1
|
Mitrovic M, Pantic N, Bukumiric Z, Sabljic N, Virijevic M, Pravdic Z, Cvetkovic M, Ilic N, Rajic J, Todorovic-Balint M, Vidovic A, Suvajdzic-Vukovic N, Thachil J, Antic D. Venous thromboembolism in patients with acute myeloid leukemia: development of a predictive model. Thromb J 2024; 22:37. [PMID: 38632595 PMCID: PMC11022429 DOI: 10.1186/s12959-024-00607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Patients with acute myeloid leukemia (AML) are at increased risk of venous thromboembolic events (VTE). However, thromboprophylaxis is largely underused. OBJECTIVES This study aimed to determine possible VTE development risk factors and to develop a novel predictive model. METHODS We conducted a retrospective cohort study of adult patients with newly diagnosed AML. We used univariate and multivariable logistic regression to estimate binary outcomes and identify potential predictors. Based on our final model, a dynamic nomogram was constructed with the goal of facilitating VTE probability calculation. RESULTS Out of 626 eligible patients with AML, 72 (11.5%) developed VTE during 6 months of follow-up. Six parameters were independent predictors: male sex (odds ratio [OR] 1.82, 95% confidence interval [CI]: 1.077-2.065), prior history of thrombotic events (OR 2.27, 95% CI: 1.4-4.96), international normalized ratio (OR 0.21, 95% CI: 0.05-0.95), Eastern Cooperative Oncology Group performance status (OR 0.71, 95% CI: 0.53-0.94), and intensive therapy (OR 2.05, 95% CI: 1.07-3.91). The C statistics for the model was 0.68. The model was adequately calibrated and internally validated. The decision-curve analysis suggested the use of thromboprophylaxis in patients with VTE risks between 8 and 20%. CONCLUSION We developed a novel and convenient tool that may assist clinicians in identifying patients whose VTE risk is high enough to warrant thromboprophylaxis.
Collapse
Affiliation(s)
- Mirjana Mitrovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Nikola Pantic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Zoran Bukumiric
- Faculty of Medicine, Institute for medical statistics and informatics, University of Belgrade, Belgrade, Serbia
| | - Nikica Sabljic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zlatko Pravdic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Cvetkovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Ilic
- Faculty of Medicine, Center for Information and Communication Technologies, University of Belgrade, Belgrade, Serbia
| | - Jovan Rajic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milena Todorovic-Balint
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Vidovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Suvajdzic-Vukovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jecko Thachil
- Manchester University NHS, Manchester, Great Britain
| | - Darko Antic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
2
|
Pantic N, Cvetkovic M, Milin-Lazovic J, Vukmirovic J, Pavlovic A, Virijevic M, Pravdic Z, Kozarac S, Sabljic N, Suvajdzic-Vukovic N, Dragas M, Mitrovic M. Deep venous thrombosis in patients with atresia of the inferior vena cava and right kidney hypoplasia (KILT syndrome): Systematic review of the literature. Vasc Med 2024:1358863X241240427. [PMID: 38573108 DOI: 10.1177/1358863x241240427] [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: 04/05/2024]
Abstract
Inferior vena cava (IVC) anomalies are uncommon congenital causes of deep vein thrombosis (DVT). KILT syndrome (kidney and IVC abnormalities with leg thrombosis) has only been described as case reports in the literature. Therefore, the characteristics, evaluation, and management of patients with KILT syndrome have not yet been standardized. This study aimed to systematically review and analyze the clinical and radiographic data and treatment of previously reported cases of KILT syndrome. In this systematic review, we performed a literature search of the PubMed, Scopus, and Web of Science databases in December 2023, with no restrictions on the publication date. After duplicate extractions, 4195 articles were screened. Case reports and case series reporting on KILT syndrome were included. In addition to previously published cases, we included a new case of a previously healthy 25-year-old man with KILT syndrome in the analysis. A total of 34 cases were therefore included in this study. The majority (76.5%) were male patients with a median age of 24 years. In most patients, unprovoked bilateral iliofemoral thrombosis was diagnosed, and 64.7% had left kidney abnormalities. Our study suggests that anomalies of the IVC should be suspected in all young patients, especially male patients, with proximal, recurrent, or idiopathic DVT. If an IVC anomaly is confirmed, the kidneys should be examined to monitor and preserve healthy kidneys in cases of KILT syndrome. The data collected from all patients emphasize the requirement of long-term anticoagulation and risk factor control. Surgical measures may be effective for treating symptomatic refractory cases.
