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Stefanovic A, Matic N, Ritchie G, Lowe CF, Leung V, Hull M, Alam M, Dawar M, Champagne S, Romney MG. Multidrug-Resistant Shigella sonnei Bacteremia among Persons Experiencing Homelessness, Vancouver, British Columbia, Canada. Emerg Infect Dis 2023; 29:1668-1671. [PMID: 37486309 PMCID: PMC10370870 DOI: 10.3201/eid2908.230323] [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] [Indexed: 07/25/2023] Open
Abstract
Increased invasive bloodstream infections caused by multidrug resistant Shigella sonnei were noted in Vancouver, British Columbia, Canada, during 2021-2023. Whole-genome sequencing revealed clonal transmission of genotype 3.6.1.1.2 (CipR.MSM5) among persons experiencing homelessness. Improvements in identifying Shigella species, expanding treatment options for multidrug resistant infections, and developing public health partnerships are needed.
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Cavic M, Damjanovic A, Boljevic I, Pavlovic M, Stefanovic A, Zivic K, Vukovic M, Tanic M, Jankovic R. 953P EGFR mutation testing from pleural effusions of advanced lung adenocarcinoma patients in Serbia. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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3
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Alderuccio JP, Arcaini L, Watkins MP, Beaven AW, Shouse G, Epperla N, Spina M, Stefanovic A, Sandoval-Sus J, Torka P, Alpert AB, Olszewski AJ, Kim SH, Hess B, Gaballa S, Ayyappan S, Castillo JJ, Argnani L, Voorhees TJ, Saba R, Chowdhury SM, Vargas F, Reis IM, Kwon D, Alexander JS, Zhao W, Edwards D, Martin P, Cencini E, Kamdar M, Link BK, Logothetis CN, Herrera AF, Friedberg JW, Kahl BS, Luminari S, Zinzani PL, Lossos IS. An international analysis evaluating frontline bendamustine with rituximab in extranodal marginal zone lymphoma. Blood Adv 2022; 6:2035-2044. [PMID: 35196377 PMCID: PMC9006265 DOI: 10.1182/bloodadvances.2021006844] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/13/2022] [Indexed: 11/20/2022] Open
Abstract
Extranodal marginal zone lymphoma (EMZL) is a heterogeneous non-Hodgkin lymphoma. No consensus exists regarding the standard-of-care in patients with advanced-stage disease. Current recommendations are largely adapted from follicular lymphoma, for which bendamustine with rituximab (BR) is an established approach. We analyzed the safety and efficacy of frontline BR in EMZL using a large international consortium. We included 237 patients with a median age of 63 years (range, 21-85). Most patients presented with Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1 (n = 228; 96.2%), stage III/IV (n = 179; 75.5%), and intermediate (49.8%) or high (33.3%) Mucosa Associated Lymphoid Tissue International Prognosis Index (MALT-IPI). Patients received a median of 6 (range, 1-8) cycles of BR, and 20.3% (n = 48) received rituximab maintenance. Thirteen percent experienced infectious complications during BR therapy; herpes zoster (4%) was the most common. Overall response rate was 93.2% with 81% complete responses. Estimated 5-year progression-free survival (PFS) and overall survival (OS) were 80.5% (95% CI, 73.1% to 86%) and 89.6% (95% CI, 83.1% to 93.6%), respectively. MALT-IPI failed to predict outcomes. In the multivariable model, the presence of B symptoms was associated with shorter PFS. Rituximab maintenance was associated with longer PFS (hazard ratio = 0.16; 95% CI, 0.04-0.71; P = .016) but did not impact OS. BR is a highly effective upfront regimen in EMZL, providing durable remissions and overcoming known adverse prognosis factors. This regimen is associated with occurrence of herpes zoster; thus, prophylactic treatment may be considered.
