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Kang X, Hong S, Tan C, Di W, Zhang N. Successful management of VTE with essential thrombocythemia and cavernous transformation of the portal vein in early pregnancy: a case report. BMC Womens Health 2024; 24:211. [PMID: 38566064 PMCID: PMC10985859 DOI: 10.1186/s12905-024-03051-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Due to the thrombohemorrhagic potential of essential thrombocythemia, pregnancy complicated by essential thrombocythemia should be recognized as a risk factor for obstetric complications. Here, we report the case of a patient with essential thrombocythemia with two significantly different pregnancy outcomes. Her first pregnancy (at 30 years of age) ended with an uneventful term delivery. However, the patient progressed to cavernous transformation of the portal vein in the period between her two pregnancies and subsequently experienced deep venous thrombosis during the first trimester of her second pregnancy (at 36 years of age). The patient's platelet count during pregnancy was within the normal range, so she ignored previous instances of essential thrombocytosis (at 26 years of age). The patient's main symptom was unrelieved pain in her leg. After that, she was successfully treated with anticoagulant throughout her entire pregnancy, resulting in a term vaginal delivery. This case highlights the importance of assessing pregnant patients with essential thrombocythemia according to their risk stratification. Specifically, risk assessments for potential pregnancy complications should take into account advanced maternal age and a previous history of thrombosis. Patients with essential thrombocythemia should be encouraged to participate in preconception counseling for risk assessment and to initiate prophylactic anticoagulation as soon as possible.
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Affiliation(s)
- Xin Kang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shibin Hong
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chengxi Tan
- Department of Ophthalmology, University of California, San Francisco, 1550 4th Street, San Francisco, CA, 94143-2811, USA
| | - Wen Di
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Ning Zhang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Yang Y, Ren Y, Zhang K, Chen M, Chen C. Bone infarction: A rare complication of essential thrombocytosis with JAK2-V617F mutation. Eur J Intern Med 2024; 122:142-143. [PMID: 38245460 DOI: 10.1016/j.ejim.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/22/2024]
Affiliation(s)
- Yun Yang
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yanjun Ren
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Kaining Zhang
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Meng Chen
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Changjun Chen
- Department of Orthopedic Surgery, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Yang Z, Yang Y, Wu Y, Peng D, Chen C. JAK2-V617F-mutated myeloproliferative neoplasms: A cannot be missed cause of symptomatic postoperative epidural hematoma after lumber spine surgery. Eur J Intern Med 2024; 121:149-151. [PMID: 38177027 DOI: 10.1016/j.ejim.2023.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Zhiquan Yang
- Department of Orthopedic Surgery, Shouguang Hospital of Traditional Chinese Medicine, Weifang, China
| | - Yun Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Yingguang Wu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Dayong Peng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Changjun Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China; Tissue Engineering Laboratory, Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
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Narlı Özdemir Z, İpek Y, Patır P, Ermiş G, Çiftçiler R, Özmen D, Baysal M, Gürsoy V, Yıldızhan E, Güven S, Ercan T, Elibol T, Mersin S, Genç E, Davulcu EA, Karakuş V, Erkut N, Güneş G, Diz Küçükkaya R, Eşkazan AE. Impact of CALR and JAK2V617F Mutations on Clinical Course and Disease Outcomes in Essential Thrombocythemia: A Multicenter Retrospective Study in Turkish Patients. Turk J Haematol 2024; 41:26-36. [PMID: 38433449 PMCID: PMC10918406 DOI: 10.4274/tjh.galenos.2024.2023.0430] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024] Open
Abstract
Objective In this study, we investigated the effects of calreticulin (CALR) and JAK2V617F mutational status on clinical course and disease outcomes in Turkish patients with essential thrombocythemia (ET). Materials and Methods Seventeen centers from Türkiye participated in the study and CALR- and JAK2V617F-mutated ET patients were evaluated retrospectively. Results A total of 302 patients were included, of whom 203 (67.2%) and 99 (32.8%) were JAK2V617F- and CALR-positive, respectively. CALR-mutated patients were significantly younger (51 years vs. 57.5 years, p=0.03), with higher median platelet counts (987x109/L vs. 709x109/L, p<0.001) and lower median hemoglobin levels (13.1 g/dL vs. 14.1 g/dL, p<0.001) compared to JAK2V617F-mutated patients. Thromboembolic events (TEEs) occurred in 54 patients (17.9%), 77.8% of which were arterial. Compared to CALR mutation, JAK2V617F was associated with a higher risk of thrombosis (8.1% vs. 22.7%, p=0.002). Rates of transformation to myelofibrosis (MF) and leukemia were 4% and 0.7%, respectively, and these rates were comparable between JAK2V617F- and CALR-mutated cases. The estimated overall survival (OS) and MF-free survival of the entire cohort were 265.1 months and 235.7 months, respectively. OS and MF-free survival durations were similar between JAK2V617F- and CALR-mutated patients. Thrombosis-free survival (TFS) was superior in CALR-mutated patients compared to JAK2V617F-positive patients (5-year TFS: 90% vs. 71%, respectively; p=0.001). Age at diagnosis was an independent factor affecting the incidence of TEEs. Conclusion In our ET cohort, CALR mutations resulted in higher platelet counts and lower hemoglobin levels than JAK2V617F and were associated with younger age at diagnosis. JAK2V617F was strongly associated with thrombosis and worse TFS. Hydroxyurea was the most preferred cytoreductive agent for patients with high thrombosis risk.
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Affiliation(s)
| | - Yıldız İpek
- Kartal Dr. Lüfti Kırdar City Hospital, Clinic of Hematology, İstanbul, Türkiye
| | - Püsem Patır
- Antalya Training and Research Hospital, Clinic of Hematology, Antalya, Türkiye
| | - Gözde Ermiş
- Karadeniz Technical University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Türkiye
| | - Rafiye Çiftçiler
- Selçuk University Faculty of Medicine, Department of Hematology, Konya, Türkiye
| | - Deniz Özmen
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
| | - Mehmet Baysal
- Ali Osman Sönmez Oncology Hospital, Clinic of Hematology, Bursa, Türkiye
| | - Vildan Gürsoy
- Bursa City Hospital, Clinic of Orthopedics and Traumatology, Bursa, Türkiye
| | - Esra Yıldızhan
- Kayseri City Hospital, Clinic of Hematology, Kayseri, Türkiye
| | - Serkan Güven
- Mehmet Akif Ersoy State Hospital, Clinic of Hematology, Çanakkale, Türkiye
| | - Tarık Ercan
- Haydarpaşa Numune Training and Research Hospital, Clinic of Hematology, İstanbul, Türkiye
| | - Tayfun Elibol
- Medeniyet University Göztepe Training and Research Hospital, Clinic of Hematology, İstanbul, Türkiye
| | - Sinan Mersin
- Muğla Sıtkı Koçman University Training and Research Hospital, Clinic of Hematology, Muğla, Türkiye
| | - Eylem Genç
- Tekirdağ Dr. İsmail Fehmi Cumalıoğlu City Hospital, Clinic of Hematology, Tekirdağ, Türkiye
| | - Eren Arslan Davulcu
- University of Health Sciences Türkiye, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Hematology, İstanbul, Türkiye
| | - Volkan Karakuş
- Antalya Training and Research Hospital, Clinic of Hematology, Antalya, Türkiye
| | - Nergiz Erkut
- Karadeniz Technical University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Trabzon, Türkiye
| | - Gürsel Güneş
- University of Health Sciences Türkiye, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Hematology, Ankara, Türkiye
| | - Reyhan Diz Küçükkaya
- İstanbul University Faculty of Science, Department of Molecular Biology and Genetics, İstanbul, Türkiye
| | - Ahmet Emre Eşkazan
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Türkiye
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Tosoni L, Liberi M, Morelli G, Zannier ME, Lazzarotto D, Filì C, Simeone E, Battaglia G, Callegari C, Fanin M, Damiani D, Fanin R, Tiribelli M. Correlation between IPSET-t risk at diagnosis and subsequent hemorrhage in patients with essential thrombocythemia; a single institution experience. Ann Hematol 2024; 103:443-448. [PMID: 38072850 DOI: 10.1007/s00277-023-05578-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/30/2023] [Indexed: 12/28/2023]
Abstract
Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by an increased risk of thrombotic and hemorrhagic events, that represent the leading causes of mortality and morbidity. Currently, while thrombotic risk is assessed through the IPSET-t and r-IPSET scores, there is no specific prognostic tool used to predict hemorrhagic risk in ET. The aim of the study was to define incidence and risk factors connected to hemorrhagic events by retrospectively analyzing 308 ET patients diagnosed between 1996 and 2022 at the Division of Hematology of Udine and treated according to the current international guidelines. According to molecular status, 193 patients (62.7%) were JAK2 mutated, 66 (21.4%) had a CALR mutation, 14 (4.5%) had a MPL mutation, 21 patients (6.8%) were "triple negative," and 14 patients (4.5%) were not evaluable. According to IPSET-t score, 49.7% patients were at high, 24.3% at intermediate, and 26.0% at low-risk, respectively. Twelve (3.9%) patients experienced bleeding at ET diagnosis, while 24 (7.8%) had at least one hemorrhagic event during follow-up at a median time of 103 months (range: 1-309). Forty hemorrhagic events were totally recorded and defined as minor in 22 cases, moderate in 11 cases, and severe in 7 cases. Cumulative incidence (CI) of hemorrhage at 10 and 20 years was 6.0% and 12.0%, respectively. A statistically significant correlation between hemorrhagic risk and IPSET-t score emerged: 10 years hemorrhage CI was 3.2% for low-risk, 2.9% for intermediate-risk, and 9.8% for high-risk patients, respectively (p=0.002). We found no correlation between hemorrhagic risk and gender or mutational status. Results of our study highlight the validity of IPSET-t score in predicting individual hemorrhagic risk among ET patients, suggesting a possible role of IPSET-t scoring system as a global evaluator for vascular events in ET patients.
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Affiliation(s)
- Luca Tosoni
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Matteo Liberi
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Gianluca Morelli
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Maria Elena Zannier
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Davide Lazzarotto
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Carla Filì
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Erica Simeone
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Giulia Battaglia
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Chiara Callegari
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Matteo Fanin
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
| | - Daniela Damiani
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, P.le S. M. Misericordia 15, 33100, Udine, Italy.
- Department of Medicine, University of Udine, Udine, Italy.
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Shyu M, Winters A, Naymagon L, Patel R, Schiano TD, Tremblay D. Decreased patency of transjugular intrahepatic portosystemic shunts performed for splanchnic vein thrombosis in patients with myeloproliferative neoplasms. Thromb Res 2024; 234:32-35. [PMID: 38154200 DOI: 10.1016/j.thromres.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Margaret Shyu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Adam Winters
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, United States of America Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leonard Naymagon
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rahul Patel
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas D Schiano
- Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, United States of America Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Douglas Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Xiang D, Yang X, Qian H, Zhang L, Han Y, Sun Y, Lu Y, Chen Y, Cao D, Hu M, Wang L, Tang Q, Wu D, Tian G, Tong H, Jin J, Huang J. Development and validation of a model for the early prediction of progression from essential thrombocythemia to post-essential thrombocythemia myelofibrosis: a multicentre retrospective study. EClinicalMedicine 2024; 67:102378. [PMID: 38188688 PMCID: PMC10770426 DOI: 10.1016/j.eclinm.2023.102378] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Background Essential thrombocythemia (ET), a myeloproliferative neoplasm (MPN), has a substantial risk of evolving into post-essential thrombocythemia myelofibrosis (post-ET MF). This study aims to establish a prediction nomogram for early prediction of post-ET MF in ET patients. Methods The training cohort comprised 558 patients from 8 haematology centres between January 1, 2010, and May 1, 2023, while the external validation cohort consisted of 165 patients from 6 additional haematology centres between January 1, 2010, and May 1, 2023. Univariable and multivariable Cox regression analysis was performed to identified independent risk factors and establish a nomogram to predict the post-ET MF free survival. Both bias-corrected area under the curve (AUC), calibration curves and concordance index (C-index) were employed to assess the predictive accuracy of the nomogram. Findings Multivariate Cox regression demonstrated that elevated red blood cell distribution width (RDW), elevated levels of lactate dehydrogenase (LDH) and the level of haemoglobin (Hb), a history of smoking and the presence of splenomegaly were independent risk factors for post-ET MF. The C-index displayed of the training and validation cohorts were 0.877 and 0.853. The 5 years, 10 years AUC values in training and external validation cohorts were 0.948, 0.769 and 0.978, 0.804 respectively. Bias-corrected curve is close to the ideal curve and revealed a strong consistency between actual observation and prediction. Interpretation We developed a nomogram capable of predicting the post-ET MF free survival probability at 5 years and 10 years in ET patients. This tool helps doctors identify patients who need close monitoring and appropriate counselling. Funding This research was funded by the Key R&D Program of Zhejiang (No. 2022C03137); the Public Technology Application Research Program of Zhejiang, China (No. LGF21H080003); and the Zhejiang Medical Association Clinical Medical Research special fund project (No. 2022ZYC-D09).
