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Jaime-Pérez JC, Hernández-Coronado M, González-Treviño M, Barragán-Longoria RV, Ramos-Dávila EM, Gómez-Almaguer D. Outcomes after treating advanced mantle cell lymphoma in a low-income group at a Latin American center: The role of outpatient hematopoietic stem cell transplantation. Hematol Oncol 2024; 42:e3271. [PMID: 38606890 DOI: 10.1002/hon.3271] [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: 04/13/2024]
Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Marcela Hernández-Coronado
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Mariana González-Treviño
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Renata V Barragán-Longoria
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Eugenia M Ramos-Dávila
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Jaime-Pérez JC, Meléndez-Flores JD, Valdespino-Valdes J, Gómez-De León A, Colunga-Pedraza PR, Gutiérrez-Aguirre CH, Cantú-Rodríguez OG, Gómez-Almaguer D. Graft-versus-host disease after an outpatient peripheral blood hematopoietic cell transplant using reduced-intensity conditioning: a single-center LATAM experience. Expert Rev Hematol 2024; 17:77-86. [PMID: 38226642 DOI: 10.1080/17474086.2024.2305372] [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: 02/08/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND HLA compatibility predicts allogeneic hematopoietic cell transplant (allo-HCT) and graft-versus-host disease (GvHD) outcomes. There is insufficient information regarding GvHD outcomes for outpatient HLA-identical and haploidentical-HCT employing reduced-intensity conditioning (RIC). RESEARCH DESIGN AND METHODS We compare GvHD outcomes between donor types and report risk factors associated with GvHD. Stem cell source was T-cell replete peripheral blood. GvHD prophylaxis was post-transplant cyclophosphamide (PT-CY), mycophenolic acid, and calcineurin inhibitors for haploidentical (n = 107) and oral cyclosporine (CsA) plus methotrexate i.v. for HLA-identical (n = 89) recipients. RESULTS One hundred and ninety-six HCT transplant patients were included. aGvHD and cGvHD frequency were similar between HCT types. aGvHD severity was comparable, but severe cGvHD was less frequent in the haploidentical group (p = .011). One-hundred-day cumulative incidence (CI) of aGvHD for haploidentical and HLA-identical was 31% and 33% (p = .84); 2-year CI of cGvHD was 32% and 38% (p = .6), respectively. Haploidentical recipients had less steroid-refractory cGvHD (p = .043). Patients with cGvHD had less 2-year relapse (p = .003); both aGvHD and cGvHD conferred higher OS (p = .010 and p = .001), respectively. Male sex was protective for steroid-refractory cGvHD (p = .028). CONCLUSIONS Acute and chronic GvHD rates were comparable between HLA-identical and haploidentical transplant groups. cGvHD severity was lower in the haploidentical group.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jesús Daniel Meléndez-Flores
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Valdespino-Valdes
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Gómez-De León
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Perla Rocío Colunga-Pedraza
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - César Homero Gutiérrez-Aguirre
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Olga Graciela Cantú-Rodríguez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
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Colunga-Pedraza PR, Irabien-Zuñiga M, Rodriguez-Roque CS, de la Cruz-de la Cruz C, Gómez-De León A, Santana-Hernández P, Jaime-Pérez JC, Mancías-Guerra C, Gómez-Almaguer D. Lactate dehydrogenase as a hematopoietic stem cell mobilization biomarker in autologous transplantation. Hematol Transfus Cell Ther 2023; 45:435-441. [PMID: 36163321 PMCID: PMC10627851 DOI: 10.1016/j.htct.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/17/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Pre-apheresis peripheral blood CD34+ cell count (PBCD34+) is the most important predictor of good cell mobilization before hematopoietic stem cell transplantation, albeit flow cytometry is not always immediately available. Identification of surrogate markers can be useful. The CD34+ cells proliferate after mobilization, resulting in elevated lactate dehydrogenase (LDH) activity and correlating with the PBCD34+ count. OBJECTIVE To determine the LDH cut-off value at which adequate CD34+ cell mobilization is achieved and its diagnostic yield. MATERIALS AND METHODS A total of 103 patients who received an autologous stem cell transplantation (ASCT) between January 2015 and January 2020 were included. Demographic and laboratory characteristics were obtained, including complete blood count, pre-apheresis PBCD34+ and LDH levels. Receiver operating characteristic (ROC) curves were performed to identify the optimal serum LDH activity cut-off points for ≥ 2 and ≥ 4 × 106 cells/kg post-mobilization CD34+ count and their diagnostic yield. RESULTS A post-mobilization serum LDH cut-off value of 462 U/L yielded a sensitivity (Se) = 86.8% (positive predictive value [PPV] = 72.7%), a pre- and post-mobilization serum LDH difference cut-off value of 387 U/L, an Se = 45.7% (PPV = 97%) and an LDH ratio of 2.46, with an Se = 47.1% (PPV = 97%) for an optimal mobilization count (CD34+ ≥ 4 × 106). CONCLUSION The LDH measurement represents a fast and affordable way to predict PBCD34+ mobilization in cases where flow cytometry is not immediately available. According to the LDH diagnostic yield, it could be used as a surrogate marker in transplant centers, supporting the CD34+ count, which remains the gold standard.
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Affiliation(s)
- Perla R Colunga-Pedraza
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Mariela Irabien-Zuñiga
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Carlos Saúl Rodriguez-Roque
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Carlos de la Cruz-de la Cruz
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Paola Santana-Hernández
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - José Carlos Jaime-Pérez
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - Consuelo Mancías-Guerra
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México
| | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero Ave. No number. Mitras Centro, Monterrey, Nuevo León, México.
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Jaime-Pérez JC, Ramos-Dávila EM, Picón-Galindo E, Jiménez-Castillo RA, León AGD, Gómez-Almaguer D. Outcomes and survival predictors of Latin American older adults with acute myeloid leukemia: Data from a single center. Hematol Transfus Cell Ther 2023; 45 Suppl 2:S43-S50. [PMID: 35115270 PMCID: PMC10433310 DOI: 10.1016/j.htct.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/04/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is most commonly presented in older adults; however, it appears 10 years earlier in Latin American countries. Clinical evolution in older adults from this populations has not been characterized. We analyzed outcomes and survival predictors. METHODS Patients ≥ 55 years old diagnosed with AML at a hematology referral center from 2005 to 2020 receiving intensive chemotherapy (IC), low-dose cytarabine (LDAC) and best supportive care (BSC) were included. Survival analysis included the Kaplan-Meier and Cox models and the cumulative incidence of relapse (CIR). RESULTS Seventy-five adults were included and the overall survival (OS) was 4.87, 1.67 and 1.16 months, using IC, LDAC and BSC, respectively. The IC led to a higher OS (p < 0.001) and was a protective factor for early death, at a cost of more days spent hospitalized and more non-fatal treatment complications; non-significant differences were found between the LDAC and BSC. Eight (10.7%) patients underwent hematopoietic cell transplantation, with a higher OS (p = 0.013). Twenty (26.7%) patients achieved complete remission; 12 (60%) relapsed with a 6-month CIR of 57.9% in those < 70 years old vs. 86.5% in those ≥ 70 years old, p = 0.034. Multivariate analysis showed the white blood cell count (WBC) and IC had a significant impact on the patient survival, whereas chronological age and the Charlson comorbidity index (CCI) did not. CONCLUSION AML in low-middle income countries demands a different approach; the IC improves survival, even with a high incidence of relapse, and should be offered as first-line treatment. Eligibility criteria should include WBC and a multidimensional evaluation. The age per se and the CCI should not be exclusion criteria to consider IC.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Eugenia M Ramos-Dávila
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ernesto Picón-Galindo
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Raúl A Jiménez-Castillo
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Dr. Jose E. Gonzalez University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Coronado-Alejandro EU, Martínez-Hernández JP, Gómez-De León A, Colunga-Pedraza PR, Jaime-Pérez JC, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, Gómez-Almaguer D. Low-dose rituximab plus high-dose dexamethasone in newly diagnosed immune thrombocytopenia. Eur J Haematol 2023; 110:778-779. [PMID: 36919276 DOI: 10.1111/ejh.13954] [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] [Received: 01/11/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Affiliation(s)
| | | | - Andrés Gómez-De León
- Hematology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - José Carlos Jaime-Pérez
- Hematology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | | | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Noyola-Pérez A, Gil-Flores L, Martínez-Espinosa HA, Ramos-Barrera E, Rodríguez-González V, Sung L, Guzman M, Hamad N, Colunga-Pedraza PR, Tarín-Arzaga L, Cantú-Rodríguez OG, Gutiérrez-Aguirre H, Jaime-Pérez JC, Gómez-Almaguer D, León AGD. Global representation among journal editors in haematology: are we diverse, equitable, and inclusive? The Lancet Haematology 2023; 10:e246-e247. [PMID: 36990621 DOI: 10.1016/s2352-3026(23)00069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Jaime-Pérez JC, Meléndez-Flores JD, Ramos-Dávila EM, Gutiérrez-Aguirre CH, Cantú-Rodríguez OG, Marfil-Rivera LJ, Áncer-Rodríguez J, Gómez-Almaguer D. Infection-related mortality after HLA-identical and haploidentical hematopoietic cell transplantation using reduced-intensity conditioning in an outpatient setting. Clin Transplant 2023:e14972. [PMID: 36943871 DOI: 10.1111/ctr.14972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/22/2022] [Revised: 02/03/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Despite the improvements in supportive care for allogeneic-hematopoietic cell transplantation (allo-HCT) recipients, infectious complications and infection-related mortality (IRM) continue to be a major issue for transplantation centers. METHODS We herein report the infectious complications and IRM of 107 and 89 patients that underwent haploidentical (haplo-HCT) or HLA-identical HCT at a tertiary referral center during 2013-2020. Patients in the haplo-HCT group received post-transplant cyclophosphamide (PT-Cy), and all received reduced-intensity conditioning regimens. RESULTS More haplo-HCT recipients presented severe infections in the pre-engraftment period (22.4% vs. 6.7%, p = 0.003). Viral (14.9% vs. 4.5%, p = 0.016) and fungal (12.1% vs. 1.1%, p = 0.003) etiologies were more common in this period in this group. The 100-day and 2-year cumulative incidence of IRM was 15% and 21% for the haplo-HCT and 5.6% and 17% for the HLA-identical group; no significant differences were observed between the groups. Fungal pathogens mainly contributed to IRM (33.3%). Infections were the most common cause of mortality (40/81, 49.4%). There were significant differences in donor/recipient CMV serostatus between transplant groups (0.002). CONCLUSIONS No differences in IRM were observed based on allo-HCT type, with more haplo-HCT patients suffering from severe infections in the pre-engraftment period. Studies to assess future prevention, diagnostic, and treatment strategies to reduce IRM are warranted.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jesús D Meléndez-Flores