Collapse
Affiliation(s)
- Nikola Pantic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Mirjana Cvetkovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Jelena Milin-Lazovic
- Faculty of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Republic of Serbia
| | - Jelica Vukmirovic
- Center for Radiology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Aleksandar Pavlovic
- Center for Radiology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Marijana Virijevic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia
| | - Zlatko Pravdic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Sofija Kozarac
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Nikica Sabljic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Nada Suvajdzic-Vukovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia
| | - Marko Dragas
- Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia
- Clinic of Vascular and Endovascular Surgery, University Clinical Center of Serbia, Belgrade, Republic of Serbia
| | - Mirjana Mitrovic
- Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Republic of Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia
| |
Collapse
|
3
|
Mitrovic M, Pantic N, Sabljic N, Bukumiric Z, Virijevic M, Pravdic Z, Cvetkovic M, Rajic J, Bodrozic J, Milosevic V, Todorovic-Balint M, Vidovic A, Suvajdzic-Vukovic N, Antic D. Arterial Thrombosis in Patients with Acute Myeloid Leukemia: Incidence and Risk Factors. Cancers (Basel) 2023; 15:cancers15113060. [PMID: 37297022 DOI: 10.3390/cancers15113060] [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: 05/14/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients with hematological malignancies have an increased risk of arterial thrombotic events (ATEs) after diagnosis, compared to matched controls without cancer. However, data about incidence and risk factors for ATE development in patients with acute myeloid leukemia (AML) are missing. AIM The objectives of this study were to determine the incidence of ATE in non-promyelocytic-AML patients and to define the potential risk factors for ATE development. METHODS We conducted a retrospective cohort study of adult patients with newly diagnosed AML. The primary outcome was the occurrence of confirmed ATE, defined as myocardial infarction, stroke or critical limb ischemia. RESULTS Out of 626 eligible AML patients, 18 (2.9%) patients developed ATE in the median time of 3 (range: 0.23-6) months. Half of these patients died due to ATE complications. Five parameters were predictors of ATE: BMI > 30 (p = 0.000, odds ratio [OR] 20.488, 95% CI: 6.581-63.780), prior history of TE (p = 0.041, OR 4.233, 95% CI: 1.329-13.486), presence of comorbidities (p = 0.027, OR 5.318, 95% CI: 1.212-23.342), presence of cardiovascular comorbidities (p < 0.0001, OR 8.0168, 95% CI: 2.948-21.800) and cytogenetic risk score (p = 0.002, OR 2.113, 95% CI: 1.092-5.007). CONCLUSIONS Our study showed that patients with AML are at increased risk of ATE. The risk was increased in patients with cardiovascular comorbidities, previous thrombosis, adverse cytogenetic risk as well as BMI > 30.