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Affiliation(s)
- Danhong Xiang
- Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Haematology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
- Zhejiang Clinical Medical Research Centre of Haematology, Hangzhou, Zhejiang, China
| | - Xiudi Yang
- Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Clinical Medical Research Centre of Haematology, Hangzhou, Zhejiang, China
| | - Honglan Qian
- Department of Haematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Li Zhang
- Department of Haematology, Taizhou Hospital of Zhejiang Province Affiliated with Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Yanxia Han
- Department of Haematology, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Yongcheng Sun
- Department of Haematology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Ying Lu
- Department of Haematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yu Chen
- Department of Haematology, College of Medicine, Lishui Hospital, Zhejiang University, Lishui, Zhejiang, China
| | - Dan Cao
- Department of Haematology, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Meiwei Hu
- Department of Haematology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lifeng Wang
- Department of Haematology, The Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Qinli Tang
- Department of Haematologist, The First People's Hospital of PingHu, PingHu, Zhejiang, China
| | - Dijiong Wu
- Department of Haematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Guoyan Tian
- Department of Haematology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Hongyan Tong
- Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Clinical Medical Research Centre of Haematology, Hangzhou, Zhejiang, China
| | - Jie Jin
- Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Clinical Medical Research Centre of Haematology, Hangzhou, Zhejiang, China
| | - Jian Huang
- Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Clinical Medical Research Centre of Haematology, Hangzhou, Zhejiang, China
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Wan ZD, Li WZ. Repairing of recurrent leg ulcer induced by hydroxyurea with posterior tibial artery perforator propeller flap: Case report. Int J Surg Case Rep 2024; 114:109049. [PMID: 38029574 PMCID: PMC10698520 DOI: 10.1016/j.ijscr.2023.109049] [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: 10/30/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Hydroxyurea is a cytotoxic drug commonly used to treat various myeloproliferative disorders. However, prolonged oral administration of this drug may trigger skin side effects and ulcers. There are few clinical reports on treating leg ulcers caused by hydroxyurea and even fewer clinical reports on managing recurrent ulcers after treatment. CASE PRESENTATION An 87-year-old woman with essential thrombocythemia presented with a painful skin ulcer on her left calf. After failed outpatient treatment, she opted for hospitalisation for free skin grafting. Four months later, ulcers reappeared at the transplant site, leading to her readmission to the hospital. The diagnosis revealed that the leg ulcers were caused by hydroxyurea. Despite this, she persisted with hydroxyurea treatment and subsequently underwent posterior tibial artery perforator flap surgery. During the two-year follow-up, a new ulcer developed on the medial condyle of her other calf. However, no new ulcers or local pain were observed in the area where perforator flap grafting was performed. CLINICAL DISCUSSION Leg ulcers caused by hydroxyurea are rare clinically and can easily be misdiagnosed. There is currently minimal research on ulcer recurrence after treatment. Posterior tibial perforator flaps may more effectively promote the healing of recurrent ulcers. CONCLUSION Compared to conservative treatment and skin grafting surgery, the posterior tibial artery perforator flap offers a dependable blood supply and enhances the likelihood of wound healing. It can be considered an option, particularly for recurrent and refractory ulcers, even without discontinuing medication.
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Affiliation(s)
- Zheng-Dong Wan
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei, China.
| | - Wu-Zhou Li
- Department of Plastic Surgery, The First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei, China
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Matsui K, Kitamura T, Torii S, Mishima T, Shikata F, Fukuzumi M, Fujioka S, Araki H, Horikoshi R, Tamura Y, Mori H, Miyaji K. Recurrent left ventricular thrombus due to essential thrombocythemia complicated by COVID-19. J Cardiol Cases 2024; 29:15-18. [PMID: 38188321 PMCID: PMC10770075 DOI: 10.1016/j.jccase.2023.09.006] [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: 05/06/2023] [Revised: 07/18/2023] [Accepted: 09/05/2023] [Indexed: 01/09/2024] Open
Abstract
Essential thrombocythemia is a risk factor for thrombosis and hemorrhage. During the perioperative period of cardiac surgery, the risk of thrombosis and hemorrhage increases. Coronavirus disease 2019 (COVID-19) is also associated with thrombosis. We present the case of a 69-year-old man with essential thrombocythemia complicated by COVID-19 who developed a left ventricular thrombus. We performed thrombectomy, but the patient developed recurrent left ventricular thrombus 8 days after surgery. Emergency redo thrombectomy was performed followed by aggressive blood-thinning therapy. The postoperative course was complicated by cardiac tamponade requiring surgical drainage 8 days after the second surgery. The patient was discharged home 25 days after the second operation without any complications. Learning objective Left ventricular thrombus is a rare but fatal complication associated with essential thrombocythemia. COVID-19 has also been reported to cause coagulopathy. This case suggested that after surgery for left ventricular thrombus complicated by multiple risk factors including essential thrombocythemia and COVID-19, aggressive blood-thinning therapy with combination of anticoagulation, antiplatelet, and metabolic antagonist may help prevent recurrent thrombosis.
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Affiliation(s)
- Kenta Matsui
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shinzo Torii
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiaki Mishima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaomi Fukuzumi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shunichiro Fujioka
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Haruna Araki
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Rihito Horikoshi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshimi Tamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hisaya Mori
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Lee MW, Koh JS, Kang S, Ryu H, Song IC, Lee HJ, Yun HJ, Kim SY, Kim SS, Jo DY. Abdominal aortic calcification in patients newly diagnosed with essential thrombocythemia. Blood Res 2023; 58:173-180. [PMID: 37853439 PMCID: PMC10758625 DOI: 10.5045/br.2023.2023125] [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: 07/05/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
Background Although atherosclerosis is likely to be involved in the development of arterial thrombotic events in patients with essential thrombocythemia (ET), abdominal aortic calcification (AAC) has rarely been investigated. We evaluated the prevalence and clinical relevance of AAC at the time of ET diagnosis. Methods This retrospective study included patients newly diagnosed with ET who underwent abdominal computed tomography (CT) at the time of diagnosis between January 2002 and December 2021 at Chungnam National University Hospital, Daejeon, Korea. CT images were reviewed and an aortic calcification score was assigned. Results Of the 94 patients (median age, 62 yr; range, 18‒90 yr), AAC was detected in 62 (66.0%). AAC was most commonly mild (33.0%), followed by moderate (22.7%) and severe (5.3%). Old age [odds ratio (OR), 34.37; 95% confidence interval (CI), 12.32‒95.91; P<0.001] was an independent risk factor for AAC. The patients with AAC had a higher WBC count (11.8±4.7 vs. 9.7±2.9×109/L, P=0.017), higher neutrophil-to-lymphocyte ratio (4.3±2.7 vs. 3.1±1.5, P=0.039), and higher JAK2V617F positivity (81.5% vs. 58.8%, P=0.020) compared to those without AAC. AAC was an independent risk factor for arterial thrombotic vascular events that occurred before or at diagnosis of ET (OR, 4.12; 95% CI, 1.11‒15.85; P=0.034). Conclusion AAC is common in patients with ET and is associated with arterial thrombotic events.
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Affiliation(s)
- Myung-Won Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jeong Suk Koh
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sora Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyewon Ryu
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ik-Chan Song
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyo-Jin Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hwan-Jung Yun
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seon Young Kim
- Department of Laboratory Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seong Soo Kim
- Department of Thoracic Radiology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Deog-Yeon Jo
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Seyhan Erdoğan D, Benbir Şenel G, Gündüz A, Uçar BP, Elverdi T, Salihoğlu A, Ar MC, Öngören Ş, Başlar Z, Eşkazan AE. A cross-sectional study on restless legs syndrome (RLS) in polycythemia vera (PV): is iron deficiency the only culprit? Neurol Res 2023; 45:1144-1151. [PMID: 37736879 DOI: 10.1080/01616412.2023.2257443] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/03/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION In polycythemia vera (PV) patients undergoing phlebotomy, iron deficiency (ID) may develop. ID has been linked to restless legs syndrome (RLS), and in one study, 29.6% of PV patients had RLS. We aimed to evaluate the frequency of RLS in PV and to evaluate factors that might play a role in RLS development among PV and essential thrombocythemia (ET) patients. METHODS We consecutively included PV cases as the patient group, and ET and ID patients and healthy subjects (HSs) were included as controls. Those with conditions that could lead to RLS were excluded. All subjects were questioned according to the diagnostic criteria of the International Restless Legs Syndrome Study Group. RESULTS Twenty-seven PV, 23 ET, and 22 ID patients and 23 HSs were included. RLS was detected in 25.9%, 34.8%, and 45.5% of PV, ET, and ID patients, respectively. None of the HSs had RLS. In univariate analysis, interferon-α and anagrelide use, magnesium levels, and the Leeds assessment of neuropathic symptoms and signs (LANSS) scores had a significant impact on RLS in PV and ET patients (p = 0.014, p = 0.032, p = 0.036, and p = 0.003, respectively). CONCLUSION RLS was more common among PV and ET patients than HSs, which was irrespective to the iron status. RLS was more frequent in ET patients than that observed in PV cases, indicating that ID may not be the only causative factor for RLS development in PV. Further prospective studies are needed to determine the prevalence and risk factors of RLS developing in PV and ET.
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Affiliation(s)
- Duygu Seyhan Erdoğan
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gülçin Benbir Şenel
- Department of Neurology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Beria Peren Uçar
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tuğrul Elverdi
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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12
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Manan MR, Kipkorir V, Nawaz I, Waithaka MW, Srichawla BS, Găman AM, Diaconu CC, Găman MA. Acute myocardial infarction in myeloproliferative neoplasms. World J Cardiol 2023; 15:571-581. [PMID: 38058401 PMCID: PMC10696206 DOI: 10.4330/wjc.v15.i11.571] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/21/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs) are a heterogeneous group of hematologic malignancies characterized by an abnormal proliferation of cells of the myeloid lineage. Affected individuals are at increased risk for cardiovascular and thrombotic events. Myocardial infarction (MI) may be one of the earliest clinical manifestations of MPNs or may be a thrombotic complication that develops during the natural course of the disease. In the present review, we examine the epidemiology, pathogenesis, clinical presentation, and management of MI in MPNs based on the available literature. Moreover, we review potential biomarkers that could mediate the MI-MPNs crosstalk, from classical biochemical tests, e.g., lactate dehydrogenase, creatine kinase and troponins, to pro-inflammatory cytokines, oxidative stress markers, and clonal hematopoiesis.
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Affiliation(s)
| | - Vincent Kipkorir
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi 00100, Kenya
| | - Iqra Nawaz
- Quaid-e-Azam Medical College, Bahawalpur 63100, Pakistan
| | | | - Bahadar Singh Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Amelia Maria Găman
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, Craiova 200143, Romania
- Clinic of Hematology, Filantropia City Hospital, Craiova 200143, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest 050474, Romania
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, Bucharest 105402, Romania
| | - Mihnea-Alexandru Găman
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest 022328, Romania
- Department of Cellular and Molecular Pathology, Stefan S. Nicolau Institute of Virology, Romanian Academy, Bucharest 030304, Romania.
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13
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Kaya A, Kuku İ, Erkurt MA, Kaya E, Berber İ, Biçim S, Hidayet E, Cırık S, Arslan S, Yagin FH, Sarıcı A. The effect of thrombocytapheresis on hemogram and biochemistry parameters in patients with essential thrombocytemia. Transfus Clin Biol 2023; 30:421-425. [PMID: 37558046 DOI: 10.1016/j.tracli.2023.08.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Essential thrombocythemia is one of the chronic myeloproliferative neoplasms characterized by clonal proliferation of myeloid cells with variable morphological maturation and hematopoietic activity.It is characterized by excessive clonal platelet production with a tendency to thrombosis and bleeding. Thrombocytapheresıs is the removal of platelets by apheresis techniques. Thrombocytapheresıs is generally recommended in patients with essential thrombocythemia with acute, severe thrombotic or hemorrhagic events. METHODS The study included 39 patients who were diagnosed with essential thrombocythemia, started cytoreductive and aspirin therapy, and underwent thrombocytapheresıs due to the development of acute severe thrombotic or hemorrhagic events, diagnosed in the adult hematology clinic of İnönü University Turgut Ozal Medical Center. Hemogram and biochemistry values of the patients were scanned retrospectively. RESULTS After thrombocytapheresıs, a statistically significant difference was found between the first and last measurements of hemoglobin, mean platelet volume, White blood cell, neutrophil, platelet, platelet distribution width, creatine, lactate dehydrogenase, fibronogen and calcium levels of the patients. CONCLUSION The use of thrombocytapheresıs in patients with essential thrombocytosis causes a rapid decrease in platelet values as well as an effect on hemogram and biochemistry parameters. Other hemogram and biochemistry parameters such as platelet value should be monitored in patients.
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Affiliation(s)
- Ahmet Kaya
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey
| | - İrfan Kuku
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey.
| | - Mehmet Ali Erkurt
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey.
| | - Emin Kaya
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey.
| | - İlhami Berber
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey.
| | - Soykan Biçim
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey
| | - Emine Hidayet
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey
| | - Salih Cırık
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey
| | - Süleyman Arslan
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey
| | - Fatma Hilal Yagin
- Inonu University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Malatya, Turkey.
| | - Ahmet Sarıcı
- Inonu University, Turgut Ozal Medical Center, Department of Hematology, Malatya, Turkey.
