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Chatzileontiadou S, Hatjiharissi E, Angelopoulou M, Asimakopoulos JV, Loutsidi NE, Chatzikonstantinou T, Zikos P, Bouchla A, Bezirgiannidou Z, Kouvata E, Frouzaki C, Chaloudis P, Sotiropoulos D, Douka V, Sirigou A, Mandala E, Psyllaki M, Papadaki HA, Marinakis T, Viniou NA, Kokkori S, Kontopidou F, Skepetari A, Vassilopoulos G, Kotsianidis I, Pappa V, Lalayanni C, Baltadakis I, Delimpassi S, Pagoni M, Papaioannou M. Thromboembolic events in patients with paroxysmal nocturnal hemoglobinuria (PNH): Real world data of a Greek nationwide multicenter retrospective study. Front Oncol 2023; 13:1128994. [PMID: 36959785 PMCID: PMC10028290 DOI: 10.3389/fonc.2023.1128994] [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: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
Thrombosis is the most common and a life-threatening complication in patients with Paroxysmal Nocturnal Hemoglobinuria. One-third of patients with PNH experience at least one thromboembolic event during the course of the disease, with thrombosis being the most common cause of death in these patients. The mechanism of thrombosis in PNH is complex and continues to be of great research interest. Since the introduction of C5 complement inhibitors in the treatment of PNH, the incidence of thromboembolic events has decreased substantially. We retrospectively analyzed data concerning the thrombotic episodes of 41 patients with PNH from 14 different national hematology centers in Greece. Sixteen patients (39%) experienced at least one episode of thrombosis, including, seven (43.8%) at diagnosis, seven (43.8%) during the course of the disease and two (12.5%) patients prior to PNH diagnosis. Nearly half of these individuals (n=7, 43.8%) had multiple episodes of thrombosis during the course of their disease. The most common sites of thrombosis were intra-abdominal veins. Three out of 26 patients developed thrombosis while on eculizumab. In none of the 16 patients, the thrombotic event was fatal. Our findings, despite the small number of patients, confirmed that thrombosis continues to be a significant complication of PNH affecting more than one third of the patients.
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Affiliation(s)
- S. Chatzileontiadou
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E. Hatjiharissi
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M. Angelopoulou
- Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - J. V. Asimakopoulos
- Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - N. E. Loutsidi
- Hematology - Lymphomas Department and Bone Marrow Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - T. Chatzikonstantinou
- Department of Hematology, Bone Marrow Transplantation Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - P. Zikos
- Department of Hematology, General Hospital of Patras “Aghios Andreas”, Patras, Greece
| | - A. Bouchla
- Second Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital, “Attikon”, Athens, Greece
| | - Z. Bezirgiannidou
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - E. Kouvata
- Department of Hematology, University Hospital of Larissa, Larissa, Greece
| | - C. Frouzaki
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P. Chaloudis
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D. Sotiropoulos
- Department of Hematology, Bone Marrow Transplantation Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - V. Douka
- Department of Hematology, Bone Marrow Transplantation Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - A. Sirigou
- Department of Hematology, Bone Marrow Transplantation Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - E. Mandala
- Forth Department of Medicine, Aristotle University of Thessaloniki, “Hippokration” Hospital, Thessaloniki, Greece
| | - M. Psyllaki
- Department of Hematology, University of Crete School of Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - H. A. Papadaki
- Department of Hematology, University of Crete School of Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - T. Marinakis
- Department of Hematology, “G. Gennimatas” General Hospital, Athens, Greece
| | - N. A. Viniou
- Hematology Unit, First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - S. Kokkori
- Hematology Laboratory, University General Hospital “Attikon”, Athens, Greece
| | - F. Kontopidou
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| | - A. Skepetari
- 2nd Department of Internal Medicine, Medical School, University of Athens, Hippokration General Hospital, Athens, Greece
| | - G. Vassilopoulos
- Department of Hematology, University Hospital of Larissa, Larissa, Greece
| | - I. Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - V. Pappa
- Second Department of Internal Medicine and Research Unit, Hematology Unit, University General Hospital, “Attikon”, Athens, Greece
| | - C. Lalayanni
- Department of Hematology, Bone Marrow Transplantation Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - I. Baltadakis
- Hematology - Lymphomas Department and Bone Marrow Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - S. Delimpassi