Collapse
Affiliation(s)
- Mirjana Mitrovic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nikola Pantic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Nikica Sabljic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Zoran Bukumiric
- Faculty of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Zlatko Pravdic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Mirjana Cvetkovic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Jovan Rajic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Jelena Bodrozic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Violeta Milosevic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
| | - Milena Todorovic-Balint
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ana Vidovic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nada Suvajdzic-Vukovic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Darko Antic
- Clinic of Hematology, Unviersity Clinical Center of Serbia, 2 Koste Todorovica St., 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| |
Collapse
|
4
|
Pravdic Z, Suvajdzic-Vukovic N, Djurdjevic P, Pantic N, Bukumiric Z, Virijevic M, Todorovic-Tirnanic M, Thachil J, Mitrovic M. Platelet kinetics in patients with chronic immune thrombocytopaenia treated with thrombopoietin receptor agonists. Eur J Haematol 2023; 110:548-553. [PMID: 36656555 DOI: 10.1111/ejh.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Thrombopoietin receptor agonists (TPO-RAs) increase platelet counts (PC) in the majority of patients with chronic immune thrombocytopaenia (ITP). Platelet kinetics study (PKS) might contribute to the understanding of mechanisms that lead to durable response. OBJECTIVES To evaluate the effects of TPO-RAs on PKS parameters in chronic ITP patients. METHODS Fifteen chronic ITP patients, aged 59 years [range: 22-84], female/male: 10/5, splenectomised 7/15, were treated with TPO-RAs (eltrombopag/romiplostim: 11/4). Durable response was defined as PC ≥30 × 109 /L at 6 months. Autologous 111 Indium-oxinate PKS was performed before and 5 months after TPO-RAs initiation. Accordingly, platelet survival (PS), platelet turnover, production ratio and sequestration site were assessed. RESULTS Durable response was achieved in 13/15 of patients (eltrombopag/romiplostim: 10/3). Pre-treatment parameters were: PC 10 × 109 /L [range: 1-110], PS 0.5 days [range: 0.1-1.7 (normal values: 7-10)], platelet turnover 30 857 Plt/μL/day [range: 944-103 500] and platelet production ratio 0.64 [range: 0.01-3.2 (normal values: 1 ± 0.2)]. Post-treatment assessment showed significantly higher: PC 92.5 × 109 /L [range: 28-260, p = .001], PS 2.2 days [range: 0.1-3.6, p = .008], platelet turnover 70 213 Plt/μL/day [range: 2800-462 236, p = .02] and platelet production ratio 1.8 [range: 0.5-37.9, p = .011] compared to the pre-treatment values. Platelet sequestration site altered in 3/15 treated with TPO-RAs. CONCLUSIONS TPO-RAs could increase PC by simultaneous increasing of platelet production and decreasing of platelet destruction.
Collapse
Affiliation(s)
- Zlatko Pravdic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nada Suvajdzic-Vukovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Djurdjevic
- Clinic of Haematology, Clinical Centre of Kragujevac, Kragujevac, Serbia.,Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Nikola Pantic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Zoran Bukumiric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mila Todorovic-Tirnanic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Centre of Nuclear Medicine, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jecko Thachil
- Department of Haematology, Manchester University Hospitals, Manchester, UK
| | - Mirjana Mitrovic
- Clinic of Haematology, University Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
5
|
Pantic N, Suvajdzic-Vukovic N, Virijevic M, Pravdic Z, Sabljic N, Adzic-Vukicevic T, Mitrovic M. Coronavirus disease 2019 in patients with chronic immune thrombocytopenia on thrombopoietin receptor agonists: new perspectives and old challenges. Blood Coagul Fibrinolysis 2022; 33:51-55. [PMID: 34861655 DOI: 10.1097/mbc.0000000000001109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There are limited data on the impact of severe acute respiratory syndrome corona virus 2 infection in patients previously diagnosed with primary immune thrombocytopenia (ITP) on thrombopoietin receptor agonist therapy (TPO-RA). Seven chronic ITP patients who had contracted COVID-19 and had been treated with TPO-RA are included in the study. Demographic, ITP treatment and comorbidities data were collected retrospectively from patients' medical records. Data regarding clinical course of COVID-19 were collected prospectively. During the infection, all patients had platelet count higher than average, and platelet count peak was mainly observed on day 7. For that reason, therapy modification was required. However, platelet count increment was transient in most ITP patients. One patient developed pulmonary embolism despite the use of therapeutic dose of anticoagulants. One patient died of respiratory failure whereas another developed rebound thrombocytopenia after the infection and consequential intracerebral hemorrhage. Careful platelet count monitoring and therapy management are needed in chronic ITP patients on TPO-RAs with COVID-19.