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14
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Stuckey R, Ianotto JC, Santoro M, Czyż A, Encinas MMP, Gómez-Casares MT, Pereira MSN, de Nałęcz AK, Gołos A, Lewandowski K, Szukalski Ł, González-Martín JM, Sobas MA. Prediction of major bleeding events in 1381 patients with essential thrombocythemia. Int J Hematol 2023; 118:589-595. [PMID: 37660316 PMCID: PMC10615906 DOI: 10.1007/s12185-023-03650-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/27/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
The goal of therapy in essential thrombocythemia (ET) is reducing thrombotic risk. No algorithm to predict hemorrhage risk exists. The impact ofanti-platelet, cytoreductive and anticoagulation therapies on risk of major bleeding (MB) was evaluated. MB events were retrospectively analyzed in 1381 ET from 10 European centers. There were 0.286 MB events/person-year. Neither the International Thrombosis Prognostic Score for thrombosis in essential thrombocythemia (IPSET-t) nor the revised IPSET-t (r-IPSET-t) was predictive for hemorrhage-free survival at 10 years (p = 0.092 vs p = 0.1). Ageand leukocyte count were MB risk factors, while low hemoglobin was protective. For ET with extreme thrombocytosis (ExtT) and leukocytosis cytoreduction was not protective. MB were more frequent in ET with ExtT who received anticoagulation. Antiplatelet therapy was not, while anticoagulation was a risk factor for MB (HR 3.05, p = 0.016, CI 1.23-7.56), in particular vitamin K antagonists (22.6% of those treated had a MB event, HR 2.96, p = 0.004, CI 1.41-6.22). Survival at 10 years was associated with hemorrhage (OR 2.54, p < 0.001) but not thrombosis (HR 0.95, p = 0.829). Hemorrhage has a higher risk of mortality than thrombosis. Improved risk stratification for MB is necessary. The choice of anticoagulation, cytoreduction and antiplatelet therapies is an important area of research in ET.
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Affiliation(s)
- Ruth Stuckey
- Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain
| | - Jean-Christophe Ianotto
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Marco Santoro
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Anna Czyż
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | - Manuel M Perez Encinas
- Hematology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Krzysztof Lewandowski
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Szukalski
- Department of Haematology CM UMK in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | | | - Marta Anna Sobas
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland.
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15
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Mohamad Yusof UK, Mashohor S, Hanafi M, Md Noor S, Zainal N. Histopathology imagery dataset of Ph-negative myeloproliferative neoplasm. Data Brief 2023; 50:109484. [PMID: 37636134 PMCID: PMC10458278 DOI: 10.1016/j.dib.2023.109484] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
Tumorous cancer has been a widely known and well-studied medical phenomenon; however, rare diseases like Myeloproliferative Neoplasm (MPN) have received less attention, leading to delayed diagnosis. Despite the availability of advanced technology in diagnostic tools that can boost the procedure, the morphological assessment of bone marrow trephine (BMT) images remains critical to confirm and differentiate MPN subtypes. This paper reports a histopathological imagery dataset that was created to focus on the most common MPN from the Philadelphia Chromosome (Ph)-negative type, namely Essential Thrombocythemia (ET), Polycythemia Vera (PV), and Primary Myelofibrosis (MF). The dataset consisted of 300 BMT images that can be used to enable computer vision applications, such as image segmentation, disease classification, and object recognition, in assisting the classification of the MPN disease. Ethical approval was obtained from the Ministry of Health, Malaysia and the bone marrow trephine images were captured using a digital microscope from the Olympus model (BX41 Dual head microscope) with x10, x20, and x40 lens types. The development of comprehensive tools deployed from this dataset can assist medical practitioners in diagnosing diseases, thus overcoming the current challenges.
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Affiliation(s)
- Umi Kalsom Mohamad Yusof
- Department of Computer and Communication Systems Engineering, Faculty of Engineering, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
| | - Syamsiah Mashohor
- Department of Computer and Communication Systems Engineering, Faculty of Engineering, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
| | - Marsyita Hanafi
- Department of Computer and Communication Systems Engineering, Faculty of Engineering, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
| | - Sabariah Md Noor
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia
| | - Norsafina Zainal
- Pathology Department, Hospital Serdang, Jalan Puchong, 43000 Kajang, Selangor, Malaysia
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16
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Duminuco A, Torre E, Palumbo GA, Harrison C. A Journey Through JAK Inhibitors for the Treatment of Myeloproliferative Diseases. Curr Hematol Malig Rep 2023; 18:176-189. [PMID: 37395943 DOI: 10.1007/s11899-023-00702-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW Chronic myeloproliferative neoplasms (MPN) represent a group of diseases characterised by constitutive activation of the JAK/STAT pathway in a clonal myeloid precursor. The therapeutic approach aims to treat the symptom burden (headache, itching, debilitation), splenomegaly, slow down the fibrotic proliferation in the bone marrow and reduce the risk of thrombosis/bleeding whilst avoiding leukaemic transformation. RECENT FINDINGS In recent years, the advent of JAK inhibitors (JAKi) has significantly broadened treatment options for these patients. In myelofibrosis, symptom control and splenomegaly reduction can improve quality of life with improved overall survival, not impacting progression into acute leukaemia. Several JAKi are available and used worldwide, and combination approaches are now being explored. In this chapter, we review the approved JAKi, highlighting its strengths, exploring potential guidelines in choosing which one to use and reasoning towards future perspectives, where the combinations of therapies seem to promise the best results.
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Affiliation(s)
- Andrea Duminuco
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
- Haematology with BMT Unit, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Elena Torre
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy
| | - Giuseppe A Palumbo
- Haematology with BMT Unit, A.O.U. Policlinico "G.Rodolico-San Marco", Catania, Italy
| | - Claire Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK.
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17
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Purwar S, Fatima A, Bhattacharyya H, Simhachalam Kutikuppala LV, Cozma MA, Srichawla BS, Komer L, Nurani KM, Găman MA. Toxicity of targeted anticancer treatments on the liver in myeloproliferative neoplasms. World J Hepatol 2023; 15:1021-1032. [PMID: 37900211 PMCID: PMC10600697 DOI: 10.4254/wjh.v15.i9.1021] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
The liver has a central role in metabolism, therefore, it is susceptible to harmful effects of ingested medications (drugs, herbs, and nutritional supplements). Drug-induced liver injury (DILI) comprises a range of unexpected reactions that occur after exposure to various classes of medication. Even though most cases consist of mild, temporary elevations in liver enzyme markers, DILI can also manifest as acute liver failure in some patients and can be associated with mortality. Herein, we briefly review available data on DILI induced by targeted anticancer agents in managing classical myeloproliferative neoplasms: Chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, and myelofibrosis.
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Affiliation(s)
- Shubhrat Purwar
- Department of Internal Medicine, Grant Government Medical College, Mumbai 400008, Maharashtra, India
| | - Anam Fatima
- Department of Internal Medicine, Pandit Jawaharlal Nehru Memorial Medical College, Raipur 492001, Chhattisgarh, India
| | | | | | - Matei-Alexandru Cozma
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest 020125, Romania
| | - Bahadar Singh Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Leah Komer
- Department of Psychiatry, University of Toronto, Toronto M5G 1V7, Ontario, Canada
| | | | - Mihnea-Alexandru Găman
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest 022328, Romania.
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18
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Su M, Zhu Y, Jing G, Pang P, Zhang Q. General anesthesia with nerve blocks for a patient with femoral fracture and essential thrombocythemia: a case report. J Int Med Res 2023; 51:3000605231198385. [PMID: 37728610 PMCID: PMC10515530 DOI: 10.1177/03000605231198385] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023] Open
Abstract
Essential thrombocythemia (ET) is a type of myeloproliferative neoplasm characterized by an abnormal increase in platelets. We report a female patient with a severe femoral fracture and ET who underwent the femoral intramedullary fracture fixation procedure. Her past medical history included hypertension and ET. On the second day of hospitalization, her platelet count was 922 × 109/L. In our case, general anesthesia combined with a femoral nerve block and a lateral femoral cutaneous nerve block were used when the platelet count was within normal range. After surgery, the platelet count increased to 979 × 109/L despite using anticoagulant drugs and hydroxyurea. The postoperative recovery went well after the follow-up of this patient. In this case report, we provide our experience of anesthesia management and review the progress of relevant literature to provide some reference.
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Affiliation(s)
- Ming Su
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China
| | - Yichao Zhu
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China
| | - Guangjian Jing
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China
| | - Peng Pang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China
| | - Quanyi Zhang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, China
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19
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Mori N, Ohwashi-Miyazaki M, Yoshinaga K, Shiseki M, Tanaka J. JAK2 p.V617F Variants in Non-Blood DNA from Patients with Polycythemia Vera. Turk J Haematol 2023; 40:220-222. [PMID: 37278343 PMCID: PMC10476263 DOI: 10.4274/tjh.galenos.2023.2023-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/06/2023] [Indexed: 06/07/2023] Open
Affiliation(s)
- Naoki Mori
- Tokyo Women’s Medical University, Department of Hematology, Tokyo, Japan
- International University of Health and Welfare Narita Hospital, Department of Hematology, Narita, Japan
| | | | - Kentaro Yoshinaga
- Tokyo Women’s Medical University, Department of Hematology, Tokyo, Japan
| | - Masayuki Shiseki
- Tokyo Women’s Medical University, Department of Hematology, Tokyo, Japan
| | - Junji Tanaka
- Tokyo Women’s Medical University, Department of Hematology, Tokyo, Japan
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20
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Heydinger SP, Abdulaal MR, Wang AL. Retinal neovascularization in the setting of CALR-mutation positive essential thrombocythemia. SAGE Open Med Case Rep 2023; 11:2050313X231194510. [PMID: 37654553 PMCID: PMC10467226 DOI: 10.1177/2050313x231194510] [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: 04/19/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Patients with Calreticulin (CALR) mutation positive essential thrombocythemia are often thought of as having a "low-risk" of thrombotic complications. This report examines a case of a patient with CALR-mutation positive essential thrombocythemia presenting with peripheral retinal ischemia and subsequent retinal neovascularization. This patient had a 2-year documented history of CALR-mutation positive essential thrombocythemia with a maximum platelet count of over 800,000 cells/µL. Fluorescein angiogram showed significant leakage in the areas of the vascular lesions with peripheral vascular nonperfusion consistent with neovascularization. The patient was treated with photocoagulation to the areas of avascular retina. At 6-month follow-up, some regression of neovascularization was noted with no signs of progression in the retinopathy. Furthermore, essential thrombocythemia patients can present with neovascularization secondary to retinal ischemia due to microvascular thrombotic events. Identification of these changes is important for guiding medical and procedural interventions in order to preserve vision.
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Affiliation(s)
| | | | - Angeline L Wang
- Department of Ophthalmology, UT Southwestern, Dallas, TX, USA
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21
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Guijarro-Hernández A, Vizmanos JL. Transcriptomic comparison of bone marrow CD34 + cells and peripheral blood neutrophils from ET patients with JAK2 or CALR mutations. BMC Genom Data 2023; 24:40. [PMID: 37550636 PMCID: PMC10408115 DOI: 10.1186/s12863-023-01142-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Essential thrombocythemia (ET) is one of the most common types of Ph-negative myeloproliferative neoplasms, an infrequent group of blood cancers that arise from a CD34 + hematopoietic stem cell (HSC) in the bone marrow (BM) primarily due to driver mutations in JAK2, CALR or MPL. These aberrations result in an overproduction of mature myeloid cells in peripheral blood (PB). To date, no targeted therapies have been approved for ET patients, so the study of the molecular mechanisms behind the disease and the identification of new therapeutic targets may be of interest. For this reason, in this study, we have compared the transcriptomic profile of undifferentiated CD34 + cells and mature myeloid cells from ET patients (CALR and JAK2-mutated) and healthy donors deposited in publicly available databases. The study of the similarities and differences between these samples might help to better understand the molecular mechanisms behind the disease according to the degree of maturation of the malignant clone and the type of mutation and ultimately help identify new therapeutic targets for these patients. RESULTS The results show that most of the altered hallmarks in neutrophils were also found in CD34 + cells. However, only a few genes showed a similar aberrant expression pattern in both types of cells. We have identified a signature of six genes common to patients with CALR and JAK2 mutations (BPI, CRISP3, LTF, MMP8, and PTGS1 upregulated, and PBXIP1 downregulated), a different signature of seven genes for patients with CALR mutations (BMP6, CEACAM8, ITK, LCN2, and PRG2 upregulated, and MAN1A1 and MME downregulated) and a signature of 13 genes for patients with JAK2 mutations (ARG1, CAST, CD177, CLEC5A, DAPP1, EPS15, IL18RAP, OLFM4, OLR1, RIOK3, SELP, and THBS1 upregulated, and IGHM downregulated). CONCLUSIONS Our results highlight transcriptomic similarities and differences in ET patients according to the degree of maturation of the malignant clone and the type of mutation. The genes and processes altered in both CD34 + cells and mature neutrophils may reveal altered sustained processes that could be studied as future therapeutic targets for ET patients.
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Affiliation(s)
- Ana Guijarro-Hernández
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - José Luis Vizmanos
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain.
