Srivastava A, Styczynski J, Alrajhi A, Almaghrabi R, Abid MB, Chemaly RF, Gergis U, Brissot E, El Fakih R, Riches M, Mikulska M, Worel N, Weisdorf D, Greinix H, Cordonnier C, Aljurf M. Endemic or regionally limited parasitic and fungal infections in haematopoietic stem-cell transplantation recipients: a Worldwide Network for Blood and Marrow Transplantation (WBMT) Review. The Lancet Haematology 2023; 10:e295-e305. [PMID: 36990624 DOI: 10.1016/s2352-3026(23)00031-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/17/2022] [Accepted: 01/18/2023] [Indexed: 03/29/2023]
Abstract
There is a scarcity of data on endemic and regionally limited fungal and parasitic infections in recipients of haematopoietic stem-cell transplantation (HSCT) outside western Europe and North America. This Worldwide Network for Blood and Marrow Transplantation (WBMT) Review is one of two papers aiming to provide guidance to transplantation centres worldwide regarding prevention, diagnosis, and treatment based on the currently available evidence and expert opinion. These recommendations were created and reviewed by physicians with expertise in HSCT or infectious disease, representing several infectious disease and HSCT groups and societies. In this paper, we review the literature on several endemic and regionally limited parasitic and fungal infections, some of which are listed as neglected tropical diseases by WHO, including visceral leishmaniasis, Chagas disease, strongyloidiasis, malaria, schistosomiasis, histoplasmosis, blastomycosis, and coccidioidomycosis.
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Affiliation(s)
- Ibrahim N Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Dietger Niederwieser
- Division of Hematology and Medical Oncology, University of Leipzig, Leipzig, Germany; Lithuanian University of Health Sciences Kauno Klinikos, Lithuania; Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mickey B C Koh
- Infection and Immunity Clinical Academic Group, University of London and Department of Haematology, St George's Hospital and Medical School, London, UK; Cell Therapy Facility, Blood Services Group, Health Sciences Authority, Singapore
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Karolinska Comprehensive Cancer Center, Stockholm, Sweden; Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clarisse M Machado
- Virology Laboratory Institute of Tropical Medicine-University of São Paulo Medical School, São Paulo, Brazil; HCT Program - Hospital Amaral Carvalho, Jahu, Brazil
| | | | | | - Yoshihisa Kodera
- Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Jeff Szer
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Walid Rasheed
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates; College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Adriana Seber
- Hospital Samaritano Higienópolis and Graacc - Unifesp, São Paulo, Brazil
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan; Department of Registry Science for Transplant and Cellular Therapy, Nagakute, Japan
| | - Mostafa F Mohammed Saleh
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alok Srivastava
- Department of Hematology, Christian Medical College, Vellore, India; Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Abdulrahman Alrajhi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Reem Almaghrabi
- Organ Transplantation Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Muhammad Bilal Abid
- Division of Divisions of Hematology/Oncology & Infectious Diseases, BMT & Cellular Therapy Program, Milwaukee, WI, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Usama Gergis
- Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Riad El Fakih
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Marcie Riches
- Division of Hematology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Malgorzata Mikulska
- Division of Infectious Diseases, DISSAL, University of Genova, Italy and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nina Worel
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, MN, USA
| | | | - Catherine Cordonnier
- Haematology Department, Henri Mondor Hospital and University Paris-Est-Créteil, Créteil, France
| | - Mahmoud Aljurf
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Muhsen IN, Rasheed OW, Habib EA, Alsaad RK, Maghrabi MK, Rahman MA, Sicker D, Wood WA, Beg MS, Sung AD, Hashmi SK. Current Status and Future Perspectives on the Internet of Things in Oncology. Hematol Oncol Stem Cell Ther 2023; 16:102-109. [PMID: 34687614 DOI: 10.1016/j.hemonc.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/04/2021] [Accepted: 09/24/2021] [Indexed: 01/31/2023] Open
Abstract
The Internet of Things (IoT) has penetrated many aspects of everyday human life. The use of IoT in healthcare has been expanding over the past few years. In this review, we highlighted the current applications of IoT in the medical literature, along with the challenges and opportunities. IoT use mainly involves sensors and wearables, with potential applications in improving the quality of life, personal health monitoring, and diagnosis of diseases. Our literature review highlights that the current main application studied in the literature is physical activity tracking. In addition, we discuss the current technologies that would help IoT-enabled devices achieve safe, quick, and meaningful data transfer. These technologies include machine learning/artificial intelligence, 5G, and blockchain. Data on current IoT-enabled devices are still limited, and future research should address these devices' effect on patients' outcomes and the methods by which their integration in healthcare will avoid increasing costs.