Collapse
Affiliation(s)
- Nikola Pantic
- Clinic of Hematology, University Clinical Center of Serbia
| | - Nada Suvajdzic-Vukovic
- Clinic of Hematology, University Clinical Center of Serbia
- Faculty of Medicine, University of Belgrade
| | - Marijana Virijevic
- Clinic of Hematology, University Clinical Center of Serbia
- Faculty of Medicine, University of Belgrade
| | - Zlatko Pravdic
- Clinic of Hematology, University Clinical Center of Serbia
| | - Nikica Sabljic
- Clinic of Hematology, University Clinical Center of Serbia
| | - Tatjana Adzic-Vukicevic
- Faculty of Medicine, University of Belgrade
- Clinic of Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Mitrovic
- Clinic of Hematology, University Clinical Center of Serbia
- Faculty of Medicine, University of Belgrade
| |
Collapse
|
6
|
Mitrovic M, Pantic N, Sabljic N, Vucic M, Bukumiric Z, Virijevic M, Pravdic Z, Rajic J, Todorovic-Balint M, Vidovic A, Suvajdzic-Vukovic N. Acute leukemia and SARS-CoV-2 infection: clinical characteristics and risk factors for mortality. Leuk Lymphoma 2021; 62:3516-3520. [PMID: 34387145 DOI: 10.1080/10428194.2021.1964026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients with acute leukemia (AL) have a high mortality rate from coronavirus disease 2019 (COVID-19). However, studies including patients with AL and COVID-19 are few. Fifty-one patients with AL and COVID-19 were included in our study. The mortality rate was 17/51 (29.4%). In all cases, death was associated with COVID-19 pneumonia. The major driver of outcome was the disease status (worse outcome was observed in newly diagnosed (OR, 6.00; 95% CI, 1.133 - 15.188) and patients with bone marrow aplasia (OR 4.148 [95% CI 1.133 - 15.188])). Higher mortality rate was associated with lower platelet count, prolonged PT, higher ISTH DIC score, CRP and LDH. Moreover, careful risk-benefit assessment regarding the continuation of anticancer therapy is required in patients receiving nonintensive and supportive therapy. Considering the high frequency of intrahospital viral transmission (50.98%), isolation of AL patients in single rooms, and permanent symptom monitoring and testing should be prioritized.
Collapse
Affiliation(s)
- Mirjana Mitrovic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Pantic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Nikica Sabljic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Miodrag Vucic
- Clinic of Hematology, Clinical Center of Nis, Nis, Serbia.,Faculty of Medicine, University of Nis, Nis, Serbia
| | - Zoran Bukumiric
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zlatko Pravdic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Rajic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milena Todorovic-Balint
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Vidovic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Suvajdzic-Vukovic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
7
|
Virijevic M, Karan-Djurasevic T, Marjanovic I, Tosic N, Mitrovic M, Djunic I, Colovic N, Vidovic A, Suvajdzic-Vukovic N, Tomin D, Pavlovic S. Somatic mutations of isocitrate dehydrogenases 1 and 2 are prognostic and follow-up markers in patients with acute myeloid leukaemia with normal karyotype. Radiol Oncol 2016; 50:385-393. [PMID: 27904446 PMCID: PMC5120579 DOI: 10.1515/raon-2016-0044] [Citation(s) in RCA: 11] [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: 03/28/2016] [Accepted: 06/18/2016] [Indexed: 12/22/2022] Open
Abstract
Background Mutations in the isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) genes are frequent molecular lesions in acute myeloid leukaemia with normal karyotype (AML-NK). The effects of IDH mutations on clinical features and treatment outcome in AML-NK have been widely investigated, but only a few studies monitored these mutations during follow-up. Patients and methods In our study samples from 110 adult de novo AML-NK were studied for the presence of IDH1 and IDH2 mutations, their associations with other prognostic markers and disease outcome. We also analyzed the stability of these mutations during the course of the disease in complete remission (CR) and relapse. Results IDH mutations were found in 25 (23%) patients. IDH+ patients tend to have lower CR rate compared to IDH-patients (44% vs 62.2%, p = 0.152), and had slightly lower disease free survival (12 months vs 17 months; p = 0.091). On the other hand, the presence of IDH mutations had significant impact on overall survival (2 vs 7 months; p = 0.039). The stability of IDH mutations were studied sequentially in 19 IDH+ patients. All of them lost the mutation in CR, and the same IDH mutations were detected in relapsed samples. Conclusions Our study shows that the presence of IDH mutations confer an adverse effect in AML-NK patients, which in combination with other molecular markers can lead to an improved risk stratification and better treatment. Also, IDH mutations are very stable during the course of the disease and can be potentially used as markers for minimal residual disease detection.