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22
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Schmidt A, Bernhardt C, Bürkle D, Fries S, Hannig CV, Jentsch-Ullrich K, Josting A, Kreher S, Reiser M, Steinmetz HT, Tesch H, Terner S, Schulte A, Crodel CC, Palandri F, Heidel FH. Diagnosis and treatment of MPN in real life: exploratory and retrospective chart review including 960 MPN patients diagnosed with ET or MF in Germany. J Cancer Res Clin Oncol 2023; 149:7197-7206. [PMID: 36884118 PMCID: PMC10374473 DOI: 10.1007/s00432-023-04669-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE The WHO 2016 re-classification of myeloproliferative neoplasms resulted in a separation of essential thrombocythemia (ET) from the pre-fibrotic and fibrotic (overt) phases of primary myelofibrosis (MF). This study reports on a chart review conducted to evaluate the real life approach regarding clinical characteristics, diagnostic assessment, risk stratification and treatment decisions for MPN patients classified as ET or MF after implementation of the WHO 2016 classification. METHODS In this retrospective chart review, 31 office-based hematologists/oncologists and primary care centers in Germany participated between April 2021 and May 2022. Physicians reported available data obtained from patient charts via paper-pencil based survey (secondary use of data). Patient features were evaluated using descriptive analysis, also including diagnostic assessment, therapeutic strategies and risk stratification. RESULTS Data of 960 MPN patients diagnosed with essential thrombocythemia (ET) (n = 495) or myelofibrosis (MF) (n = 465) after implementation of the revised 2016 WHO classification of myeloid neoplasms was collected from the patient charts. While they met at least one minor WHO-criteria for primary myelofibrosis, 39.8% of those diagnosed with ET did not have histological BM testing at diagnosis. 63.4% of patients who were classified as having MF, however, did not obtain an early prognostic risk assessment. More than 50% of MF patients showed characteristics consistent with the pre-fibrotic phase, which was emphasized by the frequent use of cytoreductive therapy. Hydroxyurea was the most frequently used cytoreductive medication in 84.7% of ET and 53.1% of MF patients. While both ET and MF cohorts showed cardiovascular risk factors in more than 2/3 of the cases, the use of platelet inhibitors or anticoagulants varied between 56.8% in ET and 38.1% in MF patients. CONCLUSIONS Improved histopathologic diagnostics, dynamic risk stratification including genetic risk factors for cases of suspected ET and MF are recommended for precise risk assessment and therapeutic stratification according to WHO criteria.
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Affiliation(s)
- Andreas Schmidt
- Internal Medicine C, University Medicine Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany
| | | | - Dieter Bürkle
- Zentrum für Ambulante Onkologie, Schorndorf, Germany
| | - Stefan Fries
- Onkologische Schwerpunktpraxis, Bamberg, Germany
| | | | | | | | - Stephan Kreher
- Hämatologisch-Onkologische Schwerpunktpraxis, Bad Liebenwerda, Germany
| | - Marcel Reiser
- Praxis Internistischer Onkologie und Hämatologie, Cologne, Germany
| | | | - Hans Tesch
- Onkologie Bethanien, Frankfurt a.M., Germany
| | | | | | - Carl C Crodel
- Department of Hematology and Oncology, University Hospital Jena, Jena, Germany
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Florian H Heidel
- Internal Medicine C, University Medicine Greifswald, Sauerbruchstrasse, 17475, Greifswald, Germany.
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Maeda M, Sakamoto SI, Murata T, Hiromoto A, Suzuki K, Ishii Y. Multiple cardiac surgical procedures in a case of an octogenarian with essential thrombocythemia. Surg Case Rep 2023; 9:96. [PMID: 37277566 DOI: 10.1186/s40792-023-01682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Essential thrombocythemia (ET) is a chronic myeloproliferative disorder characterized by an elevation of platelet counts with a tendency for thrombosis and hemorrhage. The perioperative management of cardiovascular surgery of an ET patient is complicated. There is limited literature on the perioperative management of patients with ET undergoing cardiovascular surgery, particularly those requiring multiple procedures. CASE PRESENTATION An 85-year-old woman with a history of essential thrombocythemia (ET), which resulted in an abnormally high platelet count, was diagnosed with aortic valve stenosis, ischemic heart disease and paroxysmal atrial fibrillation. She underwent aortic valve replacement, coronary artery bypass grafting, and pulmonary vein isolation. The postoperative course was uneventful, nor hemorrhage and thrombosis. CONCLUSIONS We represent a case of perioperative management and successful treatment of three combined cardiac surgery for an octogenarian ET patient who is the oldest case ever reported.
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Affiliation(s)
- Motohiro Maeda
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-Cho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Shun-Ichiro Sakamoto
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-Cho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan.
| | - Tomohiro Murata
- Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Atsushi Hiromoto
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-Cho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Kenji Suzuki
- Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-Cho, Nakahara-Ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
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Chen J, Dong H, Fu R, Liu X, Xue F, Liu W, Chen Y, Sun T, Ju M, Dai X, Li H, Wang W, Chi Y, Yang R, Zhang L. Machine learning analyses constructed a novel model to predict recurrent thrombosis in adults with essential thrombocythemia. J Thromb Thrombolysis 2023:10.1007/s11239-023-02833-7. [PMID: 37249742 DOI: 10.1007/s11239-023-02833-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
The current study involving 318 essential thrombocythemia (ET) patients with prior thrombosis was designed to identify risk factors that were predictive of recurrent thrombosis. The whole cohort was randomly split into derivation and validation cohorts. The random forest method, support vector machine with built-in recursive feature elimination model, and logistic multivariable analysis were performed in the derivation cohort, and cardiovascular risk factor (CVF) and RBC distribution width with standard deviation (RDW-SD) were finally selected as independent predictors. Subsequently we devise a 3-tiered model (low risk: 0 points; intermediate risk: 1-1.5 points; and high risk: 2.5 points) and it showed good discrimination in all cohorts. Moreover, the model was significantly correlated with rethrombosis-free survival (rTFS) (p = 0.0007 in the derivation cohort; p = 0.0019 in the validation cohort). In the whole cohort, cytoreductive therapy was more effective than antiplatelet agents alone for 10-year rTFS (p = 0.0336). No significant difference in 10-year rTFS was observed among interferon (IFN), hydroxyurea (HU), and IFN + HU therapy (p = 0.444). The present study helps identify individuals who need close monitoring and provides valuable risk signals for recurrence in ET patients with prior thrombosis.
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Affiliation(s)
- Jia Chen
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Huan Dong
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Rongfeng Fu
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Xiaofan Liu
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Feng Xue
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yunfei Chen
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Ting Sun
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Mankai Ju
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Xinyue Dai
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Huiyuan Li
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Wentian Wang
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Ying Chi
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
- Tianjin Institutes of Health Science, Tianjin, 301600, China.
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Qin C, Yin D, Liu F, Qiu H. Thrombotic thrombocytopenic purpura in a patient on long-term alpha-interferon therapy for essential thrombocythemia: a case report. BMC Nephrol 2023; 24:143. [PMID: 37221468 DOI: 10.1186/s12882-023-03200-7] [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: 09/06/2022] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is rare and severe thrombotic microangiopathy characterized by thrombocytopenia, hemolytic anemia, and renal dysfunction. In contrast, essential thrombocythemia (ET) is a myeloproliferative disease associated with an abnormal increase in platelet numbers. Previous studies reported several cases of the development of ET in patients with TTP. However, the case of an ET patient complicated with TTP has not been previously reported. In this case study, we present a patient with TTP who was previously diagnosed with ET. Therefore, to the best of our knowledge, this is the first report of TTP in ET. CASE PRESENTATION A 31-year-old Chinese female who was previously diagnosed with ET presented with anemia and renal dysfunction. The patient had been on long-term treatment with hydroxyurea, aspirin, and alpha interferon (INF-α) for ten years. The diagnosis of TTP was confirmed by clinical features, schistocytes noted on the peripheral blood smear, and lower ADAMTS13 activity (8.5%), together with the renal biopsy results. INF-α was discontinued, and the patient was then treated with plasma exchange and corticosteroids. After one year of follow-up, the patient had a normal hemoglobin level and platelet numbers, and her ADAMTS13 activity had improved. However, the patient's renal function remains impaired. CONCLUSIONS We report a case of an ET patient complicated with TTP that was possibly due to INF-α, highlighting the potential complications associated with long-term ET therapy. The case also highlights the importance of considering TTP in patients with pre-existing ET who present with anemia and renal dysfunction, extending the spectrum of known studies.
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Affiliation(s)
- Chunmei Qin
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
- Department of Nephrology, Luzhou People's Hospital, Luzhou, China
| | - Dan Yin
- Bioinformatics Under Biology Department, University of California-San Diego, San Diego, USA
| | - Fang Liu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Hongyu Qiu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
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26
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Iurlo A, Bucelli C, Cattaneo D. Essential Thrombocythemia in Adolescents and Young Adults: Clinical Aspects, Treatment Options and Unmet Medical Needs. Curr Treat Options Oncol 2023:10.1007/s11864-023-01099-8. [PMID: 37195587 DOI: 10.1007/s11864-023-01099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
OPINION STATEMENT Current treatment of essential thrombocythemia (ET) should primarily prevent thrombo-hemorrhagic events, without increasing the rate of fibrotic progression or leukemic evolution, and secondarily control microvascular symptoms. Unlike other classic BCR::ABL1-negative myeloproliferative neoplasms, ET is frequently diagnosed in adolescents and young adults (AYA), defined as individuals aged 15 to 39 years, in up to 20% of patients. However, since the current risk stratification of this disease is based on models, including that of ELN, IPSET-Thrombosis and its revised version, mainly applied to an older patients' population, international guidelines are needed that specifically consider how to evaluate the prognosis of AYAs with ET. Furthermore, although ET is the most frequent MPN among AYA subjects, there is a lack of specific recommendations on how to treat it in this subgroup of patients, as management decisions are typically extrapolated from those for the elderly. Accordingly, since AYAs with ET represent a unique disease subset defined by attenuated genetic risk, more indolent phenotype, and longer survival than their older counterparts, treatment selection requires special attention to specific issues such as the risk of fibrotic/leukemic transformation, carcinogenicity, and fertility. This review article will provide a comprehensive overview of the diagnosis, prognostic stratification, and possible therapeutic approaches for AYA patients with ET, including antiplatelets/anticoagulants and cytoreductive agents, with a focus on pregnancy management in real-life clinical practice.
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Affiliation(s)
- Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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27
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Yoon SY, Won JH. Novel therapeutic strategies for essential thrombocythemia/polycythemia vera. Blood Res 2023; 58:83-89. [PMID: 37105562 PMCID: PMC10133851 DOI: 10.5045/br.2023.2023013] [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: 01/16/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs) are clonal disorders of hematopoietic stem cells; these include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). MPNs are inflammatory cancers, wherein the malignant clone generates cytokines that sustain the inflammatory drive in a self-perpetuating vicious cycle. The course of MPNs follows a biological continuum, that is, from early cancer stages (ET/PV) to advanced myelofibrosis as well as impending leukemic transformation. MPN-related symptoms, e.g., fatigue, general weakness, and itching, are caused by inflammatory cytokines. Thrombosis and bleeding are also exacerbated by inflammatory cytokines in patients with MPN. Until recently, the primary objective of ET and PV therapy was to increase survival rates by preventing thrombosis. However, several medications have recently demonstrated the ability to modify the course of the disease; symptom relief is expected for most patients. In addition, there is increasing interest in the active treatment of patients at low risk with PV and ET. This review focuses on the ET/PV treatment strategies as well as novel treatment options for clinical development.
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Affiliation(s)
- Seug Yun Yoon
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jong-Ho Won
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
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28
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Herbreteau L, Couturaud F, Hoffmann C, Bressollette L, Pan-Petesch B, Rio L, Lippert E, Ianotto JC. Atrial fibrillation and peripheral arterial disease define MPN patients with very high risk of thrombosis. Thromb Res 2023; 226:93-99. [PMID: 37141796 DOI: 10.1016/j.thromres.2023.04.021] [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: 08/16/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
Myeloproliferative neoplasms (MPNs) are associated with a high risk of thrombotic and hemorrhagic complications, especially in elderly patients. Atrial fibrillation (AF) and peripheral arterial disease (PAD), also frequently discovered in aging patients, are associated with similar complications. We analysed the incidence and complication rates of AF and PAD in a large cohort of MPN patients. In total, 289/1113 patients (26 %) suffered at least one of these diseases as follows: 179 (16.1 %) with AF alone, 81 with PAD alone (7.3 %) and 29 (2.6 %) with both conditions. Postdiagnosis thrombotic events were observed in 31.3 % of AF patients (p = 0.002, OR = 1.80 [1.23;2.61]), 35.8 % of PAD patients (p = 0.002, OR = 2.21[1.31;3.67]) and 62.1 % of AF/PAD patients (p < 0.0001, OR = 6.47 [2.83;15.46]) compared to 20.1 % of no-AF/no-PAD patients. Postdiagnosis hemorrhagic events were also identified in 17.9 %, 16 %, 24.1 % and 10.1 % of AF, PAD, AF/PAD, and no-AF/no-PAD patients, respectively (p = 0.003). This significantly higher risk of thrombosis/bleeding was also observed in patients <60 years old. AF and PAD were significant risk factors for both thrombotic and hemorrhagic risks in multivariate analysis. We identified AF and PAD as criteria for high risk of thrombosis, hemorrhage, and death, emphasizing the interest in early detection and efficient treatment of these conditions.