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Affiliation(s)
- Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Omar W Rasheed
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Eiad A Habib
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rakan K Alsaad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Md A Rahman
- Department of Cyber Security and Forensic Computing, University of Prince Mugrin, Medina, Saudi Arabia
| | - Douglas Sicker
- School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Muhammad S Beg
- Division of Hematology/Medical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, NC, USA
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
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Burns EA, Gee K, Kieser RB, Xu J, Zhang Y, Crenshaw A, Muhsen IN, Mylavarapu C, Esmail A, Shah S, Umoru G, Sun K, Guerrero C, Gong Z, Heyne K, Singh M, Zhang J, Bernicker EH, Abdelrahim M. Impact of Infections in Patients Receiving Pembrolizumab-Based Therapies for Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 15:cancers15010081. [PMID: 36612078 PMCID: PMC9817839 DOI: 10.3390/cancers15010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/04/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Immune checkpoint inhibitor (ICI) therapy has significantly improved outcomes across a range of malignancies. While infections are a well-known contributor to morbidity and mortality amongst patients receiving systemic chemotherapy regimens, little is known about the impact of infections on patients receiving ICI therapy. This study aims to assess incidence, risk factors, and outcomes in patients who develop infections while on pembrolizumab-based therapies for non-small cell lung cancer (NSCLC). Methods: Patients receiving pembrolizumab for stage III/IV NSCLC from 1/1/2017-8/1/2021 across seven hospitals were identified. Incidence and type of infection were characterized. Covariates including baseline demographics, treatment information, treatment toxicities, and immunosuppressive use were collected and compared between infected and non-infected patients. Outcomes included the rate of infections, all-cause hospital admissions, median number of treatment cycles, overall survival (OS), and progression free survival (PFS). Univariable and multivariable analysis with reported odds ratio (OR) and 95% confidence intervals (CI) were utilized to evaluate infection risks. OS and PFS were analyzed by Kaplan−Meier analysis and tested by log-rank test. p-value < 0.05 was considered statistically significant. Results: There were 243 NSCLC patients that met the inclusion criteria. Of these, 111 (45.7%) had one documented infection, and 36 (14.8%) had two or more. Compared to non-infected patients, infected patients had significantly more all-cause Emergency Department (ED) [37 (33.3%) vs. 26 (19.7%), p = 0.016], hospital [87 (78.4%) vs. 53 (40.1%), p < 0.001], and ICU visits [26 (23.4%) vs. 5 (3.8%), p < 0.001], and had poorer median OS (11.53 [95% CI 6.4−16.7] vs. 21.03 [95% CI: 14.7−24.2] months, p = 0.033). On multivariable analysis, anti-infective therapy (OR 3.32, [95% CI: 1.26−8.76], p = 0.015) and ECOG of >1 (OR 5.79, [95% CI 1.72−19.47], p = 0.005) at ICI initiation conferred an increased risk for infections. At last evaluation, 74 (66.7%) infected and 70 (53.0%) non-infected patients died (p = 0.041). Conclusion: Infections occurred in nearly half of patients receiving pembrolizumab-based therapies for NSCLC. Infected patients had frequent hospitalizations, treatment delays, and poorer survival. ECOG status and anti-infective use at ICI initiation conferred a higher infection risk. Infection prevention and control strategies are needed to ameliorate the risk for infections in patients receiving ICIs.
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Affiliation(s)
- Ethan A. Burns
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Kelly Gee
- Department of Medicine, Houston Methodist Hospital, 6565 Fannin St., Smith Tower, Floor 10, Houston, TX 77030, USA
| | - Ryan B. Kieser
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, 7550 Greenbriar RB4-129, Houston, TX 77030, USA
| | - Yuqi Zhang
- Department of Medicine, Houston Methodist Hospital, 6565 Fannin St., Smith Tower, Floor 10, Houston, TX 77030, USA
| | - Aubrey Crenshaw
- Department of Medicine, Houston Methodist Hospital, 6565 Fannin St., Smith Tower, Floor 10, Houston, TX 77030, USA
| | - Ibrahim N. Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, 7200 Cambridge St. 7th Fl, Houston, TX 77030, USA
| | - Charisma Mylavarapu
- Section of Hematology and Oncology, Scripps Health, 10666 N. Torrey Pines Rd., La Jolla, CA 92037, USA
| | - Abdullah Esmail
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Shivan Shah
- Department of Infectious Diseases, Houston Methodist Hospital, 6550 Fannin St., Ste 1101, Houston, TX 77030, USA
| | - Godsfavour Umoru
- Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin St, Houston, TX 77030, USA
| | - Kai Sun
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Carlo Guerrero
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Zimu Gong
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Kirk Heyne
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Monisha Singh
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Jun Zhang
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Eric H. Bernicker
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
| | - Maen Abdelrahim
- Houston Methodist Neal Cancer Center, Houston Methodist Hospital, 6445 Main St. Outpatient Center, Floor 24, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-441-9948; Fax: +1-713-441-8791
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11
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Haque E, Muhsen IN, Esmail A, Umoru G, Mylavarapu C, Ajewole VB, Abdelrahim M. Case report: Efficacy and safety of regorafenib plus fluorouracil combination therapy in the treatment of refractory metastatic colorectal cancer. Front Oncol 2022; 12:992455. [PMID: 36620581 PMCID: PMC9822717 DOI: 10.3389/fonc.2022.992455] [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: 07/12/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background More than half of patients with colorectal cancer (CRC) present with metastatic disease or develop recurrent disease on first-line and second-line options. Treatment beyond the second line remains an area of unmet need for patients with progressive or recurrent disease. Methods We retrospectively reviewed data of adult (>18 years old) patients with mCRC who received regorafenib + 5FU combination therapy at Houston Methodist Hospital with outcomes of interest including response rate, discontinuation due to side effects, and overall survival. Results Seven patients received regorafenib + 5FU combination therapy for mCRC after receiving at least two other lines of therapy (including at least one fluorouracil-based therapy). Four patients (57%) achieved disease control in 7-12 weeks after therapy initiation while three patients developed recurrent disease. In patients who achieved disease control, no new adverse events were reported among patients with this combination. Conclusion Regorafenib and Fluorouracil combination could be considered an option beyond the second line for patients with treatment-refractory metastatic colorectal cancer. Further studies, including a prospective trial, are needed to investigate the efficacy and safety of regorafenib plus 5FU therapy compared to other limited available therapies.