- Hematology - Lymphomas Department and Bone Marrow Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - M. Pagoni
- Hematology - Lymphomas Department and Bone Marrow Transplant Unit, Evangelismos General Hospital, Athens, Greece
| | - M. Papaioannou
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- *Correspondence: M. Papaioannou,
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Bergamaschi C, Pagoni M, Rosati M, Angel M, Tzannou I, Vlachou M, Darmani I, Ullah A, Bear J, Devasundaram S, Burns R, Baltadakis I, Gigantes S, Dimopoulos MA, Pavlakis GN, Terpos E, Felber BK. Reduced Antibodies and Innate Cytokine Changes in SARS-CoV-2 BNT162b2 mRNA Vaccinated Transplant Patients With Hematological Malignancies. Front Immunol 2022; 13:899972. [PMID: 35693807 PMCID: PMC9174567 DOI: 10.3389/fimmu.2022.899972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/28/2022] [Indexed: 12/29/2022] Open
Abstract
Immunocompromised individuals including patients with hematological malignancies constitute a population at high risk of developing severe disease upon SARS-CoV-2 infection. Protection afforded by vaccination is frequently low and the biology leading to altered vaccine efficacy is not fully understood. A patient cohort who had received bone marrow transplantation or CAR-T cells was studied following a 2-dose BNT162b2 mRNA vaccination and compared to healthy vaccine recipients. Anti-Spike antibody and systemic innate responses were compared in the two vaccine cohorts. The patients had significantly lower SARS-CoV-2 Spike antibodies to the Wuhan strain, with proportional lower cross-recognition of Beta, Delta, and Omicron Spike-RBD proteins. Both cohorts neutralized the wildtype WA1 and Delta but not Omicron. Vaccination elicited an innate cytokine signature featuring IFN-γ, IL-15 and IP-10/CXCL10, but most patients showed a diminished systemic cytokine response. In patients who failed to develop antibodies, the innate systemic response was dominated by IL-8 and MIP-1α with significant attenuation in the IFN-γ, IL-15 and IP-10/CXCL10 signature response. Changes in IFN-γ and IP-10/CXCL10 at priming vaccination and IFN-γ, IL-15, IL-7 and IL-10 upon booster vaccination correlated with the Spike antibody magnitude and were predictive of successful antibody development. Overall, the patients showed heterogeneous adaptive and innate responses with lower humoral and reduced innate cytokine responses to vaccination compared to naïve vaccine recipients. The pattern of responses described offer novel prognostic approaches for potentiating the effectiveness of COVID-19 vaccination in transplant patients with hematological malignancies.
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Affiliation(s)
- Cristina Bergamaschi
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Maria Pagoni
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | - Margherita Rosati
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Matthew Angel
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States.,Center for Cancer Research Collaborative Bioinformatics Resource, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Ifigeneia Tzannou
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | | | - Ismini Darmani
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | - Amirah Ullah
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Jenifer Bear
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Santhi Devasundaram
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Robert Burns
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Ioannis Baltadakis
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | - Stavros Gigantes
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | | | - George N Pavlakis
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Barbara K Felber
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
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Komitopoulou A, Baltadakis I, Peristeri I, Goussetis E. Immunotherapy and Allogeneic Bone Marrow Transplantation in B Acute Lymphoblastic Leukemia: How to Sequence? Clin Hematol Int 2022; 4:11-20. [PMID: 35950202 PMCID: PMC9358786 DOI: 10.1007/s44228-022-00006-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/10/2022] [Indexed: 01/04/2023] Open
Abstract
Long-term disease control is achieved in 80–90% of patients with acute lymphoblastic leukemia of B origin (B-ALL). About half of adult and 10% of pediatric patients develop refractory or relapsed disease, whereas survival after relapse accounts about 10% in adults and 30–50% in children. Allogeneic bone marrow transplantation offers remarkable benefit in cases with unfavorable outcome. Nevertheless, novel immunotherapeutic options have been approved for patients with adverse prognosis. Immunotherapeutic agents, nowadays, are preferred over standard chemotherapy for patients with relapsed or refractory B-ALL The mode of action, efficacy and safety data of immunotherapeutic agents released, indications and sequence of those therapies over the course of treatment, are herein reviewed.
