1
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Castaño-Díez S, Pomares H, Esteban D, Guijarro F, Jiménez-Vicente C, Zugasti I, Álamo JR, Mayayo VT, López-Guerra M, de la Fuente C, Charry P, Cortés-Bullich A, Bataller Á, Maluquer C, Colomer D, Rozman M, Arnan M, Xicoy B, Esteve J, Díaz-Beyá M. Characteristics and long-term outcome in a large series of chronic myelomonocytic leukaemia patients including 104 formerly referred to as oligomonocytic. Br J Haematol 2024; 204:892-897. [PMID: 38013238 DOI: 10.1111/bjh.19217] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/24/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
Recently modified diagnostic criteria for chronic myelomonocytic leukaemia (CMML) have lowered the cut-off for absolute monocytosis. In the largest series to date, we have analysed 313 CMML patients, including 104 with oligomonocytic (OM)-CMML. Five-year survival was longer for OM-CMML than for other patients (p < 0.001). Multivariate analysis identified OM-CMML as a favourable prognostic factor (HR 0.58; p = 0.002). The 5-year cumulative incidence of progression to classical CMML was 47%. Older age and transfusion dependence were adverse prognostic factors for OM-CMML. Our results support the inclusion of OM-CMML in the CMML category as a subtype with superior outcomes.
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Affiliation(s)
- Sandra Castaño-Díez
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Helena Pomares
- Hematology Department, Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, Hospitalet de Llobregat, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Daniel Esteban
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Francesca Guijarro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Servei d'Anatomia Patològica, CDB, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carlos Jiménez-Vicente
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Inés Zugasti
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - José Ramón Álamo
- Hematopathology Section, Servei d'Anatomia Patològica, CDB, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Mònica López-Guerra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Servei d'Anatomia Patològica, CDB, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Cristina de la Fuente
- Hematology Department, Institut Català d'Oncologia (ICO), Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paola Charry
- Apheresis Department, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Álex Bataller
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Clara Maluquer
- Hematology Department, Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, Hospitalet de Llobregat, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Dolors Colomer
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Servei d'Anatomia Patològica, CDB, Hospital Clínic Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - María Rozman
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hematopathology Section, Servei d'Anatomia Patològica, CDB, Hospital Clínic Barcelona, Barcelona, Spain
| | - Montserrat Arnan
- Hematology Department, Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, Hospitalet de Llobregat, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Blanca Xicoy
- Hematology Department, Institut Català d'Oncologia (ICO), Hospital Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Jordi Esteve
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Marina Díaz-Beyá
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Badalona, Spain
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Castaño-Díez S, Guijarro F, López-Guerra M, Pérez-Valencia AI, Gómez-Núñez M, Colomer D, Díaz-Beyá M, Esteve J, Rozman M. Infrequent Presentations of Chronic NPM1-Mutated Myeloid Neoplasms: Clinicopathological Features of Eight Cases from a Single Institution and Review of the Literature. Cancers (Basel) 2024; 16:705. [PMID: 38398096 PMCID: PMC10886643 DOI: 10.3390/cancers16040705] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Non-acute myeloid neoplasms (MNs) with NPM1 mutations (NPM1mut-MNs) pose a diagnostic and therapeutic dilemma, primarily manifesting as chronic myelomonocytic leukemia (CMML) and myelodysplastic syndromes (MDS). The classification and treatment approach for these conditions as acute myeloid leukemia (AML) are debated. We describe eight cases of atypical NPM1mut-MNs from our institution and review the literature. We include a rare case of concurrent prostate carcinoma and MN consistent with chronic eosinophilic leukemia, progressing to myeloid sarcoma of the skin. Of the remaining seven cases, five were CMML and two were MDS. NPM1 mutations occur in 3-5% of CMML and 1-6% of MDS, with an increased likelihood of rapid evolution to AML. Their influence on disease progression varies, and their prognostic significance in non-acute MNs is less established than in AML. Non-acute MNs with NPM1 mutations may display an aggressive clinical course, emphasizing the need for a comprehensive diagnosis integrating clinical and biological data. Tailoring patient management on an individualized basis, favoring intensive treatment aligned with AML protocols, is crucial, regardless of blast percentage. Research on the impact of NPM1 mutations in non-acute myeloid neoplasms is ongoing, requiring challenging prospective studies with substantial patient cohorts and extended follow-up periods for validation.
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Affiliation(s)
- Sandra Castaño-Díez
- Hematology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (A.I.P.-V.); (M.D.-B.); (J.E.)
- Medical School, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (F.G.); (M.L.-G.); (D.C.)
| | - Francesca Guijarro
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (F.G.); (M.L.-G.); (D.C.)
