1
|
Yang CF, Hsu CY, Hsiao LT, Chen SW, Chuang SS. Clinicopathological characteristics of myelodysplastic syndromes with del(5q) in Taiwan. Malays J Pathol 2023; 45:405-416. [PMID: 38155382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND Myelodysplastic syndromes (MDS) are a group of clonal haematopoietic stem cell disorders characterised by ineffective haematopoiesis and cytopenia. Studies have reported differences in MDS between Asian and Western countries, but data from Taiwan are scarce. MATERIALS AND METHODS In this study we analysed the clinical and pathological features of 32 Taiwanese MDS patients with del(5q) (ie, del(5q) alone [Group A, n = 11], del(5q) with one additional cytogenetic abnormality other than monosomy 7 or del(7q) [Group B, del(5q)+1; n = 6], and del(5q) with ≥2 additional cytogenetic abnormalities [Group C, n = 15]). RESULTS Progression-free survival (PFS) and overall survival (OS) were more favourable for Group A than for Groups B (p < 0.05) and C (p ≤ 0.001). Multivariate analysis showed that age >70 years, thrombocytopenia, and karyotype other than del(5q) alone were poor prognostic factors. Among the patients that had World Health Organization (WHO)-defined MDS with isolated del(5q), one patient (9%) had a typical marrow morphology of 5q minus syndrome with erythroid hypoplasia and four patients (36%) had hypolobated megakaryocytes. In addition, PFS and OS were significantly more favorable for the patients with del(5q) alone than for those with del(5q)+1 (p < 0.05). CONCLUSION The bone marrow morphology, clinical features, and prognosis of Taiwanese MDS patients with del(5q) were different from those associated with MDS with isolated del(5q) as defined in the current WHO classification. Researchers should compare different geographic regions and racial populations to determine whether geographic and racial differences exist with respect to MDS with del(5q).
Collapse
Affiliation(s)
- C F Yang
- Taipei Veterans General Hospital, Department of Pathology and Laboratory Medicine, Taipei, Taiwan
| | - C Y Hsu
- Taipei Veterans General Hospital, Department of Pathology and Laboratory Medicine, Taipei, Taiwan
| | - L T Hsiao
- National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
| | - S W Chen
- Chi-Mei Hospital, Department of Internal Medicine, Division of Hemato-Oncology, Lioying, Tainan, Taiwan
| | - S S Chuang
- Chi-Mei Medical Center, Department of Pathology, Tainan, Taiwan.
| |
Collapse
|
2
|
Chen PM, Hsiao LT, Tang JL, Yen CC, Liu JH, Lin KH, Chiou TJ, Tzeng CH. Haematopoietic stem cell transplantation in Taiwan: past, present, and future. Hong Kong Med J 2009; 15:13-16. [PMID: 19494390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
In Taiwan, haematopoietic stem cell transplantation (HSCT) has been used to treat patients with haematological diseases since 1983. Thereafter till 2007, there were 2537 patients who had undergone HSCT in more than 15 hospitals. Their diseases included acute myeloid leukaemia in 27.8% of cases, non-Hodgkin's lymphoma 23.3%, acute lymphoblastic leukaemia 12.8%, chronic myeloid leukaemia 11.9%, severe aplastic anaemia 8.7%, and multiple myeloma 4.1%. Most of the cases received myeloablative conditioning regimens. More than 15% of cases received non-myeloablative regimens, and the mean age of these cases was at least 10 years older than those who received myeloablative regimens. The types of graft included peripheral blood (60.4%) and bone marrow (32.0%). A total of 35% of patients received autologous grafts. Of 1557 allogeneic HSCT patients, 338 (21.7%) received grafts from unrelated donors. Cord blood transplantation has been successfully performed in paediatric patients with thalassaemia major and with a large body size, and adult patients. The incidence of acute graft-versus-host disease was relatively low in Taiwan. On the contrary, a relatively higher proportion of hepatitis B carrier in the recipients had led to a higher incidence of reactivation hepatitis, which was markedly decreased following lamivudine prophylaxis. In conclusion, HSCT has become a routine therapy for major medical centres in Taiwan. Our unique experiences in the past decades also contributed to the progress of HSCT. With the establishment of professional association and patient supportive groups, we hope we can fully improve our daily practice and clinical as well as basic research in HSCT.
