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Minguela A, Salido EJ, Soto-Ramírez MF, Olga MA, Leal JD, García-Garay MC, Periago A, Berenguer M, Blanque M, Campillo JA. Low-affinity immunoglobulin gamma Fc region receptor III-B (FcγRIIIB, CD16B) deficiency in patients with blood and immune system disorders. Br J Haematol 2021; 195:743-747. [PMID: 34544201 DOI: 10.1111/bjh.17828] [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: 07/13/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
Low-affinity immunoglobulin gamma Fc region receptor III-B (FcγRIIIB) deficiency is present in ˜0·05% of the general population. Among our patients, FcγRIIIB deficiency was less frequent in those with immune-system disorders (one of 1815 patients, 0·05%) than in those with blood disorders (nine of 2147 patients, 0·42%, P = 0·023): mainly primary immune thrombocytopenia (4·34%), therapy related myeloid neoplasms (1·16%) and myelodysplastic syndrome with excess blasts (1·28%). Four of the nine (44·4%) patients with blood disorders were diagnosed with or quickly evolved to acute myeloid leukaemia (AML), suggesting that FcγRIIIB deficiency could be an adverse prognostic factor for progression to AML that should be confirmed in large multicentre studies.
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Affiliation(s)
- Alfredo Minguela
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Murcia, Spain.,Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Eduardo J Salido
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.,Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Murcia, Spain
| | - María F Soto-Ramírez
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Murcia, Spain.,Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Montes-Ares Olga
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Murcia, Spain.,Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Juan D Leal
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.,Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Murcia, Spain
| | - María C García-Garay
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.,Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Murcia, Spain
| | - Adela Periago
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.,Hematology Service, Hospital Rafael Méndez, Lorca, Spain
| | - Mercedes Berenguer
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.,Hematology Service, General University Hospital Santa Lucía, Cartagena, Spain
| | - Miguel Blanque
- Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.,Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Murcia, Spain
| | - José A Campillo
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Murcia, Spain.,Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
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2
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Minguela A, Vasco-Mogorrón MA, Campillo JA, Cabañas V, Remigia MJ, Berenguer M, García-Garay MC, Blanquer M, Cava C, Galian JA, Gimeno L, Soto-Ramírez MF, Martínez-Hernández MD, de la Rubia J, Teruel AI, Muro M, Periago A. Predictive value of 1q21 gain in multiple myeloma is strongly dependent on concurrent cytogenetic abnormalities and first-line treatment. Am J Cancer Res 2021; 11:4438-4454. [PMID: 34659897 PMCID: PMC8493371] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023] Open
Abstract
Improved therapies in multiple myeloma (MM) have forced a constant risk stratification update, first Durie-Salmon, then international scoring systems (ISS), next revised-ISS (RISS) including high-risk cytogenetic abnormalities (HRCAs) such as del(17p) and t(4;14), and now R2-ISS including 1q21 gain has been proposed. Predictive value of 1q21 gain by itself or in concurrence with other cytogenetic abnormalities is evaluated in 737 real-world plasma cell neoplasm (PCN) patients under current therapies. Ten-year progression-free survival (10y-PFS) rates for patients with 2, 3 and >3 copies of 1q21 were 72.2%, 42.5% and 43.4% (P<1.1×10-17). Cox regression analysis confirmed that 1q21 gain was an independent prognostic factor for PFS (HR=1.804, P<0.0001, Harrell C-statistic =0.7779±0.01495) but not for OS (P=0.131). Gain of 1q21 was strongly associated with hypodiploidy (38.8% vs. 7.0%, P=1.3×10-22), hyperdiploidy (44.1% vs. 16.4%, P=1.6×10-13), HRCAs (12.6% vs. 3.5%, 1.8×10-5), IGH breaks (12.3% vs. 2.1%, P=2.1×10-7) and del(13q) (8.0% vs. 4.0%, P=0.031). In our series, 1q21 gain by itself did not improve RISS predictive capacity in patients either eligible or ineligible for autologous stem cell transplantation (ASCT). However, compared with patients with other 1q21 gains: concurrence with hyperdiploidy improved the prognosis of ASCT-eligible patients from 62.5% to 96.0% 10-year overall-survival (10y-OS, P<0.002); concurrence with hypodiploidy improved the prognosis of ASCT-ineligible patients from 35.7% to 71.0% (P=0.013); and concurrence with del(13q) worsened the prognosis of ASCT-ineligible patients from 12.5% to 53.4% (P=0.035). Gain of 1q21 should be patient-wisely evaluated, irrespective of the RISS, considering its concurrence with other cytogenetic abnormalities and eligibility for ASCT.