Collapse
Affiliation(s)
| | - Teodora Karan-Djurasevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Irena Marjanovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Natasa Tosic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Mirjana Mitrovic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Irena Djunic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Natasa Colovic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Ana Vidovic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Nada Suvajdzic-Vukovic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Dragica Tomin
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Sonja Pavlovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
8
|
Mitrovic M, Elezovic I, Suvajdzic-Vukovic N. 'On-demand' romiplostim therapy in immune thrombocytopenia. J Clin Pharm Ther 2016; 41:351-353. [PMID: 26849975 DOI: 10.1111/jcpt.12359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/04/2016] [Indexed: 12/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Although thrombopoietin receptor agonists are a second-line treatment for refractory immune thrombocytopenia (ITP), we lack guidelines recommending maintenance modality in patients who achieve complete remission (CR). CASE SUMMARY We report a patient with refractory ITP who achieved CR on romiplostim. Obtaining romiplostim for 6 months of therapy, we decided to try extending this by modifying the standard treatment regimen. Romiplostim was successfully administered 'on-demand', only if the patient's platelet count dropped below 150 × 109 /L, over a period of 12 months. WHAT IS NEW AND CONCLUSION The strategy of 'on-demand' therapy is a promising procedure for the maintenance of response, lowering costs and improving treatment safety.
Collapse
Affiliation(s)
- M Mitrovic
- Clinic of Haematology, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Elezovic
- Clinic of Haematology, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Suvajdzic-Vukovic
- Clinic of Haematology, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
9
|
Djunic I, Dopsaj V, Miljic P, Savic N, Milic N, Mitrovic M, Suvajdzic-Vukovic N, Tomin D, Elezovic I. Comparison of two laboratory assays in monitoring the efficacy of different prophylaxis regimens for severe haemophilia. Clin Lab 2014; 60:1325-31. [PMID: 25185418 DOI: 10.7754/clin.lab.2013.130817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The goal of this study was to compare the validity of two laboratory assays, rotation thromboelastometry (ROTEM) and endogenous thrombin potential (ETP), in monitoring and evaluating different prophylactic treatment regimens in patients with severe haemophilia. METHODS Twenty adult patients with severe haemophilia were divided into three groups according to treatment regimen with concentrate of factor (F) VIII/IX: full-dose prophylaxis (5 patients), intermediate-dose prophylaxis (5 patients), and on demand treatment (10 patients). RESULTS The ROTEM for the group treated with full-dose prophylaxis was significantly lower than ROTEM for the group treated with intermediate-dose prophylaxis (p = 0.025). Among the patients given full-dose prophylaxis, 40% (2 patients) had prolonged ROTEM after 3 months of treatment, while among those given intermediate-dose prophylaxis all patients (100%, 5 patients) had prolonged ROTEM (p = 0.038). The ETP was significantly improved after 3 months of full-dose in comparison with intermediate-dose prophylaxis (p = 0.042). CONCLUSIONS ROTEM and ETP are useful laboratory assays for monitoring efficacy of different prophylaxis regimens with concentrate of FVIII/IX in patients with severe haemophilia, helping in making decisions regarding optimal dose-regimen prophylaxis.