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Affiliation(s)
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS San Mateo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Anne W. Beaven
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | | | - Michele Spina
- Medical Oncology Division, Centro Riferimento Oncologico, Aviano, Italy
| | | | - Jose Sandoval-Sus
- Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ash B. Alpert
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
| | | | - Seo-Hyun Kim
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL
| | - Brian Hess
- Hollings Cancer Center at Medical University of South Carolina, Charleston, SC
| | | | - Sabarish Ayyappan
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | | | - Lisa Argnani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli”
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Timothy J. Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Raya Saba
- Washington University in St. Louis, St. Louis, MO
| | | | - Fernando Vargas
- Moffitt Cancer Center at Memorial Healthcare System, Pembroke Pines, FL
| | | | - Deukwoo Kwon
- Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Wei Zhao
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dali Edwards
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Peter Martin
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY
| | - Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena SI, Italy
| | | | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | | | | | | | - Brad S. Kahl
- Washington University in St. Louis, St. Louis, MO
| | - Stefano Luminari
- CHIMOMO Department University of Modena and Reggio Emilia, Reggio Emilia, Italy; and
- Department of Hematology, Azienda USL IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli”
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
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4
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Go RS, Jacobsen E, Baiocchi R, Buhtoiarov I, Butler EB, Campbell PK, Coulter DW, Diamond E, Flagg A, Goodman AM, Goyal G, Gratzinger D, Hendrie PC, Higman M, Hogarty MD, Janku F, Karmali R, Morgan D, Raldow AC, Stefanovic A, Tantravahi SK, Walkovich K, Zhang L, Bergman MA, Darlow SD. Histiocytic Neoplasms, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:1277-1303. [PMID: 34781268 DOI: 10.6004/jnccn.2021.0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Histiocytic neoplasms are rare hematologic disorders accounting for less than 1% of cancers of the soft tissue and lymph nodes. Clinical presentation and prognosis of these disorders can be highly variable, leading to challenges for diagnosis and optimal management of these patients. Treatment often consists of systemic therapy, and recent studies support use of targeted therapies for patients with these disorders. Observation ("watch and wait") may be sufficient for select patients with mild disease. These NCCN Guidelines for Histiocytic Neoplasms include recommendations for diagnosis and treatment of adults with the most common histiocytic disorders: Langerhans cell histiocytosis, Erdheim-Chester disease, and Rosai-Dorfman disease.
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Affiliation(s)
| | - Eric Jacobsen
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Robert Baiocchi
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Ilia Buhtoiarov
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Cleveland Clinic Children's Hospital
| | | | - Patrick K Campbell
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Aron Flagg
- Yale Cancer Center/Smilow Cancer Hospital
| | | | | | | | - Paul C Hendrie
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Filip Janku
- The University of Texas MD Anderson Cancer Center
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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Wonnaparhown A, Stefanovic A, Lugar P, Hostetler HP. Acquired angioedema in B cell lymphoproliferative disease: A retrospective case series. Clin Exp Immunol 2021; 206:378-383. [PMID: 34586637 DOI: 10.1111/cei.13667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023] Open
Abstract
Acquired angioedema due to C1-inhibitor (C1-INH) deficiency (AAE-C1-INH) is rare and is associated with underlying lymphoproliferative diseases. C1-INH deficiency may be due to neoplastic over-consumption of C1-INH and the generation of anti-C1-INH autoantibodies. Uncovering an occult malignancy can lead to earlier oncology referral and improvement of angioedema after treatment of the underlying lymphoproliferative disorder. We characterized seven patients with C1-INH-AAE that highlights the importance of recognizing the association between C1-INH-AAE and underlying malignancy. In acute attacks, patients may be resistant to C1-INH therapy due to the presence of anti-C1-INH autoantibodies or rapid complement consumption, and may respond better to icatibant or ecallantide, which directly affect bradykinin. Treatment of the underlying malignancy also improves AAE-C1-INH symptoms and supports the role of lymphoproliferative B cells in AAE-C1-INH pathophysiology. Monitoring levels of C4, C1-INH function and level, and C1q may be predictive of AAE-C1-INH control and be used as surrogates for treatment efficacy. With close monitoring, low-dose danazol can be effective for long-term prophylaxis. Annual evaluation in AAE-C1-INH is recommended if an underlying malignancy is not found, as angioedema may precede the development of malignancy by several years. Our single-center study has aided in standardization of comprehensive AAE-C1-INH diagnosis, treatment, and monitoring strategies towards future therapeutic clinical trials.
