1
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Mata DA, Lee JK, Shanmugam V, Marcus CB, Schrock AB, Williams EA, Ritterhouse LL, Hickman RA, Janovitz T, Patel NR, Kroger BR, Ross JS, Mirza KM, Oxnard GR, Vergilio JA, Elvin JA, Benhamida JK, Decker B, Xu ML. Liquid biopsy-based circulating tumour (ct)DNA analysis of a spectrum of myeloid and lymphoid malignancies yields clinically actionable results. Histopathology 2024; 84:1224-1237. [PMID: 38422618 DOI: 10.1111/his.15168] [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: 10/11/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
AIMS Liquid biopsy (LBx)-based next-generation sequencing (NGS) of circulating tumour DNA (ctDNA) can facilitate molecular profiling of haematopoietic neoplasms (HNs), particularly when tissue-based NGS is infeasible. METHODS AND RESULTS We studied HN LBx samples tested with FoundationOne Liquid CDx, FoundationOne Liquid, or FoundationACT between July 2016 and March 2022. We identified 271 samples: 89 non-Hodgkin lymphoma (NHL), 43 plasma-cell neoplasm (PCN), 41 histiocytoses, 27 myelodysplastic syndrome (MDS), 25 diffuse large B-cell lymphoma (DLBCL), 22 myeloproliferative neoplasm (MPN), 14 Hodgkin lymphoma (HL), and 10 acute myeloid leukaemia (AML). Among 73.4% with detectable pathogenic alterations, median maximum somatic allele frequency (MSAF) was 16.6%, with AML (36.2%), MDS (19.7%), and MPN (44.5%) having higher MSAFs than DLBCL (3.9%), NHL (8.4%), HL (1.5%), PCN (2.8%), and histiocytoses (1.8%) (P = 0.001). LBx detected characteristic alterations across HNs, including in TP53, KRAS, MYD88, and BTK in NHLs; TP53, KRAS, NRAS, and BRAF in PCNs; IGH in DLBCL; TP53, ATM, and PDCD1LG2 in HL; BRAF and MAP2K1 in histiocytoses; TP53, SF3B1, DNMT3A, TET2, and ASXL1 in MDS; JAK2 in MPNs; and FLT3, IDH2, and NPM1 in AML. Among 24 samples, the positive percent agreement by LBx was 75.7% for variants present in paired buffy coat, marrow, or tissues. Also, 75.0% of pairs exhibited alterations only present on LBx. These were predominantly subclonal (clonal fraction of 3.8%), reflecting the analytical sensitivity of LBx. CONCLUSION These data demonstrate that LBx can detect relevant genomic alterations across HNs, including at low clonal fractions, suggesting a potential clinical utility for identifying residual or emerging therapy-resistant clones that may be undetectable in site-specific tissue biopsies.
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Affiliation(s)
| | | | - Vignesh Shanmugam
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Erik A Williams
- Foundation Medicine, Inc., Cambridge, MA, USA
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | | | - Benjamin R Kroger
- Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey S Ross
- Foundation Medicine, Inc., Cambridge, MA, USA
- Departments of Pathology, Urology, and Medicine (Oncology), State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Kamran M Mirza
- Department of Pathology, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | | | - Jamal K Benhamida
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mina L Xu
- Department of Pathology, Yale New-Haven Hospital, Yale School of Medicine, New Haven, CT, USA
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Chang A, Wilson SR, Morris S, Wichlan D, LeVarge BL, Little JA. Nocturnal hypoxaemia is common in adults with sickle cell anaemia. Br J Haematol 2024; 204:1495-1499. [PMID: 38311363 DOI: 10.1111/bjh.19305] [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: 10/23/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
The symptoms and sequelae of sickle cell anaemia (SCA) are caused by the polymerization of deoxygenated sickle haemoglobin, and people with SCA may be uniquely susceptible to adverse outcomes from hypoxia and haemoglobin desaturation. We examined by oximetry adults (aged 18-45 years) with SCA presenting symptoms indicative of polysomnography, at a single institution, irrespective of treatment, for nocturnal hypoxaemia. Clinical labs and blood for in vitro assessments were taken upon enrolment and after 8-12 weeks of oxygen therapy or observation. Of 21 screened participants, nine (43%) had sufficient nocturnal hypoxaemia to warrant oxygen therapy (≥5 min at SpO2 ≤ 88%). Time spent at SpO2 ≤ 88% associated with age (p = 0.0092), annual hospitalizations (p = 0.0018) and anaemia (p = 0.0139), as well as plasma levels of TNFα (p = 0.0019) and IL-4 (p = 0.0147). Longitudinal analysis showed that WBC significantly decreased during the follow-up period in hypoxic individuals but not in non-hypoxic individuals (p = 0.0361 and p = 0.6969 respectively). Plasma levels of CCL2 and IL-1ra tended to increase, while levels of red blood cell reactive oxygen species tended to decrease with oxygen therapy. Overall, nocturnal hypoxaemia was common in this pilot study population and associated with plausible clinical comorbidities; oxygen therapy may decrease inflammation and oxidative damage in hypoxic individuals.
