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Sacha T, Szczepanek E. Management of ponatinib dosing in chronic myeloid leukemia patients. J Physiol Pharmacol 2021; 72. [PMID: 34810285 DOI: 10.26402/jpp.2021.3.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Ponatinib (Iclusig®, Takeda/Incyte) is a third-generation highly-potent-pan-inhibitor of tyrosine kinases, active in all single resistance ABL kinase mutations including the T315l mutation. It is approved to treat of chronic myeloid leukemia (CML) in every phase of disease-resistant or intolerant to second-generation tyrosine kinase inhibitors (2GTKIs) and for whom imatinib is not clinically appropriate as well as for patients with T315I mutation. The drug is also indicated for Ph+ acute lymphoblastic leukemia (ALL). The approved starting dose for ponatinib is 45 mg once daily. Available data revealed ponatinib dose-dependent increased risk of cardiovascular toxicity. There is still no consensus about the optimal, initial dose of ponatinib and its management during therapy. It is crucial to start treatment with the risk-adjusted dose and assess the benefit-risk profile of ponatinib dosing. Evaluation of dosing modification should be considered during treatment, mainly if toxicity occurs. Our study summarizes current knowledge and recommendations about the choice of starting dose of ponatinib and management of ponatinib dosing during the treatment.
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Affiliation(s)
- T Sacha
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland.
| | - E Szczepanek
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
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Cross NCP, White HE, Ernst T, Welden L, Dietz C, Saglio G, Mahon FX, Wong CC, Zheng D, Wong S, Wang SS, Akiki S, Albano F, Andrikovics H, Anwar J, Balatzenko G, Bendit I, Beveridge J, Boeckx N, Cerveira N, Cheng SM, Colomer D, Czurda S, Daraio F, Dulucq S, Eggen L, El Housni H, Gerrard G, Gniot M, Izzo B, Jacquin D, Janssen JJWM, Jeromin S, Jurcek T, Kim DW, Machova-Polakova K, Martinez-Lopez J, McBean M, Mesanovic S, Mitterbauer-Hohendanner G, Mobtaker H, Mozziconacci MJ, Pajič T, Pallisgaard N, Panagiotidis P, Press RD, Qin YZ, Radich J, Sacha T, Touloumenidou T, Waits P, Wilkinson E, Zadro R, Müller MC, Hochhaus A, Branford S. Development and evaluation of a secondary reference panel for BCR-ABL1 quantification on the International Scale. Leukemia 2016; 30:1844-52. [PMID: 27109508 PMCID: PMC5240017 DOI: 10.1038/leu.2016.90] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 03/22/2016] [Accepted: 04/11/2016] [Indexed: 12/24/2022]
Abstract
Molecular monitoring of chronic myeloid leukemia patients using robust BCR-ABL1 tests standardized to the International Scale (IS) is key to proper disease management, especially when treatment cessation is considered. Most laboratories currently use a time-consuming sample exchange process with reference laboratories for IS calibration. A World Health Organization (WHO) BCR-ABL1 reference panel was developed (MR1–MR4), but access to the material is limited. In this study, we describe the development of the first cell-based secondary reference panel that is traceable to and faithfully replicates the WHO panel, with an additional MR4.5 level. The secondary panel was calibrated to IS using digital PCR with ABL1, BCR and GUSB as reference genes and evaluated by 44 laboratories worldwide. Interestingly, we found that >40% of BCR-ABL1 assays showed signs of inadequate optimization such as poor linearity and suboptimal PCR efficiency. Nonetheless, when optimized sample inputs were used, >60% demonstrated satisfactory IS accuracy, precision and/or MR4.5 sensitivity, and 58% obtained IS conversion factors from the secondary reference concordant with their current values. Correlation analysis indicated no significant alterations in %BCR-ABL1 results caused by different assay configurations. More assays achieved good precision and/or sensitivity than IS accuracy, indicating the need for better IS calibration mechanisms.