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Affiliation(s)
- Emaan Haque
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ibrahim N. Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Abdullah Esmail
- Section of Gastrointestinal Oncology, Houston Methodist Neal Cancer Center, Houston, TX, United States,*Correspondence: Maen Abdelrahim, ; Abdullah Esmail,
| | - Godsfavour Umoru
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, United States,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, United States
| | - Charisma Mylavarapu
- Department of Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Veronica B. Ajewole
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, United States,College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, United States
| | - Maen Abdelrahim
- Section of Gastrointestinal Oncology, Houston Methodist Neal Cancer Center, Houston, TX, United States,Cockrell Center for Advanced Therapeutic Phase I program, Houston Methodist Research Institute, Houston, TX, United States,Department of Medicine, Weill Cornell Medical College, New York, NY, United States,*Correspondence: Maen Abdelrahim, ; Abdullah Esmail,
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12
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Muacevic A, Adler JR, Nassri RB, Alabdaljabar MS, Hashmi S, Muhsen IN. Quality of Life in Hematologic Malignancy in the Eastern Mediterranean Region: A Systematic Review. Cureus 2022; 14:e32436. [PMID: 36644089 PMCID: PMC9833332 DOI: 10.7759/cureus.32436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Health-related quality of life (HRQoL) indicates patients' overall health and is an essential aspect of cancer care. Although multiple studies have addressed the various aspects of HRQoL in cancer patients, few studies have investigated HRQoL in hematologic malignancy patients in the Eastern Mediterranean region (EMR). This review conducted an electronic search using OVID-Medline to identify HRQoL-related articles involving hematologic malignancy patients in the EMR. Eight studies met the inclusion criteria. Two studies validated translated QoL psychometric instruments, three were observational studies, and three were interventional studies. Except for the validation studies, all studies discussed HRQoL in leukemia patients. Our review highlighted a scarcity in the number of studies focusing on patients with hematological malignancies in this region. The included studies demonstrated the negative impact of hematological malignancies and therapies on patients' HRQoL. In addition, the studies displayed the association between physical symptoms and QoL of cancer patients, necessitating the importance of addressing these symptoms. The studies were limited by publication year, the number of patients, geographical locations, and disease entities. Future studies in this area are encouraged to help understand factors affecting HRQoL in the EMR region and ways to improve it. Consequently, further research is needed to establish translated and validated QoL assessment instruments that target patients in the EMR using the most common tools including the Short-Form 36-item Health Survey and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire.
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13
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Haroon A, Muhsen IN, Abid MB, Albabtain A, Alahmari A, Ahmed SO, Fakih RE, Aljurf M. Infectious Complications and Preventative Strategies following Chimeric Antigen Receptor T-cells (CAR-T cells) Therapy for B-Cell Malignancies. Hematol Oncol Stem Cell Ther 2022; 15:153-158. [PMID: 36633965 DOI: 10.56875/2589-0646.1049] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Several chimeric antigen receptor T-cell constructs (CAR-T cells) are currently approved for the treatment of B-cell malignancies, including non-Hodgkin lymphoma and acute lymphoblastic leukemia. Additionally, multiple other products are being investigated and developed for other hematological malignancies and solid cancers. Patients receiving CAR-T cells are at increased risk of infectious complications that lead to increased morbidity and inferior mortality in these patients. In this review, we discuss the literature on the incidence and types of infection in patients in the early and late-phase after CAR-T cells infusion. Additionally, we summarize the current literature on prophylaxis against viral, bacterial, and fungal infections after CAR-T cells infusion and the utility of preventative and supportive measures including intravenous immunoglobulins and myeloid growth factors.
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Affiliation(s)
- Alfadil Haroon
- Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ibrahim N Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Muhammad B Abid
- Divisions of Infectious Diseases & Hematology/Oncology. BMT and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abdulwahab Albabtain
- Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali Alahmari
- Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Syed O Ahmed
- Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riad E Fakih
- Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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14
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Steffin DHM, Muhsen IN, Hill LC, Ramos CA, Ahmed N, Hegde M, Wang T, Wu M, Gottschalk S, Whittle SB, Lulla PD, Mamonkin M, Omer B, Rouce RH, Heczey A, Metelitsa LS, Grilley BJ, Robertson C, Torrano V, Lapteva N, Gee AP, Rooney CM, Brenner MK, Heslop HE. Long-term follow-up for the development of subsequent malignancies in patients treated with genetically modified IECs. Blood 2022; 140:16-24. [PMID: 35325065 PMCID: PMC9346960 DOI: 10.1182/blood.2022015728] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
Subsequent malignancies are well-documented complications in long-term follow-up of cancer patients. Recently, genetically modified immune effector (IE) cells have shown benefit in hematologic malignancies and are being evaluated in clinical trials for solid tumors. Although the short-term complications of IE cells are well described, there is limited literature summarizing long-term follow-up, including subsequent malignancies. We retrospectively reviewed data from 340 patients treated across 27 investigator-initiated pediatric and adult clinical trials at our center. All patients received IE cells genetically modified with γ-retroviral vectors to treat relapsed and/or refractory hematologic or solid malignancies. In a cumulative 1027 years of long-term follow-up, 13 patients (3.8%) developed another cancer with a total of 16 events (4 hematologic malignancies and 12 solid tumors). The 5-year cumulative incidence of a first subsequent malignancy in the recipients of genetically modified IE cells was 3.6% (95% confidence interval, 1.8% to 6.4%). For 11 of the 16 subsequent tumors, biopsies were available, and no sample was transgene positive by polymerase chain reaction. Replication-competent retrovirus testing of peripheral blood mononuclear cells was negative in the 13 patients with subsequent malignancies tested. Rates of subsequent malignancy were low and comparable to standard chemotherapy. These results suggest that the administration of IE cells genetically modified with γ retroviral vectors does not increase the risk for subsequent malignancy.