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Affiliation(s)
- Anna Komitopoulou
- Stem Cell Transplant Unit, “Agia Sofia Children’s Hospital”, Mikras Asias 46 and Levadias 8, 11527 Athens, Greece
| | - I. Baltadakis
- Department of Haematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - I. Peristeri
- Stem Cell Transplant Unit, “Agia Sofia Children’s Hospital”, Mikras Asias 46 and Levadias 8, 11527 Athens, Greece
| | - E. Goussetis
- Stem Cell Transplant Unit, “Agia Sofia Children’s Hospital”, Mikras Asias 46 and Levadias 8, 11527 Athens, Greece
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4
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Terpos E, Gavriatopoulou M, Fotiou D, Giatra C, Asimakopoulos I, Dimou M, Sklirou AD, Ntanasis-Stathopoulos I, Darmani I, Briasoulis A, Kastritis E, Angelopoulou M, Baltadakis I, Panayiotidis P, Trougakos IP, Vassilakopoulos TP, Pagoni M, Dimopoulos MA. Poor Neutralizing Antibody Responses in 132 Patients with CLL, NHL and HL after Vaccination against SARS-CoV-2: A Prospective Study. Cancers (Basel) 2021; 13:4480. [PMID: 34503290 PMCID: PMC8430746 DOI: 10.3390/cancers13174480] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Emerging data suggest suboptimal antibody responses to COVID-19 vaccination in patients with hematological malignancies. We evaluated the humoral response following the BNT162b2 vaccine in patients with chronic lymphocytic leukemia (CLL), non-Hodgkin's lymphoma (NHL), and Hodgkin's lymphoma (HL). An FDA-approved, ELISA-based methodology was implemented to evaluate the titers of neutralizing antibodies (NAbs) against SARS-CoV-2 on day 1 of the first vaccine, and afterwards on day 22 and 50. One hundred and thirty-two patients with CLL/lymphomas and 214 healthy matched controls vaccinated during the same period, at the same center were enrolled in the study (NCT04743388). Vaccination with two doses of the BNT162b2 vaccine led to lower production of NAbs against SARS-CoV-2 in patients with CLL/lymphomas compared with controls both on day 22 and on day 50 (p < 0.001 for all comparisons). Disease-related immune dysregulation and therapy-related immunosuppression are involved in the low humoral response. Importantly, active treatment with Rituximab, Bruton's tyrosine kinase inhibitors, or chemotherapy was an independent prognostic factor for suboptimal antibody response. Patients with HL showed superior humoral responses to the NHL/CLL subgroups. In conclusion, patients with CLL/lymphomas have low humoral response following COVID-19 vaccination, underlining the need for timely vaccination ideally during a treatment-free period and for continuous vigilance on infection control measures.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.G.); (D.F.); (I.N.-S.); (A.B.); (E.K.); (M.A.D.)
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.G.); (D.F.); (I.N.-S.); (A.B.); (E.K.); (M.A.D.)
| | - Despina Fotiou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.G.); (D.F.); (I.N.-S.); (A.B.); (E.K.); (M.A.D.)
| | - Chara Giatra
- BMT Unit, Department of Hematology and Lymphomas, Evangelismos General Hospital, 10676 Athens, Greece; (C.G.); (I.D.); (I.B.); (M.P.)
| | - Ioannis Asimakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (I.A.); (M.A.); (T.P.V.)
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (M.D.); (P.P.)
| | - Aimilia D. Sklirou
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, 15784 Athens, Greece; (A.D.S.); (I.P.T.)
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.G.); (D.F.); (I.N.-S.); (A.B.); (E.K.); (M.A.D.)
| | - Ismini Darmani
- BMT Unit, Department of Hematology and Lymphomas, Evangelismos General Hospital, 10676 Athens, Greece; (C.G.); (I.D.); (I.B.); (M.P.)
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.G.); (D.F.); (I.N.-S.); (A.B.); (E.K.); (M.A.D.)
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.G.); (D.F.); (I.N.-S.); (A.B.); (E.K.); (M.A.D.)
| | - Maria Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (I.A.); (M.A.); (T.P.V.)
| | - Ioannis Baltadakis
- BMT Unit, Department of Hematology and Lymphomas, Evangelismos General Hospital, 10676 Athens, Greece; (C.G.); (I.D.); (I.B.); (M.P.)
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (M.D.); (P.P.)
| | - Ioannis P. Trougakos
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, 15784 Athens, Greece; (A.D.S.); (I.P.T.)
| | - Theodoros P. Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (I.A.); (M.A.); (T.P.V.)
| | - Maria Pagoni
- BMT Unit, Department of Hematology and Lymphomas, Evangelismos General Hospital, 10676 Athens, Greece; (C.G.); (I.D.); (I.B.); (M.P.)
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (M.G.); (D.F.); (I.N.-S.); (A.B.); (E.K.); (M.A.D.)