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Eugenia M Ramos-Dávila
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - César Homero Gutiérrez-Aguirre
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Olga G Cantú-Rodríguez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Luis Javier Marfil-Rivera
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jesús Áncer-Rodríguez
- Pathology Department, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Jaime-Pérez JC, Meléndez-Flores JD, Ramos-Dávila EM, González-Treviño M, Gómez-Almaguer D. Hematopoietic stem cell transplantation for uncommon immune-mediated neurological disorders: A literature review. Cytotherapy 2022; 24:676-685. [DOI: 10.1016/j.jcyt.2021.12.006] [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] [Received: 11/01/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022]
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Jaime-Pérez JC, González-Treviño M, Meléndez-Flores JD, Ramos-Dávila EM, Cantú-Rodriguez OG, Gutiérrez-Aguirre CH, Galarza-Delgado DA, Gómez-Almaguer D. Autologous ATG-free hematopoietic stem cell transplantation for refractory autoimmune rheumatic diseases: a Latin American cohort. Clin Rheumatol 2021; 41:869-876. [PMID: 34585327 DOI: 10.1007/s10067-021-05931-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/12/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
Autologous hematopoietic stem cell transplantation (HSCT) has been recognized as treatment alternative for patients with severe, refractory autoimmune rheumatic diseases (ARDs). Usually, anti-thymocyte globulin (ATG)-containing conditioning regimens are employed; however, ATG is unavailable in some developing nations. We report our 15-year clinical experience autografting patients with ARDs with an ATG-free conditioning regimen and a brief assessment of patient-reported outcomes post-HSCT. All patients had active disease and were resistant to multiple lines of treatment. Event-free survival (EFS) was assessed using the Kaplan-Meier method. Eight patients underwent autologous HSCT. Diagnoses included juvenile idiopathic arthritis (n = 3), systemic lupus erythematosus (n = 2), systemic sclerosis (n = 2), and rheumatoid arthritis (n = 1). Median time from diagnosis to HSCT was 3 years (0.75-19). Hematological recovery was documented in all recipients, and 4 patients (50%) completed the procedure in a completely ambulatory setting. Five (62.5%) patients achieved complete response and 3 (37.5%) partial response. The median EFS was 7 months (95% CI, 4.97-9.02), and the 1-year EFS rate was 21.9% (95% CI, 18.25-25.76). Transplant-related mortality was 0%, and 1 recipient died 8 years post-HSCT due to chronic kidney disease. Six (75%) patients presented steroid dosage reduction post-HSCT, and 2 (25%) perceived improvement in functionality despite having relapsed. HSCT is a viable treatment alternative for selected patients with severe therapy-resistant ARDs, as an improvement in disease management and quality of life was documented. The need remains to elucidate the characteristics of the optimal HSCT candidate, as well as the adequate conditioning regimen when ATG is not available. Key Points • Despite advances in the treatment of autoimmune rheumatic diseases, some patients remain refractory. In this context, autologous hematopoietic stem cell transplantation (HSCT) rises as a viable alternative. • Of 8 HSCT recipients with autoimmune rheumatic diseases, 5 (62.5%) patients achieved complete response and 3 (37.5%) partial response, with a 1-year event-free survival of 21.9%. • Transplant-related mortality was 0%, with 4 (50%) patients autografted in a completely outpatient setting. • Even when relapse presented, patients reported an improvement in functionality and quality of life; also, a better response to DMARDs and a reduction in steroid dependency post-HSCT were documented.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Mariana González-Treviño
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jesús D Meléndez-Flores
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Eugenia M Ramos-Dávila
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Olga G Cantú-Rodriguez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - César H Gutiérrez-Aguirre
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Dionicio A Galarza-Delgado
- Rheumatology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Hernández-Coronado M, Gómez-Almaguer D, Jaime-Pérez JC. Haploidentical hematopoietic cell transplantation for mycosis fungoides/ Sezary syndrome using reduced intensity conditioning after brentuximab therapy discontinuation: advantages of an outpatient program in the times of COVID-19. Hematol Transfus Cell Ther 2021; 43:357-360. [PMID: 34253503 PMCID: PMC8446262 DOI: 10.1016/j.htct.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marcela Hernández-Coronado
- Dr. José E. González University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - David Gómez-Almaguer
- Dr. José E. González University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - José Carlos Jaime-Pérez
- Dr. José E. González University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.
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Reyes Mondragón AL, Cantú-Rodríguez OG, Garza-Acosta AC, Gutiérrez-Aguirre CH, Colunga Pedraza PR, Del Carmen Tarín-Arzaga L, Jaime-Pérez JC, Hawing Zárate JA, González-Cantú GA, Villalobos-Gutiérrez LE, Jiménez-Castillo RA, Vera-Pineda R, Gómez-Almaguer D. Performance of serum procalcitonin as a biochemical predictor of death in hematology patients with febrile neutropenia. Blood Cells Mol Dis 2021; 90:102586. [PMID: 34126299 DOI: 10.1016/j.bcmd.2021.102586] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Historically, the measurement of serum procalcitonin (PCT) levels in patients with leukopenia has been rejected without sufficient prospective evidence to justify this argument. On the other hand, the accumulated use of broad spectrum antibiotics in these patients and their consequences make the use of PCT attractive in an effort to reduce its use. PATIENTS AND METHODS We conducted a prospective study between 2016 and 2018, recruiting newly diagnosed FN patients, evaluating them with PCT levels during the first 24 h. After this we evaluate them with overall survival throughout the follow-up. RESULTS A total of 81 episodes of FN in 72 patients were included. We report a mortality of 27.2% in our cohort. The mean serum PCT in these patients was 4.01 ng/mL compared to 0.42 ng/mL in the survivors group (p < 0.01). Using ROC curves, we determined a cut-off point to predict septic shock/death at 0.46 ng/mL. Patients with a procalcitonin >0.46 ng/mL had an increased risk of death, with a HR of 4.43, (p = 0.048). CONCLUSION In conclusion, in our trial a single PCT on admission at a cut-off value of 0.46 ng/mL was able to predict the occurrence of septic shock and death in FN patients.
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Affiliation(s)
- Alan Ledif Reyes Mondragón
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
| | - Olga Graciela Cantú-Rodríguez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico.
| | - Andrea Cecilia Garza-Acosta
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
| | - César Homero Gutiérrez-Aguirre
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
| | - Perla Rocío Colunga Pedraza
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
| | - Luz Del Carmen Tarín-Arzaga
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
| | - José Carlos Jaime-Pérez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
| | - José Angel Hawing Zárate
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
| | - Graciela Alejandra González-Cantú
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
| | | | - Raúl Alberto Jiménez-Castillo
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Internal Medicine Department, Monterrey, N.L., Mexico
| | - Raymundo Vera-Pineda
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Internal Medicine Department, Monterrey, N.L., Mexico
| | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Hematology Service, Monterrey, N.L., Mexico
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Hernández-Coronado M, Jaime-Pérez JC, Villarreal-Martínez A, Ocampo-Candiani J, Gómez-Almaguer D. Successful second outpatient autologous hematopoietic cell transplant for relapsed POEMS syndrome in a patient with coexisting HIV, HBV and syphilis infections during the COVID-19 pandemic. Transpl Immunol 2021; 67:101412. [PMID: 34020046 DOI: 10.1016/j.trim.2021.101412] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022]
Abstract
Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a multisystem autoinflammatory disease due to an underlying plasma cell disorder that lacks a standard treatment strategy because of its rarity. We report a case of relapsed POEMS syndrome successfully treated with a second ambulatory autologous hematopoietic-cell transplantation (AHCT) after a daratumumab desensitization protocol performed during the coronavirus disease (COVID-19) pandemic in a patient with coexisting human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis infections. He is a 37-year old Latin-American male who had been treated with radiation, CyBorD regimen, AHCT and bortezomib therapy before being referred to our service. It was decided to administer daratumumab therapy and subsequently perform the transplant. Placement of central venous access, fluid infusion, conditioning regimen with melphalan and previously cryopreserved autograft infusion were carried out in an outpatient basis. Following second AHCT, the patient demonstrated clinical, VEGF, hematological response and remains SARS-CoV-2 infection-free and in POEMS remission with excellent quality-of-life at last follow up (6 months). We evidenced that thanks to an outpatient transplant program, the best therapeutic modalities can be offered to patients with hematologic malignancies in the context of present or future pandemics. Finally, high-complexity patients with HIV infection should have access to the same treatment strategies as non-infected patients. A second AHCT in the outpatient setting is feasible, safe and highly effective to treat patients with relapsed POEMS syndrome.