- Hematopathology Section, Servei d’Anatomia Patològica, CDB, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Mònica López-Guerra
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (F.G.); (M.L.-G.); (D.C.)
- Hematopathology Section, Servei d’Anatomia Patològica, CDB, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Amanda Isabel Pérez-Valencia
- Hematology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (A.I.P.-V.); (M.D.-B.); (J.E.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (F.G.); (M.L.-G.); (D.C.)
| | | | - Dolors Colomer
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (F.G.); (M.L.-G.); (D.C.)
- Hematopathology Section, Servei d’Anatomia Patològica, CDB, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Marina Díaz-Beyá
- Hematology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (A.I.P.-V.); (M.D.-B.); (J.E.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (F.G.); (M.L.-G.); (D.C.)
- Josep Carreras Leukemia Research Institute, 08916 Badalona, Spain
| | - Jordi Esteve
- Hematology Department, Hospital Clínic Barcelona, 08036 Barcelona, Spain; (S.C.-D.); (A.I.P.-V.); (M.D.-B.); (J.E.)
- Medical School, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (F.G.); (M.L.-G.); (D.C.)
- Josep Carreras Leukemia Research Institute, 08916 Badalona, Spain
| | - María Rozman
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (F.G.); (M.L.-G.); (D.C.)
- Hematopathology Section, Servei d’Anatomia Patològica, CDB, Hospital Clínic Barcelona, 08036 Barcelona, Spain
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Guijarro F, López-Guerra M, Morata J, Bataller A, Paz S, Cornet-Masana JM, Banús-Mulet A, Cuesta-Casanovas L, Carbó JM, Castaño-Díez S, Jiménez-Vicente C, Cortés-Bullich A, Triguero A, Martínez-Roca A, Esteban D, Gómez-Hernando M, Álamo Moreno JR, López-Oreja I, Garrote M, Risueño RM, Tonda R, Gut I, Colomer D, Díaz-Beya M, Esteve J. Germ line variants in patients with acute myeloid leukemia without a suspicion of hereditary hematologic malignancy syndrome. Blood Adv 2023; 7:5799-5811. [PMID: 37450374 PMCID: PMC10561046 DOI: 10.1182/bloodadvances.2023009742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Germ line predisposition in acute myeloid leukemia (AML) has gained attention in recent years because of a nonnegligible frequency and an impact on management of patients and their relatives. Risk alleles for AML development may be present in patients without a clinical suspicion of hereditary hematologic malignancy syndrome. In this study we investigated the presence of germ line variants (GVs) in 288 genes related to cancer predisposition in 47 patients with available paired, tumor-normal material, namely bone marrow stroma cells (n = 29), postremission bone marrow (n = 17), and saliva (n = 1). These patients correspond to 2 broad AML categories with heterogeneous genetic background (AML myelodysplasia related and AML defined by differentiation) and none of them had phenotypic abnormalities, previous history of cytopenia, or strong cancer aggregation. We found 11 pathogenic or likely pathogenic variants, 6 affecting genes related to autosomal dominant cancer predisposition syndromes (ATM, DDX41, and CHEK2) and 5 related to autosomal recessive bone marrow failure syndromes (FANCA, FANCM, SBDS, DNAJC21, and CSF3R). We did not find differences in clinical characteristics nor outcome between carriers of GVs vs noncarriers. Further studies in unselected AML cohorts are needed to determine GV incidence and penetrance and, in particular, to clarify the role of ATM nonsense mutations in AML predisposition.