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Affiliation(s)
- David H M Steffin
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | | | - LaQuisa C Hill
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Carlos A Ramos
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Nabil Ahmed
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Meenakshi Hegde
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Tao Wang
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; and
| | - Mengfen Wu
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; and
| | - Stephen Gottschalk
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN
| | - Sarah B Whittle
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Premal D Lulla
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Maksim Mamonkin
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Bilal Omer
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Rayne H Rouce
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Andras Heczey
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Leonid S Metelitsa
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Bambi J Grilley
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Catherine Robertson
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Virginia Torrano
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Natalia Lapteva
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Adrian P Gee
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Cliona M Rooney
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Malcolm K Brenner
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
| | - Helen E Heslop
- Center for Cell and Gene Therapy, Baylor College of Medicine-Texas Children's Hospital, Houston, TX
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; and
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15
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Muhsen IN, El Fakih R, Hamadani M, Lazarus HM, Kharfan-Dabaja MA, Aljurf M. Clinical, Diagnostic and Prognostic Characteristics of Primary Cutaneous Gamma Delta T-cell Lymphomas. Clin Hematol Int 2022; 4:1-10. [PMID: 35950208 PMCID: PMC9358781 DOI: 10.1007/s44228-022-00011-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/26/2021] [Indexed: 12/04/2022] Open
Abstract
Primary cutaneous γδ T-cell lymphoma (PCGDTL) is a rare subtype of non-Hodgkin lymphoma (NHL) that arises from T-cells with γδ T-cell receptors. The exact incidence of PCGDTL is unknown, as it is usually lumped with other cutaneous lymphomas, which are also uncommon. It is one of the peripheral T-cell lymphoma (PTCL) subtypes which is known to have a dismal prognosis due to poor response and the paucity of available therapies. Despite the rarity and uncertainties of PCGDTL, a number of studies over the past decade were published about the pathologic, diagnostic, cytogenetic and clinical features of this disease. These diagnostic advances will open the doors to explore new therapeutics for this rare entity, specifically targeted and immune therapies. In this review, we highlight these advances, summarize the contemporary treatment approaches, and shed the light on future potential therapeutic targets.
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Affiliation(s)
| | - Riad El Fakih
- Oncology Center, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211 Saudi Arabia
| | - Mehdi Hamadani
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI USA
| | - Hillard M. Lazarus
- Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH USA
| | - Mohamed A. Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, FL USA
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211 Saudi Arabia
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16
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Muhsen IN, Hashmi SK. Utilizing machine learning in predictive modeling: what's next? Bone Marrow Transplant 2022; 57:699-700. [PMID: 35292752 DOI: 10.1038/s41409-022-01622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Shahrukh K Hashmi
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE. .,Medical Affairs, Khalifa University, Abu Dhabi, UAE. .,Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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17
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Steffin DH, Muhsen IN, Ahmed NM, Hegde M, Dakhova O, Wang T, Wu J, Gottschalk S, Whittle S, Lulla PD, Mamonkin M, Omer B, Rouce RH, Heczey A, Metelitsa LS, Hill L, Ramos CA, Rooney CM, Brenner MK, Heslop HE. Long Term Follow up for the Development of Subsequent Malignancies in Patients Treated with Genetically Modified Immune Effectors. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00406-7] [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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18
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Chitturi KR, Burns EA, Muhsen IN, Anand K, Trachtenberg BH. Cardiovascular Risks with Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors and Monoclonal Antibody Therapy. Curr Oncol Rep 2022; 24:475-491. [PMID: 35192115 DOI: 10.1007/s11912-022-01215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 12/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Tyrosine kinase inhibitors (TKI) and monoclonal antibodies (mAbs) that target the epidermal growth factor receptor (EGFR) have changed the therapeutic landscape across a range of solid malignancies. However, there is little data regarding the cardiovascular (CV) impact of these agents. The purpose of this review is to discuss reported CV effects, pathophysiology, pre-treatment screening, diagnostic workup, and treatment recommendations in this patient population. RECENT FINDINGS It is apparent that CV events are not class dependent, and while infrequently reported in clinical trials, unique CV toxicity may occur with EGFR inhibitors, including structural, electrical, and vascular events. There remains an unmet need to fully elucidate the spectrum of CV events associated with EGFR inhibitors. Early CV screening, close clinical monitoring, coupled with a multidisciplinary approach between medical and cardio-oncology is needed to minimize the potentially detrimental impact of cardiotoxicity in this patient population.
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Affiliation(s)
- Kalyan R Chitturi
- Division of Cardiovascular Medicine, Department of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, CE30665201, USA
| | - Ethan A Burns
- Houston Methodist Cancer Center, 6445 Main St. Outpatient Center, Floor 24, Houston, TX, 77030, USA
| | - Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Kartik Anand
- Great Plains Health Callahan Cancer Center, 601 W Leota St, North Platte, NE, 69101, USA
| | - Barry H Trachtenberg
- Methodist DeBakey Heart and Vascular Center, 6400 Fannin St. Suite 3000, Houston, TX, 77030, USA.
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Mohammed Saleh MF, Kotb A, Abdallah GEM, Muhsen IN, El Fakih R, Aljurf M. Recent Advances in Diagnosis and Therapy of Angioimmunoblastic T Cell Lymphoma. Curr Oncol 2021; 28:5480-5498. [PMID: 34940095 PMCID: PMC8699908 DOI: 10.3390/curroncol28060456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 12/28/2022] Open
Abstract
Angioimmunoblastic T cell lymphoma (AITL) is a common subtype of mature peripheral T cell lymphoma (PTCL). As per the 2016 World Health Organization classification, AITL is now considered as a subtype of nodal T cell lymphoma with follicular helper T cells. The diagnosis is challenging and requires a constellation of clinical, laboratory and histopathological findings. Significant progress in the molecular pathophysiology of AITL has been achieved in the past two decades. Characteristic genomic features have been recognized that could provide a potential platform for better diagnosis and future prognostic models. Frontline therapy for AITL was mainly depending on chemotherapy and the management of relapsed or refractory AITL is still unsatisfactory with a very poor prognosis. Upfront transplantation offers better survival. Novel agents have been introduced recently with promising outcomes. Several clinical trials of combinations using novel agents are underway. Herein, we briefly review recent advances in AITL diagnosis and the evolving treatment landscape.
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Affiliation(s)
- Mostafa F. Mohammed Saleh
- Adult Hematology, Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; (A.K.); (R.E.F.); (M.A.)
- Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Ahmed Kotb
- Adult Hematology, Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; (A.K.); (R.E.F.); (M.A.)
- Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Ghada E. M. Abdallah
- Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Ibrahim N. Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Riad El Fakih
- Adult Hematology, Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; (A.K.); (R.E.F.); (M.A.)
| | - Mahmoud Aljurf
- Adult Hematology, Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; (A.K.); (R.E.F.); (M.A.)
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20
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Muhsen IN, Shyr D, Sung AD, Hashmi SK. Machine Learning Applications in the Diagnosis of Benign and Malignant Hematological Diseases. Clin Hematol Int 2021; 3:13-20. [PMID: 34595462 PMCID: PMC8432325 DOI: 10.2991/chi.k.201130.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/02/2020] [Accepted: 11/05/2020] [Indexed: 12/23/2022] Open
Abstract
The use of machine learning (ML) and deep learning (DL) methods in hematology includes diagnostic, prognostic, and therapeutic applications. This increase is due to the improved access to ML and DL tools and the expansion of medical data. The utilization of ML remains limited in clinical practice, with some disciplines further along in their adoption, such as radiology and histopathology. In this review, we discuss the current uses of ML in diagnosis in the field of hematology, including image-recognition, laboratory, and genomics-based diagnosis. Additionally, we provide an introduction to the fields of ML and DL, highlighting current trends, limitations, and possible areas of improvement.
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Affiliation(s)
- Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - David Shyr
- Division of Stem Cell Transplantation and Regenerative Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| | - Anthony D Sung
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, NC, USA
| | - Shahrukh K Hashmi
- Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Sheikh Shakbout Medical City, Abu Dhabi, UAE
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21
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Mina SA, Muhsen IN, Burns EA, Sarfraz H, Pingali SR, Xu J, Hashmi SK. Post-Marketing Analysis of Peripheral Neuropathy Burden with New-Generation Proteasome Inhibitors Using the FDA Adverse Event Reporting System. Turk J Haematol 2021; 38:218-221. [PMID: 34190655 PMCID: PMC8386311 DOI: 10.4274/tjh.galenos.2021.2021.0052] [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] [Indexed: 12/01/2022] Open
Abstract
Proteasome inhibitors (PIs) are an integral component of multiple myeloma therapies. Peripheral neuropathy (PN) is a well-knownconsequence of PIs, most frequently reported with earlier generations such as bortezomib (BTZ). There is a paucity of data highlighting the risk of developing PN with the new-generation PIs carfilzomib (CFZ) and ixazomib (IZB). This study evaluated reports of PN encountered with all three PIs using the Food and Drug Administration Adverse Event (AE) Reporting System (FAERS). Signal disproportionality analysis was reported using the reporting odds ratio (ROR) with 95% confidence interval (CI). PN was reported in a total of 2.1%, 5.0%, and 10.9% of AEs with CFZ, IZB, and BTZ, respectively. The ROR (95% CI) for PN secondary to BTZ, CFZ, and IZB was 34.10 (32.76-35.49), 6.37 (5.50-7.37), and 14.97 (13.63-16.44), respectively. Compared to BTZ, CFZ and IZB have lower rates of reported PN, with RORs of 0.19 (0.16-0.22) and 0.48 (0.43-0.54), respectively.
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Affiliation(s)
| | | | - Ethan A. Burns
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, USA
| | - Humaira Sarfraz
- Houston Methodist Hospital, Department of Medicine, Houston, USA
| | - Sai Ravi Pingali
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, USA
| | - Jiaqiong Xu
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, USA
| | - Shahrukh K. Hashmi
- Mayo Clinic, Department of Medicine, Rochester, USA,Sheikh Shakbout Medical City, Department of Medicine, Abu Dhabi, UAE
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22
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Burns EA, Muhsen IN, Anand K, Xu J, Umoru G, Arain AN, Abdelrahim M. Hepatitis B Virus Reactivation in Cancer Patients Treated With Immune Checkpoint Inhibitors. J Immunother 2021; 44:132-139. [PMID: 33480637 PMCID: PMC7946380 DOI: 10.1097/cji.0000000000000358] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
There have been unique adverse events reported with targeted blockade of programmed death-1 (PD-1), programmed death-ligand-1 (PD-L1), and cytotoxic T-lymphocyte-associated protein-4 (CTLA4), including immune mediated toxicities. Recently, there have been reports of hepatitis B reactivation (HBVr) occurring with PD-1/PD-L1 inhibitors, which may result in treatment delays, interruptions, or discontinuation. This retrospective literature review and analysis of the Food and Drug Administration's (FDA) Adverse Events Reporting System (FAERS) queried reported cases of "Hepatitis B reactivation" reported with the PD-1/PD-L1 inhibitors "Pembrolizumab," "Atezolizumab," "Nivolumab," "Durvalumab," "Avelumab," and "Ipilimumab" from initial FDA approval to June 30, 2020. Disproportionality signal analysis was determined by calculating a reporting odds ratio (ROR) and 95% confidence intervals (CI). The ROR was considered significant when the lower and upper limits of the 95% CI were >1 and confirmed by the Fisher exact test (P<0.05). Pembrolizumab had a strong signal associated with HBVr, with a ROR of 2.32 (95% CI: 1.11-4.28) (P=0.013) and was the only statistically significant finding. There were no reports of HBVr with Ipilimumab or Avelumab. Additional prospective studies should be conducted to validate the findings of this retrospective pharmacovigilance analysis to determine the risk of HBVr in patients receiving immune checkpoint inhibitors.