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Affiliation(s)
- N C P Cross
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - H E White
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - T Ernst
- Department of Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany
| | - L Welden
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia
| | - C Dietz
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - G Saglio
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - F-X Mahon
- Bergonie Institute Cancer Center Bordeaux, INSERM U1218, University of Bordeaux, Bordeaux, France
| | - C C Wong
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - D Zheng
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Wong
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S-S Wang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Akiki
- West Midlands Regional Genetics Laboratory, Birmingham, UK
| | - F Albano
- Department of Hematology, University of Bari, Bari, Italy
| | - H Andrikovics
- Laboratory of Molecular Diagnostics, Hungarian National Blood Transfusion Service, Budapest, Hungary.,Department of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - J Anwar
- King's College Hospital London, London, UK
| | - G Balatzenko
- National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | - I Bendit
- Laboratorio de Biologia Tumoral, Disciplina de Hematologia do HC-FMUSP, São Paulo, Brazil
| | - J Beveridge
- PathWest Laboratory Medicine WA, Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
| | - N Boeckx
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KUL, Leuven, Belgium
| | - N Cerveira
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | - S-M Cheng
- Department of Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - D Colomer
- Hematopathology Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - S Czurda
- Division of Molecular Microbiology, Children's Cancer Research Institute, Vienna, Austria
| | - F Daraio
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - S Dulucq
- Laboratoire Hematologie, Centre Hospitalier Universitaire de Bordeaux, Universite Bordeaux, Bordeaux, France
| | - L Eggen
- Laboratory of Molecular Pathology, Oslo University Hospital, Oslo, Norway
| | - H El Housni
- Clinique de Genetique Oncologique-Service de genetique, Hopital Erasme, Brussels, Belgium
| | - G Gerrard
- Imperial Molecular Pathology, Hammersmith Hospital, London, UK
| | - M Gniot
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - B Izzo
- Department of Clinical Medicine and Surgery, University 'Federico II' of Naples, Naples, Italy.,CEINGE - Biotecnologie Avanzate, Naples, Italy
| | | | - J J W M Janssen
- Department of Hematology and Molecular Diagnostics, VU University Medical Center, Amsterdam, The Netherlands
| | - S Jeromin
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - T Jurcek
- Center of Molecular Biology and Gene Therapy, Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - D-W Kim
- Seoul St Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - K Machova-Polakova
- Department of Molecular Genetics, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - J Martinez-Lopez
- Department of Hematology, Hospital Universitario 12 de Octubre, Universidad Complutense, CNIO, Madrid, Spain
| | - M McBean
- Division of Cancer Medicine, Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - S Mesanovic
- Pathology Department, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - G Mitterbauer-Hohendanner
- Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | | | - M-J Mozziconacci
- Departement de Biopathologie, Institut Paoli-Calmettes, Marseille, France
| | - T Pajič
- Specialized Haematology Laboratory, Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - N Pallisgaard
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - P Panagiotidis
- Hematology Unit, First Department of Internal Medicine, Laiko Hospital, University of Athens, Athens, Greece
| | - R D Press
- Department of Pathology and Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Y-Z Qin
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - J Radich
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - T Sacha
- Chair and Department of Hematology, Jagiellonian University, Kraków, Poland
| | - T Touloumenidou
- Laboratory of Molecular Biology, Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - P Waits
- Bristol Genetics Laboratory, Bristol, UK
| | | | - R Zadro
- Faculty of Pharmacy and Biochemistry and University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - M C Müller
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - A Hochhaus
- Department of Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany
| | - S Branford
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia.,School of Pharmacy and Medical Science, University of South Australia, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, SA, Adelaide, Australia.,School of Molecular and Biomedical Science, University of Adelaide, Adelaide, SA, Australia