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Affiliation(s)
- Marcela Hernández-Coronado
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Carlos Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Alejandra Villarreal-Martínez
- Department of Dermatology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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13
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Jaime-Pérez JC, Ramos-Dávila EM, Meléndez-Flores JD, Gómez-De León A, Gómez-Almaguer D. Insights on chronic immune thrombocytopenia pathogenesis: A bench to bedside update. Blood Rev 2021; 49:100827. [PMID: 33771403 DOI: 10.1016/j.blre.2021.100827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
Immune thrombocytopenia (ITP) is a heterogeneous disease with an unpredictable course. Chronicity can develop in up to two-thirds of adults and 20-25% of children, representing a significant burden on patients' quality of life. Despite acceptable responses to treatment, precise etiology and pathophysiology phenomena driving evolution to chronicity remain undefined. We analyzed reported risk factors for chronic ITP and associated them with proposed underlying mechanisms in its pathogenesis, including bone marrow (BM) microenvironment disturbances, clinical features, and immunological markers. Their understanding has diagnostic implications, such as screening for the presence of specific antibodies or BM examination employing molecular tools, which could help predict prognosis and recognize main pathogenic pathways in each patient. Identifying these underlying mechanisms could guide the use of personalized therapies such as all-trans retinoic acid, mTor inhibitors, FcRn inhibitors, oseltamivir, and others. Further research should lead to tailored treatments and chronic course prevention, improving patients' quality of life.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Eugenia M Ramos-Dávila
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jesús D Meléndez-Flores
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. Jose E. González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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14
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Murrieta-Álvarez I, Cantero-Fortiz Y, León-Peña AA, Olivares-Gazca JC, Priesca-Marín JM, Ruiz-Delgado GJ, Gómez-De-León A, Gonzalez-Lopez EE, Jaime-Pérez JC, Gómez-Almaguer D, Ruiz-Argüelles GJ. The 1,000th Transplant for Multiple Sclerosis and Other Autoimmune Disorders at the HSCT-México Program: A Myriad of Experiences and Knowledge. Front Neurol 2021; 12:647425. [PMID: 33692748 PMCID: PMC7937693 DOI: 10.3389/fneur.2021.647425] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/01/2021] [Indexed: 12/17/2022] Open
Abstract
After gaining experience conducting both auto and allografts in persons with hematological diseases in the HSCT programs in Puebla and Monterrey, México, this study outlines subsequent program autografting patients with autoimmune conditions. The first transplant in multiple sclerosis was conducted in Puebla on July 5, 2006. From 2015 we increased activity autografting persons with autoimmune conditions in the two campuses of the HSCT-México program: Puebla and Monterrey. By December 6, 2020, patient number 1,000 in the program was autografted. In our experience, a significant reduction in the expanded disability status scale score was achieved in all of the three phenotypes of the disease (from a median of 5.1 to 4.5 points), whereas the response rate (defined as a decrease of at least 0.5 of EDSS score regardless of baseline EDSS, or unchanged EDSS) was 83, 78, and 73% after 12 months in the relapsing-remitting, primary-progressive and secondary-progressive forms of multiple sclerosis, respectively. In addition to analyzing the viability, safety, and efficacy of our method, this study contributes new knowledge to the field of both stem cell transplantation and multiple sclerosis.
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Affiliation(s)
- Iván Murrieta-Álvarez
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Yahveth Cantero-Fortiz
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Escuela de Medicina, Universidad de las Américas Puebla, Puebla, Mexico
| | - Andrés A León-Peña
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Juan C Olivares-Gazca
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | | | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,Laboratorios Clínicos de Puebla, Puebla, Mexico
| | | | | | | | | | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,Laboratorios Clínicos de Puebla, Puebla, Mexico
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15
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Jaime-Pérez JC, Hernández-Coronado M, Ancer-Rodríguez J, Gómez-Almaguer D. Increased blood transfusion after outpatient autologous transplantation with reduced intensity conditioning for hematological malignancies predicts worse outcomes. Clin Transplant 2021; 35:e14247. [PMID: 33559181 DOI: 10.1111/ctr.14247] [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: 11/06/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
Transfusion has a recognized immunomodulatory effect, and its role on the outcomes after an ambulatory autologous hematopoietic stem cell transplantation (auto-HSCT) following reduced intensity conditioning (RIC) has not been documented. A study to assess factors associated with the number of packed red blood cells (PRBCs) and platelet units transfused and their impact on survival rates of auto-HSCT recipients after RIC was conducted between 2013 and 2019. Transfusions were recorded from days 0 to 100. Of the 130 patients studied, seventy (53.9%) required transfusion support. The median number of PRBC transfused was 2 (range 1-20), and for platelets, it was also 2 units (range 1-19). Infused CD34 + cells/kg, pre-transplant CMV status, and relapse/progression were significantly associated with the number of PRBC units transfused and sex, infused CD34 + cells/kg, and pre-transplant CMV status with the number of platelet units transfused. In multivariate analysis, a high/very high Disease Risk Index (P = .001) (P = .001) and transfusion of ≥ 5 total blood products (P = .001) (P = .010) were associated with decreased disease-free and overall survival. Two-year cumulative incidence of relapse was 50% for transfused patients vs. 34% for those not transfused (P = .009). These data suggest that the transfusion burden and its interplay with other patient and transplant-related factors could be associated with inferior auto-HSCT outcomes.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Marcela Hernández-Coronado
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jesús Ancer-Rodríguez
- Department of Pathology, Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México
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16
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Jaime-Pérez JC, González-Treviño M, Gómez-Almaguer D. Pregnancy-associated aplastic anemia: a case-based review. Expert Rev Hematol 2021; 14:175-184. [PMID: 33430674 DOI: 10.1080/17474086.2021.1875816] [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] [Indexed: 10/22/2022]
Abstract
Introduction: Pregnancy-associated aplastic anemia (pAA) occurs when aplastic anemia (AA) is diagnosed for the first time during pregnancy and it is a rare but serious condition leading to severe maternal and fetal complications. It is unknown whether pregnancy triggers bone marrow failure or if this state is unrelated to the pathogenesis of pAA.Areas covered: In this review, three new cases of pAA are presented and its controversial etiologic relationship with pregnancy, its atypical presentation, and management are also discussed. Furthermore, a literature review of pAA cases between 1975 and 2020 was performed in PubMed, accessed via the National Library of Medicine PubMed interface. Keywords included 'aplastic anemia' AND 'pregnancy'. We found 54 cases reported in the literature with a clear diagnosis of pAA.Expert opinion: The diagnosis of pAA is challenging since pregnancy is associated with physiologic hematological changes in the complete blood count which can mask the disease. Meticulous monitoring and adequate support therapy given by a trained multidisciplinary team have the potential to improve outcomes for women and their neonates. All women should receive frequent assessments to optimize their care during pregnancy and after delivery, definitive treatment should be offered.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. Jos Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Mariana González-Treviño
- Department of Hematology, Internal Medicine Division, Dr. Jos Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. Jos Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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17
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Jaime-Pérez JC, Hernández-Coronado M, Salazar-Cavazos L, Marfil-Rivera LJ, Gómez-Almaguer D. A high transfusion burden following an ambulatory-allogeneic hematopoietic cell transplantation using reduced-intensity conditioning is associated with adverse outcomes. Blood Cells Mol Dis 2021; 88:102537. [PMID: 33493823 DOI: 10.1016/j.bcmd.2021.102537] [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: 12/17/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Ambulatory allogeneic hematopoietic cell transplantation (allo-HCT) after reduced-intensity conditioning (RIC) is a cost-effective option for hematology patients. Data on the impact of transfusion burden in this setting are scarce; we analyzed this retrospectively. METHODS A study of 177 HLA-identical and haploidentical allo-HCT recipients on an outpatient basis was conducted between 2013 and 2019. Packed red blood cell (PRBC) and platelet transfusions were documented from days 0-100 after HCT. RESULTS A total of 121 patients (68.4%) required transfusion while 56 (31.6%) did not. In the multivariate analysis, a lower disease-free (DFS) and overall survival (OS) were documented for patients that received ≥9 total blood products (p = 0.018) (p = 0.014), those who required hospitalization (p = 0.001) (p < 0.001), had acute graft-versus-host disease (p = 0.016) (p = 0.004), and a high/very high Disease-Risk-Index (p = 0.002; p = 0.004), respectively. Transfusion of ≥5 PRBC units was associated with a lower OS (p = 0.027). The cumulative incidence of transplant-related mortality at two years for an HLA-identical transplant was 9.5% and for haploidentical, it was 27.1% (p = 0.027); this last group had significantly more transfusion demands than HLA-identical recipients (p = 0.029). CONCLUSION Increased blood product utilization is an independent predictor of decreased survival in ambulatory RIC allo-HCT recipients. Further evidence leading to individualized guidelines to transfuse in this complex scenario is needed.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Marcela Hernández-Coronado
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Lorena Salazar-Cavazos
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Luis Javier Marfil-Rivera
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Gutiérrez-Aguirre CH, Esparza-Sandoval AC, Palomares-Leal A, Jaime-Pérez JC, Gómez-Almaguer D, Cantú-Rodríguez OG. Outpatient haploidentical hematopoietic stem cell transplant using post-transplant cyclophosphamide and incidence of hemorrhagic cystitis. Hematol Transfus Cell Ther 2020; 44:163-168. [PMID: 33814347 PMCID: PMC9123564 DOI: 10.1016/j.htct.2020.09.149] [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] [Received: 06/10/2020] [Revised: 08/03/2020] [Accepted: 09/19/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Hemorrhagic cystitis (HC) is a common complication of haploidentical hematopoietic stem cell transplantation (haplo-HSCT), characterized by irritative symptoms of the urinary tract and a higher morbidity and mortality rate. The worldwide incidence is reported between 10% and 70%. The use of alkylating agents and BK viral infection are the most frequent etiologies. The aim of this study was to report the HC incidence in an outpatient haplo-HCST program with a reduced intensity-conditioning (RIC) regimen, cataloguing risk factors, complications and final outcomes. Methods The medical database of patients who received a haplo-HSCT between January 2012 and November 2017 was retrospectively analyzed. Demographic variables, general characteristics and HC incidence were included. Results One hundred and eleven patients were included, 30 (27%) of whom developed HC, most of them (70%) being grade II, with a 30-day (7–149) median time of post-transplant HC onset. The BK virus was detected in 71% of the urine samples analyzed. All HC patients responded to treatment, except two (6.6%), who died due to HC complications. Conclusions There was no difference in the HC incidence or severity, compared to that reported when performing haplo-HSCT in hospitalized patients, although the donor-recipient sex mismatch did relate to a higher HC incidence.