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Affiliation(s)
- Alex Wonnaparhown
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Alexandra Stefanovic
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina, USA
| | - Patricia Lugar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Haley P Hostetler
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
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6
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Zeljkovic A, Mihajlovic M, Stefanovic A, Zeljkovic D, Trifunovic B, Miljkovic M, Spasojevic-Kalimanovska V, Vekic J. Potential use of serum insulin-like growth factor 1 and E-cadherin as biomarkers of colorectal cancer. Colorectal Dis 2020; 22:2078-2086. [PMID: 32929869 DOI: 10.1111/codi.15360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 03/08/2020] [Accepted: 05/26/2020] [Indexed: 01/15/2023]
Abstract
AIM Despite many efforts, reliable biomarkers for the prediction and diagnosis of colorectal cancer (CRC) are still missing. Insulin-like growth factor 1 (IGF-1) and E-cadherin are recognized as potential biomarkers, but their diagnostic capacity is largely unexplored in CRC. The aim of this work is to investigate IGF-1 and E-cadherin levels with respect to various characteristics of CRC and to estimate their diagnostic potential. METHOD Seventy CRC patients and 75 healthy individuals were enrolled. IGF-1 and E-cadherin were determined using enzyme-linked immunosorbent assay. The predictive and diagnostic capacities of IGF-1 and E-cadherin were estimated by logistic regression analysis and by determination of the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS Concentrations of IGF-1 were lower (P = 0.019) while levels of E-cadherin were higher (P < 0.001) in CRC patients than in controls. IGF-1 concentration decreased in parallel with age and progression of CRC (P = 0.023). Also, IGF-1 was higher in men with CRC than in women (P = 0.003). E-cadherin levels were unaffected by variations in either anthropometric characteristics of CRC patients, or localization, grade and stage of the tumour. Both IGF-1 and E-cadherin were independently associated with CRC (P = 0.040; P < 0.001, respectively). The diagnostic accuracy of IGF-1 was estimated as acceptable (AUC = 0.757; P < 0.001), while the diagnostic accuracy of E-cadherin was outstanding (AUC = 0.954; P < 0.001). CONCLUSIONS Decreased IGF-1 and increased E-cadherin levels were found in CRC patients. IGF-1, but not E-cadherin, concentrations differed according to age, gender and stage of CRC. Both markers were independently associated with the presence of the disease, while E-cadherin demonstrated high diagnostic accuracy.
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Affiliation(s)
- A Zeljkovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - M Mihajlovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - A Stefanovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - D Zeljkovic
- Clinic of General Surgery, Military Medical Academy, Belgrade, Serbia
| | - B Trifunovic
- Clinic of General Surgery, Military Medical Academy, Belgrade, Serbia.,Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | - M Miljkovic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | - J Vekic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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7
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Cirkovic A, Garovic V, Milin Lazovic J, Milicevic O, Savic M, Rajovic N, Aleksic N, Weissgerber T, Stefanovic A, Stanisavljevic D, Milic N. Systematic review supports the role of DNA methylation in the pathophysiology of preeclampsia: a call for analytical and methodological standardization. Biol Sex Differ 2020; 11:36. [PMID: 32631423 PMCID: PMC7336649 DOI: 10.1186/s13293-020-00313-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/11/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Studies have recently examined the role of epigenetic mechanisms in preeclampsia pathophysiology. One commonly examined epigenetic process is DNA methylation. This heritable epigenetic marker is involved in many important cellular functions. The aim of this study was to establish the association between DNA methylation and preeclampsia and to critically appraise the roles of major study characteristics that can significantly impact the association between DNA methylation and preeclampsia. MAIN BODY A systematic review was performed by searching PubMed, Web of Science, and EMBASE for original research articles published over time, until May 31, 2019 in English. Eligible studies compared DNA methylation levels in pregnant women with vs. without preeclampsia. Ninety articles were included. Epigenome-wide studies identified hundreds of differentially methylated places/regions in preeclamptic patients. Hypomethylation was the predominant finding in studies analyzing placental tissue (14/19), while hypermethylation was detected in three studies that analyzed maternal white blood cells (3/3). In candidate gene studies, methylation alterations for a number of genes were found to be associated with preeclampsia. A greater number of differentially methylated genes was found when analyzing more severe preeclampsia (70/82), compared to studies analyzing less severe preeclampsia vs. controls (13/27). A high degree of heterogeneity existed among the studies in terms of methodological study characteristics including design (study design, definition of preeclampsia, control group, sample size, confounders), implementation (biological sample, DNA methylation method, purification of DNA extraction, and validation of methylation), analysis (analytical method, batch effect, genotyping, and gene expression), and data presentation (methylation quantification measure, measure of variability, reporting). Based on the results of this review, we provide recommendations for study design and analytical approach for further studies. CONCLUSIONS The findings from this review support the role of DNA methylation in the pathophysiology of preeclampsia. Establishing field-wide methodological and analytical standards may increase value and reduce waste, allowing researchers to gain additional insights into the role of DNA methylation in the pathophysiology of preeclampsia.