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Affiliation(s)
- Francesca Guijarro
- Pathology Department, Hematopathology Section, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Monica López-Guerra
- Pathology Department, Hematopathology Section, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Jordi Morata
- Centro Nacional de Análisis Genómico, Barcelona, Spain
| | - Alex Bataller
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Sara Paz
- Pathology Department, Hematopathology Section, Hospital Clínic Barcelona, Barcelona, Spain
| | | | | | | | | | - Sandra Castaño-Díez
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carlos Jiménez-Vicente
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Albert Cortés-Bullich
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ana Triguero
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Alexandra Martínez-Roca
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Daniel Esteban
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Marta Gómez-Hernando
- Pathology Department, Hematopathology Section, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Irene López-Oreja
- Pathology Department, Hematopathology Section, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marta Garrote
- Pathology Department, Hematopathology Section, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ruth M. Risueño
- Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Raúl Tonda
- Centro Nacional de Análisis Genómico, Barcelona, Spain
| | - Ivo Gut
- Centro Nacional de Análisis Genómico, Barcelona, Spain
| | - Dolors Colomer
- Pathology Department, Hematopathology Section, Hospital Clínic Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- University of Barcelona, Barcelona, Spain
| | - Marina Díaz-Beya
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
- Josep Carreras Leukaemia Research Institute, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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Castaño-Díez S, López-Guerra M, Bosch-Castañeda C, Bataller A, Charry P, Esteban D, Guijarro F, Jiménez-Vicente C, Castillo-Girón C, Cortes A, Martínez-Roca A, Triguero A, Álamo JR, Beà S, Costa D, Colomer D, Rozman M, Esteve J, Díaz-Beyá M. Real-World Data on Chronic Myelomonocytic Leukemia: Clinical and Molecular Characteristics, Treatment, Emerging Drugs, and Patient Outcomes. Cancers (Basel) 2022; 14:cancers14174107. [PMID: 36077644 PMCID: PMC9455040 DOI: 10.3390/cancers14174107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Despite emerging molecular information on chronic myelomonocytic leukemia (CMML), patient outcome remains unsatisfactory and little is known about the transformation to acute myeloid leukemia (AML). In a single-center cohort of 219 CMML patients, we explored the potential correlation between clinical features, gene mutations, and treatment regimens with overall survival (OS) and clonal evolution into AML. The most commonly detected mutations were TET2, SRSF2, ASXL1, and RUNX1. Median OS was 34 months and varied according to age, cytogenetic risk, FAB, CPSS and CPSS-Mol categories, and number of gene mutations. Hypomethylating agents were administered to 37 patients, 18 of whom responded. Allogeneic stem cell transplantation (alloSCT) was performed in 22 patients. Two-year OS after alloSCT was 60.6%. Six patients received targeted therapy with IDH or FLT3 inhibitors, three of whom attained a long-lasting response. AML transformation occurred in 53 patients and the analysis of paired samples showed changes in gene mutation status. Our real-world data emphasize that the outcome of CMML patients is still unsatisfactory and alloSCT remains the only potentially curative treatment. However, targeted therapies show promise in patients with specific gene mutations. Complete molecular characterization can help to improve risk stratification, understand transformation, and personalize therapy.
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Affiliation(s)
- Sandra Castaño-Díez
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medical School, University of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Mónica López-Guerra
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | | | - Alex Bataller
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medical School, University of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Josep Carreras Leukemia Research Institute, 08916 Badalona, Spain
| | - Paola Charry
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Daniel Esteban
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Francesca Guijarro
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medical School, University of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Carlos Jiménez-Vicente
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Carlos Castillo-Girón
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Albert Cortes
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Hematology Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - Alexandra Martínez-Roca
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Ana Triguero
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - José Ramón Álamo
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
| | - Silvia Beà
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Dolors Costa
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Dolors Colomer
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - María Rozman
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Jordi Esteve
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Medical School, University of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Josep Carreras Leukemia Research Institute, 08916 Badalona, Spain
| | - Marina Díaz-Beyá
- Hematology and Hematopathology Departments, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Josep Carreras Leukemia Research Institute, 08916 Badalona, Spain
- Correspondence: ; Tel.: +34-9-227-54-28
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Serra-García L, Morgado-Carrasco D, Pérez-Valencia AI, Castaño-Díez S, Alamon-Reig F, Badenas C, To-Figueras J, Aguilera P. Acquired erythropoietic uroporphyria secondary to myeloid malignancy: A case report and literature review. Photodermatol Photoimmunol Photomed 2022; 38:86-91. [PMID: 34319628 DOI: 10.1111/phpp.12720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/25/2021] [Accepted: 07/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Laura Serra-García
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Sandra Castaño-Díez
- Department of Haematology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Alamon-Reig
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Cèlia Badenas
- Department of Biochemistry and Molecular Genetics, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jordi To-Figueras
- Department of Biochemistry and Molecular Genetics, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Paula Aguilera
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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6