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Affiliation(s)
- Alfredo Minguela
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - María A Vasco-Mogorrón
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - José A Campillo
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Valentin Cabañas
- Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - María J Remigia
- Department of Hematology, University Hospital La Fe and School of Medicine and Dentistry, Catholic University of ValenciaValencia, Spain
| | - Mercedes Berenguer
- Hematology Service, General University Hospital Santa Lucía, Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - María C García-Garay
- Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Miguel Blanquer
- Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Catalina Cava
- Hematology Service, General University Hospital Rafael Méndez, Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - José Antonio Galian
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Lourdes Gimeno
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
- Human Anatomy Department, Medicine Faculty, Murcia University, Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - María F Soto-Ramírez
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - María D Martínez-Hernández
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Javier de la Rubia
- Department of Hematology, University Hospital La Fe and School of Medicine and Dentistry, Catholic University of ValenciaValencia, Spain
| | - Ana I Teruel
- Department of Hematology, University Hospital La Fe and School of Medicine and Dentistry, Catholic University of ValenciaValencia, Spain
| | - Manuel Muro
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Adela Periago
- Hematology Service, General University Hospital Rafael Méndez, Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
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Vasco-Mogorrón MA, Campillo JA, Periago A, Cabañas V, Berenguer M, García-Garay MC, Gimeno L, Soto-Ramírez MF, Martínez-Hernández MD, Muro M, Minguela A. Blood-based risk stratification for pre-malignant and symptomatic plasma cell neoplasms to improve patient management. Am J Cancer Res 2021; 11:2736-2753. [PMID: 34249425 PMCID: PMC8263680] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/21/2021] [Indexed: 06/13/2023] Open
Abstract
Standard risk stratification (sRisk) guides clinical management in monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM) and multiple myeloma (MM). Nonetheless, clinical results are considerably heterogeneous among patients with similar risk status. Blood and bone marrow samples from 276 MGUS, 56 SMM and 242 MM in regular clinical practice were analyzed at diagnosis by flow cytometry. Higher levels of aberrant circulating plasma cells (cPC) (> 0.0035% of leukocytes), combined with albumin, beta2-microglobuline and lactate-dehydrogenase levels, offered minimally-invasive risk stratification (RcPC) with results comparable to sRisk. RcPC and sRisk 10-year progression-free-survival (10y-PFS) rates were: 93.8% vs. 95.1% for low-risk, 78.4% vs. 81.7% for intermediate-risk and 50.0% vs. 47.8% for high-risk MGUS; 58.3% vs. 57.8% low-risk, 44.4% vs. 45.8% intermediate-risk and 8.9% vs. 15.0% high-risk SMM; and 44.4% vs. 44.4% low-risk, 36.1% vs. 36.8% intermediate-risk, and 13.3% vs. 16.2% high-risk MM. Circulating-PC > 0.0035% vs. cPC<0.0035% was an independent prognostic factor for PFS (HR=4.389, P=1.2×10-15, Harrell C-statistic =0.7705±0.0190) and over-all survival (OS, HR=4.286, 2.3×10-9, Harrell C-statistic =0.8225±0.0197) that complemented sRisk in patients with low-sRisk (10y-PFS rates 48.1% vs. 87.3%, P=1.2×10-8) and intermediate-sRisk (10y-PFS rates 28.9% vs. 74.1%, P=8.6×10-12). Patients with high cPCs values are associated with higher proliferation and lower apoptosis rates of PC. Circulating-PC > 0.0035% identified MGUS, SMM and MM patients at higher risk of progression or death and predicted a cohort of patients that after relapse from stringent complete response showed shorter OS. These patients could benefit from early consolidation therapy, tandem ASCT or intensive maintenance.