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Affiliation(s)
- Ada Chang
- Department of Medicine, Hematology and Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samuel R Wilson
- Department of Medicine, Hematology and Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sherri Morris
- Department of Medicine, Hematology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Wichlan
- Department of Medicine, Hematology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Barbara L LeVarge
- Department of Medicine, Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jane Alison Little
- Department of Medicine, Hematology and Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Tedjaseputra A, Roy S, Htun K, Oh D, McQuilten Z, Yeh P, Bennett A, Yuan Low MS, Chunilal S, Wood EM, Shortt J. Day-21 bone marrow findings incorrectly designate residual leukaemia in FLT3-mutated acute myeloid leukaemia treated with intensive induction plus midostaurin: a morphology-focused study. Pathology 2024:S0031-3025(24)00085-0. [PMID: 38580614 DOI: 10.1016/j.pathol.2024.01.004] [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: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 04/07/2024]
Abstract
Early induction response assessment with day-21 bone marrow (D21-BM) is commonly performed in patients with FLT3-mutated acute myeloid leukaemia (AML), where detection of residual leukaemia (RL; blasts ≥5%) typically results in the administration of a second induction course. However, whether D21-BM results predict for RL at the end of first induction has not been systematically assessed. This study evaluates the predictive role of D21-BM morphology in detecting RL following first induction. Between August 2018 and March 2022, all patients with FLT3-AML receiving 7+3 plus midostaurin, with D21-BM performed, were identified. Correlation between D21-BM morphology vs D21-BM ancillary flow/molecular results, as well as vs D28-BM end of first induction response, were retrospectively reviewed. Subsequently, D21-BMs were subjected to anonymised morphological re-assessments by independent haematopathologists (total in triplicate per patient). Of nine patients included in this study, three (33%) were designated to have RL at D21-BM, all of whom entered complete remission at D28-BM. Furthermore, only low-level measurable residual disease was detected in all three cases by flow or molecular methods at D21-BM, hence none proceeded to a second induction. Independent re-evaluations of these cases failed to correctly reassign D21-BM responses, yielding a final false positive rate of 33%. In summary, based on morphology alone, D21-BM assessment following 7+3 intensive induction plus midostaurin for FLT3-AML incorrectly designates RL in some patients; thus correlating with associated flow and molecular results is essential before concluding RL following first induction. Where remission status is unclear, repeat D28-BMs should be performed.
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Affiliation(s)
| | | | - Kay Htun
- Monash Haematology, Clayton, Vic, Australia
| | | | - Zoe McQuilten
- Monash Haematology, Clayton, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Paul Yeh
- Monash Haematology, Clayton, Vic, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia
| | - Ashwini Bennett
- Monash Haematology, Clayton, Vic, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia
| | - Michael Sze Yuan Low
- Monash Haematology, Clayton, Vic, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia
| | - Sanjeev Chunilal
- Monash Haematology, Clayton, Vic, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia
| | - Erica M Wood
- Monash Haematology, Clayton, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jake Shortt
- Monash Haematology, Clayton, Vic, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia.