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Affiliation(s)
- A Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Garovic
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - J Milin Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - O Milicevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Savic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Aleksic
- Center for Molecular Biology, University of Vienna, Vienna, Austria
| | - T Weissgerber
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Charité - Universitätsmedizin Berlin, Berlin Institute of Health, QUEST Center, Berlin, Germany
| | - A Stefanovic
- Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
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8
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Sung AD, Jauhari S, Siamakpour‐Reihani S, Rao AV, Staats J, Chan C, Meyer E, Gadi VK, Nixon AB, Lyu J, Xie J, Bohannon L, Li Z, Hourigan CS, Dillon LW, Wong HY, Shelby R, Diehl L, Castro C, LeBlanc T, Brander D, Erba H, Galal A, Stefanovic A, Chao N, Rizzieri DA. Microtransplantation in older patients with AML: A pilot study of safety, efficacy and immunologic effects. Am J Hematol 2020; 95:662-671. [PMID: 32162718 DOI: 10.1002/ajh.25781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/24/2022]
Abstract
Older AML patients have low remission rates and poor survival outcomes with standard chemotherapy. Microtransplantation (MST) refers to infusion of allogeneic hematopoietic stem cells without substantial engraftment. MST has been shown to improve clinical outcomes compared with chemotherapy alone. This is the first trial reporting on broad correlative studies to define immunologic mechanisms of action of MST in older AML patients. Older patients with newly diagnosed AML were eligible for enrollment, receiving induction chemotherapy with cytarabine (100 mg/m2) on days 1-7 and idarubicin (12 mg/m2) on days 1-3 (7 + 3). MST was administered 24 hours later. Patients with complete response (CR) were eligible for consolidation with high dose cytarabine (HiDAC) and a second cycle of MST. Responses were evaluated according to standard criteria per NCCN. Immune correlative studies were performed. Sixteen patients were enrolled and received 7 + 3 and MST (median age 73 years). Nine (56%) had high-risk and seven (44%) had standard-risk cytogenetics. Ten episodes of CRS were observed. No cases of GVHD or treatment-related mortality were reported. Event-free survival (EFS) was 50% at 6 months and 19% at 1 year. Overall survival (OS) was 63% at 6 months and 44% at 1 year. Donor microchimerism was not detected. Longitudinal changes were noted in NGS, TCR sequencing, and cytokine assays. Addition of MST to induction and consolidation chemotherapy was well tolerated in older AML patients. Inferior survival outcomes in our study may be attributed to a higher proportion of very elderly patients with high-risk features. Potential immunologic mechanisms of activity of MST include attenuation of inflammatory cytokines and emergence of tumor-specific T cell clones.
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Affiliation(s)
- Anthony D. Sung
- Duke University School of Medicine Durham North Carolina USA
| | - Shekeab Jauhari
- Duke University School of Medicine Durham North Carolina USA
| | | | | | - Janet Staats
- Duke University School of Medicine Durham North Carolina USA
| | - Cliburn Chan
- Duke University School of Medicine Durham North Carolina USA
| | - Everett Meyer
- Stanford University Medical School Palo Alto California USA
| | | | - Andrew B. Nixon
- Duke University School of Medicine Durham North Carolina USA
| | - Jing Lyu
- Duke University School of Medicine Durham North Carolina USA
| | - Jichun Xie
- Duke University School of Medicine Durham North Carolina USA
| | - Lauren Bohannon
- Duke University School of Medicine Durham North Carolina USA
| | - Zhiguo Li
- Duke University School of Medicine Durham North Carolina USA
| | - Christopher S. Hourigan
- Laboratory of Myeloid MalignanciesHematology Branch, National Heart, Lung and Blood Institute Bethesda Maryland USA
| | - Laura W. Dillon
- Laboratory of Myeloid MalignanciesHematology Branch, National Heart, Lung and Blood Institute Bethesda Maryland USA
| | - Hong Yuen Wong
- Laboratory of Myeloid MalignanciesHematology Branch, National Heart, Lung and Blood Institute Bethesda Maryland USA
| | - Rebecca Shelby
- Duke University School of Medicine Durham North Carolina USA
| | - Louis Diehl
- Duke University School of Medicine Durham North Carolina USA
| | - Carlos Castro
- Duke University School of Medicine Durham North Carolina USA
| | - Thomas LeBlanc
- Duke University School of Medicine Durham North Carolina USA
| | | | - Harry Erba
- Duke University School of Medicine Durham North Carolina USA
| | - Ahmed Galal
- Duke University School of Medicine Durham North Carolina USA
| | | | - Nelson Chao
- Duke University School of Medicine Durham North Carolina USA