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Puerta-Alcalde P, Chumbita M, Charry P, Castaño-Díez S, Cardozo C, Moreno-García E, Marco F, Suárez-Lledó M, Garcia-Pouton N, Morata L, Fernández-Avilés F, Martínez-Roca A, Rodríguez G, Martínez JA, Martínez C, Mensa J, Urbano Á, Rovira M, Soriano A, Garcia-Vidal C. Risk Factors for Mortality in Hematopoietic Stem Cell Transplantation Recipients with Bloodstream Infection: Points To Be Addressed by Future Guidelines. Transplant Cell Ther 2021; 27:501.e1-501.e6. [PMID: 33891882 DOI: 10.1016/j.jtct.2021.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/05/2023]
Abstract
In recent years, important epidemiologic changes have been described in hematopoietic stem cell transplantation (HSCT) recipients with bloodstream infection (BSI), with increases in gram-negative bacilli and multidrug resistant (MDR) gram-negative bacilli. These changes have been linked to a worrisome increase in mortality. We aimed to define the risk factors for mortality of HSCT patients experiencing BSI. All episodes of BSI in patients with HSCT between 2008 and 2017 were prospectively collected. Multivariate analyses were performed. A total of 402 BSI episodes were documented in 293 patients who had undergone HSCT (75.4% allogenic, 32.3% autologous, 19.3% second HSCT). The median time from HSCT to BSI was 62 days (interquartile range, 9 to 182 days). Gram-positive cocci accounted for 56.7% of the episodes; gram-negative bacilli, for 42%. The most common microorganisms were coagulase-negative staphylococci (30.6%) and Pseudomonas aeruginosa (15.9%). MDR gram-negative bacilli caused 11.9% of all episodes. Clinical characteristics, source of BSI, etiology, and outcomes changed depending on time since HSCT. Globally, 26.6% of episodes were treated with inappropriate empiric antibiotic therapy, more frequently in BSI episodes caused by P. aeruginosa, MDR P. aeruginosa, and MDR gram-negative bacilli. The 30-day mortality was 19.2%. Independent risk factors for mortality were BSI occurring ≥30 days after HSCT (odds ratio [OR], 11.21; 95% confidence interval [CI], 4.63 to 27.19), shock (OR, 7.10; 95% CI, 2.98 to 16.94), BSI caused by MDR P. aeruginosa (OR, 4.45; 95% CI, 1.12 to 17.72), and inappropriate empiric antibiotic therapy for gram-negative bacilli or Candida spp. (OR, 3.73; 95% CI, 1.27 to 10.89). HSCT recipients experiencing BSI have high mortality related to host and procedure factors, causative microorganism, and empiric antibiotic therapy. Strategies to identify HSCT recipients at risk of MDR P. aeruginosa and reducing inappropriate empiric antibiotic therapy are paramount to reduce mortality.
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Affiliation(s)
| | - Mariana Chumbita
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Paola Charry
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | | | - Celia Cardozo
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | | | - Francesc Marco
- Microbiology Department, Biomedical Diagnostic Center, Hospital Clinic, Barcelona, Spain; ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Laura Morata
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | | | | | | | - Jose A Martínez
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Josep Mensa
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Álvaro Urbano
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
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Rodríguez-Lobato LG, Martínez-Roca A, Castaño-Díez S, Palomino-Mosquera A, Gutiérrez-García G, Pedraza A, Suárez-Lledó M, Rovira M, Martínez C, Fernández de Larrea C, Cibeira MT, Rosiñol L, Lozano E, Marín P, Cid J, Lozano M, Moreno-Castaño AB, Palomo M, Díaz-Ricart M, Gallego C, Hernando A, Segura S, Carreras E, Urbano-Ispizua Á, Bladé J, Fernández-Avilés F. The avoidance of G-CSF and the addition of prophylactic corticosteroids after autologous stem cell transplantation for multiple myeloma patients appeal for the at-home setting to reduce readmission for neutropenic fever. PLoS One 2020; 15:e0241778. [PMID: 33147257 PMCID: PMC7641449 DOI: 10.1371/journal.pone.0241778] [Citation(s) in RCA: 3] [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: 07/28/2020] [Accepted: 10/20/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT. METHODS Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning +1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT. RESULTS The incidence of NF among the groups was reduced (64%, 44%, and 24%; P<0.001), with a non-significant decrease in hospital readmissions as well (12%, 6%, and 2%; P = 0.07). The most important variables identified for NF were: HCT-CI >2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P<0.001); and for hospital readmission: age ≥60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05). CONCLUSIONS G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT. This approach should be explored in a prospective randomized clinical trial.
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Affiliation(s)
- Luis-Gerardo Rodríguez-Lobato
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandra Martínez-Roca
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Sandra Castaño-Díez
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Alicia Palomino-Mosquera
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandra Pedraza
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Rovira
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Martínez
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlos Fernández de Larrea
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María-Teresa Cibeira
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Rosiñol
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ester Lozano
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Marín
- Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Joan Cid
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ana Belén Moreno-Castaño
- Department of Hematopathology, Laboratory of Hemostasis and Eritropathology, Biomedical Diagnosis Center (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Marta Palomo
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Hematopathology, Laboratory of Hemostasis and Eritropathology, Biomedical Diagnosis Center (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
- Josep Carreras Leukemia Research Institute, Hospital Clínic/University of Barcelona Campus, Barcelona, Spain
| | - Maribel Díaz-Ricart
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Hematopathology, Laboratory of Hemostasis and Eritropathology, Biomedical Diagnosis Center (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Cristina Gallego
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Adelina Hernando
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Susana Segura
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
- Josep Carreras Leukemia Research Institute, Hospital Clínic/University of Barcelona Campus, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Bladé
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Fernández-Avilés
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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