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Affiliation(s)
- María A Vasco-Mogorrón
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - José A Campillo
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Adela Periago
- Hematology Service, General University Hospital Rafael Méndez, Lorca, and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Valentin Cabañas
- Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Mercedes Berenguer
- Hematology Service, General University Hospital Santa Lucía, Cartagena, and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - María C García-Garay
- Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Lourdes Gimeno
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
- Human Anatomy Department, Medicine Faculty, Murcia UniversityMurcia, Spain
| | - María F Soto-Ramírez
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - María D Martínez-Hernández
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Manuel Muro
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
| | - Alfredo Minguela
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA) and Biomedical Research Institute of Murcia (IMIB)Murcia, Spain
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Vasco-Mogorrón MA, Campillo JA, Periago A, Cabañas V, Berenguer M, García-Garay MC, Gimeno L, Soto-Ramírez MF, Martínez-Hernández MD, Muro M, Minguela A. Proliferation to Apoptosis Tumor Cell Ratio as a Biomarker to Improve Clinical Management of Pre-Malignant and Symptomatic Plasma Cell Neoplasms. Int J Mol Sci 2021; 22:ijms22083895. [PMID: 33918790 PMCID: PMC8068942 DOI: 10.3390/ijms22083895] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/05/2022] Open
Abstract
Proliferation and apoptosis of neoplastic cells are prognostic biomarkers in plasma cell neoplasms (PCNs). The prognostic capacity of proliferation to apoptosis ratio (Ratio-PA) in the era of immunomodulatory treatments is re-evaluated in 316 gammopathy of undetermined significance (MGUS), 57 smoldering multiple myeloma (SMM), and 266 multiple myeloma (MM) patients. Ratio-PA of 0.77 ± 0.12, 1.94 ± 0.52, and 11.2 ± 0.7 (p < 0.0001) were observed in MGUS, SMM, and MM patients. Ten-year overall survival (10y-OS) rates for patients with low/high Ratio-PA were 93.5%/77.3% p < 0.0001) for MGUS, 82.5%/64.7% (p < 0.05) for SMM, and 62.3%/47.0% (p < 0.05) for MM. For patients with low, intermediate, and high risk, 10y-OS for low/high Ratio-PA were 95.5%/72.9% (p < 0.0001), 74.2%/50.4% (p < 0.0001), and 35.3%/20.0% (p = 0.836), respectively. Ratio-PA was an independent prognostic factor for OS (HR = 2.119, p < 0.0001, Harrell-C-statistic = 0.7440 ± 0.0194) when co-analyzed with sex, age, and standard risk. In patients with Ratio-PAhigh, only first-line therapy with VRd/VTd, but not PAD/VCD, coupled with ASCT was associated with high 10y-OS (82.7%). Tumor cell Ratio-PA estimated at diagnosis offers a prognostic biomarker that complements standard risk stratification and helps to guide the clinical management of pre-malignant and symptomatic PCNs. Every effort should be made to provide first-line therapies including VTd or VRd associated with ASCT to patients with Ratio-PAhigh at higher risk of progression and death.
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Affiliation(s)
- María A. Vasco-Mogorrón
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.V.-M.); (J.A.C.); (L.G.); (M.F.S.-R.); (M.D.M.-H.); (M.M.)
| | - José A. Campillo
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.V.-M.); (J.A.C.); (L.G.); (M.F.S.-R.); (M.D.M.-H.); (M.M.)
| | - Adela Periago
- Hematology Service, General University Hospital Rafael Méndez, Biomedical Research Institute of Murcia (IMIB), 30813 Murcia, Spain;
| | - Valentin Cabañas
- Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (V.C.); (M.C.G.-G.)
| | - Mercedes Berenguer
- Hematology Service, General University Hospital Santa Lucía, Biomedical Research Institute of Murcia (IMIB), 30202 Murcia, Spain;
| | - María C. García-Garay
- Hematology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (V.C.); (M.C.G.-G.)
| | - Lourdes Gimeno
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.V.-M.); (J.A.C.); (L.G.); (M.F.S.-R.); (M.D.M.-H.); (M.M.)
- Human Anatomy Department, Medicine Faculty, Biomedical Research Institute of Murcia (IMIB), Murcia University, 30120 Murcia, Spain
| | - María F. Soto-Ramírez
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.V.-M.); (J.A.C.); (L.G.); (M.F.S.-R.); (M.D.M.-H.); (M.M.)
| | - María D. Martínez-Hernández
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.V.-M.); (J.A.C.); (L.G.); (M.F.S.-R.); (M.D.M.-H.); (M.M.)
| | - Manuel Muro
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.V.-M.); (J.A.C.); (L.G.); (M.F.S.-R.); (M.D.M.-H.); (M.M.)
| | - Alfredo Minguela
- Immunology Service, Clinic University Hospital Virgen de la Arrrixaca (HCUVA), Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain; (M.A.V.-M.); (J.A.C.); (L.G.); (M.F.S.-R.); (M.D.M.-H.); (M.M.)