Collapse
Affiliation(s)
- P M Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Hsiao LT, Chiou TJ, Gau JP, Liu JH, Tzeng CH, Chen PM. Hepatitis B infection in haematopoietic stem cell transplantation: still unresolved. Hong Kong Med J 2009; 15:42-44. [PMID: 19494397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Impact of hepatitis B virus (HBV) infection on haematopoietic stem cell transplantation (HSCT) was reported earlier since late 1980s. It was shown that changing patterns of HBV serological markers was accompanied by variable severity of hepatitis after transplantation. Recipient's hepatitis B virus surface antigen (HBsAg) positivity was not considered an absolute contra-indication to allogeneic HSCT. However, HBsAg positivity was an important risk factor of reactivation hepatitis after transplantation, especially in allogeneic setting. Managing HBV reactivation in HSCT recipients was not successful till the availability of lamivudine since mid-1990s. For HBsAg-positive recipients, prophylactic lamivudine has been shown to significantly reduce reactivation hepatitis. As for HBsAg-negative recipients, there have been a small number of patients who develop so-called reverse seroconversion, that is, appearance of HBsAg after transplantation. In addition to chronic graft-versus-host disease, the risk was also high in allogeneic HSCT recipients who received fludarabine-antithymocyte globulin-containing conditioning regimens. The HBV is harboured earlier in the recipients before transplantation rather than transmitted via transfusion. At present, the optimal duration of lamivudine prophylaxis is not well-defined, and there are several fatal cases associated with early withdrawal and resistant HBV mutants. In conclusion, in HBV-endemic areas, the war between HBV and HSCT recipients continued even though several anti-HBV agents and molecular detection techniques are available. It deserves additional effort to overcome and also presents a chance to elucidate underlying mechanisms of HBV immunity, which are not easily studied in non-HSCT setting.
Collapse
Affiliation(s)
- L T Hsiao
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | | | | | | | | | | |
Collapse
|
4
|
Lee MY, Chiou TJ, Yang MH, Bai LY, Hsiao LT, Chao TC, Tung SL, Wang WS, Yen CC, Liu JH, Chen PM. Relatively favorable outcomes of post-transplant pulmonary function in patients with chronic myeloid leukemia receiving non-myeloablative allogeneic hematopoietic stem cell transplantation. Eur J Haematol 2005; 74:152-7. [PMID: 15654907 DOI: 10.1111/j.1600-0609.2004.00366.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pulmonary function tests were performed in 20 patients with chronic myeloid leukemia before and after human leukocyte antigen-matched allogeneic sibling hematopoietic stem cell transplantation (HSCT) to identify any conditioning treatment effects on post-transplant function from January 1995 to December 2002. Of 20 patients, eight received non-myeloablative conditioning treatment and 12 received conventional myeloablative conditioning treatment. Pulmonary function tests including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and diffusion capacity for carbon monoxide (DLCO) were performed pretransplant, 6 and 12 months post-transplant. Possible pre-HSCT and post-HSCT risk factors were evaluated for association with pulmonary function. The results showed that myeloablative conditioning treatment had greater negative impact on FEV1, FVC, and DLCO than non-myeloablative conditioning therapy. We conclude that non-myeloablative allogeneic HSCT may apply a better transplant choice in patients who need special concern with post-transplant pulmonary function changes.
Collapse
Affiliation(s)
- M Y Lee
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Bai LY, Chiou TJ, Liu JH, Yen CC, Wang WS, Yan MH, Hsiao LT, Chao TC, Chen PM. Hematopoietic stem cell transplantation for severe aplastic anemia--experience of an institute in Taiwan. Ann Hematol 2003; 83:38-43. [PMID: 14530878 PMCID: PMC7102357 DOI: 10.1007/s00277-003-0781-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 12/14/2002] [Accepted: 08/29/2003] [Indexed: 11/27/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is an accepted treatment strategy for patients with severe aplastic anemia (SAA). We report our experience in a general hospital in Taiwan. From March 1985 to July 2001, 79 consecutive SAA patients, 46 male and 33 female, with a median age of 22 (4–43) years, received 80 courses of transplantation. Cyclophosphamide and total body radiation were used for the conditioning regimen, and cyclosporine-A and methotrexate for graft-versus-host disease (GVHD) prevention. Patients were followed for a median of 39 months (from 8 days to 194 months). Myeloid and platelet engraftment occurred in a median of 15 (8–27) days and 18 (8–77) days, respectively. Three patients had primary and three patients secondary graft failure. Five patients (6.8%) had grade II–IV acute GVHD in 73 evaluable patients. Chronic GVHD occurred in 23 (34.8%) patients, with extensive stage in six. Only two patients had CMV disease. The projected 3- and 5-year overall survival rates estimated by the Kaplan-Meier method were 76.08 and 74.13%, respectively. Age at transplant, non-sibling donor, mononuclear cell dose, grade II–IV acute GVHD, interval from diagnosis to transplant, and red blood cell and platelet transfusion before transplant were poor prognostic factors for overall survival by univariate analysis. Grade II–IV acute GVHD was the only prognostic factor affecting overall survival after multivariate Cox regression analysis (P=0.040). In conclusion, SAA patients receiving HSCT have good long-term survival. The low incidence of acute GVHD in our patients may be related to ethnicity.