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White H, Deprez L, Corbisier P, Hall V, Lin F, Mazoua S, Trapmann S, Aggerholm A, Andrikovics H, Akiki S, Barbany G, Boeckx N, Bench A, Catherwood M, Cayuela JM, Chudleigh S, Clench T, Colomer D, Daraio F, Dulucq S, Farrugia J, Fletcher L, Foroni L, Ganderton R, Gerrard G, Gineikienė E, Hayette S, El Housni H, Izzo B, Jansson M, Johnels P, Jurcek T, Kairisto V, Kizilors A, Kim DW, Lange T, Lion T, Polakova KM, Martinelli G, McCarron S, Merle PA, Milner B, Mitterbauer-Hohendanner G, Nagar M, Nickless G, Nomdedéu J, Nymoen DA, Leibundgut EO, Ozbek U, Pajič T, Pfeifer H, Preudhomme C, Raudsepp K, Romeo G, Sacha T, Talmaci R, Touloumenidou T, Van der Velden VHJ, Waits P, Wang L, Wilkinson E, Wilson G, Wren D, Zadro R, Ziermann J, Zoi K, Müller MC, Hochhaus A, Schimmel H, Cross NCP, Emons H. A certified plasmid reference material for the standardisation of BCR-ABL1 mRNA quantification by real-time quantitative PCR. Leukemia 2014; 29:369-76. [PMID: 25036192 PMCID: PMC4320294 DOI: 10.1038/leu.2014.217] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [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: 03/31/2014] [Revised: 05/21/2014] [Accepted: 06/25/2014] [Indexed: 11/14/2022]
Abstract
Serial quantification of BCR–ABL1 mRNA is an important therapeutic indicator in chronic myeloid leukaemia, but there is a substantial variation in results reported by different laboratories. To improve comparability, an internationally accepted plasmid certified reference material (CRM) was developed according to ISO Guide 34:2009. Fragments of BCR–ABL1 (e14a2 mRNA fusion), BCR and GUSB transcripts were amplified and cloned into pUC18 to yield plasmid pIRMM0099. Six different linearised plasmid solutions were produced with the following copy number concentrations, assigned by digital PCR, and expanded uncertainties: 1.08±0.13 × 106, 1.08±0.11 × 105, 1.03±0.10 × 104, 1.02±0.09 × 103, 1.04±0.10 × 102 and 10.0±1.5 copies/μl. The certification of the material for the number of specific DNA fragments per plasmid, copy number concentration of the plasmid solutions and the assessment of inter-unit heterogeneity and stability were performed according to ISO Guide 35:2006. Two suitability studies performed by 63 BCR–ABL1 testing laboratories demonstrated that this set of 6 plasmid CRMs can help to standardise a number of measured transcripts of e14a2 BCR–ABL1 and three control genes (ABL1, BCR and GUSB). The set of six plasmid CRMs is distributed worldwide by the Institute for Reference Materials and Measurements (Belgium) and its authorised distributors (https://ec.europa.eu/jrc/en/reference-materials/catalogue/; CRM code ERM-AD623a-f).
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Affiliation(s)
- H White
- 1] National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - L Deprez
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - P Corbisier
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - V Hall
- National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK
| | - F Lin
- 1] National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - S Mazoua
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - S Trapmann
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - A Aggerholm
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - H Andrikovics
- Hungarian National Blood Transfusion Service, Budapest, Hungary
| | - S Akiki
- Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - G Barbany
- Department of Molecular Medicine and Surgery, Clinical Genetics Karolinska Institutet, Stockholm, Sweden
| | - N Boeckx
- 1] Department of Laboratory Medicine, UZ Leuven, Belgium [2] Department of Oncology, KU Leuven, Belgium
| | - A Bench
- Molecular Malignancy Laboratory and Haemato-Oncology Diagnostic Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Catherwood
- Haematology Department, Belfast City Hospital, Belfast, UK
| | - J-M Cayuela
- Haematology Laboratory and EA3518, University Hospital Saint-Louis, AP-HP, University Paris Diderot, Paris, France
| | - S Chudleigh
- Department of Molecular Haematology, Yorkhill NHS Trust, Glasgow, UK
| | - T Clench
- Molecular Haematology, Bristol Royal Infirmary, Bristol, UK
| | - D Colomer
- Hematopathology Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - F Daraio
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - S Dulucq
- Laboratoire Hematologie, CHU Bordeaux, Hematopoiese Leucemique et Cibles Therapeutiques, INSERM U1035, Universite Bordeaux, Bordeaux, France
| | - J Farrugia
- Combined Laboratories, Derriford Hospital, Plymouth, UK
| | - L Fletcher
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - L Foroni
- Imperial Molecular Pathology, Centre for Haematology, Imperial College London, London, UK
| | - R Ganderton
- Molecular Pathology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - G Gerrard
- Imperial Molecular Pathology, Centre for Haematology, Imperial College London, London, UK
| | - E Gineikienė
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
| | - S Hayette
- Laboratory of Molecular Biology and UMR5239, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - H El Housni
- Medical Genetics Department, Erasme Hospital, Brussels, Belgium
| | - B Izzo
- Department of Clinical Medicine and Surgery, University 'Federico II' of Naples, Naples, Italy
| | - M Jansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - P Johnels
- Department of Clinical Genetics, University and Regional Laboratories, Lund, Sweden
| | - T Jurcek
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - V Kairisto
- Turku University Hospital, TYKSLAB, Laboratory of Molecular Genetics, Turku, Finland
| | - A Kizilors