Collapse
|
10
|
Djunic I, Elezovic I, Ilic V, Milosevic-Jovcic N, Bila J, Suvajdzic-Vukovic N, Antic D, Vidovic A, Tomin D. The effect of paraprotein on platelet aggregation. J Clin Lab Anal 2014; 28:141-6. [PMID: 24395751 DOI: 10.1002/jcla.21658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 06/10/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Some patients with paraproteinemia have platelet aggregation disorders and the aim of this study was to examine disturbance of platelet aggregation in healthy blood donors by isolated paraprotein in vitro. METHODS Using Rivanol, paraprotein was separated from the serum of ten patients with paraproteinemia, who had decreased platelet aggregation with several inducers. Platelet aggregation in ten healthy donors was measured with and without addition of the isolated induced paraprotein. The test was repeated with added human immunoglobulins for intravenous use. RESULTS Average of maximal levels of platelet aggregation has been significantly decreased in plasma rich in platelets (PRP) of healthy donors after addition of paraprotein when inducers are used: adenosine diphosphate (ADP) (P = 0.007), collagen (COL) (P = 0.008), ristocetin (RIS) (P = 0.001), and epinephrine (EPI) (P = 0.002). Average of latent time of platelet aggregation was significantly prolonged in healthy donors after addition of paraprotein with inducers: COL (P = 0.008), RIS (P = 0.008) and EPI (P = 0.006) while addition of human immunoglobulins caused no change in platelet aggregation. In comparison, when human immunoglobulins were added, maximal platelet aggregation and latent time did not change significantly. Paraprotein isolated from patients with paraproteinamia, who had decrease platelet aggregation, had significantly decreased platelet aggregation when added to PRP of healthy donors, in vitro. CONCLUSION Platelet aggregation was not significantly changed was confirmed with addition of human immunoglobulins.
Collapse
Affiliation(s)
- Irena Djunic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Djunic I, Elezovic I, Vucic M, Srdic-Rajic T, Konic-Ristic A, Ilic V, Milic N, Bila J, Suvajdzic-Vukovic N, Virijevic M, Antic D, Vidovic A, Tomin D. Specific binding of paraprotein to platelet receptors as a cause of platelet dysfunction in monoclonal gammopathies. Acta Haematol 2013; 130:101-7. [PMID: 23548666 DOI: 10.1159/000345418] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/23/2012] [Indexed: 12/22/2022]
Abstract
The study included 48 untreated patients with monoclonal gammopathies (MG). Paraprotein was isolated from the serum of 10 patients with decreased platelet aggregation. Platelet aggregation was measured before and after the addition of the isolated paraprotein to platelet-rich plasma (PRP) from 10 healthy donors, in vitro. Expression of platelet von Willebrand factor (vWF) receptor glycoprotein (GP)Ib and platelet collagen receptor GPVI was determined by flow cytometry in the PRP of healthy donors before and after the addition of isolated paraprotein using the monoclonal antibodies, CD42b (for GPIb) and CD36 (for GPVI). Flowcytometry showed that expression of CD42b and CD36 positive cells was reduced after the addition of isolated paraprotein to PRP from healthy donors (p < 0.001). These investigations demonstrated that paraprotein causes platelet dysfunction in patients with MG due to specific binding to the platelet vWF receptor GPIb and platelet collagen receptor GPVI.
Collapse
Affiliation(s)
- I Djunic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Djunic I, Virijevic M, Novkovic A, Djurasinovic V, Colovic N, Vidovic A, Suvajdzic-Vukovic N, Tomin D. Pretreatment risk factors and importance of comorbidity for overall survival, complete remission, and early death in patients with acute myeloid leukemia. ACTA ACUST UNITED AC 2012; 17:53-8. [PMID: 22664041 DOI: 10.1179/102453312x13221316477651] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The objective of this single-center study was to determine the pretreatment risk factors and influence of comorbidity on outcome in patients with acute myeloid leukemia (AML). The research involved 145 patients with AML during a 58-month follow-up period. The results suggest that the most significant predictor of poor overall survival (OS) is an adverse karyotype (P = 0.007), while for poor rate of complete remission (CR) it is age ≥55 years, and for early death the most significant predictor is comorbidity, as scored by the Hematopoetic Cell Transplantation Comorbidity Index (HCT-CI), P = 0.001. When we divided the patients into two groups: aged ≥55 years and aged <55 years, these predictors differed. In the group aged ≥55 years the most significant predictor of OS (P = 0.013) and for early death (P = 0.003) was HCT-CI (P = 0.013), while in the younger group it was karyotype (P < 0.001). The most significant predictor of CR in the elderly was increased serum lactate dehydrogenase (LDH) level (P = 0.045). In the younger patients, the most significant predictor of CR was leukocytosis (P = 0.001) and for early death it was infection as the comorbidity (P = 0.007). We point out the importance of comorbidity for OS and early death, as well as the impact of infection in patients with AML.