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4
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Premawardhena A, Perera C, Wijethilaka MN, Wanasinghe SK, Rajakaruna RHMG, Samarasinghe RANKK, Williams S, Mettananda S. Efficacy and safety of deferoxamine, deferasirox and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a protocol for randomised controlled clinical trial. BMJ Open 2024; 14:e077342. [PMID: 38331857 PMCID: PMC10860110 DOI: 10.1136/bmjopen-2023-077342] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Despite the improvement in medical management, many patients with transfusion-dependent β-thalassaemia die prematurely due to transfusion-related iron overload. As per the current guidelines, the optimal chelation of iron cannot be achieved in many patients, even with two iron chelators at their maximum therapeutic doses. Here, we evaluate the efficacy and safety of triple combination treatment with deferoxamine, deferasirox and deferiprone over dual combination of deferoxamine and deferasirox on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload. METHODS AND ANALYSIS This is a single-centre, open-label, randomised, controlled clinical trial conducted at the Adult and Adolescent Thalassaemia Centre of Colombo North Teaching Hospital, Ragama, Sri Lanka. Patients with haematologically and genetically confirmed transfusion-dependent β-thalassaemia are enrolled and randomised into intervention or control groups. The intervention arm will receive a combination of oral deferasirox, oral deferiprone and subcutaneous deferoxamine for 6 months. The control arm will receive the combination of oral deferasirox and subcutaneous deferoxamine for 6 months. Reduction in iron overload, as measured by a reduction in the serum ferritin after completion of the treatment, will be the primary outcome measure. Reduction in liver and cardiac iron content as measured by T2* MRI and the side effect profile of trial medications are the secondary outcome measures. ETHICS AND DISSEMINATION Ethical approval for the study has been obtained from the Ethics Committee of the Faculty of Medicine, University of Kelaniya (Ref. P/06/02/2023). The trial results will be disseminated in scientific publications in reputed journals. TRIAL REGISTRATION NUMBER The trial is registered in the Sri Lanka Clinical Trials Registry (Ref: SLCTR/2023/010).
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Affiliation(s)
- Anuja Premawardhena
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Chamodi Perera
- Department of Paediatrics, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | | | | | - Senani Williams
- Department of Pathology, University of Kelaniya, Kelaniya, Sri Lanka
| | - Sachith Mettananda
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Paediatrics, University of Kelaniya, Kelaniya, Sri Lanka
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5
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Jasim A, Vergara‐Lluri ME. Cryoglobulinemic vasculitis with blood schistocytosis and bone marrow vasculitis. EJHaem 2023; 4:1168-1169. [PMID: 38024618 PMCID: PMC10660388 DOI: 10.1002/jha2.810] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Afreen Jasim
- Keck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
- Los Angeles County + University of Southern California Medical CenterLos AngelesCaliforniaUSA
| | - Maria E. Vergara‐Lluri
- Keck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
- Los Angeles County + University of Southern California Medical CenterLos AngelesCaliforniaUSA
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6
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Pizzi M, Binotto G, Rigoni Savioli G, Dei Tos AP, Orazi A. Of drills and bones: Giovanni Ghedini and the origin of bone marrow biopsy. Br J Haematol 2022; 198:943-952. [PMID: 35510703 DOI: 10.1111/bjh.18206] [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: 03/06/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
Bone marrow (BM) studies are pivotal for the diagnosis of haematological disorders. Their introduction into clinical haematology dates back to the work of Giovanni Ghedini (1877-1959), an Italian physician who first conceived BM sampling in 1908. Ghedini's proposal stemmed from his clinical experience and from the scientific developments that characterised his epoch. By presenting selected passages of Ghedini's publications, this report considers the theoretical and historical bases of his work and analyses its practical implications for modern haematology.
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Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Gianni Binotto
- Haematology and Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Giulia Rigoni Savioli
- Central Medical Library 'Vincenzo Pinali' - Section of Ancient Books and Special Collections, University of Padua, Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Attilio Orazi
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
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7
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Baron T, Novak A. Tranexamic acid in acute traumatic brain injury. BMJ Evid Based Med 2021; 26:e7. [PMID: 32317278 DOI: 10.1136/bmjebm-2019-111319] [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] [Accepted: 02/18/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Tanya Baron
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Alex Novak
- Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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8
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Abstract
Specimens from the gastrointestinal (GI) tract are among the most commonly encountered in routine pathology practice worldwide. It is well known that the luminal GI tract is home to various areas rich in mucosa-associated lymphoid tissue (MALT), whether native or acquired. The latter may be particularly problematic due to its well-known predisposing factors such as Helicobacter pylori infection and autoimmune conditions. Nevertheless, native GI structures are often the subject of query, particularly in conditions that may mimic lymphoproliferative conditions, including infectious and inflammatory diseases. Herein, we describe and share common clinicopathological findings in our daily practice that are challenging to distinguish from subtle low-grade neoplastic lymphoproliferative disorders.