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Roumelioti A, Giatra C, Dellatola M, Dimitraki E, Bouzani M, Kanellis G, Ikonopoulou D, Kaouranis K, El‐Gkotmi N, Loutsidi A, Kosmas P, Darmani I, Souravla K, Babali V, Gardeli D, Ligdi L, Andreou E, Tounta G, Mellios Z, Karaolidou F, Tsonis I, Tzenou T, Gigantes S, Baltadakis I, Karakasis D, Sakellariou K, Rontogianni D, Bakiri M, Karmiris T. MANTLE CELL LYMPHOMA, A SINGLE CENTER EXPERIENCE. Hematol Oncol 2021. [DOI: 10.1002/hon.31_2881] [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] [Indexed: 11/12/2022]
Affiliation(s)
- A Roumelioti
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - C Giatra
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - M Dellatola
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - E.‐K Dimitraki
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - M Bouzani
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - G Kanellis
- Evaggelismos General Hospital, Department of Hematopathology Athens Greece
| | - D Ikonopoulou
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - K Kaouranis
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - N El‐Gkotmi
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - A Loutsidi
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - P Kosmas
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - I Darmani
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - K Souravla
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - V Babali
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - D Gardeli
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - L Ligdi
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - E Andreou
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - G Tounta
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - Z Mellios
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - F Karaolidou
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - I Tsonis
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - T Tzenou
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - S Gigantes
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - I Baltadakis
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - D Karakasis
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - K Sakellariou
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - D Rontogianni
- Evaggelismos General Hospital, Department of Pathology Athens Greece
| | - M Bakiri
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
| | - T Karmiris
- Evaggelismos General Hospital, Hematology & Lymphoma Department, BMTU Athens Greece
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6
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Gavriilaki E, Touloumenidou T, Sakellari I, Batsis I, Mallouri D, Psomopoulos F, Tsagiopoulou M, Koutra M, Yannaki E, Papalexandri A, Taylor P, Nikolousis E, Stamouli M, Holbro A, Baltadakis I, Liga M, Spyridonidis A, Tsirigotis P, Charchalakis N, Tsakiris DA, Brodsky RA, Passweg J, Stamatopoulos K, Anagnostopoulos A. Pretransplant Genetic Susceptibility: Clinical Relevance in Transplant-Associated Thrombotic Microangiopathy. Thromb Haemost 2020; 120:638-646. [DOI: 10.1055/s-0040-1702225] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractTransplant-associated thrombotic microangiopathy (TA-TMA) is a life-threatening complication of allogeneic hematopoietic cell transplantation (HCT). We hypothesized that pretransplant genetic susceptibility is evident in adult TA-TMA and further investigated the association of TMA-associated variants with clinical outcomes. We studied 40 patients with TA-TMA, donors of 18 patients and 40 control non-TMA HCT recipients, without significant differences in transplant characteristics. Genomic DNA from pretransplant peripheral blood was sequenced for TMA-associated genes. Donors presented significantly lower frequency of rare variants and variants in exonic/splicing/untranslated region (UTR) regions, compared with TA-TMA patients. Controls also showed a significantly lower frequency of rare variants in ADAMTS13, CD46, CFH, and CFI. The majority of TA-TMA patients (31/40) presented with pathogenic or likely pathogenic variants. Patients refractory to conventional treatment (62%) and patients that succumbed to transplant-related mortality (65%) were significantly enriched for variants in exonic/splicing/UTR regions. In conclusion, increased incidence of pathogenic, rare and variants in exonic/splicing/UTR regions of TA-TMA patients suggests genetic susceptibility not evident in controls or donors. Notably, variants in exonic/splicing/UTR regions were associated with poor response and survival. Therefore, pretransplant genomic screening may be useful to intensify monitoring and early intervention in patients at high risk for TA-TMA.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Ioanna Sakellari
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Ioannis Batsis
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Despina Mallouri
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Fotis Psomopoulos
- Department of Hematology, Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Maria Tsagiopoulou
- Department of Hematology, Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Maria Koutra