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Affiliation(s)
| | | | - Kartik Anand
- Department of Oncology, Great Plains Health, North Platte, NE
| | - Jiaqiong Xu
- Center for Outcomes Research, Houston Methodist Research Institute
| | | | | | - Maen Abdelrahim
- Houston Methodist Cancer Center, Outpatient Center
- Cockrell Center of Advanced Therapeutics Phase I Program, Houston Methodist Research Institute, Outpatient Center
- Weill Cornell Medical College, Institute of Academic Medicine, Houston, TX
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23
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Muhsen IN, Wang T, Lulla P, Ramos CA, Kamble RT, Heslop HE, Carrum G, Hill L. Efficacy of Letermovir for CMV Prophylaxis Following Allogeneic Hematopoietic Stem Cell Transplant T-Cell Depleted with Alemtuzumab. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00474-7] [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: 11/28/2022]
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24
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Friend BD, Muhsen IN, Patel S, John T, Salem B, Doherty EE, Yassine K, Craddock J, Sasa G, Hill L, Lulla P, Ramos CA, Kamble RT, Martinez C, Krance RA, Heslop HE, Carrum G. Excellent Outcomes for Pediatric and Adult Patients with Hodgkin Lymphoma Receiving Rituximab As Adjunctive Therapy to BEAM Conditioning for Autologous Stem Cell Transplantation. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Alabdaljabar MS, Muhsen IN, Knight JM, Syrjala KL, Hashmi SK. Free of malignancy but not of fears: A closer look at Damocles syndrome in survivors of hematologic malignancies. Blood Rev 2020; 48:100783. [PMID: 33342584 DOI: 10.1016/j.blre.2020.100783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/08/2020] [Revised: 09/02/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
Fear of cancer recurrence (FoR) is an important yet underestimated long term sequela that many cancer survivors suffer from. The continuous state of uncertainty the survivors might go through can lead to a serious impact on their quality of life (QoL), which is collectively referred to as Damocles syndrome. Given the increasing numbers of cancer survivors, it is crucial to understand the different psychological issues that face them, including Damocles syndrome. Herein, we review the current literature of Damocles syndrome specifically in hematologic cancer survivors. Although with inconsistent terms, current literature demonstrates the impact and the prevalence of Damocles syndrome on QoL of survivors of leukemia, lymphoma, and hematopoietic cell transplant. Interventional studies are very limited in this area. Moreover, hematologic malignancy survivors can also meet the diagnostic criteria of other psychiatric diseases, including depression, anxiety, and post-traumatic stress disorder, wherein they should be managed accordingly. It is important to increase the awareness about Damocles syndrome and screen patients for it and other related psychological disorders. Additionally, this review has shown the need for standardization of Damocles syndrome definitions. Finally, the lack of interventional studies that target survivors' psychosocial challenges calls for prospective research to better address this rising problem.
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Affiliation(s)
| | - Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA
| | - Jennifer M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shahrukh K Hashmi
- Division of Hematology, Dept. of Medicine, Mayo Clinic, Rochester, MN, USA.
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26
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Muhsen IN, Bar M, Savani BN, Estey EH, Hashmi SK. Follow-up issues in survivors of hematologic malignancies – Current stance and future perspectives. Blood Rev 2020; 44:100674. [DOI: 10.1016/j.blre.2020.100674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/12/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
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27
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Abstract
Acquired haemophilia is a severe haematological disorder characterised by the presence of anti-factor VIII antibodies. Although rare, it can lead to serious bleeding complications. Acquired haemophilia can be seen in patients with malignancies as a paraneoplastic phenomenon. This is a case of a 52-year-old patient who presented with haematuria and retroperitoneal bleeding soon after being diagnosed with pancreatic adenocarcinoma and subsequently was found to have acquired haemophilia. The treatment of underlying malignancy with chemotherapy may accelerate the eradication of anti-factor VIII antibodies.
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Affiliation(s)
- Abeer Arain
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA.,https://orcid.org/0000-0001-6295-4318
| | - Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Maen Abdelrahim
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX 77030, USA.,Cockrell Center for Advanced Therapeutic-Phase I program, The Methodist Hospital Research Institute, Houston, TX 77030, USA.,Weill Cornell Medical College, Institute of Academic Medicine, Houston, TX 77030, USA
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28
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Mannan A, Muhsen IN, Barragán E, Sanz MA, Mohty M, Hashmi SK, Aljurf M. Genotypic and Phenotypic Characteristics of Acute Promyelocytic Leukemia Translocation Variants. Hematol Oncol Stem Cell Ther 2020; 13:189-201. [PMID: 32473106 DOI: 10.1016/j.hemonc.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is a special disease entity of acute myeloid leukemia (AML). The clinical use of all-trans retinoic acid (ATRA) has transformed APL into the most curable form of AML. The majority of APL cases are characterized by the fusion gene PML-RARA. Although the PML-RARA fusion gene can be detected in almost all APL cases, translocation variants of APL have been reported. To date, this is the most comprehensive review of these translocations, discussing 15 different variants. Reviewed genes involved in APL variants include: ZBTB16, NPM, NuMA, STAT5b, PRKAR1A, FIP1L1, BCOR, NABP1, TBLR1, GTF2I, IRF2BP2, FNDC3B, ADAMDTS17, STAT3, and TFG. The genotypic and phenotypic features of APL translocations are summarized. All reported studies were either case reports or case series indicating the rarity of these entities and limiting the ability to drive conclusions regarding their characteristics. However, reported variants have shown variable clinical and morphological features, with diverse responsiveness to ATRA.