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Affiliation(s)
- Jessica Alvarez-Lesmes
- Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, FL, USA
| | - Jennifer R Chapman
- Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, FL, USA
| | - Julio C Poveda
- Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospital, Miami, FL, USA.
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9
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Nanaa A, Akkus Z, Lee WY, Pantanowitz L, Salama ME. Machine learning and augmented human intelligence use in histomorphology for haematolymphoid disorders. Pathology 2021; 53:400-7. [PMID: 33642096 DOI: 10.1016/j.pathol.2020.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Advances in digital pathology have allowed a number of opportunities such as decision support using artificial intelligence (AI). The application of AI to digital pathology data shows promise as an aid for pathologists in the diagnosis of haematological disorders. AI-based applications have embraced benign haematology, diagnosing leukaemia and lymphoma, as well as ancillary testing modalities including flow cytometry. In this review, we highlight the progress made to date in machine learning applications in haematopathology, summarise important studies in this field, and highlight key limitations. We further present our outlook on the future direction and trends for AI to support diagnostic decisions in haematopathology.
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Yasara N, Wickramarathne N, Mettananda C, Manamperi A, Premawardhena A, Mettananda S. Efficacy and safety of oral hydroxyurea in transfusion-dependent β-thalassaemia: a protocol for randomised double-blind controlled clinical trial. BMJ Open 2020; 10:e041958. [PMID: 33109679 PMCID: PMC7592299 DOI: 10.1136/bmjopen-2020-041958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Despite being one of the first diseases to be genetically characterised, β-thalassaemia remains a disorder without a cure in a majority of patients. Most patients with β-thalassaemia receive only supportive treatment and therefore have a poor quality of life and shorter life spans. Hydroxyurea, which has shown to induce fetal haemoglobin synthesis in human erythroid cells, is currently recommended for the treatment of sickle cell disease. However, its clinical usefulness in transfusion-dependent β-thalassaemia is unclear. Here, we present a protocol for a randomised double-blind controlled clinical trial to evaluate the efficacy and safety of oral hydroxyurea in transfusion-dependent β-thalassaemia. METHODS AND ANALYSIS This single-centre randomised double-blind placebo-controlled clinical trial is conducted at the Thalassaemia Centre of Colombo North Teaching Hospital, Ragama, Sri Lanka. Adult and adolescent patients with haematologically and genetically confirmed transfusion-dependent β-thalassaemia are enrolled and randomised into the intervention or control group. The intervention group receives oral hydroxyurea 10-20 mg/kg daily for 6 months, while the control group receives a placebo which is identical in size, shape and colour to hydroxyurea without its active ingredient. Transfused blood volume, pretransfusion haemoglobin level, fetal haemoglobin percentage and adverse effects of treatment are monitored during treatment and 6 months post-treatment. Cessation or reduction of blood transfusions during the treatment period will be the primary outcome measure. The statistical analysis will be based on intention to treat. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Faculty of Medicine, University of Kelaniya (P/116/05/2018) and the trial is approved by the National Medicinal Regulatory Authority of Sri Lanka. Results of the trial will be disseminated in scientific publications in reputed journals. TRIAL REGISTRATION NUMBER SLCTR/2018/024; Pre-results.