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Affiliation(s)
- Laura Herbreteau
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHU de Brest, Brest, France
| | - Francis Couturaud
- Département de Médecine Interne et Pneumologie, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France
| | - Clément Hoffmann
- Service de Médecine vasculaire, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France
| | - Luc Bressollette
- Service de Médecine vasculaire, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France
| | - Brigitte Pan-Petesch
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France
| | - Laetitia Rio
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHU de Brest, Brest, France
| | - Eric Lippert
- Laboratoire d'Hématologie, CHU de Brest, Brest, France; France Intergroupe des syndromes Myéloprolifératifs (FIM), Paris, France
| | - Jean-Christophe Ianotto
- Service d'Hématologie et d'Hémostase Clinique, Institut de Cancéro-Hématologie, CHU de Brest, Brest, France; INSERM, Univ Brest, CHU de Brest, UMR 1304, GETBO, Brest, France; France Intergroupe des syndromes Myéloprolifératifs (FIM), Paris, France.
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Găman MA, Cozma MA, Manan MR, Srichawla BS, Dhali A, Ali S, Nahian A, Elton AC, Simhachalam Kutikuppala LV, Suteja RC, Diebel S, Găman AM, Diaconu CC. Budd-Chiari syndrome in myeloproliferative neoplasms: A review of literature. World J Clin Oncol 2023; 14:99-116. [PMID: 37009527 PMCID: PMC10052333 DOI: 10.5306/wjco.v14.i3.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/10/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Myeloproliferative neoplasms (MPNs) are defined as clonal disorders of the hematopoietic stem cell in which an exaggerated production of terminally differentiated myeloid cells occurs. Classical, Philadelphia-negative MPNs, i.e., polycythemia vera, essential thrombocythemia and primary myelofibrosis, exhibit a propensity towards the development of thrombotic complications that can occur in unusual sites, e.g., portal, splanchnic or hepatic veins, the placenta or cerebral sinuses. The pathogenesis of thrombotic events in MPNs is complex and requires an intricate mechanism involving endothelial injury, stasis, elevated leukocyte adhesion, integrins, neutrophil extracellular traps, somatic mutations (e.g., the V617F point mutation in the JAK2 gene), microparticles, circulating endothelial cells, and other factors, to name a few. Herein, we review the available data on Budd-Chiari syndrome in Philadelphia-negative MPNs, with a particular focus on its epidemiology, pathogenesis, histopathology, risk factors, classification, clinical presentation, diagnosis, and management.
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Affiliation(s)
- Mihnea-Alexandru Găman
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest 050474, Romania
- Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Matei-Alexandru Cozma
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest 050474, Romania
| | | | - Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Massachusetts 01655, United States
| | - Arkadeep Dhali
- Department of Internal Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, United Kingdom
| | - Sajjad Ali
- Department of Medicine, Ziauddin University, Karachi 75600, Pakistan
| | - Ahmed Nahian
- California Baptist University-Lake Erie College of Osteopathic Medicine, Riverside, CA 92504, United States
| | - Andrew C Elton
- University of Minnesota Medical School, Minneapolis, MN 55455, United States
| | - L V Simhachalam Kutikuppala
- Department of General Surgery, Dr NTR University of Health Sciences, Andhra Pradesh, Vijayawada 520008, India
| | - Richard Christian Suteja
- Department of Undergraduate Medicine, Faculty of Medicine, Udayana University Denpasar, Bali 80232, Indonesia
| | - Sebastian Diebel
- Department of Family Medicine, Northern Ontario School of Medicine Timmins, Ontario 91762, Canada
| | - Amelia Maria Găman
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, Romania & Clinic of Hematology, Filantropia City Hospital, Craiova 200143, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Romania & Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, Bucharest 105402, Romania
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Kuo MC, Chuang WY, Chang H, Lin TH, Wu JH, Lin TL, Ou CW, Hung YS, Huang TY, Huang YJ, Wang PN, Shih LY. Comparison of Clinical and Molecular Features Between Patients With Essential Thrombocythemia and Early/Prefibrotic Primary Myelofibrosis Presenting With Thrombocytosis in Taiwan. Am J Clin Pathol 2023; 159:474-483. [PMID: 36857745 DOI: 10.1093/ajcp/aqac173] [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: 10/04/2022] [Accepted: 12/07/2022] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES The clinical presentations of essential thrombocythemia (ET) may be quite similar to early/prefibrotic primary myelofibrosis (pre-PMF), especially in pre-PMF presenting with thrombocytosis (pre-PMF-T), but may be associated with a different outcome. It is very important to distinguish these two entities. The aim of this study was to address the clinical and prognostic relevance of distinguishing pre-PMF-T from ET. METHODS All patients, including 258 with ET and 105 with pre-PMF-T, received JAK2V617F, MPL (exon 10), and CALR (exon 9) mutation analysis and allele burden measurement for JAK2V617F and CALR mutants. RESULTS Patients with pre-PMF-T had an older age and higher leukocyte and platelet counts but lower hemoglobin levels than patients with ET. Patients with pre-PMF-T had a shorter overall, leukemia-free, and thrombosis-free survival compared with patients with ET. Patients with ET had a higher rate of cerebral ischemic stroke, whereas patients with pre-PMF-T tended to have splanchnic vein thrombosis. The frequencies of JAK2V617F, CALR, and MPL mutations and CALR allele burden were no different, but JAK2V617F allele burden was significantly higher in pre-PMF-T. Patients with pre-PMF-T with the JAK2V617F mutation had an inferior overall survival and thrombosis-free survival, whereas the status of driver gene mutations did not influence the outcomes of patients with ET. CONCLUSIONS ET and pre-PMF-T were two distinct disease entities and exhibited different clinical phenotype, genotype, and outcomes.
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Affiliation(s)
- Ming-Chung Kuo
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Yu Chuang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Hung Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tung-Huei Lin
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Jin-Hou Wu
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Tung-Liang Lin
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Che-Wei Ou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Yu-Shin Hung
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Huang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Ying-Jung Huang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Po-Nan Wang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Lee-Yung Shih
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chen H, Lin C, Xue HM, Chen C, Yang M. The heat shock protein DNAJB2 as a novel biomarker for essential thrombocythemia diagnosis associated with immune infiltration. Thromb Res 2023; 223:131-138. [PMID: 36746103 DOI: 10.1016/j.thromres.2023.01.029] [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: 11/01/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Essential thrombocythemia (ET) is a rare myeloproliferative malignancy which may lead to severe thrombohemorrhagic complications. The diagnosis of ET is primarily based on bone marrow morphology and exclusion of other possibilities of myeloproliferative neoplastic diseases; the lack of gene biomarkers fails to provide a prompt diagnosis of ET. Therefore, this study was designed to identify biomarkers for early ET diagnosis, especially that associated with immune cell infiltration, by using the Gene Expression Omnibus (GEO) database and machine-learning algorithms. METHODS Two publicly available gene expression profiles (GSE9827 and GSE123732) from the GEO database were used to identify the differentially expressed genes (DEGs) between bone marrow samples of ET patients and healthy individuals, and functional enrichment analyses were conducted. The least absolute shrinkage and selection operator (LASSO) regression model and Support Vector Machine-Recursive Feature Elimination (SVM-RFE) machine-learning algorithm were performed to select the candidate gene biomarker. The expression level and diagnostic effectiveness of the identified gene biomarker were further validated using GSE567 and GSE2006 datasets. The involvement of infiltrating immune cells and their correlations with the gene biomarker were examined using cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT) algorithm. RESULTS There were 105 DEGs identified between ET and healthy control samples. Disease Ontology (DO) analysis showed that the diseases enriched by those DEGs were mainly human cancers, neurological diseases and inflammation while Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis demonstrated that pathways related to immune responses were primarily involved. The heat shock protein, DNAJB2, was identified as the potential biomarker for ET diagnosis with high effectiveness, with the area under the receiver operating characteristic (ROC) curve (AUC) equals to 0.905 in the validation cohort. The expression level of DNAJB2 in ET samples was indeed significantly higher than that in healthy control ones. The immune cell infiltration analysis showed that DNAJB2 was positively correlated with CD8+ T cells in ET with the proportion significantly higher than that in normal controls. CONCLUSION The present study identified DNAJB2 as a novel diagnostic biomarker for ET with high effectiveness based on ET and normal samples from the GEO database, which provides new insights into predicting ET with accuracy and promptness in clinical practice.
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Affiliation(s)
- Hui Chen
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Chao Lin
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hong-Man Xue
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Chun Chen
- Department of Pediatrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Mo Yang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
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32
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Song IC, Kang S, Lee MW, Ryu H, Lee HJ, Yun HJ, Jo DY. Acquired von willebrand syndrome in patients with philadelphia-negative myeloproliferative neoplasm. Blood Res 2023; 58:42-50. [PMID: 36774948 PMCID: PMC10063591 DOI: 10.5045/br.2023.2022218] [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: 11/07/2022] [Revised: 12/27/2022] [Accepted: 01/25/2023] [Indexed: 02/14/2023] Open
Abstract
Background Acquired von Willebrand syndrome (AVWS) has not been investigated in Korean patients with Philadelphia chromosome-negative myeloproliferative neoplasm. Methods This study analyzed the prevalence at diagnosis and clinical features of AVWS in patients with essential thrombocythemia (ET), polycythemia vera (PV), prefibrotic/early primary myelofibrosis (pre-PMF), or overt PMF (PMF) diagnosed between January 2019 and December 2021 at Chungam National University Hospital, Daejeon, Korea. AVWS was defined as below the lower reference limit (56%) of ristocetin cofactor activity (VWF:RCo). Results Sixty-four consecutive patients (36 with ET, 17 with PV, 6 with pre-PMF, and 5 with PMF; 30 men and 34 women) with a median age of 67 years (range, 18-87 yr) were followed for a median of 25.1 months (range, 2.6-46.4 mo). AVWS was detected in 20 (31.3%) patients at diagnosis and was most frequent in ET patients (41.4%), followed by patients with pre-PMF (33.3%) and PV (17.6%) patients. VWF:RCo was negatively correlated with the platelet count (r=0.937; P=0.002). Only one episode of minor bleeding occurred in a patient with ET and AVWS. Younger age (<50 yr) [odds ratio (OR), 7.08; 95% confidence interval (CI), 1.27-39.48; P=0.026] and thrombocytosis (>600×109/L) (OR, 13.70; 95% CI, 1.35-138.17; P=0.026) were independent risk factors for developing AVWS. Conclusions AVWS based on VWF:RCo was common in patients with ET and pre-PMF, but less common in patients with PV in the Korean population. Clinically significant bleeding is rare in these patients.
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Affiliation(s)
- Ik-Chan Song
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sora Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Myung-Won Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyewon Ryu
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyo-Jin Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hwan-Jung Yun
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Deog-Yeon Jo
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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Yu J, Paranagama D, Hanna B, Tang J, Chojecki A. A Retrospective Chart Review of 809 Patients with Physician-Diagnosed Essential Thrombocythemia Receiving Cytoreductive Therapy in US Community Oncology Practices. Acta Haematol 2023; 146:26-36. [PMID: 36001945 DOI: 10.1159/000526599] [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: 03/15/2021] [Accepted: 07/01/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This analysis reports demographic and clinical characteristics of patients with physician-diagnosed essential thrombocythemia (ET) receiving cytoreductive therapy in US community clinical practice. METHODS Patient characteristics, medical history, diagnostic test results, signs/symptoms, treatment patterns, and physician practice settings were extracted from medical charts for patients with physician-diagnosed ET receiving cytoreductive therapy. RESULTS Among 809 patients (51.1% female; 75.4% White; median age, 69 years) from 50 community practices, 64.5% had physician-reported diagnosis per World Health Organization criteria. Only 48.8% underwent diagnostic bone marrow biopsies; 87.5% had JAK2 mutation testing. Among those tested, 512/708 (72.3%), 57/213 (26.8%), and 37/213 (17.4%) had JAK2, CALR, and MPLmutations, respectively. Of physician-assigned risk assessments, 41.8% were misclassifications based on data-derived risk assessment. Most patients (93.3%) received first-line hydroxyurea (HU) cytoreductive therapy. Discontinuations were primarily for intolerance (35.4%) and resistance (23.8%). Of those who discontinued, 65.9% received no subsequent therapy and had higher ET symptom rates at last visit versus patients continuing HU (48.8% vs. 25.0%). CONCLUSION This study shows notable gaps in ET diagnosis and management. Half of patients were diagnosed without bone marrow biopsy, many received incorrect risk assignment, and the majority who discontinued HU received no subsequent therapy despite continued need.