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Hematology Department–BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Pat Taylor
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Emmanuel Nikolousis
- Department of Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Maria Stamouli
- Division of Hematology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Holbro
- Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Ioannis Baltadakis
- Department of Hematology, Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Maria Liga
- Department of Hematology, BMT Unit, University Hospital of Patras, Patras, Greece
| | | | - Panagiotis Tsirigotis
- Division of Hematology, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Charchalakis
- Department of Hematology, Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Dimitrios A. Tsakiris
- Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Robert A. Brodsky
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jacob Passweg
- Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Kostas Stamatopoulos
- Department of Hematology, Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
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Baltadakis I, Gigantes S, Tsonis I, Gardeli D, Oikonomopoulou D, Tzenou T, Bouzani M, Giatra C, Mellios Z, Grispou E, Katsareli M, Karatza ME, Karmiris T, Karakasis D. Viral Reactivation after T Cell Replete Haploidentical Stem Cell Transplantation: Increased Incidence in Association with Immune Reconstitution. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.564] [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: 10/25/2022]
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Kotsopoulou M, Papadaki C, Anargyrou K, Spyridonidis A, Baltadakis I, Papadaki HA, Angelopoulou M, Pappa V, Liakou K, Tzanetakou M, Moustaka M, Vassilopoulos G. Effectiveness and Safety of Micafungin in Managing Invasive Fungal Infections among Patients in Greece with Hematologic Disorders: The ASPIRE Study. Infect Dis Ther 2019; 8:255-268. [PMID: 30767170 PMCID: PMC6522581 DOI: 10.1007/s40121-019-0236-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/25/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Invasive candidiasis (IC) can be a life-threatening infection in immunocompromised patients, particularly those with cancer, hematologic diseases and/or hematopoietic stem cell transplantation (HSCT) recipients. The objective of this study was to evaluate the effectiveness of micafungin in patients with hematologic malignancies or HSCT recipients, relevant to clinical presentation of IC, in real-life practice in Greece. METHODS ASPIRE was a phase IV, multicenter, non-interventional, prospective cohort study, conducted at ten tertiary hospitals in Greece, in adults with hematologic disease. Micafungin treatment for IC or prophylaxis for Candida infection was administered per standard clinical practice until a clinical outcome (success or failure) was reached. Treatment success was defined by the EORTC/MSG criteria for invasive fungal infections (IFI) and was assessed by the investigator. Treatment discontinuation and safety were also evaluated. RESULTS One hundred forty-three patients were enrolled. Median age was 62; 85 (59.4%) patients were male, and 133 (93.0%) had Greek ethnicity. One hundred twenty-six (88.1%) patients had hematologic malignancies, and 21 (14.7%) had received HSCT. Prophylaxis was administered to 74 (51.7%) patients [median (range) dose: 50 (50-150) mg/day] with no signs of IFI. Overall, 52 (36.4%) patients with possible IFI at baseline received micafungin treatment [100 (50-125) mg/day] versus 12 (17.2%) with probable [100 (75-150) mg/day] and 5 (3.5%) with confirmed [125 (100-150) mg/day] IFI. Treatment success was 91.6% (95% CI 85.80-95.59; n = 131) overall and 90.5% (n = 67) in patients receiving prophylaxis. Median time on treatment was 13 days. Treatment discontinuation (n = 26; 18.2%) was not related to adverse events. No treatment-related serious adverse events were reported. CONCLUSION Micafungin treatment for IC or prophylaxis for Candida infection was effective and well tolerated in patients with hematologic disorders in clinical practice in Greece. These results demonstrate that micafungin could be used more widely for prophylaxis. Further work is required to determine the efficacy and safety of micafungin for the management of IFIs in hematologic settings. FUNDING Astellas Pharma Inc.
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Affiliation(s)
| | | | | | | | - Ioannis Baltadakis
- Department of Hematology and Bone Marrow Transplantation Unit, Evaggelismos Hospital, Athens, Greece
| | - Helen A Papadaki
- University of Crete School of Medicine and University General Hospital of Heraklion, Heraklion, Greece
| | - Maria Angelopoulou
- Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Athens, Greece
| | - Kleoniki Liakou
- Medical Affairs, Astellas Pharmaceuticals AEBE, Athens, Greece
| | | | - Marina Moustaka
- Medical Affairs, Astellas Pharmaceuticals AEBE, Athens, Greece