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Affiliation(s)
- Nirmani Yasara
- Department of Paediatrics, University of Kelaniya, Ragama, Sri Lanka
| | | | | | - Aresha Manamperi
- Molecular Medicine Unit, University of Kelaniya, Ragama, Sri Lanka
| | - Anuja Premawardhena
- Department of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Sachith Mettananda
- Department of Paediatrics, University of Kelaniya, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
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Jeon K, Kim M, Han J, Lee J, Lee JS, Kim HS, Kang HJ, Lee YK. Establishment of sex-specific reference intervals for automated haematology analyser-delivered research parameters in healthy Korean adults: a retrospective database review. BMJ Open 2020; 10:e036887. [PMID: 33033084 PMCID: PMC7545637 DOI: 10.1136/bmjopen-2020-036887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Automated haematology analysers measure various parameters of relevance to clinical research along with routine complete blood count (CBC)-related components. We aimed to establish ethnicity-specific and sex-specific reference intervals for 26 research-specific parameters as well as 18 routinely reported components using a large cohort of healthy Korean adults. The necessity of requiring separate sex-specific reference intervals for each parameter was also examined. DESIGN A retrospective database review. SETTING Single tertiary-care hospital of approximately 375 physicians and 530 nurses. PARTICIPANTS This study included 1383 reference individuals (840 men and 543 women). PRIMARY AND SECONDARY OUTCOME MEASURES Following the Clinical and Laboratory Standards Institute guidelines for establishing reference intervals, routine CBCs as well as research parameters were measured using an ADVIA 2120i instrument. RESULTS All the routine components except for mean platelet volume and per cent lymphocytes differed significantly between men and women. Most research parameters also differed between the sexes; the exceptions were large platelets, platelet dry mass distribution width, per cent basophil saturation, per cent peroxidase saturation and per cent abnormal peroxidase absorption. Despite these differences, separate reference intervals for men and women were required only for two research-specific parameters: 'percentage high cellular haemoglobin' and 'percentage of hyperchromic red blood cells (RBCs)'. CONCLUSION Even though most parameters showed significant differences between men and women, none of the evaluated parameters except two RBC-related factors required separate reference intervals for each sex.
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Affiliation(s)
- Kibum Jeon
- Department of Laboratory Medicine, Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Miyoung Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, The Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Gangwon, The Republic of Korea
| | - Jiwon Lee
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, The Republic of Korea
| | - Jee-Soo Lee
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, The Republic of Korea
| | - Han-Sung Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, The Republic of Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, The Republic of Korea
| | - Young Kyung Lee
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, The Republic of Korea
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12
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Duffles Amarante G, Collins G, Rocha V. What do we know about duodenal-type follicular lymphoma? From pathological definition to treatment options. Br J Haematol 2019; 188:831-837. [PMID: 31880329 DOI: 10.1111/bjh.16348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Duodenal-type follicular lymphoma (DFL) is a newly recognised variant of follicular lymphoma (FL), although little is known about its biology and clinical evolution. In general, patients tend to have mild symptoms and do not require therapy, comparable with other forms of low-tumour burden asymptomatic FL. Specific pathological features, such as a dendritic cell meshwork, low expression of CD10 and upregulation of activation-induced cytidine deaminase can help the diagnosis. The molecular landscape of DFL is similar to the classical nodal presentation of FL, although studies using gene expression profiling demonstrate a close relation with MALT lymphomas. Markers associated with inflammation have suggested that the microenvironment plays a likely role in the pathogenesis of DFL and its low progression rate. Clinical series published vary between 20-63 patients with an estimated overall survival between 92-100% and a median follow-up ranging between 20 and 107 months. Treatment options include a watch and wait strategy, rituximab monotherapy and radiotherapy. In this review, we summarise current pathological data and treatment studies in DFL.