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Affiliation(s)
| | | | - Alain Palomares-Leal
- University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Carlos Jaime-Pérez
- University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Jaime-Pérez JC, Picón-Galindo E, Herrera-Garza JL, Gómez-Almaguer D. Outcomes of second hematopoietic stem cell transplantation using reduced-intensity conditioning in an outpatient setting. Hematol Oncol 2020; 39:87-96. [PMID: 32978807 DOI: 10.1002/hon.2812] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/21/2020] [Accepted: 09/21/2020] [Indexed: 01/17/2023]
Abstract
Relapse and graft failure after autologous (auto) or allogeneic (allo) hematopoietic stem cell transplantation (HSCT) are serious and frequently fatal events. A second HSCT can be a life-saving alternative, however, information on the results of such intervention in an outpatient setting is limited. Outpatient second hematoprogenitors transplant after reduced-intensity conditioning (RIC) at a single academic center was analyzed. Twenty-seven consecutive adults who received an allo-HSCT after an initial auto- or allo-HSCT from 2006 to 2019 were included. Data were compared using the χ2 -test. Survival analysis using Kaplan-Meier and Cox proportional hazard models was performed; cumulative incidence estimation of transplant-related mortality (TRM) was assessed. Hodgkin lymphoma was the most frequent diagnosis for the group with a first auto-HSCT with 5/12 (41.7%) cases, and acute myeloid leukemia for those with a first allo-HSCT with 6/15 (40%). One-year overall survival and disease-free survival (DFS) was 66.7% (95% CI 27.2-88.2) and 59% (95% CI 16-86) for 12 patients with a first auto-HSCT; and for 15 patients with a first allo-HSCT, it was 43.3% (95% CI 17.9-66.5) and 36% (95% CI 13.2-59.9), respectively. Eight (29.6%) patients died of TRM and the cumulative incidence of TRM at 1 year was 22% (95% CI 8.6-39.27). Chronic graft-versus-host disease and late (>10 months) second transplantation were protective factors for longer survival. Neutropenic fever was more common in the group with a first allo-HSCT (p = 0.01). In conclusion, outpatient second allo-HSCT using RIC after auto- or allografting failure or relapse is feasible and offers a reasonable alternative for patients with severe life-threatening hematological diseases.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Ernesto Picón-Galindo
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - José Luis Herrera-Garza
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. Jose Eleuterio Gonzalez University Hospital and School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Jaime-Pérez JC, Aguilar-Calderón P, Jiménez-Castillo RA, Ramos-Dávila EM, Salazar-Cavazos L, Gómez-Almaguer D. Treatment outcomes and chronicity predictors for primary immune thrombocytopenia: 10-year data from an academic center. Ann Hematol 2020; 99:2513-2520. [DOI: 10.1007/s00277-020-04257-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/07/2020] [Indexed: 01/13/2023]
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Jaime-Pérez JC, García-Salas G, Áncer-Rodríguez J, Gómez-Almaguer D. Audit of red blood cell transfusion in patients with acute leukemia at a tertiary care university hospital. Transfusion 2020; 60:724-730. [PMID: 32056229 DOI: 10.1111/trf.15700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Red blood cell (RBC) transfusion support is essential in patients with acute leukemia (AL). A restrictive RBC transfusion approach is assumed to be safe for most individuals with AL. The aim of this audit was to assess RBC transfusion appropriateness in AL patients at an academic center. STUDY DESIGN AND METHODS RBC transfusions in acute lymphoblastic leukemia and acute myeloid leukemia patients of all ages between January 1, 2013, and March 31, 2019, were analyzed for adherence to evidence-based criteria. Transfusion appropriateness was compared among ordering specialties, patient locations, and hematologic diagnoses. Pretransfusion hemoglobin was compared between categories. Overtransfusion rates were also analyzed. Descriptive statistics and categorical and numerical tests were employed to determine statistical significance. RESULTS A total of 510 RBC transfusions were received by 133 AL patients in the departments of internal medicine, hematology, and pediatrics. Overall, 84.5% were appropriate according to established criteria. Internal medicine was the ordering department with the highest rate of appropriateness (88.1%). The outpatient clinic was the location with the highest adherence (85.9%), whereas the intensive care unit had the lowest (70%; p = 0.03). The reasons for most appropriate and inappropriate transfusions were asymptomatic anemia with a hemoglobin below (60.6%) or above (69.6%) 7 g/dL in patients without cardiac disease, respectively. Overtransfusion was present in 22% of episodes. CONCLUSION RBC transfusion in AL patients reflected good adherence to guidelines. However, continuing education in transfusion medicine and prospective chart auditing are needed to improve adherence to established guidelines.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Gerardo García-Salas
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Jesús Áncer-Rodríguez
- Department of Pathology, Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Jaime-Pérez JC, Santos JAHDL, Gómez-Almaguer D. Childhood T-cell acute lymphoblastic leukemia in a single Latin American center: impact of improved treatment scheme and support therapy on survival. Hematol Transfus Cell Ther 2019; 42:320-325. [PMID: 31810895 PMCID: PMC7599264 DOI: 10.1016/j.htct.2019.09.005] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/08/2019] [Accepted: 09/05/2019] [Indexed: 12/28/2022] Open
Abstract
Background and objective T-cell acute lymphoblastic leukemia (T-ALL) in children represents a high-risk disease. There is a lack of studies assessing the outcome of T-ALL in Hispanic populations, in which it is a rare malignancy. We report the characteristics and results of treatment for childhood T-cell ALL in children over 14 years at a Latin American reference center. Material and methods From January 2005 to December 2018, there occurred the analysis of twenty patients ≤ 16 years of age from a low-income open population diagnosed at a university hospital in Northeast Mexico. Clinical and laboratory characteristics, treatment regimens and outcomes were assessed by scrutinizing clinical records and electronic databases. Diagnosis was confirmed by flow cytometry, including positivity for CD-2, 5, 7 and surface/cytoplasmic CD3. Survival rates were assessed by the Kaplan-Meier method. Results There was a male preponderance (70 %), with a 2.3 male-to-female ratio (p = .074), the median age being 9.5 years. Leucocytes at diagnosis were ≥ 50 × 109/L in 13 (65 %) children, with CNS infiltration in 6 (30 %) and organomegaly in 10 (50 %). The five-year overall survival (OS) was 44.3 % (95 % CI 41.96–46.62), significantly lower in girls, at 20.8 % (95 % CI 17.32–24.51) vs. 53.1 % (95 % CI 50.30–55.82), (p = .035) in boys; there was no sex difference in the event-free survival (EFS) (p = .215). The survival was significantly higher after 2010 (p = .034). Conclusion The T-cell ALL was more frequent in boys, had a higher mortality in girls and the survival has increased over the last decade with improved chemotherapy and supportive care.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterry, Mexico.
| | | | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterry, Mexico
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Jaime-Pérez JC, Turrubiates-Hernández GA, Nava-Obregón T, Coronado-Hernández B, Gutiérrez-Aguirre H, Cantú-Rodríguez OG, Herrera-Garza JL, Gómez-Almaguer D. Palliative Care for Patients With Hematologic Malignancies in a Low-Middle Income Country: Prevalence of Symptoms and the Need for Improving Quality of Attention at the End of Life. Am J Hosp Palliat Care 2019; 37:600-605. [PMID: 31714147 DOI: 10.1177/1049909119887951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Palliative care (PC) for patients with malignant hematological diseases is scarcely documented, particularly in low- and middle-income countries. This study aimed to document PC provided to patients with hematologic malignancies. METHODS Bidirectional study conducted from July 2016 to June 2019 at the hematology and palliative care departments at a reference center in Northeast Mexico for low-income open population uninsured patients. Clinical records and electronic files of patients with malignant hematological diseases of both sexes and all ages attending an academic hematology center were reviewed. Statistical analysis was performed with the SPSS version 22 program. Acute and chronic leukemias, multiple myeloma, Hodgkin lymphoma, non-Hodgkin lymphoma, and others were included. RESULTS Five-hundred ten patients were studied, of which 148 (29%) died. Eighty-one (15.88%) patients including 31 (20.9%) who died received PC. Median age at palliative diagnosis was 42 (2-91) years. The most common symptom was pain (69.7%). The most frequent reason for palliative referral was treatment-refractory disease (39%). During the last week of life, 19 (95%) of 20 patients had blood sampling; 17 (85%) received antibiotics; 16 (80%) had a urinalysis performed; 16 (80%) received analgesia, including paracetamol (11, 35.5%) and buprenorphine (7, 22.6%); 10 (50%) received blood products; 9 (45%) were intubated; and central venous catheters were inserted in 5 (25%) patients. CONCLUSIONS Palliative care was provided to a minority of patients with hematologic malignancies and considerable improvement is required in its timely use and extension.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Grecia Abigayl Turrubiates-Hernández
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Teresa Nava-Obregón
- Department of Pain and Palliative Care Clinic, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Blanca Coronado-Hernández
- Department of Pain and Palliative Care Clinic, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Homero Gutiérrez-Aguirre
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Olga Graciela Cantú-Rodríguez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Luis Herrera-Garza
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Cantú-Rodríguez OG, Vázquez-Mellado A, González-Treviño JL, Martínez-Garza DM, Gómez-De León A, Hawing-Zarate JA, Jaime-Pérez JC, Gutierrez-Aguirre CH, Garza-Acosta AC, Mancías-Guerra C, González-Llano O, González-Cantú GA, Herrera-Rojas MA, Sada-Ovalle I, Gómez-Almaguer D. Cyclosporine A for the Prevention of Ocular Graft versus Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients Is Safe and Feasible. Acta Haematol 2019; 143:425-431. [PMID: 31505491 DOI: 10.1159/000502405] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/27/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of ocular cyclosporine in the prevention of the development of ocular graft versus host disease (oGVHD) in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT) in comparison with historic data. DESIGN We developed a longitudinal, observational, prospective nonrandomized study. We evaluated the feasibility of prophylactic use of topical cyclosporine A (CsA) to prevent or decrease the incidence of oGVHD and compared this with historic data. METHODS Patients undergoing AHSCT were treated with prophylactic topical CsA for 12 months after engraftment, followed by serial ophthalmic evaluations, including the Schirmer test. RESULTS Twenty patients were included. No serious adverse effects were reported. Poor adherence was documented in 15% of patients. In spite of observing extra-ocular GVHD (acute and chronic GVHD incidence of 50 and 45%, respectively), only 1 in 20 patients developed oGVHD over the 20-month follow-up for the entire cohort. No statistically significant difference was observed in the incidence of oGVHD when compared to a historical cohort. CONCLUSIONS Topical CsA as a prophylactic measure for oGVHD, administered over a period of 1 year after grafting, is safe and feasible and may decrease the incidence of ophthalmic manifestations of GVHD. These findings must be confirmed in a randomized trial.