- Laboratory for Molecular Haemato-Oncology, Kings College Hospital, London, UK
| | - D-W Kim
- Cancer Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - T Lange
- Abteilung für Hämatologie und internistische Onkologie, Universität Leipzig, Leipzig, Germany
| | - T Lion
- Children's Cancer Research Institute/LabDia Labordiagnostik and Medical University, Vienna, Austria
| | - K M Polakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - G Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - S McCarron
- Cancer Molecular Diagnostics, St James's Hospital, Dublin, Ireland
| | - P A Merle
- VU Medical Centre, Department of Haematology, Amsterdam, The Netherlands
| | - B Milner
- Department of Medical Genetics, NHS-Grampian, Aberdeen, UK
| | | | - M Nagar
- Laboratory of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | - G Nickless
- Molecular Oncology Diagnostics Unit, Guy's Hospital, London, UK
| | - J Nomdedéu
- Lab Hematologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - D A Nymoen
- Division of Pathology, Rikshospital, Oslo University Hospital, Oslo, Norway
| | - E O Leibundgut
- Molecular Diagnostics Laboratory, Department of Hematology, University Hospital Bern, Bern, Switzerland
| | - U Ozbek
- Genetics Department, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - T Pajič
- Specialized Haematology Laboratory, Division of Internal Medicine, Department of Haematology, University Medical Centre, Ljubljana, Slovenia
| | - H Pfeifer
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - C Preudhomme
- Laboratoire d'hématologie, CHU Lille, Lille, France
| | - K Raudsepp
- United Laboratories of Tartu University Hospitals, Tartu, Estonia
| | - G Romeo
- Molecular Haematology Laboratory, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - T Sacha
- Hematology Department, Jagiellonian University, Krakow, Poland
| | - R Talmaci
- Hematology Department, Fundeni Clinical Institute, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - T Touloumenidou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - P Waits
- Bristol Genetics Laboratory, Southmead Hospital, Bristol, UK
| | - L Wang
- Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK
| | - E Wilkinson
- HMDS, Leeds Institute of Oncology, St James's University Hospital, Leeds, UK
| | - G Wilson
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - D Wren
- Molecular Diagnostics, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R Zadro
- Department of Laboratory Diagnostics, Clinical Hospital Center, Zagreb University School of Medicine, Zagreb, Croatia
| | - J Ziermann
- Department of Hematology/Oncology, Jena University Hospital, Jena, Germany
| | - K Zoi
- Haematology Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - M C Müller
- III. Medizinische Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - A Hochhaus
- Department of Hematology/Oncology, Jena University Hospital, Jena, Germany
| | - H Schimmel
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - N C P Cross
- 1] National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Emons
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
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Foryciarz K, Sacha T, Salamanczuk Z, Jakobczyk M, Czekalska S, Zawada M, Szostek M, Florek I, Skotnicki AB. Early intensification of imatinib treatment based on precise definition of accelerated phase in patients with chronic myeloid leukemia: Population-based analysis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6588] [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: 11/20/2022] Open
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Budzynski A, Bobrzyński A, Sacha T, Skotnicki A. Laparoscopic removal of retroperitoneal accessory spleen in patient with relapsing idiopathic thrombocytopenic purpura 30 years after classical splenectomy. Surg Endosc 2002; 16:1636. [PMID: 12170349 DOI: 10.1007/s00464-002-4222-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 03/21/2002] [Accepted: 04/15/2002] [Indexed: 11/26/2022]
Abstract
The clinical success of therapeutic splenectomy for idiopathic thrombocytopenic purpura depends on the complete removal of all functional splenic tissue. Among reasons for poor response to splenectomy, failure to remove accessory spleens is mentioned. We present our experience with laparoscopic removal of accessory spleen from retroperitoneal space in a patient with relapse of ITP 30 years after classical splenectomy. A 45-year-old female patient underwent in 1972 classical splenectomy for ITP. Progressive decline in thrombocyte count was observed 7 years ago. Scintigraphy, CT, and ultrasound revealed residual splenic tissue. A laparoscopic approach was proposed. Four trocars placed along left costal margin were used. After dissection of all the adhesions behind the pancreatic tail deep in the retroperitoneal space a round structure 4 cm in diameter, macroscopically resembling splenic tissue, was found. The accessory spleen was removed intact. The patient recovered well; 2 months later steroids were discontinued while the thrombocyte level was 251 x 10(9)/L. Identification of accessory spleen seems to be major intraoperative problem. We believe that accessory spleen can be safely removed laparoscopically, avoiding a major open procedure, and a satisfactory postoperative result could be expected.