Collapse
Affiliation(s)
- Irena Djunic
- Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Kuzmanovic M, Tosic N, Colovic N, Karan-Djurasevic T, Spasovski V, Radmilovic M, Nikcevic G, Suvajdzic-Vukovic N, Tomin D, Vidovic A, Virijevic M, Pavlovic S, Colovic M. Prognostic impact of NPM1 mutations in Serbian adult patients with acute myeloid leukemia. Acta Haematol 2012; 128:203-12. [PMID: 22906848 DOI: 10.1159/000339506] [Citation(s) in RCA: 8] [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: 12/20/2011] [Accepted: 05/15/2012] [Indexed: 11/19/2022]
Abstract
Based on current findings, the presence of NPM1 mutations in acute myeloid leukemia (AML) patients is associated with an increased probability of complete remission (CR) and better overall survival (OS). We determined the incidence and prognostic relevance of NPM1 mutations, their association with FLT3 and IDH mutations, and other clinical characteristics in Serbian adult AML patients. Samples from 111 adult de novo AML patients, including 73 AML cases with a normal karyotype (NK-AML), were studied. NPM1, FLT3, and IDH mutations were detected by PCR and direct sequencing. NPM1 mutations were detected in 22.5% of patients. The presence of NPM1 mutations predicted a low CR rate and shorter OS. NPM1 mutations showed an association with both FLT3 and IDH mutations. Survival analysis based on NPM1/FLT3 mutational status revealed a lower OS for NPM1(+)/FLT3(-) compared to the NPM1(-)/FLT3(-) group in NK-AML patients. The lack of impact or unfavorable prognostic effect of NPM1 mutations found in this study can be assigned to a small cohort of analyzed AML patients, as can the presence of FLT3 and IDH mutations or other genetic lesions that cooperate with NPM1 mutations influencing prognosis.
Collapse
Affiliation(s)
- Milos Kuzmanovic
- Institute of Molecular Genetics and Genetic Engineering, Belgrade, Serbia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Djunic I, Elezovic I, Ilic V, Tomin D, Bila J, Suvajdzic-Vukovic N, Antic D, Vidovic A, Milosevic-Jovcic N. Platelets dysfunction in multiple myeloma. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Djunic I, Virijevic M, Djurasinovic V, Novkovic A, Colovic N, Kraguljac-Kurtovic N, Vidovic A, Suvajdzic-Vukovic N, Tomin D. Prognostic significance of CD56 antigen expression in patients with acute myeloid leukemia. Med Oncol 2011; 29:2077-82. [PMID: 22081445 DOI: 10.1007/s12032-011-0104-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/28/2011] [Indexed: 11/25/2022]
Abstract
The aims of this study were to investigate the frequency and prognostic relevance of CD56 expression in patients with acute myeloid leukemia (AML) and to compare the importance of CD56 expression with standard prognostic factors, such as age, leukocytosis, cytogenetic abnormalities and performance status. We analyzed the data of 184 newly diagnosed patients with non-promyelocytic AML and a follow-up of 36 months. The median patient age was 58 years, with a range of 18-79. CD56+ antigen was recorded in 40 patients (21.7%). CD56 + was the most significant risk factor for OS: P = 0.05. The most significant factor for a poor rate of CR was age ≥ 55 years (P = 0.001). CD56 positivity had no significant influence on CR rate, but it was the most significant risk factor for disease-free survival (P = 0.005). The CD56 antigen is an independent prognostic risk factor, and its presence should be measured regularly for a better prognostic assessment of patients with AML.