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Affiliation(s)
- Olga Graciela Cantú-Rodríguez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico,
| | - Alberto Vázquez-Mellado
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | | | - David Mauricio Martínez-Garza
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - José Angel Hawing-Zarate
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - José Carlos Jaime-Pérez
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - César Homero Gutierrez-Aguirre
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Andrea Cecilia Garza-Acosta
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Consuelo Mancías-Guerra
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Oscar González-Llano
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | | | - Miguel Angel Herrera-Rojas
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - Isabel Sada-Ovalle
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
| | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González" Hematology Service, Monterrey, Mexico
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Jaime-Pérez JC, Sotomayor-Duque G, Aguilar-Calderón P, Salazar-Cavazos L, Gómez-Almaguer D. Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center. Int J Hematol Oncol Stem Cell Res 2019. [DOI: 10.18502/ijhoscr.v13i3.1274] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Lumbar puncture (LP) is a hematology procedure that can require repeated attempts leading to traumatic LP (TLP), which has been related to the central nervous system (CNS) relapse. LP success can depend on the size and anatomy of the patient and the skill of the hematologist. The main objective was to determine the influence of body mass index (BMI) on LP outcomes.
Materials and Methods: Adults with lymphoid malignancies requiring LP were included prospectively over one year; hematology residents performed most procedures. A 22-gauge Quincke needle was employed. Comparison between non-traumatic vs. traumatic LPs according to BMI, CNS relapse, and residents’ year was performed.
Results: Fifty-four patients with a mean age of 31.5±15.57 years were included. Diagnosis was Acute Lymphoblastic Leukemia-B (74%), Acute Lymphoblastic Leukemia-T (13%) and Non-Hodgkin Lymphoma (13%). 227 LPs were performed, 121 (53.3%) successful, 98 (43.2%) traumatic, 11 (11.2%) TLPs were macroscopically detectable and 87 (88%) microscopic; 8 (3.5%) were dry-taps. Median time between punctures was 11 days (1-202). Median BMI was 25 (22.8-39.6). Main indication for LP was prophylactic (74.5%); 39.2% were performed by first-year, 35.2% by second-year, 19.6% by third-year hematology residents. No difference (p = 0.145) for a TLP was found among residents. A BMI ≥30 (p = 0.040), non-palpable intervertebral space (p = 0.001) and more than one attempt (p = 0.001) were significant for TLP. TLP was not associated with CNS relapse (p = 0.962).
Conclusion: Obesity predicted a TLP. A traumatic puncture did not increase the risk of CNS relapse at one-year follow-up.
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Jaime-Pérez JC, Sotomayor-Duque G, Aguilar-Calderón P, Salazar-Cavazos L, Gómez-Almaguer D. Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center. Int J Hematol Oncol Stem Cell Res 2019; 13:146-152. [PMID: 31649805 PMCID: PMC6801327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background: Lumbar puncture (LP) is a hematology procedure that can require repeated attempts leading to traumatic LP (TLP), which has been related to the central nervous system (CNS) relapse. LP success can depend on the size and anatomy of the patient and the skill of the hematologist. The main objective was to determine the influence of body mass index (BMI) on LP outcomes. Materials and Methods: Adults with lymphoid malignancies requiring LP were included prospectively over one year; hematology residents performed most procedures. A 22-gauge Quincke needle was employed. Comparison between non-traumatic vs. traumatic LPs according to BMI, CNS relapse, and residents' year was performed. Results: Fifty-four patients with a mean age of 31.5±15.57 years were included. Diagnosis was Acute Lymphoblastic Leukemia-B (74%), Acute Lymphoblastic Leukemia-T (13%) and Non-Hodgkin Lymphoma (13%). 227 LPs were performed, 121 (53.3%) successful, 98 (43.2%) traumatic, 11 (11.2%) TLPs were macroscopically detectable and 87 (88%) microscopic; 8 (3.5%) were dry-taps. Median time between punctures was 11 days (1-202). Median BMI was 25 (22.8-39.6). Main indication for LP was prophylactic (74.5%); 39.2% were performed by first-year, 35.2% by second-year, 19.6% by third-year hematology residents. No difference (p = 0.145) for a TLP was found among residents. A BMI ≥30 (p = 0.040), non-palpable intervertebral space (p = 0.001) and more than one attempt (p = 0.001) were significant for TLP. TLP was not associated with CNS relapse (p = 0.962). Conclusion: Obesity predicted a TLP. A traumatic puncture did not increase the risk of CNS relapse at one-year follow-up.
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Jaime-Pérez JC, Aguilar-Calderón P, Salazar-Cavazos L, Gómez-De León A, Gómez-Almaguer D. Treatment of autoimmune hemolytic anemia: real world data from a reference center in Mexico. Blood Res 2019; 54:131-136. [PMID: 31309092 PMCID: PMC6614091 DOI: 10.5045/br.2019.54.2.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/24/2018] [Revised: 02/12/2019] [Accepted: 03/23/2019] [Indexed: 12/03/2022] Open
Abstract
Background Warm autoimmune hemolytic anemia (w-AIHA) is an uncommon disease with heterogeneous response to treatment. Steroids are the standard treatment at diagnosis, whereas rituximab has recently been recommended as the second-line therapy of choice. Our main objective was to document the response to treatment in patients with newly diagnosed w-AIHA, including the effectiveness of low-dose rituximab as frontline treatment and for refractory disease. Methods Patients with w-AIHA from 2002 to 2017 were included. Relapse-free survival (RFS), probability of maintained response (MR), and time-to-response were analyzed using the Kaplan–Meier method. Response was classified as complete, partial, and no response. Results We included 64 adults with w-AIHA (39 women and 25 men). The median age was 37 (16–77) years. Response rates to steroids alone were 76.7%, rituximab plus steroids, 100%; and cyclophosphamide, 80%. RFS with steroids at 6, 36, and 72 months was 86.3%, 65.1%, and 59.7%, respectively. Eighteen patients received rituximab at 100 mg/wk for 4 weeks plus high-dose dexamethasone as first-line therapy, with RFS at 6, 36, and 72 months of 92.3%, 58.7% and 44.1%, respectively. Eight patients refractory to several lines of therapy were treated with low-dose rituximab, and all achieved a response (three complete response and five partial response) at a median 16 days (95% confidence interval, 14.1–17.8), with a 75% probability of MR at 103 months; the mean MR was 81.93±18 months. Conclusion Outcomes of w-AIHA treatment were considerably heterogeneous. Low rituximab doses plus high dexamethasone doses were effective for refractory disease.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Patrizia Aguilar-Calderón
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Lorena Salazar-Cavazos
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. Josè E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Bugarin-Estrada E, Gómez-De León A, López-García YK, Díaz-Chuc EA, Priesca-Marín JM, Ruiz-Argüelles GJ, Jaime-Pérez JC, Gómez-Almaguer D. Clinical presentation in thrombotic thrombocytopenic purpura: Real-world data from two Mexican institutions. J Clin Apher 2018; 33:645-653. [DOI: 10.1002/jca.21659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Emmanuel Bugarin-Estrada
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - Andrés Gómez-De León
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - Yadith Karina López-García
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - Erik Alejandro Díaz-Chuc
- Department of Clinical Pathology; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - José Manuel Priesca-Marín
- Department of Internal Medicine and Hematology, Centro de Medicina Interna y Hematología; Clínica Ruiz; Puebla Puebla Mexico
| | - Guillermo J. Ruiz-Argüelles
- Department of Internal Medicine and Hematology, Centro de Medicina Interna y Hematología; Clínica Ruiz; Puebla Puebla Mexico
| | - José Carlos Jaime-Pérez
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
| | - David Gómez-Almaguer
- Hematology Service, Department of Internal Medicine; Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León Mexico
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Jaime-Pérez JC, Aguilar-Calderón PE, Salazar-Cavazos L, Gómez-Almaguer D. Evans syndrome: clinical perspectives, biological insights and treatment modalities. J Blood Med 2018; 9:171-184. [PMID: 30349415 PMCID: PMC6190623 DOI: 10.2147/jbm.s176144] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 12/23/2022] Open
Abstract
Evans syndrome (ES) is a rare and chronic autoimmune disease characterized by autoimmune hemolytic anemia and immune thrombocytopenic purpura with a positive direct anti-human globulin test. It is classified as primary and secondary, with the frequency in patients with autoimmune hemolytic anemia being 37%–73%. It predominates in children, mainly due to primary immunodeficiencies or autoimmune lymphoproliferative syndrome. ES during pregnancy is associated with high fetal morbidity, including severe hemolysis and intracranial bleeding with neurological sequelae and death. The clinical presentation can include fatigue, pallor, jaundice and mucosal bleeding, with remissions and exacerbations during the person’s lifetime, and acute manifestations as catastrophic bleeding and massive hemolysis. Recent molecular theories explaining the physiopathology of ES include deficiencies of CTLA-4, LRBA, TPP2 and a decreased CD4/CD8 ratio. As in other autoimmune cytopenias, there is no established evidence-based treatment and steroids are the first-line therapy, with intravenous immunoglobulin administered as a life-saving resource in cases of severe immune thrombocytopenic purpura manifestations. Second-line treatment for refractory ES includes rituximab, mofetil mycophenolate, cyclosporine, vincristine, azathioprine, sirolimus and thrombopoietin receptor agonists. In cases unresponsive to immunosuppressive agents, hematopoietic stem cell transplantation has been successful, although it is necessary to consider its potential serious adverse effects. In conclusion, ES is a disease with a heterogeneous course that remains challenging to patients and physicians, with prospective clinical trials needed to explore potential targeted therapy to achieve an improved long-term response or even a cure.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr José E González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México,
| | - Patrizia Elva Aguilar-Calderón