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Saul EE, Desai A, Chapman J, Lekakis LJ, Stefanovic A, Pimentel A. Adult lymphoma-associated hemophagocytic lymphohistiocytosis: A clinical case series in a predominantly Hispanic cohort from the University of Miami/Jackson Memorial Hospital. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20060 Background: Hemophagocytic Lymphohistiocytosis (HLH) is a systemic inflammation disorder secondary to immune dysregulation. Patients may present with fevers, splenomegaly, bone marrow failure, and hemophagocytosis, among other clinical and laboratory findings. Lymphoma Associated HLH (LA-HLH) is a puzzling diagnosis given both conditions overlapping presentation. There are currently no established treatment guidelines for LA-HLH. Methods: We conducted a retrospective search of the tumor registry and pathology database at the University of Miami/Jackson Memorial Hospital to identify adult patients with the combined diagnosis of Lymphoma and HLH between January 2008 and July 2018. Results: Data from nine LA-HLH patients were identified and reviewed. Median age was 53 years (range 19-73), with 78% of cases of Hispanic origin. Lymphoma subtypes consisted of six T-cell/NK-cell neoplasms - 2 Peripheral T-cell Lymphomas (PTCL), NOS; 2 EBV+ Extranodal NK/T-Cell Lymphomas; 1 EBV+, CD8+, PTCL, NOS; 1 EBV+, Post-Transplant Lymphoproliferative Disorder-Anaplastic Large Cell Lymphoma, ALK negative (PTLD ALCL ALK-); and three B-cell neoplasms - 1 EBV+ DLBCL; 2 DLBCL, NOS. HLH and Lymphoma were diagnosed simultaneously in 6/9 cases. Hemophagocytosis phenomena was demonstrated in 7/9 cases. Treatment consisted of combined HLH and Lymphoma therapies in 4 cases, while Lymphoma directed therapy was applied to four patients; another case was treated with a modified version of the HLH-1994 protocol. Overall, a total of five cases were exposed to HLH-directed regimens (HLH-1994/2004). Three patients had refractory LA-HLH and entered hospice care, whereas another 3 cases succumbed to treatment-related complications. Of the seven cases that were evaluable for Lymphoma response, four cases (57%) achieved CR, and three of them (43%) were alive with no evidence of recurrence at 10, 16, and 52 months as of last contact. Conclusions: Herein, we describe our unique experience of an LA-HLH case series in a predominantly Hispanic population in South Florida. The diagnosis is challenging, often delayed, and the prognosis is dismal in refractory cases despite currently available rescue therapies. Furthermore, we describe for the first time the association between HLH and PTLD ALCL.
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Affiliation(s)
- Eduardo Edelman Saul
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL
| | - Amrita Desai
- Department of Hematology-Oncology, OHSU Knight Cancer Institute, Oregon Health Sciences University, Oregon, OR
| | - Jennifer Chapman
- Department of Pathology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Alexandra Stefanovic
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Agustin Pimentel
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
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10
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Lee JW, Prosnitz LR, Stefanovic A, Kelsey CR. Are Higher Doses of Consolidation Radiation Therapy Necessary in Diffuse Large B-cell Lymphoma Involving Osseous Sites? Adv Radiat Oncol 2019; 4:507-512. [PMID: 31360807 PMCID: PMC6639737 DOI: 10.1016/j.adro.2019.03.010] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/22/2019] [Accepted: 03/20/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to evaluate whether higher doses of consolidation radiation therapy (RT), which have been traditionally recommended for osseous sites in diffuse large B-cell lymphoma (DLBCL), are still necessary. Methods and materials Patients with DLBCL with osseous involvement treated with first-line chemotherapy followed by consolidation RT between 1995 and 2016 were reviewed. The primary endpoint was 5-year freedom from local recurrence, estimated using the Kaplan-Meier method. Outcomes based on the RT dose received were also assessed. Results A total of 51 patients were identified. The most common chemotherapy regimens were rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (80%) and cyclophosphamide, doxorubicin, vincristine, and prednisone (12%) with a median of 6 cycles (range, 3-8 cycles). After chemotherapy, 82% of patients achieved a complete response (CR), and 18% achieved a partial response (PR). All patients in PR were deemed appropriate for consolidation RT. The median dose was 29 Gy (24 Gy for CR; 36 Gy for PR). After a median follow-up of 86 months, 8 patients relapsed, with 2 relapses in the RT field after consolidation RT of 30 and 39.6 Gy, respectively. Overall, the 5-year freedom from local recurrence was 96% (95% confidence interval [CI], 91%-100%), disease-free survival was 76% (95% CI, 65%-89%), and overall survival was 86% (95% CI, 76%-96%). No dose-response relationship was observed. Conclusions In patients with DLBCL with osseous involvement who achieved a CR after first-line chemotherapy, 20 to 30 Gy of consolidation RT led to high rates of local control. Higher doses should be reserved for patients in PR.