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Affiliation(s)
- A Budzynski
- 2nd Department of General Surgery, Collegium Medicum of Jagiellonian University, Krakow, Poland.
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Sacha T, Dulak J, Skotnicki AB, Dembińska-Kiec A. [Molecular basis of chronic myelogenous leukemia and significance of diagnostic methods based on BCR-ABL gene amplification]. Przegl Lek 1999; 56 Suppl 1:57-61. [PMID: 10494184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Chronic myelogenous leukemia is characterized by an abnormal 22nd chromosome known as a Philadelphia chromosome, which can be detected in 95% of patients with CML. Molecular equivalent of this aberration is a BCR-ABL translocation resulting in chimeric gene formation. A BCR-ABL chimeric gene plays a key role in the hematopoietic cells proliferation regulation. RT-PCR can be used in diagnosis of CML, to detect chimeric BCR-ABL gene, and to reveal the type of translocation what could have prognostic importance, and in monitoring of minimal residual disease, confirming the eradication of pathological cells clone after treatment and identifying the group of patients with best prognosis and best overall survival. RT-PCR in monitoring of minimal residual disease after allo- or autologous hemopoietic cells transplantation can early reveal relapse of the disease. Detection of molecular relapse is an important prognostic factor and may implicate induction of treatment which should prevent haematological relapse of the disease.
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MESH Headings
- Chimera
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Philadelphia Chromosome
- Prognosis
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction
- Survival Analysis
- Translocation, Genetic
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Affiliation(s)
- T Sacha
- Kliniki Hematologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie
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Sacha T, Zawirska D, Jurczak W, Hawrylecka D, Skotnicki AB. [Harvesting bone marrow from the posterior superior iliac crest for transplantation]. Przegl Lek 1999; 56 Suppl 1:40-3. [PMID: 10494181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The purpose of bone marrow cells harvesting is to isolate haemopoietic stem cell for the transplantation, by means of multiple punctures from the posterior iliac crest under general anaesthesia. This method is the alternative procedure for collecting circulating peripheral blood progenitor cells performed with continuous-flow cell separators. The aim of the both procedures is the collection of progenitor cells for transplantation in the number enabling reconstitution of marrow function after myeloablative therapy. The bone marrow cell harvesting is a safe measure: the infrequent complication related to general anaesthesia may occur and the simultaneous or subsequent blood transfusion is usually required.
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Affiliation(s)
- T Sacha
- Kliniki Hematologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie
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Sacha T, Hawrylecka D, Skotnicki AB. [Autologous hemopoietic stem cell transplantation in treatment of chronic myelogenous leukemia]. Przegl Lek 1999; 56 Suppl 1:62-6. [PMID: 10494185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Chronic myelogenous leukemia in more than 90% of patients is associated with the abnormal Philadelphia chromosome, which results in aberrant BCR-ABL chimeric gene expression. The mean overall survival on standard chemotherapy (which is not curative) ranges between 54-72 months. Selected patients with CML can be cured by allogeneic hemopoietic stem cell transplantation. Only 30% of patients has an optimal HLA-identical sibling donor. It is possible to find well-matched unrelated donor for another 20-30% of patients, however matched-unrelated donor transplantation is still associated with relative high risk of complications and cannot be used in elderly patients. Interferon alpha treatment in monotherapy or in combination with ARA-C can induce a cytogenetical and molecular remission in selected group of patients, which benefits with significantly prolonged survival. Nevertheless the cost of this treatment is high and long period of therapy is required to assess its efficacy. In patients lacking matched related or unrelated donors for allogeneic transplantation, autologous stem cell transplantation could be the alternative method of treatment. Discussed in the paper method of mobilization and transplantation of Philadelphia-negative peripheral-blood progenitor cells collected during early phase of bone marrow regeneration after "mobilizing" chemotherapy (mini-ICE) enables to achieve a complete or major cytogenetical response in about 77% of patients. There is only minimal morbidity and no transplant-related mortality. This procedure and the post-transplant immunotherapy (IFN alpha, interleukin-2) can considerably suppress the pathological clone and significantly prolong the overall survival in CML patients not eligible for allogeneic transplantation.