- Department of Hematology, Internal Medicine Division, Dr José E González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México,
| | - Lorena Salazar-Cavazos
- Department of Hematology, Internal Medicine Division, Dr José E González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México,
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr José E González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México,
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Jaime-Pérez JC, Salazar-Cavazos L, Aguilar-Calderón P, Herrera-Garza JL, Gutiérrez-Aguirre CH, Gómez-Almaguer D. Assessing the efficacy of an ambulatory peripheral blood hematopoietic stem cell transplant program using reduced intensity conditioning in a low-middle-income country. Bone Marrow Transplant 2018; 54:828-838. [DOI: 10.1038/s41409-018-0338-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/12/2018] [Accepted: 08/30/2018] [Indexed: 01/02/2023]
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Jaime-Pérez JC, Treviño-Reyna G, Aguilar-Calderón P, Cantú-Rodríguez OG, Marfil-Rivera L, Gómez-Almaguer D. Contributions of a regional approach to document hematologic disease in Mexico: a 10-year experience in an open population. Hematology 2018; 23:803-809. [DOI: 10.1080/10245332.2018.1498166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Goel Treviño-Reyna
- Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Patrizia Aguilar-Calderón
- Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Olga G. Cantú-Rodríguez
- Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Luis Javier Marfil-Rivera
- Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, Dr. José E. González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
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López-García YK, Colunga-Pedraza PR, Tarín-Arzaga L, López Garza MI, Jaime-Pérez JC, Gómez-Almaguer D. Iron deficiency anemia referral to the hematologist. Real-world data from Mexico: the need for targeted teaching in primary care. Hematology 2018; 23:658-663. [DOI: 10.1080/10245332.2018.1461290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yadith Karina López-García
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Perla Rocío Colunga-Pedraza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Luz Tarín-Arzaga
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Mariana Itzel López Garza
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Carlos Jaime-Pérez
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Hematology Service, Hospital Universitario ‘Dr. José Eleuterio González’, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Jaime-Pérez JC, Padilla-Medina JR, Fernández LT, Herrera-Garza JL, Gutiérrez-Aguirre CH, Tarín-Arzaga L, Gómez-Almaguer D. Outcomes of Adolescents and Young Adults With Acute Myeloid Leukemia Treated in a Single Latin American Center. Clinical Lymphoma Myeloma and Leukemia 2018; 18:286-292. [DOI: 10.1016/j.clml.2018.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 01/23/2023]
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Tarín-Arzaga L, Arredondo-Campos D, Martínez-Pacheco V, Martínez-González O, Ramírez-López A, Gómez-De León A, Gutiérrez-Aguirre CH, Cantú-Rodríguez O, Jaime-Pérez JC, Gómez-Almaguer D. Impact of the affordability of novel agents in patients with multiple myeloma: Real-world data of current clinical practice in Mexico. Cancer 2018; 124:1946-1953. [DOI: 10.1002/cncr.31305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Luz Tarín-Arzaga
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Daniela Arredondo-Campos
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Victor Martínez-Pacheco
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Odra Martínez-González
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Alba Ramírez-López
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Andrés Gómez-De León
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Cesar Homero Gutiérrez-Aguirre
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - Olga Cantú-Rodríguez
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - José Carlos Jaime-Pérez
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
| | - David Gómez-Almaguer
- Department of Hematology; University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey Mexico
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Jaime-Pérez JC, Fernández LT, Jiménez-Castillo RA, Colunga-Pedraza JE, Padilla-Medina JR, Mancías-Guerra C, Gómez-Almaguer D. Hospitalization rate and costs in acute lymphoblastic leukemia of childhood in a low-income group: Financial impact in Northeast Mexico. Pediatr Blood Cancer 2017; 64. [PMID: 28598592 DOI: 10.1002/pbc.26673] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/08/2017] [Accepted: 05/15/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is one of the main and most expensive and prolonged causes of hospitalization for childhood cancer. We describe the hospitalization rate and its costs for an open population with ALL in a low-middle income country. PROCEDURE We retrospectively analyzed 449 hospital admissions for 101 pediatric patients with ALL over 8 years. Clinical files and electronic databases were scrutinized to document causes, duration, readmission rate, costs, and outcome of each admission. Hospitalizations were divided into two categories: general pediatric ward and pediatric intensive care unit (PICU). Hospitalization rates and its costs per patient were estimated considering person-time at risk. RESULTS Patients had an admission rate of 2.09 hospitalizations per patient-year and median length of stay per admission was 5 days. Most admissions occurred during the first 2 years from diagnosis. Mean cost per day was 239 US dollars (USD) and mean cost per stay was 2,246 USD versus 1,016 and 19,004 USD (P = 0.001) in the PICU, respectively. Total hospitalization cost per patient per year (PPPY) was 5,991 USD for high-risk patients and 3,038 USD for standard-risk patients. Patients between ages 1 and 9 years had a PPPY cost of $4,057; while for children younger than 1 year or older than 9 years, it was 7,463 USD. The popular medical insurance program covered 70% of hospitalizations and 63% of its total cost; patients contributed 2%, with the hospital absorbing 35%. CONCLUSIONS Hospitalizations for children with ALL were less expensive than in high-income countries but had a significant cost to low-income families and to the healthcare system.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Lucía Teresa Fernández
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Raúl Alberto Jiménez-Castillo
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Julia Esther Colunga-Pedraza
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - José Ramón Padilla-Medina
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Consuelo Mancías-Guerra
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Jaime-Pérez JC, Borrego-López MF, Jiménez-Castillo RA, Méndez-Ramírez N, Salazar-Riojas R, Fernández LT, Gómez-Almaguer D. Comparison of conventional cytomorphology, flow cytometry immunophenotyping, and automated cell counting of CSF for detection of CNS involvement in acute lymphoblastic leukemia. Int J Lab Hematol 2017; 40:169-174. [PMID: 29115725 DOI: 10.1111/ijlh.12760] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/13/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Cytospin conventional cytomorphology (CCC) is the standard method for detecting lymphoblasts in cerebrospinal fluid (CSF) of patients with acute lymphoblastic leukemia (ALL) and for guiding treatment decisions. We evaluated flow cytometry immunophenotyping (FCI) performance for improving detection of central nervous system (CNS) involvement in ALL. METHODS This prospective study included analysis of consecutive CSF samples of patients of all ages with ALL at 3 clinical stages: new diagnosis, relapse suspicion, and after relapse treatment. Manual, cytospin, automated, and FCI methods were compared and their performance statistically assessed. Using FCI as the reference method, optimal CSF cutoff cell count that better correlated with presence of lymphoblasts was established by receiver operating characteristic (ROC) curve analysis. RESULTS Seventy-seven CSF samples were investigated, 35 (45.4%) from newly diagnosed cases, 30 (39%) suspicion of relapse, and 12 (15.6%) after treatment for relapse. Median manual WBC count in patients with CNS involvement detected by FCI was 3.75 cells/μL (0.0-1280), and this was also the count that best correlated with CNS infiltration (sensitivity, 50.0%; specificity, 82.2%). Compared with FCI, CCC sensitivity and specificity were 28.6% and 100%. Automated CSF WBC count in patients with CNS involvement detected by FCI was 5 (0.0-1578). For automated count, optimal WBC cutoff was 4.5 cells/μL (sensitivity, 62.5%; specificity, 70.5%). CONCLUSION Flow cytometry immunophenotyping complements conventional cytospin analysis for detection of lymphoblasts in the CSF of ALL patients at any clinical stage.
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Affiliation(s)
- J C Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - M F Borrego-López
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - R A Jiménez-Castillo
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - N Méndez-Ramírez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - R Salazar-Riojas
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - L T Fernández
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - D Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
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Gutiérrez-Aguirre CH, Flores-Jiménez JA, Alatorre-Ricardo J, Cantú-Rodríguez OG, Rosas-Taraco A, Salazar-Riojas R, Jaime-Pérez JC, Sánchez-Cárdenas M, López-Silva L, Martínez-Castilla AM, Salinas-Carmona MC, Gómez-Almaguer D. The prognostic significance of serum XCL1 concentration in patients with acute lymphoblastic leukemia: a pilot study. Ann Hematol 2017; 96:2015-2024. [PMID: 29027574 DOI: 10.1007/s00277-017-3142-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/24/2017] [Indexed: 01/10/2023]
Abstract
There is no information about XCL1 in patients with acute lymphoblastic leukemia (ALL). The objective of this study was to correlate the serum levels of XCL1 and survival in ALL patients. Only ALL patients older than 12 months were considered to participate. Serum XCL1 was measured at diagnosis, end of remission induction, and end of consolidation. Thirty-three ALL patients with median age of 21 years (1-78) were included. Higher XCL1 level (above 50 pg/mL) at ALL diagnosis correlated with higher survival (p = 0.038), whereas XCL1 level at end of induction and consolidation had no significant correlation. Concerning the behavior of serum XCL1 during treatment, higher survival at 5 years was observed in the group with progressively decreased levels of XCL1 (70%) than those with progressively increasing (29%) or no detectable XCL1 (14%). In conclusion, higher serum XCL1 levels at diagnosis and their progressive decline throughout chemotherapy could be correlated with higher survival.