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Affiliation(s)
- Jingbo Yu
- Incyte Corporation, Wilmington, Delaware, USA
| | | | - Becky Hanna
- Asclepius Analytics LLC, New York City, New York, USA
| | - Jackson Tang
- Asclepius Analytics LLC, New York City, New York, USA
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Furuya C, Hashimoto Y, Morishita S, Inano T, Ochiai T, Shirane S, Edahiro Y, Araki M, Ando M, Komatsu N. Reevaluation of cardiovascular risk factors for thrombotic events in 580 Japanese patients with essential thrombocythemia. J Thromb Thrombolysis 2023; 55:263-272. [PMID: 36484956 DOI: 10.1007/s11239-022-02751-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
Risk-adapted therapy is recommended to prevent thrombosis in essential thrombocythemia (ET) patients. An advanced age, a history of thrombosis, and the presence of the JAK2V617F mutation are well-defined risk factors for thrombosis in ET; however, the impact of cardiovascular risk (CVR) factors on thrombosis in ET remains elusive. Therefore, we herein investigated the impact of CVR factors on thrombosis in 580 ET patients who met the 2017 World Health Organization Classification diagnostic criteria. A univariate analysis identified hypertriglyceridemia and multiple CVR factors as strong risk factors for thrombosis (hazard ratio [HR] 3.530, 95% confidence interval [CI] 1.630-7.643, P = 0.001 and HR 3.368, 95% CI 1.284-8.833, P = 0.014, respectively) and hyper-LDL cholesterolemia as a potential risk factor (HR 2.191, 95% CI 0.966-4.971, P = 0.061). A multivariate analysis revealed that hypertriglyceridemia was an independent risk factor for thrombosis (HR 3.364, 95% CI 1.541-7.346, P = 0.002). Furthermore, poor thrombosis-free survival was observed in patients with a serum triglyceride level ≥ 1.2 mmol/L (HR = 2.592, P = 0.026 vs. < 1.2 mmol/L) or two or more CVR factors (P = 0.011 vs. no CVR factors and P = 0.005 vs. one CVR factor). These results revealed the impact of CVR factors on thrombosis in ET. Since CVR factors are manageable, lifestyle interventions, such as the control of serum triglyceride levels, may effectively prevent thrombosis in ET patients.
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Affiliation(s)
- Chiho Furuya
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoshinori Hashimoto
- Department of Hematology, Tottori Prefectural Central Hospital, 730 Ezu, Tottori City, Tottori, 680-0901, Japan.,Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Soji Morishita
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Laboratory for the Development of Therapies Against MPN, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tadaaki Inano
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomonori Ochiai
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Laboratory for the Development of Therapies Against MPN, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shuichi Shirane
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Laboratory for the Development of Therapies Against MPN, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoko Edahiro
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Laboratory for the Development of Therapies Against MPN, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Marito Araki
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Laboratory for the Development of Therapies Against MPN, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Laboratory for the Development of Therapies Against MPN, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,PharmaEssentia Japan KK, 1-3-13 Motoakasaka, Minato-ku, Tokyo, 107-0051, Japan.
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Saelue P, Thongsukhsai P. Risk of thrombosis in essential thrombocythemia according to three prediction models: an external validation study. J Thromb Thrombolysis 2023. [PMID: 36652138 DOI: 10.1007/s11239-023-02769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thrombosis is a major complication of essential thrombocythemia (ET). There are three well-known prediction models for thrombotic risk in ET patients. However, only few external validation studies for the performance of these models in Asian populations have been conducted. Thus, we aimed to evaluate the performance of these models for predicting the risk of thrombosis in Thai patients with ET. METHODS We retrospectively evaluated the clinical characteristics and thrombotic risk of 149 Thai ET patients in a university hospital in Southern Thailand between 2002 and 2019. Thrombotic risk variables were evaluated using Cox proportional hazard regression. The Brier score, calibration plot, and Harrel concordance index (C-index) were used to evaluate the performance of the three models. RESULTS With a median follow-up of 5.2 years, there were a total of 28 thrombotic events in 26 patients. Age > 60 years was a significant prognostic factor for thrombosis in the multivariate Cox regression analysis. The Brier scores were 0.251, 0.273, and 0.276 in the conventional, IPSET-thrombosis, and revised IPSET-thrombosis models, respectively. The conventional model had optimal calibration and good discrimination (C-index, 0.67; 95%CI:0.55-0.79). The IPSET thrombosis (C-index 0.33; 95%CI:0.20-0.49) and revised IPSET thrombosis (C-index 0.31; 95%CI:0.18-0.44) models showed poor discrimination. CONCLUSION The conventional model, which is based on age and history of thrombosis, is the best model to predict thrombotic risk in Thai ET patients. Further studies with a larger number of patients with thrombotic events are needed to validate the IPSET-thrombosis and revised IPSET-thrombosis models.
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Aswad MH, Kissova J, Ovesna P, Říhová L, Penka M. JAK2V617F mutation and circulating extracellular vesicles in essential thrombocythemia. Clin Hemorheol Microcirc 2023; 84:359-368. [PMID: 37334581 DOI: 10.3233/ch-221678] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The clinical course of essential thrombocythemia (ET) is complicated with thrombosis which significantly impacts patients' mortality. Studies have identified JAK2V617F mutation as an independent risk factor for thrombosis. Circulating extracellular vesicles (EVs) were evaluated in several studies regarding myeloproliferative neoplasms and thrombosis as potential biomarkers. The present study investigates the relationship between JAK2V617F mutation and EVs levels in 119 ET patients. Our analyses revealed that JAK2V617F-positive patients are at a significantly increased risk of thrombosis within five years before the ET diagnosis (hazard ratio [95% CI]: 11.9 [1.7-83.7], P = 0.013), and that JAK2V617F mutation is an independent risk factor for thrombosis at ET diagnosis or during the follow-up (hazard ratio [95% CI]: 3.56 [1.47-8.62], P = 0.005). ET patients have higher levels of platelet-EVs, erythrocyte-EVs and procoagulant activity of EVs than the healthy population. Absolute and relative counts of platelet-EVs are increased in the presence of JAK2V617F mutation (P = 0.018, P = 0.024, respectively). In conclusion, our results support the role of JAK2V617F mutation in the pathogenesis of thrombosis in essential thrombocythemia through enhancing platelet activation.
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Affiliation(s)
- Mohamed Hussam Aswad
- Department of Clinical Hematology, Faculty of Medicine, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jarmila Kissova
- Department of Clinical Hematology, Faculty of Medicine, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Ovesna
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucie Říhová
- Department of Clinical Hematology, Faculty of Medicine, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslav Penka
- Department of Clinical Hematology, Faculty of Medicine, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Komatsu N, Hashimoto Y, Baba T, Otsuka M, Akimoto T, Fernandez J. Safety and efficacy of anagrelide in Japanese post-marketing surveillance, with subgroup analyses on the effect of previous cytoreductive therapies, age, and starting dose. Int J Hematol 2022; 116:570-578. [PMID: 35624199 PMCID: PMC9515010 DOI: 10.1007/s12185-022-03380-2] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND In Japan, anagrelide has been approved for use in patients with essential thrombocythemia. Here, the safety and efficacy of anagrelide was assessed in clinical practice as post-marketing surveillance. Subgroup analyses were conducted to compare patients (1) with or without a history of cytoreductive therapy (CRT), (2) <60 or ≥60 years of age, and (3) with an anagrelide starting dose of ≤0.5 mg/day or 1.0 mg/day. METHODS Data were collected for all patients who received anagrelide, with an observation period of 12 months after treatment initiation. RESULTS Of the 648 patients, 54.3% experienced adverse drug reactions (ADRs). The most commonly reported ADRs were headaches, palpitations, and anemia. No significant difference was observed in overall ADRs across patient subgroups. A significantly higher incidence of headaches was observed in patients < 60 years versus those ≥ 60 years (P < 0.001). The incidence of anemia and serious ADRs were significantly higher in patients ≥ 60 years, and those with a history of CRT (P < 0.05). The discontinuation rate at 6 months was significantly lower in patients started at the lower anagrelide dose (P < 0.05). Platelet counts decreased in all analyzed groups. CONCLUSIONS This surveillance showed that anagrelide has a tolerable safety and efficacy profile.
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Affiliation(s)
- Norio Komatsu
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Laboratory for the Development of Therapies Against MPN, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan.
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yoshinori Hashimoto
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Laboratory for the Development of Therapies Against MPN, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Hematology, Tottori Prefectural Central Hospital, 730 ezu, Tottori City, Tottori, 680-0901, Japan
| | - Terumi Baba
- Japan Medical Office, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, 1-1, Nihonbashi-Honcho 2-chome, Chuo-ku, Tokyo, 680-0901, Japan
| | - Manami Otsuka
- Japan Medical Office, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, 1-1, Nihonbashi-Honcho 2-chome, Chuo-ku, Tokyo, 680-0901, Japan
| | - Takafumi Akimoto
- Japan Medical Office, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, 1-1, Nihonbashi-Honcho 2-chome, Chuo-ku, Tokyo, 680-0901, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, 1-1, Nihonbashi-Honcho 2-chome, Chuo-ku, Tokyo, 680-0901, Japan
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Bieniaszewska M, Sobieralski P, Leszczyńska A, Dutka M. Anagrelide in essential thrombocythemia: Efficacy and long-term consequences in young patient population. Leuk Res 2022; 123:106962. [PMID: 36183610 DOI: 10.1016/j.leukres.2022.106962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/31/2022] [Revised: 09/03/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
According to the current treatment recommendations, anagrelide, an oral antiplatelet agent, is recommended as a second-line therapy for patients with high-risk essential thrombocythemia experiencing intolerance or refractoriness to first-line approach, such as hydroxyurea or pegylated interferon alpha-2a. If there is a need for introduction of cytoreductive treatment in young patients with a perspective of lifelong exposure, both the efficacy and long-term outcomes should be known. We present the analysis of 48 young patients, diagnosed with essential thrombocythemia below the age of 60, who were exposed to anagrelide treatment for over 10 years. Our observations show that the highest proportion of complete remissions without adverse events and disease progression is seen in the JAK2-mutated patients. By evaluating the changes in hemoglobin concentration and serum erythropoietin throughout the study, we were able to reveal the development of progressive anemia, resulting from diminished susceptibility to erythropoietin and unrelated to bone marrow fibrosis, in patients harboring CALR mutation. Additionally, occurrence of new bone marrow fibrosis was confirmed in seven JAK2-unmutated patients at the end of the study. In summary, in young patient population, we recommend limiting the use of anagrelide to JAK2-mutated subgroup, reducing exposure time and underline the importance of periodic monitoring for the presence of bone marrow fibrosis.
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Affiliation(s)
- Maria Bieniaszewska
- Department of Hematology and Transplantology, Medical University of Gdańsk, Poland
| | - Patryk Sobieralski
- Department of Hematology and Transplantology, Medical University of Gdańsk, Poland.
| | | | - Magdalena Dutka
- Department of Hematology and Transplantology, Medical University of Gdańsk, Poland
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Mora B, Passamonti F. Towards a Personalized Definition of Prognosis in Philadelphia-Negative Myeloproliferative Neoplasms. Curr Hematol Malig Rep 2022; 17:127-139. [PMID: 36048275 PMCID: PMC9499895 DOI: 10.1007/s11899-022-00672-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Philadelphia-negative myeloproliferative neoplasms (MPNs) include polycythemia vera (PV), essential thrombocythemia (ET), prefibrotic (pre-), and overt-primary myelofibrosis (primary MF, PMF). PV and ET could evolve into secondary MF (SMF), whose early diagnosis relies on monitoring signs of possible progression. All MPNs have a risk of blast phase (BP), that is associated with a very dismal outcome. Overall survival (OS) is different among MPNs, and disease-specific prognostic scores should be applied for a correct clinical management. In this review, an overview of current prognostic scores in MPNs will be provided. Recent Findings The biological complexity of MPNs and its role on the trajectory of disease outcome have led to the design of integrated prognostic models that are nowadays of common use in PMF patients. As for PV and ET, splicing gene mutations could have a detrimental role, but with the limit of the not routinary recommended application of extensive molecular analysis in these diseases. SMF is recognized as a distinct entity compared to PMF, and OS estimates should be calculated by the MYSEC-PM (Myelofibrosis SECondary-prognostic model). Both in PMF and SMF, decisions as selection of patients potentially candidates to allogenic stem cell transplant or that could benefit from an early shift from standard treatment are based not only on conventional prognostic scores, but also on multivariable algorithms. Summary The expanding landscape of risk prediction for OS, evolution to BP, and SMF progression from PV/ET informs personalized approach to the management of patients affected by MPNs.
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Affiliation(s)
- Barbara Mora
- Hematology, Ospedale Di Circolo, A.S.S.T. Sette Laghi, Viale Borri 57, 21100, Varese, Italy.,Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy
| | - Francesco Passamonti
- Hematology, Ospedale Di Circolo, A.S.S.T. Sette Laghi, Viale Borri 57, 21100, Varese, Italy. .,Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy.
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Ali EAH, Khamees I, Alshurafa A, Qasim H, Abu-Tineh MA, Ahmed K, Saad E, Yassin M. Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant in Patients with Philadelphia-Negative Myeloproliferative Neoplasm: A Single Center Experience. Oncology 2022; 100:460-466. [PMID: 35882185 DOI: 10.1159/000525750] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the viral agent responsible for the coronavirus disease of 2019. The disease is primarily a respiratory illness; however, multisystem involvement is not uncommon. The infection is reported to be more severe in patients with multiple comorbidities and immunocompromised patients. Patients with hematological malignancies are immunocompromised and prone to develop severe SARS-CoV-2 infection. The SARS-CoV-2 had developed several mutations that resulted in different strains with different virulence and different degree of protection by vaccination or prior infection. The Omicron variant is reported to cause mild illness; however, the effect on patients with hematological malignancies like myeloproliferative neoplasms (MPNs) is not clear. We present patients with MPNs who had infection with the Omicron variant of the SARS-CoV-2 and their outcomes. METHODS Retrospective data from the National Center for Cancer Care and Research records from December 20, 2021, to January 30, 2022. Participants were adults over the age of 18 years with Omicron infection who had been diagnosed with Philadelphia-negative MPNs, essential thrombocythemia, polycythemia vera (PV), and primary myelofibrosis according to the 2008/2016 WHO classification for MPN. RESULTS Twenty-two patients with Philadelphia-negative MPN had Omicron infection. All patients had a mild disease according to the WHO classification of COVID-19 severity. Most of the patients had medical comorbidities, with hypertension being the most common comorbidity. However, only one patient with PV required hospitalization. DISCUSSION/CONCLUSIONS In patients with Philadelphia-negative MPN, the Omicron variant of SARS-CoV-2 usually results in mild infection.