Collapse
Affiliation(s)
- L. Y. Bai
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| | - T. J. Chiou
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| | - J. H. Liu
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| | - C. C. Yen
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| | - W. S. Wang
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| | - M. H. Yan
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| | - L. T. Hsiao
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| | - T. C. Chao
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| | - P. M. Chen
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, 201, Sec 2, Shih-Pai Road, 112 Taipei, Taiwan
| |
Collapse
|
6
|
Hsiao LT, Liu JH, Yen CC, Wang WS, Fan FS, Chiou TJ, Chen PM. Relapse of Graves' disease after successful allogeneic bone marrow transplantation. Bone Marrow Transplant 2001; 28:1151-3. [PMID: 11803358 DOI: 10.1038/sj.bmt.1703291] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2000] [Accepted: 09/02/2001] [Indexed: 11/09/2022]
Abstract
As shown in many reports, allogeneic BMT can help cure autoimmune diseases. Conversely, we present a 24-year-old woman with Graves' disease, which was diagnosed just before BMT for CML. The Graves' disease remitted immediately after BMT but relapsed 18 months later. Since the donor was free from thyroid diseases and the patient showed a rapid shift to complete donor chimerism after BMT, the autoimmune problem seemed neither to arise directly from the donor nor simply from the recipient's residual lymphocytes. On the contrary, it was most likely compounded by chronic GVHD as suggested by the accompanying GVHD symptoms and the absolute donor karyotype in bone marrow cells. A Graves' disease-susceptible HLA allele was also shared between recipient and donor, possibly enhancing the chances of this condition developing. Thus, allogeneic BMT may facilitate relapses in autoimmune diseases as well as alleviating them.
Collapse
Affiliation(s)
- L T Hsiao
- Division of Medical Oncology, Taipei Veterans General Hospital, National Yang-Ming University, No. 201 Shih-Pai Road, Sec. 2, Taipei 112, Taiwan, ROC
| | | | | | | | | | | | | |
Collapse
|
7
|
Chen PM, Chiou TJ, Yu IT, Fan FS, Chu CJ, Kao SC, Wang WS, Liu JH, Hsu WM, Yang MH, Chao TC, Tai CJ, Hsiao LT, Lin JT, Yen CC. Molecular analysis of mucosa-associated lymphoid tissue (MALT) lymphoma of ocular adnexa. Leuk Lymphoma 2001; 42:207-14. [PMID: 11699208 DOI: 10.3109/10428190109097692] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Lymphomas of mucosa-associated lymphoid tissue (MALT) are a distinct subgroup of extranodal B-cell non-Hodgkin's lymphomas. Most studies have failed to demonstrate the clonal rearrangement of BCL-1, BCL-2 or c-MYC genes for MALT lymphomas. Further, alteration of the p53 gene is rarely demonstrated in low-grade MALT lymphomas, but can be detected in high-grade disease. Lymphomas of the ocular adnexa represent approximately eight percent of all extranodal lymphomas, most of which are MALT lymphomas, but few studies had explored the alterations of BCL-1, BCL-2, c-MYC and p53 genes specifically for ocular MALT lymphomas. We investigated the changes to BCL-1, BCL-2, c-MYC and p53 genes in these lymphomas for Taiwanese patients. Clonal rearrangement for immunoglobulin heavy-chain (IgH), BCL-1, BCL-2, c-MYC and p53 genes was examined for 16 cases of ocular MALT lymphoma. Restriction-length polymorphism and polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) of the DNA, corresponding to exons 5 through 9, followed by DNA sequencing, were utilized to analyze the possible mutations of the p53 gene for these tumors. Thirteen of the cases revealed rearranged IgH genes using Southern blotting or PCR. No rearrangement of BCL-1, BCL-2, c-MYC or p53 genes was discovered, with point mutation of the p53 gene in one case. As for other types of MALT lymphomas, BCL-1, BCL-2 and c-MYC genes are not implicated in the pathogenesis of the ocular sub-group. Although alteration of the p53 gene is rare for low-grade ocular MALT lymphoma, its role in disease progression merits further research.