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Kelaidi C, Sakellari I, Tzannou I, Liga M, Spyridonidis A, Tsirigotis P, Papaioannou G, Mallouri D, Batsis I, Karakasis D, Baltadakis I, Harhalakis N, Athanasiadou A, Anagnostopoulos A. P-213 Impact of individual cytogenetic abnormalities, IPSS-R karyotype and monosomal karyotype on outcomes after allogeneic HCT for MDS/sAML. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70260-1] [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: 10/26/2022]
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Tsirigotis P, Kapsimalli V, Baltadakis I, Kaloyannidis P, Karakasis D, Papalexandri A, Psarra E, Nosi E, Konsta E, Vikentiou M, Papageorgiou S, Sakellari I, Pappa V, Harhalakis N, Anagnostopoulos A, Dervenoulas J. Extracorporeal photopheresis in refractory chronic graft-versus-host disease: The influence on peripheral blood T cell subpopulations. A study by the Hellenic Association of Hematology. Transfus Apher Sci 2012; 46:181-8. [DOI: 10.1016/j.transci.2011.10.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 10/13/2011] [Indexed: 12/01/2022]
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Kaloyannidis P, Voutiadou G, Baltadakis I, Tsirigotis P, Spyridonidis A, Repousis P, Balta A, Tsimberis S, Karakasis D, Sakellari I, Dervenoulas I, Harhalakis N, Anagnostopoulos A. Outcomes of Hodgkin’s Lymphoma Patients with Relapse or Progression following Autologous Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2012; 18:451-7. [DOI: 10.1016/j.bbmt.2011.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
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Liapis K, Baltadakis I, Balotis K, Karakasis D. Multisystem Febrile Illness in a Cord‐Blood Transplant Recipient. Clin Infect Dis 2010. [DOI: 10.1086/655897] [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: 11/03/2022] Open
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Liapis K, Baltadakis I, Balotis K, Karakasis D. Multisystem Febrile Illness in a Cord‐Blood Transplant Recipient. Clin Infect Dis 2010; 51:716-7, 749-50. [DOI: 10.1086/655896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Baltadakis I, Karakasis D, Manaka A, Panitsas F, Poulopoulou Z, Delistrati V, Bika E, Garofalaki M, Papageorgiou M, Vasileiou S, Gigantes S, Apostolidis J, Harhalakis N, Nikiforakis E. Double Umbilical Cord Blood Transplantation Achieves Universal Engraftment But Is Associated With Considerable Transplant-Related Mortality. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cesaro S, Hirsch H, Faraci M, Owoc‐Lempach J, Beltrame A, Tendas A, Baltadakis I, Dalle J, Koc Y, Toporski J, Styczynski J, Yesilipek M, Heinz W, Caniglia M, Rascon J, Fauser A, Michallet M, Lopez‐Corral L, Neuburger S, Tridello G, Einsele H. Cidofovir for BK Virus–Associated Hemorrhagic Cystitis: A Retrospective Study. Clin Infect Dis 2009; 49:233-40. [DOI: 10.1086/599829] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Papadakis V, Karakasis D, Sfikakis PP, Baltadakis I, Apostolidis J, Evangelou K, Gorgoulis VG, Harhalakis N. Is imatinib mesylate a promising drug in scleroderma due to extensive chronic graft-versus-host disease? Leuk Lymphoma 2009; 50:471-4. [DOI: 10.1080/10428190802668881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dimopoulos MA, Souliotis VL, Anagnostopoulos A, Bamia C, Pouli A, Baltadakis I, Terpos E, Kyrtopoulos SA, Sfikakis PP. Melphalan-induced DNA damage in vitro as a predictor for clinical outcome in multiple myeloma. Haematologica 2007; 92:1505-12. [PMID: 18024399 DOI: 10.3324/haematol.11435] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As new therapeutic options for multiple myeloma (MM) emerge, identification of biological markers which could predict clinical response to standard treatment with high-dose melphalan (HDM) supported by autologous stem cell transplantation (ASCT) becomes more important. DESIGN AND METHODS Melphalan-induced damage formation and repair of monoadducts and interstrand cross-links in the p53 gene were studied in peripheral blood mononuclear cells obtained from 32 patients prior to therapy. The same studies were performed in the peripheral blood cells of these patients immediately after subsequent HDM administration. Clinical response and time to progression were correlated with molecular endpoints obtained in vitro. RESULTS Values for all molecular end-points examined in vitro were highly correlated with the respective in vivo results within individual patients. All in vitro end-points indicative of increased DNA damage and slower repair capacity were predictive of a favorable response to HDM; the area under the curve of total adducts (AUC-TA) had the highest predictive ability. Using the cut-off value of 736 adducts/10(6) nucleotides x h for the AUC-TA, the positive predictive value for clinical response to HDM was 100%. Moreover, patients with an AUC-TA equal to or higher than this cut-off value had significantly longer times to progression than had patients with an AUC-TA lower than the cut-off value (hazard ratio 0.19; 95% confidence intervals 0.06 to 0.60). INTERPRETATION AND CONCLUSIONS An in vitro assay to quantify melphalan-induced p53-specific damage formation/repair can be used to select those patients with MM who are more likely to benefit from HDM supported by ASCT.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece.
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