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Affiliation(s)
- Guilherme Duffles Amarante
- Hematology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, SP, Brazil.,Hematology Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Graham Collins
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vanderson Rocha
- Hematology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, SP, Brazil.,Hematology Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil.,Department of Haematology, University of Oxford, Oxford, UK
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13
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Liapis K, Tsagarakis NJ, Panitsas F, Taparkou A, Liapis I, Roubakis C, Tsokanas D, Vasileiou P, Grigoriou E, Kakiopoulos G, Psarra K, Farmaki E, Paterakis G. Causes of double-negative T-cell lymphocytosis in children and adults. J Clin Pathol 2019; 73:431-438. [PMID: 31810993 DOI: 10.1136/jclinpath-2019-206255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 01/18/2023]
Abstract
AIMS The causes and diagnosis of 'double-negative' (CD3+CD4-CD8-) T-cell lymphocytosis are not well studied. We aimed to define the causes of double-negative T-cell lymphocytosis in children and adults, and to identify simple clinical and laboratory features that would help to differentiate between the underlying conditions. METHODS We collected clinical and laboratory data on 10 children and 30 adults with significantly increased peripheral-blood double-negative T-cells (>10% of total lymphocytes). We identified conditions associated with double-negative T-lymphocytosis with flow cytometry, peripheral-blood morphology and T-cell receptor-gene rearrangement studies. Patients were assigned to diagnostic categories on the basis of these test results. RESULTS AND CONCLUSIONS The causes of double-negative T-cell lymphocytosis in children were autoimmune lymphoproliferative syndrome (ALPS) and reactive γ/δ Τ-lymphocytosis. T-cell large granular lymphocyte (T-LGL) leukaemia, reactive γ/δ T-lymphocytosis and hepatosplenic T-cell lymphoma (HSTL) were the the most common disorders underlying double-negative T-cell lymphocytosis in adults. Less common causes included hypereosinophilic syndrome, peripheral T-cell lymphoma, ALPS and monoclonal, double-negative T-lymphocytosis of uncertain significance. CD5/CD7/Vδ2 expression and absolute double-negative lymphocyte count (<1.8×109/L) were useful discriminators for distinguishing patients with reactive γ/δ T-lymphocytosis from those with γ/δ lymphoproliferative disorders. Differentiating between γ/δ T-LGL and HSTL can be difficult. Expression of CD57 and cellular morphology (pale cytoplasm with distinct granules) would support a diagnosis of γ/δ T-LGL.
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Affiliation(s)
- Konstantinos Liapis
- Department of Clinical Haematology, Peripheral General Hospital Athens Giorgos Gennimatas, Athens, Greece
| | - Nikolaos J Tsagarakis
- Department of Immunology, Peripheral General Hospital Athens Giorgos Gennimatas, Athens, Greece
| | - Fotis Panitsas
- Department of Haematology, General University Hospital of Larisa, Larissa, Thessaly, Greece
| | - Anna Taparkou
- Paediatric Immunology and Rheumatology Referral Center, First Department of Paediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Liapis
- Department of Haematology, University Hospital of Crete, Heraklion, Greece
| | | | - Dimitris Tsokanas
- Department of Clinical Haematology, Peripheral General Hospital Athens Giorgos Gennimatas, Athens, Greece
| | - Paraskevi Vasileiou
- Department of Flow Cytometry, Flowdiagnosis Diagnostic Center, Athens, Greece
| | - Eirini Grigoriou
- Flow Cytometry Laboratory, Department of Immunology and Histocompatibility, Evangelismos Athens General Hospital, Athens, Greece
| | - Georgios Kakiopoulos
- Department of Pathology, Peripheral General Hospital Athens Giorgos Gennimatas, Athens, Greece
| | - Katerina Psarra
- Flow Cytometry Laboratory, Department of Immunology and Histocompatibility, Evangelismos Athens General Hospital, Athens, Greece
| | - Evangelia Farmaki
- Paediatric Immunology and Rheumatology Referral Center, First Department of Paediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Paterakis
- Department of Immunology, Peripheral General Hospital Athens Giorgos Gennimatas, Athens, Greece
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14
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Chiang CT, Wu CH, Tsai YS, Lin MC, Chang KC. Subtle lung lesion in a middle-aged woman with fever and cough. J Clin Pathol 2019; 73:296. [PMID: 31371397 DOI: 10.1136/jclinpath-2019-205856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/12/2019] [Accepted: 07/29/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Chung-Ting Chiang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Chun-Hsin Wu
- Department of Internal Medicine, Division of Allergy, Immunology, and Rheumatology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Yi-Shan Tsai
- Department of Radiology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Min-Ching Lin
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
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15
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Capo-Chichi JM, Michaels P, Tremblay-Le May R, Abelson S, Hasserjian RP, Xia D. Emerging patterns in clonal haematopoiesis. J Clin Pathol 2019; 72:453-459. [PMID: 31164443 DOI: 10.1136/jclinpath-2019-205851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/31/2022]
Abstract
Clonal haematopoiesis (CH) is defined by the presence of acquired mutations and/or cytogenetic abnormalities in haematopoietic cells. By definition, these premalignant clones do not meet criteria for haematopoietic neoplasms listed in the Revised Fourth Edition of the WHO classification. CH is fairly common in elderly individuals and is associated with higher risks for haematological cancers, in particular myelodysplastic syndrome and acute myeloid leukaemia (AML), as well as cardiovascular events. Similar small clones have also been detected during follow-up in patients with AML in morphological remission, in individuals with aplastic anaemia, and in pre-chemotherapy blood samples from patients with other types of cancers. In each of these contexts, the presence of mutations carries different clinical implications, and sometimes demonstrates unique genetic profiles. Emerging research suggests that the number and identity of mutations, the size of the mutant clones and various other factors, including age, immune status and history of exogenous drugs/toxins, are important for disease biology and progression. This review focuses specifically on the subset of CH with gene mutations detected by sequencing, and includes discussions of nomenclature and molecular technologies that detect and quantify gene mutations.