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Affiliation(s)
- Abdul Mannan
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.
| | - Eva Barragán
- Department of Hematology, Hospital Universitari i Politecnic La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Miguel A Sanz
- Department of Hematology, Hospital Universitari i Politecnic La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | | | - Shahrukh K Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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29
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Sarfraz H, Chen D, Muhsen IN, Schwartz MR, Ogbonna M. Breast Cancer Metastasis Masquerading as a Primary Gynecological / Colonic Malignancy: A Rare Diagnostic Conundrum. Cureus 2020; 12:e7806. [PMID: 32467783 PMCID: PMC7249773 DOI: 10.7759/cureus.7806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Breast cancer is the most common malignancy affecting women. Metastatic involvement of the gastrointestinal (GI) tract secondary to a primary breast malignancy is rare. Here, we describe the case of a 60-year-old woman with a history of right lobular breast cancer (diagnosed and treated five years prior to presentation) who presented with fatigue, generalized abdominal pain, distension, weight loss, and vomiting. Her initial imaging was suspicious for a primary gynecological malignancy; however, subsequent workup showed a colonic mass. Total colonoscopy revealed colon metastases, and an immunohistochemical profile favored invasive lobular carcinoma of breast. Most cases of gastrointestinal metastases from breast cancer have lobular histology; however, colonic involvement is rare.
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Affiliation(s)
| | - Diana Chen
- Internal Medicine, Houston Methodist Hospital, Houston, USA
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30
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Salah HT, Muhsen IN, Salama ME, Owaidah T, Hashmi SK. Machine learning applications in the diagnosis of leukemia: Current trends and future directions. Int J Lab Hematol 2019; 41:717-725. [PMID: 31498973 DOI: 10.1111/ijlh.13089] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 05/11/2019] [Revised: 06/27/2019] [Accepted: 07/11/2019] [Indexed: 01/08/2023]
Abstract
Machine learning (ML) offers opportunities to advance pathological diagnosis, especially with increasing trends in digitalizing microscopic images. Diagnosing leukemia is time-consuming and challenging in many areas globally and there is a growing trend in utilizing ML techniques for its diagnosis. In this review, we aimed to describe the literature of ML utilization in the diagnosis of the four common types of leukemia: acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and chronic myelogenous leukemia (CML). Using a strict selection criterion, utilizing MeSH terminology and Boolean logic, an electronic search of MEDLINE and IEEE Xplore Digital Library was performed. The electronic search was complemented by handsearching of references of related studies and the top results of Google Scholar. The full texts of 58 articles were reviewed, out of which, 22 studies were included. The number of studies discussing ALL, AML, CLL, and CML was 12, 8, 3, and 1, respectively. No studies were prospectively applying algorithms in real-world scenarios. Majority of studies had small and homogenous samples and used supervised learning for classification tasks. 91% of the studies were performed after 2010, and 74% of the included studies applied ML algorithms to microscopic diagnosis of leukemia. The included studies illustrated the need to develop the field of ML research, including the transformation from solely designing algorithms to practically applying them clinically.
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Affiliation(s)
- Haneen T Salah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamed E Salama
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | - Tarek Owaidah
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shahrukh K Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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31
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Muhsen IN, Hashmi SK, Niederwieser D, Kroeger N, Agrawal S, Pasquini MC, Atsuta Y, Ballen KK, Seber A, Saber W, Kharfan-Dabaja MA, Rasheed W, Okamoto S, Khera N, Wood WA, Koh MBC, Greinix H, Kodera Y, Szer J, Horowitz MM, Weisdorf D, Aljurf M. Worldwide Network for Blood and Marrow Transplantation (WBMT) perspective: the role of biosimilars in hematopoietic cell transplant: current opportunities and challenges in low- and lower-middle income countries. Bone Marrow Transplant 2019; 55:698-707. [PMID: 31484992 DOI: 10.1038/s41409-019-0658-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/28/2019] [Accepted: 07/05/2019] [Indexed: 12/18/2022]
Abstract
Health care costs attributed to biologics have increased exponentially in the recent years, thus biosimilars offer a possible solution to limit costs while maintaining safety and efficacy. Reducing expenditure is vital to health care especially in developing countries where affordability and access to health care is a major challenge. We discuss the opportunities and the challenges of biosimilars in the field of hematopoietic cell transplantation (HCT) in low- and lower-middle income countries. Developing countries can potentially invest in the forecasted costs reduction by utilizing biosimilars. This can be used to decrease the costs of procedures such as HCT, which is a rapidly growing field in many developing regions. The introduction of biosimilars in the developing regions faces many challenges which include, but are not limited to: legal and regulatory issues, lack of research infrastructure, and the presence of educational barriers. Thus, collaborative efforts are needed to ensure an effective and safe introduction of biosimilars into low- and lower-middle income countries.
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Affiliation(s)
- Ibrahim N Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Shahrukh K Hashmi
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. .,Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Dietger Niederwieser
- Department of Hematology and Medical Oncology, University of Leipzig, Leipzig, Germany
| | - Nicolaus Kroeger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Samir Agrawal
- Division of Haemato-Oncology, Bart's Health NHS Trust and Blizard Institute, Queen Mary University of London, London, UK
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Wael Saber
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Mohamed A Kharfan-Dabaja
- Department of Medicine, Division of Hematology-Oncology and Blood and Marrow Transplantation program, Mayo Clinic, Jacksonville, FL, USA
| | - Walid Rasheed
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Nandita Khera
- Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Yoshihisa Kodera
- Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Jeff Szer
- Department of Clinical Haematology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | | | - Mahmoud Aljurf
- Hematology Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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32
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Muhsen IN, Alahmari A, Alnahedh M, Alkhudair NA, Samarkandi H, El Fakih R. Bortezomib for immune thrombocytopenia and autoimmune hemolytic anemia. Hematol Oncol Stem Cell Ther 2019; 13:251-254. [PMID: 31202670 DOI: 10.1016/j.hemonc.2019.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 05/21/2019] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Ali Alahmari
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alnahedh
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nora A Alkhudair
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel Samarkandi
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Riad El Fakih
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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33
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Muhsen IN, Aljurf M, Wingard JR, Poland GA, Komanduri KV, Whitaker JA, Hashmi SK. Vaccinating donors for hematopoietic cell transplantation: A systematic review and future perspectives. Vaccine 2018; 36:6043-6052. [PMID: 30195488 DOI: 10.1016/j.vaccine.2018.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/17/2018] [Revised: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 12/25/2022]
Abstract
Allogeneic hematopoietic cell transplantation (Allo-HCT) recipients are at an increased risk of infectious complications, which is a major cause of morbidity and mortality post-transplant. Vaccination of donors is one of the strategies that has been studied to improve immune reconstitution post-transplant, however the efficacy and safety of this strategy is not well reviewed in the literature. In this systematic review we sought to evaluate the current strategies of donor vaccination along with their immunogenicity, effectiveness and safety. Utilizing strict selection criteria with defined MeSH terminology, an electronic search was conducted from the following databases: Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus. Abstracts of various professional society meetings were also screened and hand searching of various reviews and guideline articles was carried out. The full text of 52 articles were reviewed, from which 5 articles satisfied the inclusion/exclusion criteria for effectiveness and immunogenicity trials and 1 article was included for safety data. Jadad score was used to assess the quality of included studies. The results of the included studies were inconsistent, and the studies were generally of suboptimal methodological quality. Most of the included studies (n = 3) investigated the use of more than one vaccine, however not all commonly used vaccines in HCT were investigated. None of the studies reported any long-term benefits for HCT recipients of vaccinated donors. Only one study reported safety data of using vaccination in donors. Given the suboptimal quality of the studies, and questionable effectiveness, donor vaccination cannot be recommended for all. Prospective high-quality vaccine trials in HCT donors are needed.