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Affiliation(s)
| | - Ibrahim Khamees
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Awni Alshurafa
- Department of Hematology and Medical Oncology, Hamad Medical Corporation, Doha, Qatar
| | - Hanaa Qasim
- Department of Hematology and Medical Oncology, Hamad Medical Corporation, Doha, Qatar
| | | | - Khaled Ahmed
- Department of Hematology and Medical Oncology, Hamad Medical Corporation, Doha, Qatar
| | - Eltaib Saad
- AMITA Saint Francis Hospital at AMITA St Francis Presence Hospital, Evanston, Illinois, USA
| | - Mohamed Yassin
- Department of Hematology and Medical Oncology, Hamad Medical Corporation, Doha, Qatar
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Kwon SS, Yoon SY, Jeong SY, Lee MY, Kim KH, Lee N, Won JH. Neutrophil-lymphocyte ratio and carotid plaque burden in patients with essential thrombocythemia and polycythemia vera. Nutr Metab Cardiovasc Dis 2022; 32:1913-1916. [PMID: 35606226 DOI: 10.1016/j.numecd.2022.04.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Chronic inflammation plays a critical role in the pathogenesis of myeloproliferative neoplasm (MPN), and inflammatory conditions are closely related to the development and exacerbation of atherosclerosis. This study aimed to compare carotid plaque burden and neutrophil-lymphocyte ratio (NLR) in the essential thrombocythemia (ET)/polycythemia vera (PV) and control groups. METHODS AND RESULTS We retrospectively assessed carotid plaque burden and NLR in patients with ET/PV between January 2010 and September 2021 and propensity-score matched these patients to control subjects from the general population. All patients underwent carotid imaging using carotid ultrasonography for atherosclerosis screening. After 3:1 propensity-score matching, 140 patients in the control group were matched to 51 patients in ET/PV group. The mean NLR was significantly higher in the MPN group than in the control group (4.77 ± 3.96 vs. 1.93 ± 1.03, p < 0.001). The carotid plaque score was also higher in MPN group than in the control group (2.37 ± 1.47 vs. 1.94 ± 1.17, p = 0.038). CONCLUSION Patients with PV/ET show a higher NLR and carotid plaque burden than the normal population. This reflected that PV/ET was a highly inflammatory and atherosclerotic condition expressing potentially increased cardiovascular risk.
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Affiliation(s)
- Seong Soon Kwon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Seug Yun Yoon
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sun Young Jeong
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Min-Young Lee
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Kyoung-Ha Kim
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Namsu Lee
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jong-Ho Won
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
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Wang ZM, Chen WH, Wu YM, Wang LQ, Ye FL, Yin RL. Essential thrombocythemia with non-ST-segment elevation myocardial infarction as the first manifestation: A case report. World J Clin Cases 2022; 10:7422-7428. [PMID: 36158029 PMCID: PMC9353925 DOI: 10.12998/wjcc.v10.i21.7422] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/24/2021] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We report a case of essential thrombocythemia (ET) in a 44-year-old male who exhibited non-ST-segment-elevation myocardial infarction (NSTEMI) as the first manifestation without known cardiovascular risk factors (CVRFs). For the first time, we reported a left main trifurcation lesion in NSTEMI caused by ET, including continuous stenosis lesions from the left main to the ostial left anterior descending (LAD) artery and an obvious thrombotic lesion in the ostial and proximal left circumflex (LCX) artery. There was 60% diffuse stenosis in the left main (LM) that extended to the ostial LAD, thrombosis of the ostial LAD and proximal LCX, and 90% stenosis in the proximal LCX. During the operation, thrombus aspiration was performed, but no obvious thrombus was aspirated. Performing the kissing balloon technique (KBT) in the LCX and LM unexpectedly increased the narrowness of the LAD. Then, the single-stent crossover technique, final kissing balloon technique and proximal optimization technique (POT) were performed. On the second day after percutaneous coronary intervention (PCI), the number of platelets (PLTs) still increased significantly to as high as 696 × 109/L. The bone marrow biopsy done later, together with JAK2 (exon 14) V617F mutation, confirms the diagnosis of ET. Hydroxyurea was administered to inhibit bone marrow proliferation to control the number of PLTs.
CASE SUMMARY A 44-year-old male patient went to a local hospital for treatment for intermittent chest pain occurring over 8 h. The examination at the local hospital revealed elevated cTnI and significantly elevated platelet. Then, he was diagnosed with acute myocardial infarction and transferred to our hospital for emergency interventional treatment by ambulance. During the operation, thrombus aspiration, the single-stent crossover technique, final kissing balloon technique and POT were performed. Dual antiplatelet therapy comprising aspirin and ticagrelor was used after PCI. Evidence of mutated JAK2 V617F and bone marrow biopsy shown the onset of ET. Together with JAK2 (exon 14) V617F mutation, ET was diagnosed according to the World Health Organization (WHO) diagnostic criteria, and the patient was placed on hydroxyurea. During the one-year postoperative period, repeated examinations showed a slight increase in PLTs, but the patient no longer had chest tightness, chest pain or bleeding or developed new thromboembolisms.
CONCLUSION Routine physical examinations and screenings are conducive to the early detection of ET, and the risk for thrombosis should be assessed. Then, active antiplatelet therapy and myelosuppression therapy should be used for high-risk ET patients.
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Affiliation(s)
- Zhi-Ming Wang
- Department of Cardiology, Suzhou Ninth People's Hospital, Soochow University, Suzhou 215200, Jiangsu Province, China
| | - Wei-Hai Chen
- Department of Cardiology, Suzhou Ninth People's Hospital, Soochow University, Suzhou 215200, Jiangsu Province, China
| | - Yan-Ming Wu
- Department of Cardiology, Suzhou Ninth People's Hospital, Soochow University, Suzhou 215200, Jiangsu Province, China
| | - Lin-Quan Wang
- Department of Cardiology, Suzhou Ninth People's Hospital, Soochow University, Suzhou 215200, Jiangsu Province, China
| | - Fu-Long Ye
- Department of Cardiology, Suzhou Ninth People's Hospital, Soochow University, Suzhou 215200, Jiangsu Province, China
| | - Ren-Lin Yin
- Department of Cardiology, Suzhou Ninth People's Hospital, Soochow University, Suzhou 215200, Jiangsu Province, China
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Edahiro Y. Treatment options and pregnancy management for patients with PV and ET. Int J Hematol 2022. [PMID: 35394259 DOI: 10.1007/s12185-022-03336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Polycythemia vera (PV) and essential thrombocythemia (ET) are the two most common subtypes of Philadelphia chromosome-negative myeloproliferative neoplasm (MPN). PV results in erythrocytosis and ET in thrombocytosis. The discovery of JAK2 mutations in the majority of patients with MPN over the last 2 decades has led to the development of JAK inhibitors. Because PV and ET progress relatively slowly, the main treatment strategy for these two diseases is to prevent thrombotic complications. The first-line agent for both PV and ET is hydroxyurea, although some patients are intolerant or refractory to this compound and need other treatment options. Notably, hydroxyurea is contraindicated during pregnancy. In addition to JAK inhibitors, several new agents, such as HDAC inhibitors, LSD1 inhibitors, MDM2 inhibitors and hepcidin mimetics, have been developed as treatment options. Classical agents, such as busulfan and interferon, are still used to treat patients with PV or ET as well. Based on this context, treatment options and pregnancy management for patients with PV or ET are discussed in this review.
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Rahman KH, Surboyo MD, Radithia D, Parmadiati AE, Wihandono A, Ernawati DS. Oral squamous cell carcinoma with essential thrombocythemia and positive JAK2 (V617F) mutation. J Taibah Univ Med Sci 2022; 17:326-331. [PMID: 35592809 PMCID: PMC9073874 DOI: 10.1016/j.jtumed.2021.09.011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/24/2022] Open
Abstract
Essential thrombocythemia is a condition caused by a high platelet count and a positive JAK2 (V617F) mutation. There is an increasing occurrence of malignancy, such as oral squamous cell carcinoma (OSCC), in patients with essential thrombocythemia. The objective of this case report is to document the novel instance of a patient with OSCC after being diagnosed with essential thrombocythemia and a positive JAK2 (V617F) mutation. The patient was a 42-year-old female who complained of an ulcer and pain in the dextral lateral tongue for three months. After two weeks, the pain diminished; however, there was swelling and tenderness on the ulcer. The patient was diagnosed with essential thrombocythemia and a positive JAK2 (V617F) mutation and began undergoing hydroxyurea therapy three months prior to the OSCC diagnosis. The diagnosis of OSCC was based on exfoliative cytology and MRI. The patient was treated with an antiseptic mouthwash to prevent secondary infection and referred to an oncologist to manage the OSCC. It is possible to use the suspected markers of thrombocytosis and a positive JAK2 (V617F) mutation to define the OSCC diagnosis.
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Affiliation(s)
- Kurnia H. Rahman
- Oral Medicine Recidency, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | | | - Desiana Radithia
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | | | - Asdi Wihandono
- Department of Surgical Oncology, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Diah S. Ernawati
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
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Goulart H, Mascarenhas J, Tremblay D. Low-risk polycythemia vera and essential thrombocythemia: management considerations and future directions. Ann Hematol 2022; 101:935-951. [PMID: 35344066 DOI: 10.1007/s00277-022-04826-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 01/06/2023]
Abstract
Thrombotic events are a distinctive feature of the myeloproliferative neoplasms (MPNs) polycythemia vera (PV) and essential thrombocythemia (ET). Patients with these MPNs may also experience a poor quality of life secondary to symptom burden, as well as progression of disease to acute leukemia or myelofibrosis. Over the years, various risk stratification methods have evolved in order to attempt to predict thrombotic risk, which is the largest contributor of morbidity and mortality in these patients. More than half of PV and ET patients are low- or intermediate-risk disease status at the time of diagnosis. While therapeutic development is presently focused on high-risk patients, there is a paucity of therapies, outside of aspirin and therapeutic phlebotomy, which can reduce the thrombotic risk or delay disease progression in low-risk patients. In this review, we first describe the various complications that patients with PV and ET experience, and then detail our evolving understanding of risk stratification in these diseases. We then highlight the available evidence on the management of low-risk PV and ET and include a description of novel therapies currently under investigation in this space. We conclude with recommendations for future directions to advance our understanding and improve the treatment of low-risk PV and ET.
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Affiliation(s)
- Hannah Goulart
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - John Mascarenhas
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1079, New York, NY, 10029, USA
| | - Douglas Tremblay
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1079, New York, NY, 10029, USA.
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Fabris S, Cattaneo D, Salerio S, Bucelli C, Ciceri G, Pasquale R, Todoerti K, Gianelli U, Baldini L, Neri A, Iurlo A. Impact on thrombotic risk of canonical and atypical CALR mutations in essential thrombocythemia. A single-center cohort study. Thromb Res 2022; 210:67-69. [PMID: 35016075 DOI: 10.1016/j.thromres.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Sonia Fabris
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Simone Salerio
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriella Ciceri
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pasquale
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Katia Todoerti
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Umberto Gianelli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Division of Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Baldini
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Antonino Neri
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Bartalucci N, Galluzzi L. Philadelphia-negative myeloproliferative neoplasms: From origins to new perspectives. Int Rev Cell Mol Biol 2022; 366:ix-xx. [PMID: 35153008 DOI: 10.1016/s1937-6448(22)00019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Niccolò Bartalucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; DENOThe Excellence Center, University of Florence, Florence, Italy.
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States; Sandra and Edward Meyer Cancer Center, New York, NY, United States; Caryl and Israel Englander Institute for Precision Medicine, New York, NY, United States; Department of Dermatology, Yale School of Medicine, New Haven, CT, United States; Université de Paris, Paris, France.