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Affiliation(s)
| | - Phillip Michaels
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | | | - Sagi Abelson
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | - Daniel Xia
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
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16
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Sumarriva Lezama L, Chisholm KM, Carneal E, Nagy A, Cascio MJ, Yan J, Chang CC, Cherry A, George TI, Ohgami RS. An analysis of blastic plasmacytoid dendritic cell neoplasm with translocations involving the MYC locus identifies t(6;8)(p21;q24) as a recurrent cytogenetic abnormality. Histopathology 2018; 73:767-776. [PMID: 29884995 DOI: 10.1111/his.13668] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 04/20/2018] [Accepted: 06/06/2018] [Indexed: 12/12/2022]
Abstract
AIMS Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive neoplasm with leukaemic features and frequent skin involvement. Translocations involving the MYC locus have been recently identified as recurrent cytogenetic abnormalities in this entity. The aim of this study was to assess the clinicopathological, immunophenotypic and genetic features in MYC-rearranged BPDCN cases. METHODS AND RESULTS Pathology archives from six major institutes were queried for cases of BPDCN with 8q24 MYC translocations, and two cases were identified. A literature review identified 14 cases. Clinicopathological features, immunophenotype and cytogenetic and molecular data were reviewed. In these 16 MYC-rearranged cases, the median age at diagnosis was 70.5 years, and there was a male predominance. Whereas all cases showed marrow involvement, skin lesions (62.5%) and lymphadenopathy (50%) were variably seen. The median survival was 11 months. The median percentage of blasts in peripheral blood was 9%. All cases showed expression of CD4, with 10 of 16 being positive for CD56. HLA-DR, CD123, TCL1 and CD303 were positive in all cases tested. Cytogenetic analysis revealed a single recurrent translocation partner of MYC at 6p21 in 11 cases (69%), whereas four cases showed different MYC translocation partners (2p12, Xq24, 3p25, and 14q32). Interestingly, the group of patients with t(6;8)(p21;q24) showed an older median age at diagnosis (74 years) and a remarkably shorter median survival (3 months). CONCLUSIONS Translocations involving the 8q24 MYC locus more frequently manifest as t(6;8)(p21;q24), and, given its association with specific clinicopathological features suggesting even more aggressive behaviour, t(6;8)(p21;q24) indicate a genetically defined subgroup within BPDCN.
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Affiliation(s)
| | - Karen M Chisholm
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA
| | - Eugene Carneal
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| | - Alexandra Nagy
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| | - Michael J Cascio
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Jie Yan
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Chung-Che Chang
- Department of Pathology, Florida Hospital, University of Central Florida, Orlando, FL, USA
| | - Athena Cherry
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| | - Tracy I George
- Department of Pathology, University of New Mexico, Albuquerque, NM, USA
| | - Robert S Ohgami
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
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17
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Wang Z, Cook JR. PDCD1LG2 (PD-L2) RNA in situ hybridization is a sensitive, specific, and practical marker of primary mediastinal large B-cell lymphoma. Br J Haematol 2017; 181:564-566. [PMID: 28369778 DOI: 10.1111/bjh.14670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Zhen Wang
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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