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Affiliation(s)
- Jessica W. Lee
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
- Corresponding author. Department of Radiation Oncology, DUMC 3085, Durham, NC 27710.
| | - Leonard R. Prosnitz
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Alexandra Stefanovic
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Chris R. Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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Vekic J, Bogavac-Stanojevic N, Kacarevic D, Bojanin D, Mihajlovic M, Stefanovic A, Kotur-Stevuljevic J, Milenkovic T, Vukovic R, Todorovic S, Mitrovic K, Spasojevic-Kalimanovska V. Factor analysis of variables associated with oxidative stress status in paediatric patients with type 1 diabetes mellitus. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Bogavac-Stanojevic N, Stevanovic M, Zeljkovic A, Vekic J, Stefanovic A, Miljkovic M, Stjepanović Ž, Zeljkovic D, Trifunovic B, Janac J, Spasojevic-Kalimanovska V. Predictors of high molecular weight adiponectin in patients with colorectal cancer. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Ardalic D, Stefanovic A, Banjac G, Cabunac P, Kalimanovska V, Mikovic Z. Biomarkers of oxidative stress in the first trimester of high-risk pregnancy. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Kelly KR, Friedberg JW, Park SI, McDonagh K, Hayslip J, Persky D, Ruan J, Puvvada S, Rosen P, Iyer SP, Stefanovic A, Bernstein SH, Weitman S, Karnad A, Monohan G, VanderWalde A, Mena R, Schmelz M, Spier C, Groshen S, Venkatakrishnan K, Zhou X, Sheldon-Waniga E, Leonard EJ, Mahadevan D. Phase I Study of the Investigational Aurora A Kinase Inhibitor Alisertib plus Rituximab or Rituximab/Vincristine in Relapsed/Refractory Aggressive B-cell Lymphoma. Clin Cancer Res 2018; 24:6150-6159. [PMID: 30082475 DOI: 10.1158/1078-0432.ccr-18-0286] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/08/2018] [Accepted: 07/31/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The aurora A kinase inhibitor alisertib demonstrated single-agent clinical activity and preclinical synergy with vincristine/rituximab in B-cell non-Hodgkin lymphoma (B-NHL). This phase I study aimed to determine the safety and recommended phase II dose (RP2D) of alisertib in combination with rituximab ± vincristine in patients with relapsed/refractory aggressive B-NHL. PATIENTS AND METHODS Patients with relapsed/refractory, diffuse, large, or other aggressive B-NHL received oral alisertib 50 mg b.i.d. days 1 to 7, plus i.v. rituximab 375 mg/m2 on day 1, for up to eight 21-day cycles (MR). Patients in subsequent cohorts (3 + 3 design) received increasing doses of alisertib (30 mg starting dose; 10 mg increments) b.i.d. days 1 to 7 plus rituximab and vincristine [1.4 mg/m2 (maximum 2 mg) days 1, 8] for 8 cycles (MRV). Patients benefiting could continue single-agent alisertib beyond 8 cycles. Cell-of-origin and MYC/BCL2 IHC was performed on available archival tissue. RESULTS Forty-five patients participated. The alisertib RP2D for MR was 50 mg b.i.d. For MRV (n = 32), the RP2D was determined as 40 mg b.i.d. [1 dose-limiting toxicity (DLT) at 40 mg; 2 DLTs at 50 mg]. Drug-related adverse events were reported in 89% of patients, the most common was neutropenia (47%). Seven patients had complete responses (CR), 7 had partial responses (PRs); 9 of 20 (45%) patients at the MRV RP2D responded (4 CRs, 5 PRs), all with non-germinal center B-cell (GCB) diffuse large B-cell lymphoma (DLBCL). CONCLUSIONS The combination of alisertib 50 mg b.i.d. plus rituximab or alisertib 40 mg b.i.d. plus rituximab and vincristine was well tolerated and demonstrated activity in non-GCB DLBCL.