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48
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Barranco-Lampón G, Martínez-Castro R, Arana-Luna L, Álvarez-Vera JL, Rojas-Castillejos F, Peñaloza-Ramírez R, Carballo-Zarate AA, Olarte-Carrillo I, Minamy JIG, López-Salazar J, Navarrete JJ, Espinosa-Partida A, Ventura-Enríquez Y, Ruiz-Contreras JI, Aguirre-Reyes OG, Anaya-Cuéllar I, Aguilar-Luévano J, Díaz-Ramírez HF, Herrera-Olivares W, Aguilar-Hidalgo JA, Alcívar-Cedeño LM, Hernández-Caballero Á, Galaz-Cordero LE, Peña-Celaya JADL, Báez-Islas PE, Bates-Martín RA, Cano-León AMDLL, Espitia-Ríos ME, Barbosa D, Morales-Adrián J, Pacheco MJ, Delgado-López N, Neme-Yunes Y, Moralws-Hernández AE, Mújica-Martínez A, Pérez-Lizardi AB, Pérez-Gómez KD, Barragán-Ibáñez G, Martínez A, Flores-Ordúñez K, Ramírez-Hoyos P, Ángeles Rosales-López MDL, Acosta-Maldonado BL, Jiménez-Ochoa MA, Garzón-Velásquez KB, Hernández-Ruiz E, McNally-Guillén BM, Saucedo-Montes EE, Aguilar-Andrade C, Vivas-Arteaga CL, Guerra-Alarcón LV, Milán-Salvatierra AI, Campa-Monroy DI, Cota-Rangel X, Estrada-Domínguez P, García-Camacho AS, García-Castillo C, Banda-García LI, Rodríguez-Sánchez V, Meillón-García LA, Urbina-Escalante E, Martínez-Ramírez MA, Loera-Fragoso SJ, Martínez-Coronel J, Zapata-Canto N, Gómez-Cortés SC, Medina-Coral JE, Mójica-Balderas L, Pérez-Zúñiga JM, Pérez FJ, López-Arroyo JL, Zazueta-Pozos JF, Romero-Martínez E, Romero-Rodelo H, Tapia-Enríquez AL, Soriano-Mercedes EJ, Salazar-Ramírez Ó, Vilchis-González SP, Tepepa-Flores F, Alvarado-Ibarra M. Essential thrombocythaemia. GAC MED MEX 2022; 158:17-25. [PMID: 37734042 DOI: 10.24875/gmm.m22000803] [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: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 09/23/2023] Open
Abstract
Essential thrombocythemia (ET) is a chronic Philadelphia-negative myeloproliferative neoplasm that has its main involvement in the megakaryopoietic lineage, generating sustained thrombocytosis in peripheral blood and an increase in the number of mature megakaryocytes in the bone marrow. In addition to marked thrombocytosis, it is characterized by increased thrombotic or hemorrhagic risk and the presence of constitutional symptoms. Patients with ET have a low but known risk of disease progression to myelofibrosis and/or acute leukemia. The diagnosis is made based on the 2016 WHO criteria. At present, available treatments for patients with ET are mainly aimed at minimizing the risk of thrombosis and/or bleeding.
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Affiliation(s)
- Gilberto Barranco-Lampón
- Servicio de Hematología, Hospital General de México, Ciudad de México, México
- Servicio de Hematología, Instituto Nacional de Cancerología, Ciudad de México, México
| | - Raúl Martínez-Castro
- Servicio de Hematología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Luara Arana-Luna
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - José Luis Álvarez-Vera
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Flavio Rojas-Castillejos
- Servicio de Hematología, Hospital General de Zona No. 2, Instituto Mexicano del Seguro Social, Salina Cruz, Oax., México
| | | | | | - Irma Olarte-Carrillo
- Servicio de Hematología, Hospital General de México, Ciudad de México, México
- Biología molecular, Hospital General de México,Ciudad de México, México
| | - Jaime Israel-García Minamy
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Javier López-Salazar
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Juan José Navarrete
- Servicio de Hematología, Hospital General de México, Ciudad de México, México
| | - Arturo Espinosa-Partida
- Servicio de Hematología, Hospital General Belisario Domínguez, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Tuxtla Gutiérrez, Chis., México
| | - Yanet Ventura-Enríquez
- Banco de Sangre, Hospital Centro Médico Naval, Ciudad de México, México
- Servicio de Hematología, Hospital Centro Médico Naval, Ciudad de México, México
| | - Josué Isel Ruiz-Contreras
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | | | - Irene Anaya-Cuéllar
- Servicio de Hematología, Hospital General Presidente Lázaro Cárdenas del Río, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Chihuahua, Chih., México
| | | | - Hugo Francisco Díaz-Ramírez
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Wilfrido Herrera-Olivares
- Servicio de Hematología, Hospital Regional de Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Pue., México
| | - José Antonio Aguilar-Hidalgo
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | | | - Álvaro Hernández-Caballero
- Servicio de Hematología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Lourdes Elena Galaz-Cordero
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - José Antonio de la Peña-Celaya
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Pamela Elena Báez-Islas
- Servicio de Hematología, Instituto Mexicano del Seguro Social, Hospital de Zona No. 14, Hermosillo, Son., México
| | | | - Ana Ma de la Luz Cano-León
- Servicio de Hematología, Instituto Mexicano del Seguro Social, Hospital General Regional No. 1, Querétaro, Qro., México
| | - Ma Eugenia Espitia-Ríos
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Diego Barbosa
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Javier Morales-Adrián
- Servicio de Hematología, Hospital Regional de Mérida, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mérida, Yuc., México
| | - Martín Jacobo Pacheco
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Nancy Delgado-López
- Servicio de Hematología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Yvette Neme-Yunes
- Servicio de Hematología, Centro Médico ABC, Ciudad de México, México
| | - Alba Edna Moralws-Hernández
- Servicio de Hematología, Hospital General de Zona No. 27, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Alejandra Betsabé Pérez-Lizardi
- Servicio de Hematología, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Karen Daniela Pérez-Gómez
- Servicio de Hematología, Hospital Instituto Mexicano del Seguro Social Chihuahua, Hospital General de Zona No. 1, Chihuahua, Chih., México
| | - Gabriel Barragán-Ibáñez
- Servicio de Hematología, Hospital Regional Presidente Juárez, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Adolfo Martínez
- Laboratorio de Hematología, Hospital General de México, Ciudad de México, México
| | - Karen Flores-Ordúñez
- Servicio de Hematología, Hospital General de Zona No. 24, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Ma de Los Ángeles Rosales-López
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | | | - Marco Alejandro Jiménez-Ochoa
- Unidad de trasplante de médula ósea, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | - Eleazar Hernández-Ruiz
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Bosco Martín McNally-Guillén
- Servicio de Hematología, Trasplante de médula ósea, Centro Médico de Especialidades, Ciudad Juárez, Chih., México
| | - Erick Eduardo Saucedo-Montes
- Banco de Sangre, Hospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Tampico, Tampico, Tamps., México
| | - Carolina Aguilar-Andrade
- Banco de Sangre, Hospitalización, Instituto Nacional de Cardiología, Ciudad de México, México
- Banco de Sangre, Hospitalización, Instituto Mexicano del Seguro Social Carlos MacGregor, Ciudad de México, México
| | - Cindy Lissette Vivas-Arteaga
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | | | - Andrea Iracema Milán-Salvatierra
- Servicio de Hematología, Hospital Regional Presidente Juárez, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Dafne Itzel Campa-Monroy
- Servicio de Hematología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Xóchitl Cota-Rangel
- Servicio de Hematología, San Telmo Medical Center, Aguascalientes, Aguascalientes, Ags., México
| | - Patricia Estrada-Domínguez
- Servicio de Hematología, Hospital Instituto Mexicano del Seguro Social Chihuahua, Hospital General de Zona No. 1, Chihuahua, Chih., México
| | - Alinka Socorro García-Camacho
- Servicio de Hematología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
- Servicio de Hematología, Oncología integral satélite, Ciudad de México, México
| | - Carolina García-Castillo
- Servicio de Hematología, Oncología integral satélite, Ciudad de México, México
- Servicio de Hematología, Hospital Central Militar, SEDENA, Ciudad de México, México
| | | | - Vania Rodríguez-Sánchez
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | | | - Elizabeth Urbina-Escalante
- Servicio de Hematología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Mario Alberto Martínez-Ramírez
- Servicio de Hematología, Hospital Regional B, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Veracruz, Veracruz, Ver., México
| | | | - Jorge Martínez-Coronel
- Servicio de Hematología, Hospital Regional Valentín Gómez Farias, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Guadalajara, Jal., México
| | - Nidia Zapata-Canto
- Servicio de Hematología, Instituto Nacional de Cancerología, Ciudad de México, México
- Servicio de Hematología, Médica Sur, Ciudad de México, México
| | - Sue Cynthia Gómez-Cortés
- Servicio de Hematología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Jesús Emanuel Medina-Coral
- Servicio de Hematología, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Dr. Manuel Cárdenas de la Vega, Culiacán, Sin., México
| | | | - Juan Manuel Pérez-Zúñiga
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | | | | | | | | | - Hilda Romero-Rodelo
- Servicio de Hematología, Hospital Fray Junípero Serra, Tijuana, B.C., México
| | - Ana Laura Tapia-Enríquez
- Servicio de Hematología, Hospital General Presidente Lázaro Cárdenas del Río, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Chihuahua, Chih., México
| | - Emely Johanny Soriano-Mercedes
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Óscar Salazar-Ramírez
- Servicio de Hematología, Hospital General Dr. Darío Fernández Fierro, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | | | - Fredy Tepepa-Flores
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Martha Alvarado-Ibarra
- Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
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Kishi Y, Aota Y, Horie Y, Sutoh A, Moriyama M, Okabe M, Iguchi T, Yokouchi Y, Gotoh A, Maetani I. [Idiopathic esophageal submucosal hematoma during antithrombotic therapy for essential thrombocythemia]. Rinsho Ketsueki 2022; 63:265-270. [PMID: 35491215 DOI: 10.11406/rinketsu.63.265] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 73-year-old woman was hospitalized with sudden chest pain and hematemesis. Chest computed tomography and upper gastrointestinal endoscopy revealed an idiopathic submucosal hematoma from the cervical esophagus to the esophagogastric mucosal junction. Idiopathic esophageal submucosal hematoma is often prone to a bleeding tendency of an underlying disorder. The patient had a history of essential thrombocythemia (ET) and was taking aspirin. She successfully recovered after aspirin discontinuation and conservative treatment; however, died of cardiopulmonary arrest in the ward on day 9 of hospitalization. The autopsy revealed that the cause of death was pulmonary thromboembolism. This is the first report of ET with submucosal hematoma of the esophagus. The possibility of an esophageal submucosal hematoma should be considered when patients with ET complain of chest pain since ET and treatment with aspirin are considered risk factors for bleeding. Additionally, close attention should be focused on the risk of developing thrombosis if a patient with myeloproliferative neoplasm is required to discontinue antithrombotic therapy due to a bleeding event.
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Affiliation(s)
- Yosuke Kishi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University, Ohashi Medical Center
- Department of Internal Medicine, Kohsei Chuo General Hospital
| | - Yasuo Aota
- Department of Internal Medicine, Kohsei Chuo General Hospital
- Department of Hematology, Tokyo Medical University
| | - Yoshimasa Horie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University, Ohashi Medical Center
| | - Arisa Sutoh
- Department of Internal Medicine, Kohsei Chuo General Hospital
- Department of Hematology, Tokyo Medical University
| | - Mitsuru Moriyama
- Department of Internal Medicine, Kohsei Chuo General Hospital
- Department of Hematology, Tokyo Medical University
| | - Masahiro Okabe
- Department of Internal Medicine, Kohsei Chuo General Hospital
| | - Toyotaka Iguchi
- Department of Hematology, National Hospital Organization Tokyo Medical Center
| | - Yuki Yokouchi
- Department of Surgical Pathology, Toho University, Ohashi Medical Center
| | - Akihiko Gotoh
- Department of Internal Medicine, Kohsei Chuo General Hospital
- Department of Hematology, Tokyo Medical University
| | - Iruru Maetani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University, Ohashi Medical Center
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Lee AJ, Kim SG, Nam JY, Yun J, Ryoo HM, Bae SH. Clinical features and outcomes of JAK2 V617F-positive polycythemia vera and essential thrombocythemia according to the JAK2 V617F allele burden. Blood Res 2021; 56:259-265. [PMID: 34801987 PMCID: PMC8721460 DOI: 10.5045/br.2021.2021089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/03/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background JAK2 mutation status is a well-known risk factor for thrombosis in patients with myeloproliferative neoplasms. However, the clinical usefulness of JAK2 V617F allele burden is under investigation. Methods We retrospectively evaluated the impact of the JAK2 V617F allele burden on clinical characteristics and outcomes of JAK2 V617F-positive polycythemia vera (PV) and essential thrombocythemia (ET). The JAK2 V617F allele burden was measured using sequencing. Results Altogether, 127 patients with JAK2 V617F mutation (PV, N=61; ET, N=66) were included in this study. JAK2 V617F allele burdens were positively correlated with white blood cell counts, hemoglobin values, lactate dehydrogenase levels, and platelet counts. The median values of JAK2 V617F allele burden in patients with PV and ET were 58% and 30%, respectively. A JAK2 V617F allele burden of ≥30%, older age, and a higher hemoglobin level were risk factors for thrombotic events in ET. In patients with PV, older age was the only thrombotic risk factor. The 8-year probabilities of overall survival (OS) were 82.9% in all patients. A high JAK2 V617F allele burden (≥58%) was associated with poor OS in patients with PV. For the patients with ET, the difference in 8-year OS based on the JAK2 V617F allele burden was not significant. Conclusion The JAK2 V617F allele burden was correlated with hematologic parameters and clinical outcomes. Assessing the JAK2 V617F allele burden can be helpful in predicting the thrombotic risk and disease course in patients with JAK2 V617F-positive PV and ET.
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Affiliation(s)
- A-Jin Lee
- Department of Laboratory Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Sang-Gyung Kim
- Department of Laboratory Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jun Yeb Nam
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jaehum Yun
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hun-Mo Ryoo
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Sung Hwa Bae
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
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