Collapse
Affiliation(s)
- P M Chen
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan, R.O.C
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Yen CC, Liu JH, Wang WS, Fan FS, Chiou TJ, Tai CJ, Yang MH, Chao TC, Hsiao LT, Chen PM. Immunophenotypic and genotypic characteristics of chronic myelogenous leukemia in blast crisis. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:785-91. [PMID: 11155753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Chronic myelogenous leukemia (CML) may transform into blast crisis (BC) if not properly treated. Among patients with transformation, 20% to 30% will develop BC with lymphoid-associated antigens (Ly-BC), and the remaining cases with myeloid-associated antigens (My-BC) or with both (Mix-BC). In this study, we investigated the lineage of blast cells in CML-BC using immunophenotypic and genetic analyses and analyzed the prognostic significance of genotypic change in CML-BC. METHODS Twenty-one patients with CML-BC diagnosed at the Taipei Veterans General Hospital from 1982 to 1992 were included. Immunophenotyping was done by using the avidin-biotin immunoperoxidase technique. Genetic analyses were carried out by using Southern Blot hybridization. The prognostic influence of genotypic change was analyzed. RESULTS Thirteen patients (61.9%) expressed myeloid-associated antigens, one patient (4.8%) expressed megakaryoblast-associated antigens, four patients (19%) expressed B lymphoid-associated antigens and three patients (14.3%) expressed both myeloid and B lymphoid antigens. Clonal rearrangement of the immunoglobulin heavy chain (IgH) gene was found in six cases. Among them, four expressed B lymphoid markers only and two expressed both myeloid and B lymphoid markers. Patients with clonal IgH gene rearrangement tended to have a better response to chemotherapy (50% vs 8.3%, p = 0.08) and significantly longer survival (median survival, 5 months vs 3 months, p < 0.05) than did those with a germline configuration. CONCLUSIONS Clonal rearrangement of the IgH gene was found mostly in cases of Ly-BC and Mix-BC. We found that CML-BC with clonal rearrangement of the IgH gene had a more favorable prognosis than in cases with a germline configuration.
Collapse
Affiliation(s)
- C C Yen
- Section of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most common malignancy in Taiwan. Some patients may manifest paraneoplastic syndromes during the clinical course of the disease. In this study, the authors evaluated the clinical significance of these paraneoplastic syndromes, compared the prevalence of these syndromes between cases of hepatitis B virus (HBV)-related and hepatitis C virus (HCV)-related HCC, and estimated significant predictors associated with the syndromes. METHODS Clinical data on 1197 HCC patients, including age, gender, Child-Pugh score, survival time, laboratory data (including liver biochemistry, hepatitis markers, and serum alpha-fetoprotein [AFP]), and tumor features (including tumor size, portal vein thrombosis, and histologic pictures), were retrospectively reviewed. RESULTS A total of 232 of 1197 patients (19.4%) had paraneoplastic syndromes. HCC patients with paraneoplastic syndromes had significantly higher serum AFP; higher rates of initial main portal vein thrombosis, metastasis, and bilobal tumor involvement; larger tumor volume; and shorter survival than those without these syndromes. Patients with HBV-related HCC had a significantly higher prevalence of paraneoplastic syndromes than patients with HCV-related HCC (20.1% vs. 11.2%, P = 0.005). In a stepwise multivariate logistic regression analysis, AFP >50,000 ng/mL and tumor volume >30% were significant predictive variables associated with the presence of paraneoplastic syndromes in HCC patients. CONCLUSIONS HCC patients with paraneoplastic syndromes usually had higher levels of serum AFP and larger tumor volumes than those without. Patients with HBV-related HCC had a significantly higher prevalence of paraneoplastic syndromes than those with HCV-related HCC.
Collapse
Affiliation(s)
- J C Luo
- Division of Gastroenterology, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most common malignancy in Taiwan. Some patients may manifest paraneoplastic syndromes during the clinical course of the disease. In this study, the authors evaluated the clinical significance of these paraneoplastic syndromes, compared the prevalence of these syndromes between cases of hepatitis B virus (HBV)-related and hepatitis C virus (HCV)-related HCC, and estimated significant predictors associated with the syndromes. METHODS Clinical data on 1197 HCC patients, including age, gender, Child-Pugh score, survival time, laboratory data (including liver biochemistry, hepatitis markers, and serum alpha-fetoprotein [AFP]), and tumor features (including tumor size, portal vein thrombosis, and histologic pictures), were retrospectively reviewed. RESULTS A total of 232 of 1197 patients (19.4%) had paraneoplastic syndromes. HCC patients with paraneoplastic syndromes had significantly higher serum AFP; higher rates of initial main portal vein thrombosis, metastasis, and bilobal tumor involvement; larger tumor volume; and shorter survival than those without these syndromes. Patients with HBV-related HCC had a significantly higher prevalence of paraneoplastic syndromes than patients with HCV-related HCC (20.1% vs. 11.2%, P = 0.005). In a stepwise multivariate logistic regression analysis, AFP >50,000 ng/mL and tumor volume >30% were significant predictive variables associated with the presence of paraneoplastic syndromes in HCC patients. CONCLUSIONS HCC patients with paraneoplastic syndromes usually had higher levels of serum AFP and larger tumor volumes than those without. Patients with HBV-related HCC had a significantly higher prevalence of paraneoplastic syndromes than those with HCV-related HCC.
Collapse
Affiliation(s)
- J C Luo
- Division of Gastroenterology, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|