- Correspondence:
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5
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Martínez-Sánchez MV, Periago A, Legaz I, Gimeno L, Mrowiec A, Montes-Barqueros NR, Campillo JA, Bolarin JM, Bernardo MV, López-Álvarez MR, González C, García-Garay MC, Muro M, Cabañas-Perianes V, Fuster JL, García-Alonso AM, Moraleda JM, Álvarez-Lopez MR, Minguela A. Overexpression of KIR inhibitory ligands (HLA-I) determines that immunosurveillance of myeloma depends on diverse and strong NK cell licensing. Oncoimmunology 2015; 5:e1093721. [PMID: 27141379 DOI: 10.1080/2162402x.2015.1093721] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 12/16/2022] Open
Abstract
Missing self recognition makes cancer sensitive to natural killer cell (NKc) reactivity. However, this model disregards the NKc licensing effect, which highly increases NKc reactivity through interactions of inhibitory killer cell immunoglobulin-like receptors (iKIR) with their cognate HLA-I ligands. The influence of iKIR/HLA-ligand (HLA-C1/C2) licensing interactions on the susceptibility to and progression of plasma cell (PC) dyscrasias was evaluated in 164 Caucasian patients and 286 controls. Compared to controls, myeloma accumulates KIR2DL1-L2+L3- genotypes (2.8% vs. 13.2%, p < 0.01, OR = 5.29) and less diverse peripheral repertoires of NKc clones. Less diverse and weaker-affinity repertoires of iKIR2D/HLA-C licensing interactions increased myeloma susceptibility. Thus, the complete absence of conventional iKIR2D/HLA-C licensing interactions (KIR2DL1-L2+L3-/C2C2, 2.56% vs. 0.35%; p < 0.05; OR = 15.014), single-KIR2DL3+/C1+ (20.51% vs. 10.84%; p < 0.05; OR = 2.795) and single-KIR2DL2+/C1+ (12.82% vs. 4.9%; p < 0.01; OR = 5.18) interactions were over-represented in myeloma, compared to controls. Additionally, KIR2DL1-L2+L3- (20% vs. 83%, p < 0.00001) as well as KIR3DL1- (23% vs. 82%, p < 0.00001) genotypes had a dramatic negative impact on the 3-y progression-free survival (PFS), particularly in patients with low-tumor burden. Remarkably, myeloma-PCs, compared to K562 and other hematological cancers, showed substantial over-expression of HLA-I ("increasing-self" instead of missing-self), including HLA-C, and mild expression of ligands for NKc activating receptors (aRec) CD112, CD155, ULBP-1 and MICA/B, which apparently renders myeloma-PCs susceptible to lysis mainly by licensed NKc. KIR2DL1-L2+L3-/C2C2 patients (with no conventional iKIR2D/HLA-C licensing interactions) lyse K562 but barely lyse myeloma-PCs (4% vs. 15%; p < 0.05, compared to controls). These results support a model where immunosurveillance of no-missing-self cancers, e.g., myeloma, mainly depends on NKc licensing.
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Affiliation(s)
- María V Martínez-Sánchez
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - Adela Periago
- Hematology Service, Hospital Rafael Méndez , Lorca, Murcia, Spain
| | - Isabel Legaz
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - Lourdes Gimeno
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - Anna Mrowiec
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - Natividad R Montes-Barqueros
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - José A Campillo
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - José M Bolarin
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - María V Bernardo
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - María R López-Álvarez
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | | | | | - Manuel Muro
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | | | - Jose L Fuster
- Hematology Service, Hospital General Universitario Santa Lucía , Cartagena, Murcia, Spain
| | - Ana M García-Alonso
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | | | - María R Álvarez-Lopez
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
| | - Alfredo Minguela
- Immunology Service, Instituto Murciano de investigación biosanitaria (IMIB) and Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), El Palmar , Murcia, Spain
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