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Affiliation(s)
- Cesar Homero Gutiérrez-Aguirre
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico.
| | - Juan Antonio Flores-Jiménez
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico
| | - Julio Alatorre-Ricardo
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico
| | - Olga Graciela Cantú-Rodríguez
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico
| | - Adrián Rosas-Taraco
- Servicio de Inmunología de la Facultad de Medicina, Universidad Autónoma de Nuevo León, Gonzalitos #235 Norte. Mitras Centro. C.P, 64460, Monterrey, Nuevo León, Mexico
| | - Rosario Salazar-Riojas
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico
| | - José Carlos Jaime-Pérez
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico
| | - Mónica Sánchez-Cárdenas
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico
| | - Leslie López-Silva
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico
| | - Azalia M Martínez-Castilla
- Servicio de Inmunología de la Facultad de Medicina, Universidad Autónoma de Nuevo León, Gonzalitos #235 Norte. Mitras Centro. C.P, 64460, Monterrey, Nuevo León, Mexico
| | - Mario Cesar Salinas-Carmona
- Servicio de Inmunología de la Facultad de Medicina, Universidad Autónoma de Nuevo León, Gonzalitos #235 Norte. Mitras Centro. C.P, 64460, Monterrey, Nuevo León, Mexico
| | - David Gómez-Almaguer
- Servicio de Hematología del Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos sn Colonia Mitras Centro, C.P, 64460, Monterrey, Nuevo León, Mexico
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Jaime-Pérez JC, Gamboa-Alonso CM, Padilla-Medina JR, Jiménez-Castillo RA, Olguín-Ramírez LA, Gutiérrez-Aguirre CH, Cantú-Rodríguez OG, Gómez-Almaguer D. High frequency of primary refractory disease and low progression-free survival rate of Hodgkin's lymphoma: a decade of experience in a Latin American center. Rev Bras Hematol Hemoter 2017; 39:325-330. [PMID: 29150104 PMCID: PMC5693277 DOI: 10.1016/j.bjhh.2017.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Reports dealing with clinical outcomes of classical Hodgkin's lymphoma in low- to middle-income countries are scarce and response to therapy is poorly documented. This report describes the characteristics and clinical outcomes of patients with classical Hodgkin's lymphoma from a single institution in Latin America. METHOD A retrospective study was conducted over ten years of patients with classical Hodgkin's lymphoma treated at a referral center. Progression-free and overall survival rates were estimated by Kaplan-Meier analysis. The univariate Cox regression model was used to estimate associations between important variables and clinical outcomes. MAIN RESULTS One hundred and twenty-eight patients were analyzed. The mean age was 28.5 years. The five-year progression-free and overall survival were 37.3% and 78.9%, respectively. Of the whole group, 55 (43%) were primary refractory cases. Only 39/83 (47%) patients with advanced disease vs. 34/45 (75.6%) in early stages (p-value=0.002) achieved complete remission. Those with advanced disease had a five-year overall survival of 68.7% vs. 91.8% for early disease (p-value=0.132). Thirty-one patients relapsed (24.2%) and 20 (64.5%) received a transplant. The hazard ratio for progression with bone marrow infiltration was 2.628 (p-value=0.037). For death, an International Prognostic Score ≥4 had a hazard ratio of 3.355 (p-value=0.050) in univariate analysis. Two-thirds of classical Hodgkin's lymphoma patients diagnosed at advanced stages had a low progression-free survival but an overall survival similar to high-income countries. CONCLUSION Patients diagnosed with classical Hodgkin's lymphoma in Northeastern Mexico had a significantly low progression-free survival rate and presented with advanced disease, underscoring the need for earlier diagnosis and improved contemporary therapeutic strategies in these mainly young productive-age Hodgkin's lymphoma patients.
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Jaime-Pérez JC, Fernández LT, Jiménez-Castillo RA, Gómez-De León A, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, Gómez-Almaguer D. Age Acts as an Adverse Independent Variable for Survival in Acute Lymphoblastic Leukemia: Data From a Cohort in Northeast Mexico. Clin Lymphoma Myeloma Leuk 2017; 17:590-594. [PMID: 28689002 DOI: 10.1016/j.clml.2017.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/10/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Survival for acute lymphoblastic leukemia (ALL) decreases with age. Patients across all age groups from a homogeneous ethnic and socioeconomic background were studied to document age effect. MATERIAL AND METHODS Patients diagnosed from 2005 to 2015 at a university hospital in Northeast Mexico were divided into 4 age groups: infants (< 1), children (≥ 1 to < 16), adolescents (≥ 16 to ≤ 20), and adults (> 20 years). Correlation between age at diagnosis and relapse-free (RFS) and overall survival (OS) was investigated. RESULTS A total of 377 patients were included. Five-year RFS and OS for children were 55.6% and 66.9%; for adolescents, 36.0% and 48.3%; for adults, 19.5% and 24.1%, respectively. Differences in RFS and OS between age groups were significant (P < .001, P < .001). In the Cox regression model, all age groups reached statistical significance in univariate analysis of mortality. CONCLUSION Age plays a decisive role in clinical evolution of ALL and strongly influences outcome. Age older than 20 represents a progressive high-risk factor for death.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Lucía Teresa Fernández
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Raúl Alberto Jiménez-Castillo
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Gómez-De León
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - Olga Graciela Cantú-Rodríguez
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - César Homero Gutiérrez-Aguirre
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Department of Hematology, Internal Medicine Division, "Dr José E. González" University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, México
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Jaime-Pérez JC, Pinzón-Uresti MA, Jiménez-Castillo RA, Colunga-Pedraza JE, González-Llano Ó, Gómez-Almaguer D. Relapse of childhood acute lymphoblastic leukemia and outcomes at a reference center in Latin America: organomegaly at diagnosis is a significant clinical predictor. ACTA ACUST UNITED AC 2017; 23:1-9. [PMID: 28580844 DOI: 10.1080/10245332.2017.1333294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Relapse is the major cause of treatment failure in acute lymphoblastic leukemia (ALL) of childhood; it is more frequent among high-risk patients from low-middle income than from high-income countries. The frequency, sites and outcome of relapsed ALL in children of northeast Mexico over a decade was documented. METHODS A retrospective analysis of 246 children belonging to a low-income group <16 years with de novo ALL during 2004-2015 was performed. Five-year overall survival (OS) and event-free survival was estimated by Kaplan-Meier analysis. Data on time, site, response to therapy and final outcome of relapse were analyzed. Hazard ratios (HRs) of relapse and death were estimated by the Cox regression model. Very early relapse was defined as that occurring in <18 months, early relapse between 18 and 36 months, and late relapse >36 months from diagnosis, respectively. RESULTS Eighty-seven (35.4%) children relapsed. Five-year OS was 82.6% in children without relapse vs. 42% for relapsed patients. Bone marrow (BM) was the most frequent site of relapse (51.72%). Isolated central nervous system (CNS) relapses occurred in 29.9%. Five-year OS was 11.2% for BM and 15.5% for early relapse. HR of relapse for organomegaly was 3.683, 2.247 for an initial white blood cell count >50 000 × 109/l and 1.169 for positive minimal residual disease status. CONCLUSION A high rate of very early, CNS, and BM relapse with a considerably low 5-year OS requiring reassessment of therapy was documented. Organomegaly at diagnosis was a highly significant clinical predictor for relapse.
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Affiliation(s)
- José Carlos Jaime-Pérez
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Mónica Andrea Pinzón-Uresti
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Raúl Alberto Jiménez-Castillo
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Julia Esther Colunga-Pedraza
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - Óscar González-Llano
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
| | - David Gómez-Almaguer
- a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico
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Flores-Jiménez JA, Saldaña-Vázquez R, Villarreal-Martínez L, Gutiérrez-Aguirre CH, Jaime-Pérez JC, Cantú-Rodríguez OG, González-Llano O, Gómez-Almaguer D. Frecuencia de sobrecarga de hierro en pacientes con enfermedades hematológicas. Salud Publica Mex 2017; 59:120-122. [DOI: 10.21149/8179] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Señor editor: La sobrecarga de hierro (SH) es un problema de salud pública. La hemosiderosis asociada con la transfusión de eritrocitos produce toxicidad, disfunción tisular y susceptibilidad a infecciones; en general son daños mediados a través de la generación de radicales libres…
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González-Llano O, Mancías-Guerra C, Gamboa-Alonso CM, Gómez-De León A, Jaime-Pérez JC, Gutiérrez-Aguirre CH, Cantú-Rodríguez O, Villarreal-Martínez L, García-Sepulveda R, Herrera-Rojas MA, Gómez-Almaguer D. Measurements of Catheter, Venous, and Capillary Cyclosporine A Blood Are Comparable and Useful in Pediatric Hematopoietic Stem Cell Transplant Recipients. Acta Haematol 2017; 137:113-116. [PMID: 28226327 DOI: 10.1159/000455817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/18/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Oscar González-Llano
- Hematology Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Gómez-Almaguer D, Marcos-Ramírez ER, Montaño-Figueroa EH, Ruiz-Argüelles GJ, Best-Aguilera CR, López-Sánchez MDC, Barrera-Chairez E, López-Arrollo JL, Ramos-Peñafiel CO, León-Peña A, González-López EE, Rivas-García PE, Tellez-Hinojosa CA, Gómez-De León A, Jaime-Pérez JC. Acute Leukemia Characteristics are Different Around the World: the Mexican Perspective. Clinical Lymphoma Myeloma and Leukemia 2017; 17:46-51. [DOI: 10.1016/j.clml.2016.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 01/19/2023]
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Jaime-Pérez JC, Guerra-Leal LN, Cantú-Rodríguez OG, Gómez-Almaguer D. Myelodysplasia and acute myeloid leukemia fifteen years after high-dose cyclophosphamide in a child with severe aplastic anemia. Rev Bras Hematol Hemoter 2017; 39:57-59. [PMID: 28270348 PMCID: PMC5339365 DOI: 10.1016/j.bjhh.2016.06.003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/05/2022] Open
Affiliation(s)
- José Carlos Jaime-Pérez
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario Dr. José E. González, Monterrey, Mexico.