Collapse
Affiliation(s)
- Irena Djunic
- Clinic for Hematology, Clinical Center of Serbia, Koste Todorovica 2, 11000 Belgrade, Serbia.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Djunic I, Elezovic I, Ilic V, Tomin D, Suvajdzic-Vukovic N, Bila J, Antic D, Vidovic A, Milosevic-Jovcic N. Acquired von Willebrand syndrome in multiple myeloma. ACTA ACUST UNITED AC 2011; 16:209-12. [PMID: 21756536 DOI: 10.1179/102453311x12953015767617] [Citation(s) in RCA: 7] [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] [Indexed: 10/31/2022]
Abstract
Acquired von Willebrand syndrome (AvWS) is an uncommon complication of multiple myeloma (MM), and it is believed to be connected with paraprotein. The aim of this study was to determine the incidence of AvWS in patients with MM, and estimate the role of paraprotein in its occurrence. The study included 40 patients with MM. The plasma level of paraprotein, platelet adhesion on glass pearls, plasma von Willebrand factor antigen concentration, and ristocetin-induced platelet aggregation (RIPA) were measured initially. Absence of RIPA was found in six patients with MM (15%); however, all six of them had normal levels of von Willebrand factor antigen. Paraprotein was isolated from the serum of these patients. Platelet aggregation was measured in six healthy donors before and after addition of the isolated paraprotein. RIPA was significantly decreased in healthy donors in the presence of paraprotein (P<0·001). The same test was repeated with added human immunoglobulins for intravenous use without any change in RIPA. A significant negative correlation between plasma paraprotein level and RIPA was found (P<0·001). These investigations have shown that paraprotein is associated with AvWS in patients with MM.
Collapse
Affiliation(s)
- Irena Djunic
- Clinic for Haematology, Clinical Center of Serbia, Belgrade, Serbia.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Djunic I, Virijevic M, Novkovic A, Djurasinovic V, Colovic N, Vidovic A, Suvajdzic-Vukovic N, Tomin D. Comorbidity as a risk factor for overall survival and decision criteria for intensity of chemotherapy in elderly patients with acute myeloid leukemia. Med Oncol 2011; 29:1077-81. [PMID: 21331819 DOI: 10.1007/s12032-011-9853-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 02/01/2011] [Indexed: 01/21/2023]
Abstract
This single-center study estimated the significance of pretreatment factors, including comorbidities, which may predict outcome in elderly patients with acute myeloid leukemia and determined how poor risk factors may be used as decision criteria for intensity of chemotherapy in this group of patients. Seventy-seven patients aged ≥ 55 years treated under four different regimens were followed up 36 month. Our results suggest that the most significant predictor for poor overall survival is comorbidity, as scored by the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), P = 0.008. The most significant predictor for rate of complete remission is serum lactate dehydrogenase (LDH) level, P = 0.049, and the most significant predictor of early death is leucocytosis, P = 0.007. HCT-CI ≥ 3 was the most significant factor for treatment decision making regarding intensity of chemotherapy. The use of standardized comorbidity assessment tools, such as HCT-CI, for elderly patients with AML is practical and can help to improve treatment decision regarding the intensity of chemotherapy.
Collapse
Affiliation(s)
- Irena Djunic
- Clinic for Hematology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Koste Todorovica 2, 11000 Belgrade, Serbia.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Djunic I, Elezovic I, Ilic V, Tomin D, Suvajdzic-Vukovic N, Antic D, Bila J, Vidovic A, Milosevic-Jovcic N. P.51 Acquired von Willebrand Syndrome in women with monoclonal gammopathies. Thromb Res 2011. [DOI: 10.1016/s0049-3848(11)70106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Djunic I, Elezovic I, Tomin D, Bila J, Antic D, Vidovic A, Suvajdzic-Vukovic N. PO-48 The influence of paraprotein on bleeding complications in multiple myeloma. Thromb Res 2010. [DOI: 10.1016/s0049-3848(10)70098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|