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Affiliation(s)
- Kevin R Kelly
- USC Norris Comprehensive Cancer Center, Los Angeles, California (previously University of Texas Health Science Center at San Antonio, San Antonio, Texas).
| | | | - Steven I Park
- Levine Cancer Institute and Carolinas Healthcare System, Charlotte, North Carolina
| | - Kevin McDonagh
- Vanderbilt University, Nashville, Tennessee (previously University of Kentucky Markey Cancer Center, Lexington, Kentucky)
| | - John Hayslip
- University of Kentucky Markey Cancer Center, Lexington, Kentucky
| | | | - Jia Ruan
- Weill Cornell Medical College, New York, New York
| | | | - Peter Rosen
- Providence St Joseph Medical Center, Disney Family Cancer Center, Burbank, California
| | | | - Alexandra Stefanovic
- University of Miami Miller School of Medicine, Sylvester Cancer Center, Miami, Florida
| | | | - Steven Weitman
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anand Karnad
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Gregory Monohan
- University of Kentucky Markey Cancer Center, Lexington, Kentucky
| | - Ari VanderWalde
- University of Tennessee Health Science Center and West Clinic, Memphis, Tennessee
| | - Raul Mena
- Providence St Joseph Medical Center, Disney Family Cancer Center, Burbank, California
| | - Monika Schmelz
- Department of Pathology, College of Medicine, University of Arizona, Tucson, Arizona
| | - Catherine Spier
- Department of Pathology, College of Medicine, University of Arizona, Tucson, Arizona
| | - Susan Groshen
- USC Norris Comprehensive Cancer Center, Los Angeles, California (previously University of Texas Health Science Center at San Antonio, San Antonio, Texas)
| | - Karthik Venkatakrishnan
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Xiaofei Zhou
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Emily Sheldon-Waniga
- Bluebird Bio, Cambridge, Massachusetts (previously Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)
| | - E Jane Leonard
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
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Alderuccio JP, Stefanovic A, Dammrich D, Chapman JR, Vega F, Selvaggi G, Tzakis A, Lossos IS. Decreased survival in hepatitis C patients with monomorphic post-transplant lymphoproliferative disorder after liver transplantation treated with frontline immunochemotherapy. Leuk Lymphoma 2017; 59:2096-2104. [PMID: 29252057 DOI: 10.1080/10428194.2017.1413187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) develops in 1-3% of liver transplant recipients and no consensus exists about therapeutic management. From 2006 to 2016, 1489 liver transplants were performed at our institution with 20 patients (incidence 1.3%) developing PTLD. Hepatitis C virus (HCV) was the leading cause (n = 10) of liver transplant in PTLD patients. Diffuse large B-cell lymphoma was the most frequent histologic subtype (n = 17), and we report our experience in the management of these patients. Patients were treated with frontline immunochemotherapy without immunosuppression reduction. All evaluable patients achieved a complete remission. Statistically significant decreased survival was identified in HCV-positive patients. Six patients (60%) exhibited increases in HCV RNA levels during therapy. Four patients (40%) developed graft failure and three of them (30%) died from liver dysfunction. This is the first study providing evidence of decreased survival in HCV-positive PTLD patients after liver transplant receiving immunochemotherapy.
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Affiliation(s)
- Juan Pablo Alderuccio
- a Department of Medicine, Division of Hematology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Alexandra Stefanovic
- a Department of Medicine, Division of Hematology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Daniel Dammrich
- a Department of Medicine, Division of Hematology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Jennifer R Chapman
- b Department of Pathology and Laboratory Medicine, Division of Hematopathology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Francisco Vega
- b Department of Pathology and Laboratory Medicine, Division of Hematopathology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Gennaro Selvaggi
- c Department of Surgery, Division of Transplantation , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Andreas Tzakis
- c Department of Surgery, Division of Transplantation , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Izidore S Lossos
- a Department of Medicine, Division of Hematology , University of Miami Miller School of Medicine , Miami , FL , USA.,d Department of Molecular and Cellular Pharmacology , University of Miami Miller School of Medicine , Miami , FL , USA.,e Sylvester Comprehensive Cancer Center , Miami , FL , USA
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Dejman A, Alavi SN, Thomas DB, Stefanovic A, Asif A, Nayer A. The potential role of complements in cocaine-induced thrombotic microangiopathy. Clin Kidney J 2017; 11:26-28. [PMID: 29423197 PMCID: PMC5798089 DOI: 10.1093/ckj/sfx061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 05/18/2017] [Indexed: 11/13/2022] Open
Abstract
Thrombotic microangiopathy (TMA) is a rare disorder characterized by microvascular injury and occlusion resulting in tissue ischemia and dysfunction. TMA occurs in a variety of settings including cocaine use. Although cocaine is widely used in the United States, cocaine-associated TMA is only rarely reported. Therefore, other factors may predispose cocaine users to the development of TMA. Emerging evidence indicates that cocaine activates complements. Therefore, complement activation may contribute to the development of cocaine-induced TMA. Here, we report a cocaine user who presented with renal failure. Renal biopsy demonstrated TMA. Laboratory tests revealed reduced serum complement C3 and normal complement C4 levels indicative of alternative complement activation. We postulate that complement activation is involved in the pathogenesis of cocaine-induced TMA.