| | - Liliana Nataly Guerra-Leal
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario Dr. José E. González, Monterrey, Mexico
| | - Olga Graciela Cantú-Rodríguez
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario Dr. José E. González, Monterrey, Mexico
| | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario Dr. José E. González, Monterrey, Mexico
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Jaime-Pérez JC, Jiménez-Castillo RA, Herrera-Garza JL, Gutiérrez-Aguirre H, Marfil-Rivera LJ, Gómez-Almaguer D. Survival Rates of Adults With Acute Lymphoblastic Leukemia in a Low-Income Population: A Decade of Experience at a Single Institution in Mexico. Clinical Lymphoma Myeloma and Leukemia 2017; 17:60-68. [DOI: 10.1016/j.clml.2016.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/14/2016] [Accepted: 08/02/2016] [Indexed: 11/27/2022]
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Bustamante AE, Jaime-Pérez JC, Cordero-Pérez P, Galindo-Rodríguez G, Muñoz-Espinosa LE, Villarreal-Villarreal CD, Mercado-Longoria R. A High Level of Soluble CD40L Is Associated with P. aeruginosa Infection in Patients with Cystic Fibrosis. PLoS One 2016; 11:e0168819. [PMID: 28030642 PMCID: PMC5193430 DOI: 10.1371/journal.pone.0168819] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/18/2016] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this study was to evaluate whether the concentration of sCD40L, a product of platelet activation, correlates with the presence of Pseudomonas aeruginosa in the airway of patients with cystic fibrosis (CF) and to determine its possible clinical association. Methods Sixty patients with CF, ranging in age from 2 months to 36 years, were studied. The demographics, cystic fibrosis transmembrane conductance regulator (CFTR) genotype, spirometry measurements, radiographic and tomographic scans, platelet count in peripheral blood, sCD40L, IL-6, TNF-α and ICAM1 data were collected. Infection-colonization of the airway was evaluated using sputum and throat swab cultures; the levels of anti-Pseudomonas aeruginosa antibodies (Anti-PaAb) were evaluated. Results Patients with CF and chronic colonization had anti-PaAb values of 11.6 ± 2.1 ELISA units (EU) and sCD40L in plasma of 1530.9 ±1162.3 pg/mL; those with intermittent infection had 5.7 ± 2.7 EU and 2243.6 ± 1475.9 pg/mL; and those who were never infected had 3.46 ± 1.8 EU (p≤0.001) and 1008.1 ± 746.8 pg/mL (p≤0.01), respectively. The cutoff value of sCD40L of 1255 pg/mL was associated with an area under the ROC (receiver operating characteristic curve) of 0.84 (95% CI, 0.71 to 0.97), reflecting P. aeruginosa infection with a sensitivity of 73% and a specificity of 89%. Lung damage was determined using the Brasfield Score, the Bhalla Score, and spirometry (FVC%, FEV1%) and found to be significantly different among the groups (p≤0.001). Conclusion Circulating sCD40L levels are increased in patients with cystic fibrosis and P. aeruginosa infection. Soluble CD40L appears to reflect infection and provides a tool for monitoring the evolution of lung deterioration.
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Affiliation(s)
- Adriana Ester Bustamante
- Clínica de Fibrosis Quística, Servicio de Neumología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario “Dr. José E. González”, Monterrey Nuevo León, México
- * E-mail:
| | - José Carlos Jaime-Pérez
- Departamento de Hematología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario “Dr. José E. González”, Monterrey Nuevo León, México
| | - Paula Cordero-Pérez
- Unidad de Hígado, Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario “Dr. José E. González”, Monterrey Nuevo León, México
| | - Gabriela Galindo-Rodríguez
- Servicio de Alergia e Inmunología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario “Dr. José E. González”, Monterrey Nuevo León, México
| | - Linda Elsa Muñoz-Espinosa
- Unidad de Hígado, Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario “Dr. José E. González”, Monterrey Nuevo León, México
| | - César Daniel Villarreal-Villarreal
- Departamento de Hematología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario “Dr. José E. González”, Monterrey Nuevo León, México
| | - Roberto Mercado-Longoria
- Clínica de Fibrosis Quística, Servicio de Neumología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario “Dr. José E. González”, Monterrey Nuevo León, México
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Jaime-Pérez JC, Gamboa-Alonso CM, Jiménez-Castillo RA, López-Silva LJ, Pinzón-Uresti MA, Gómez-De León A, Gómez-Almaguer D. TNF-α increases in the CSF of children with acute lymphoblastic leukemia before CNS relapse. Blood Cells Mol Dis 2016; 63:27-31. [PMID: 28061377 DOI: 10.1016/j.bcmd.2016.12.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/21/2016] [Indexed: 12/21/2022]
Abstract
There is scarce information regarding the concentration of cytokines in cerebrospinal fluid (CSF) of children with acute lymphoblastic leukemia (ALL) and their clinical association with CNS status. A prospective analysis of 40 patients <18years with newly diagnosed ALL was performed. Human cytokine magnetic bead panel assay values of IL-2, IL-4, IL-6, IL-8, IL-10, MCP-1, TNF-α in CSF at diagnosis, end of induction to remission, and 6months after diagnosis were determined. IL-6 and MCP-1 values showed a significant increment at the end of induction. From the whole group 4 (10.0%), patients relapsed to the CNS at a median of 11.48months. A significantly higher value of TNF-α at third determination in these CNS-relapsed patients was documented, 7.48 vs. 2.86pg/mL in 36 children without relapse (p=0.024). TNF-α concentration increased at a median 5.48months before CNS relapse. By receiver-operating characteristic curve (ROC) analysis, the best cut-off point of TNF-α concentration that better predicted CNS relapse was ≥1.79pg/mL. In conclusion an increase in TNF-α concentration on CSF preceded CNS relapse in children with ALL. An increase in MCP-1 and IL-6 was not associated to CNS relapse and appears to result from an inflammatory response after IT injection of chemotherapy.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Carmen Magdalena Gamboa-Alonso
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Raúl Alberto Jiménez-Castillo
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Leslie Jazmín López-Silva
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Mónica Andrea Pinzón-Uresti
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Andrés Gómez-De León
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Jaime-Pérez JC, Jiménez-Castillo RA, Vázquez-Hernández KE, Salazar-Riojas R, Méndez-Ramírez N, Gómez-Almaguer D. Plateletpheresis efficiency and mathematical correction of software-derived platelet yield prediction: A linear regression and ROC modeling approach. J Clin Apher 2016; 32:329-334. [DOI: 10.1002/jca.21518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/08/2022]
Affiliation(s)
- José Carlos Jaime-Pérez
- Department of Hematology; Dr. José Eleuterio González University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey México
| | - Raúl Alberto Jiménez-Castillo
- Department of Hematology; Dr. José Eleuterio González University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey México
| | - Karina Elizabeth Vázquez-Hernández
- Department of Hematology; Dr. José Eleuterio González University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey México
| | - Rosario Salazar-Riojas
- Department of Hematology; Dr. José Eleuterio González University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey México
| | - Nereida Méndez-Ramírez
- Department of Hematology; Dr. José Eleuterio González University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey México
| | - David Gómez-Almaguer
- Department of Hematology; Dr. José Eleuterio González University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León; Monterrey México
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Gutierrez-Aguirre CH, García-Lozano JA, Treviño-Montemayor OR, Iglesias-Benavides JL, Cantú-Rodríguez OG, González-Llano O, Gómez-De León A, Salazar-Riojas R, Mancias-Guerra C, Jaime-Pérez JC, Guzman-López A, Gómez-Almaguer D. Comparative analysis of iron status and other hematological parameters in preeclampsia. ACTA ACUST UNITED AC 2016; 22:36-40. [PMID: 27558940 DOI: 10.1080/10245332.2016.1220120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare serum ferritin (SF) concentrations and other hematological parameters between patients with preeclampsia (PE) and normal pregnant women of the same gestational period who received supplemental iron during pregnancy. METHODS Prospective, comparative, observational pilot study that included 31 women with PE and 30 healthy pregnant women, at 20 weeks' of gestation. Ferritin, iron and complete blood cell count were compared between groups. RESULTS In comparison with controls, preeclamptic patients had a higher weight, body mass index, and arterial pressure. Serum ferritin and serum iron were higher in patients with PE (median: 36.5 μg/l vs. 20.9 μg/l and 103.9 μg/dl vs. 90.8 μg/dl) with a significant difference (P = 0.019 and P = 0.345). SF values >40 μg/l correlated with PE (r = 0.281; P = 0.032). A platelet count less than 100 × 109/l was higher in the PE group than in the control group (13% vs. 3%, P = 0.354). CONCLUSION Higher SF levels, despite being within normal range, were associated with PE. The incidence of thrombocytopenia was higher in preeclamptic women, however, the remaining hematological parameters were similar in both groups.
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Affiliation(s)
- César Homero Gutierrez-Aguirre
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - José Alberto García-Lozano
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Oscar Rubén Treviño-Montemayor
- b Obstetrics Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - José Luis Iglesias-Benavides
- b Obstetrics Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Olga Graciela Cantú-Rodríguez
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Oscar González-Llano
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Andrés Gómez-De León
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Rosario Salazar-Riojas
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Consuelo Mancias-Guerra
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - José Carlos Jaime-Pérez
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - Abel Guzman-López
- b Obstetrics Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
| | - David Gómez-Almaguer
- a Hematology Service, Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León , Madero y Gonzalitos Sn, Colonia Mitras Centro, Monterrey , N.L. C.P. 64460 , Mexico
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Gómez-Almaguer D, Vázquez-Mellado A, Navarro-Cabrera JR, Abello-Polo V, Milovic V, García J, Basquiera AL, Saba S, Balladares G, Vela-Ojeda J, Gómez S, Karduss-Aurueta A, Bustinza-Álvarez A, Requejo A, Feldman L, Jaime-Pérez JC, Yantorno S, Kusminsky G, Gutiérrez-Aguirre CH, Arbelbide J, Martinez-Rolon J, Jarchum G, Jaimovich G, Riera L, Pedraza-Mesa E, Villamizar-Gómez L, Herrera-Rojas MÁ, Gamboa-Alonso MM, Foncuberta C, Rodríguez-González G, García Ruiz-Esparza MA, Hernández-Maldonado E, Paz-Infanzón M, González-López E, Ruiz-Argüelles GJ. The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants. Bone Marrow Transplant 2016; 52:41-46. [DOI: 10.1038/bmt.2016.212] [Citation(s) in RCA: 3] [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] [Received: 01/31/2016] [Revised: 07/04/2016] [Accepted: 07/08/2016] [Indexed: 11/09/2022]
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