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Affiliation(s)
- T Sacha
- Kliniki Hematologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie
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9
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Sacha T, Skotnicki AB. [The effect of magnesium on blood coagulation--state of the art literature review from 1959 to 1995]. Przegl Lek 1997; 54:122-5. [PMID: 9198822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effect of magnesium on coagulation system is still an interesting subject for investigations. Shionoya in his publication (1927) reported for the first time possible inhibitory effect of magnesium on coagulation system. Since then, a large number of studies were undertaken to explain the mechanisms of influence of Mg++ on plasma coagulation, platelet function and fibrinolysis. In recent decades, the effect of magnesium on coagulation has led to controversy in a wide range of scientific publications. At present, series of experiments are undertaken in laboratories using modern methodology to evaluate the possible effect of magnesium on coagulation. The results of Anders's and Frisch's study reported here support the theory of the authors, who found no change in coagulation in the presence of physiological concentration of magnesium in blood serum. The influence on the final results, often contradictory, could have: different type of study (in vitro or in vivo), the object of the study (human being, animal), concentrations of magnesium (in most of cases non-physiologic and toxic) and out of date methodology. In majority of reported here studies there were no control groups, and clinical trials were not a double blind studies.
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Affiliation(s)
- T Sacha
- Kliniki Hematologii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie
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10
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Skotnicki AB, Sledziowski P, Sacha T, Jurczak W. [All-trans-retinoic acid in the differential therapy of proliferative hemocytic diseases. I. Properties of biological retinoids]. Przegl Lek 1995; 52:31-34. [PMID: 7784610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- A B Skotnicki
- Kliniki Hematologii Colegium Medicum Uniwersytetu Jagiellońskiego w Krakowie
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11
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Kubicka A, Libura M, Sacha T, Swadźba J, Undas A, Wandzilak M. [Fibrinolytic activity and tissue plasminogen activator level in healthy individuals prior to and after a ten-minute venous stasis]. Pol Tyg Lek 1993; 48:116-119. [PMID: 8361905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Fibrinolytic activity and tissue plasminogen activator (t-PA) level were measured in 33 healthy individuals prior to and after fibrinolytic system stimulation (i.e. a ten-minute venous stasis). Fibrinolytic activity was measured with the aid of euglobin lysis time, and lysis test on the fibrin plates (in own modification). Tissue plasminogen activator concentration was assayed spectrophotometrically with the COA-SET t-PA (Kabi Vitrum). No fibrinolytic activity of plasma specimens taken before the venous stasis was noted during fibrin lysis plate test whereas it was seen in 13 subjects after the venous stasis. Fibrinolytic activity of the plasma euglobins, measured as a surface on fibrin plates, increased significantly after the venous stasis in both sexes (by 35.5 mm2 on the average, i.e. by 51%). It was more marked in men than in women both prior to and after venous stasis (by 10.9% and 19.0%, respectively). A time of plasma euglobin lysis was shorter after venous stasis (by 110 minutes, on the average). There was no significant difference between the sexes. Tissue plasminogen activator concentration increased by 5.8 times (from 1.7 IU/ml to 9.9 IU/ml) after the stasis. Correlation between t-PA concentrations and fibrinolytic activity, measured on the fibrin plates, was highly positive. No such a correlation existed between t-PA concentrations and the time of euglobin lysis. The obtained results indicate variety of assessments of fibrinolytic system activity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Kubicka
- Studenckie Koło Internistyczne przy Katedrze Chorób Wewnetrznych AM, Krakowie
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Szczeklik A, Radwan J, Kubicka A, Libura M, Sacha T, Swadźba J, Undas A, Szczeklik J, Jodlowski J. Plasma fibrinolytic activity in healthy subjects with high and low lipoprotein(a) concentrations. Thromb Res 1992; 66:391-5. [PMID: 1412205 DOI: 10.1016/0049-3848(92)90288-l] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A Szczeklik
- Department of Medicine, Copernicus Academy of Medicine, Cracow, Poland
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