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Affiliation(s)
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - John R Wingard
- Department of Medicine, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - Krishna V Komanduri
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jennifer A Whitaker
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shahrukh K Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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34
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Muhsen IN, Jagasia M, Toor AA, Hashmi SK. Registries and artificial intelligence: investing in the future of hematopoietic cell transplantation. Bone Marrow Transplant 2018; 54:477-480. [PMID: 30171225 DOI: 10.1038/s41409-018-0327-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/17/2018] [Accepted: 08/12/2018] [Indexed: 11/09/2022]
Affiliation(s)
| | - Madan Jagasia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir Ahmed Toor
- Bone Marrow Transplant program, Massey Cancer Center, VCU, Richmond, VA, USA
| | - Shahrukh K Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. .,Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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35
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Muhsen IN, ElHassan T, Hashmi SK. Artificial Intelligence Approaches in Hematopoietic Cell Transplantation: A Review of the Current Status and Future Directions. Turk J Haematol 2018; 35:152-157. [PMID: 29880463 PMCID: PMC6110449 DOI: 10.4274/tjh.2018.0123] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The evidence-based literature on healthcare is currently expanding exponentially. The opportunities provided by the advancement in artificial intelligence (AI) tools such as machine learning are appealing in tackling many of the current healthcare challenges. Thus, AI integration is expanding in most fields of healthcare, including the field of hematology. This study aims to review the current applications of AI in the field of hematopoietic cell transplantation (HCT). A literature search was done involving the following databases: Ovid MEDLINE, including In-Process and other non-indexed citations, and Google Scholar. The abstracts of the following professional societies were also screened: American Society of Hematology, American Society for Blood and Marrow Transplantation, and European Society for Blood and Marrow Transplantation. The literature review showed that the integration of AI in the field of HCT has grown remarkably in the last decade and offers promising avenues in diagnosis and prognosis in HCT populations targeting both pre- and post-transplant challenges. Studies of AI integration in HCT have many limitations that include poorly tested algorithms, lack of generalizability, and limited use of different AI tools. Machine learning techniques in HCT are an intense area of research that needs much development and extensive support from hematology and HCT societies and organizations globally as we believe that this will be the future practice paradigm.
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Affiliation(s)
| | - Tusneem ElHassan
- King Faisal Specialist Hospital and Research Center, Oncology Center, Riyadh, Saudi Arabia
| | - Shahrukh K Hashmi
- King Faisal Specialist Hospital and Research Center, Oncology Center, Riyadh, Saudi Arabia,Mayo Clinic, Department of Medicine, Division of Hematology, Rochester, Minnesota, USA
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36
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Abstract
BACKGROUND/AIMS Evidence of increased risk of osteoporosis and osteopenia in chronic liver disease and cirrhosis is inconsistent. This study aims to investigate this relationship and to identify the predictors of increased loss of bone mineral density in Saudi patients. PATIENTS AND METHODS One hundred and sixty-four patients and controls who are age and gender matched, were included in this study with 1:1 ratio. Patients' included in this study were adults with confirmed liver cirrhosis. Bone mineral densitometry (BMD) at both lumbar spine (LS) and femoral neck (FN) were collected for both groups. Univariate and multivariate regression analyses were performed to identify predictors of BMD loss. RESULTS Results showed that cirrhotic patients are at higher risk of developing osteoporosis or osteopenia at LS (OR 2.23, 95% CI [1.19-4.19], P = 0.01) but not at FN, when compared to control sample. Patients with cirrhosis were found to have lower vitamin D and PTH levels (P = 0.0005) and (P = 0.006), respectively. Of the possible predictors tested (gender, age, body mass index [BMI], phosphorus, calcium, parathyroid hormone (PTH), vitamin D, and Model for End Stage Liver Disease [MELD] score), female gender was the main predictor of loss of BMD at LS only (OR 4.80, 95% CI [1.47-15.73], P = 0.01). CONCLUSIONS The study showed that cirrhotic patients are at increased susceptibility of having decreased BMD, particularly at the LS and it highlights the need for preventive measures, especially for female patients.
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Affiliation(s)
- Ibrahim N. Muhsen
- College of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Omar AlFreihi
- College of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Faisal Abaalkhail
- College of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia,Liver Transplantation and Hepatobiliary Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah AlKhenizan
- Department of Family Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Khan
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdelmoneim Eldali
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad Alsohaibani
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia,Address for correspondence: Dr. Fahad Alsohaibani, Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. E-mail:
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