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Affiliation(s)
- Adriana Dejman
- Division of Nephrology and Hypertension University of Miami, Miami, FL, USA
| | - Seyed Navid Alavi
- Division of Nephrology and Hypertension University of Miami, Miami, FL, USA
| | - David B Thomas
- Department of Pathology University of Miami, Miami, FL, USA
| | | | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Meridian Health, Neptune, NJ, USA
| | - Ali Nayer
- Miami Renal Institute, Miami, FL, USA
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Miljkovic M, Kotur-Stevuljevic J, Stefanovic A, Vekic J, Zeljkovic A, Gojkovic T, Simic-Ogrizovic S, Spasojevic-Kalimanovska V, Jelic-Ivanovic Z. Renal disease is associated with modified PON1 distribution at HDL subclasses. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Kadija S, Stefanovic A, Jeremic K, Radojevic M, Cerovic-Popovic R, Srbinovic M, Likic-Ladjevic I. Successful conservative treatment of a cervical ectopic pregnancy at 13 weeks. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog2092.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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19
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Ladjevic IL, Stefanovic A, Kadija S, Terzic M, Jeremic K, Janjic T. Vagina as a rare location of renal cell carcinoma metastasis. EUR J GYNAECOL ONCOL 2016; 37:434-435. [PMID: 27352582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Metastatic renal cell carcinoma is often found in distant organs, including lung, bone, brain, and liver. Metastases to the vagina are extremely rare. CASE REPORT The authors present a case of renal cell carcinoma metastasis to the anterior vaginal wall four months after nephrectomy in a 56-year-old patient. The vaginal lesions were excised. After two years the patient had no signs of recurrence or the disease progression. CONCLUSION Vaginal metastases should be considered in differential diagnosis of female renal cell carcinoma patients presenting with vaginal bleeding of mass.
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Kadija S, Stefanovic A, Jeremic K, Radojevic M, Cerovic-Popovic R, Srbinovic M, Likic-Ladjevic I. Successful conservative treatment of a cervical ectopic pregnancy at 13 weeks. CLIN EXP OBSTET GYN 2016; 43:291-293. [PMID: 27132433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cervical ectopic pregnancy is a potentially life-threatening condition due to the unexpected occurrence of uncontrollable bleeding from the cervix. CASE REPORT A 39-year-old secundigravida was admitted with amenorrhea of 12 weeks and four days due to suspected cervical pregnancy, without bleeding. The ultrasonography revealed a gestational sac at the anterior wall of the isthmic-cervical part with a single viable fetus, with crown-rump length (CRL) of 59 mm and regular heart rate. The serum β-human chorionic gonadotropin (β-hCG) level on admission was 143.416 mIU/l. Two possible therapeutic options were considered, (1) systemic methotrexate treatment and (2) uterine artery embolization with gelatine sponge. The first was rejected due to gestational age, viable fetus, high β-hCG level, and CRL, and the later was rejected by the vascular surgeons due to lack of experience. The curettage was performed. After the evacuation, prostin was administered into cervix accompanied with tamponade. On the next day β-hCG level was 44.342 mIU/l and the following day ultrasonography revealed the oval non-homogenous formation in the cervical cavity (blood clots or residual trophoblastic tissue); β-hCG level was 36.501 mIU/l. The reintervention was performed on the fifth day after the curettage and 200 ml of coagulated blood was aspirated; β-hCG level was 16.432 mlU/l. Since the isthmic-cervical part was slightly dilated (23 mm) seven days after the curettage, systemic methotrexate treatment (100 mg intramuscular) was initiated. Serum β-hCG level on the second and fourth day after methotrexate were 12.553 mIU/l and 8.900 mIU/l, respectively. The second dose of 100 mg of methotrexate was administered intramuscular seven days after the first dose. Three days after, β-hCG level was 2.329 U/l and ultrasound scan revealed normal isthmic-cervical finding. CONCLUSION The present case report showed efficient fertility sparing conservative treatment, dilatation and curettage, of 13 week cervical pregnancy followed by systemic methotrexate.
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Pantovic S, Kadija S, Dotlic J, Stojnic J, Jeremic K, Sparic R, Stefanovic A. Treatment of pregnant patient with disseminated intravascular coagulation (DIC) due to placental abruption – a case report. CLIN EXP OBSTET GYN 2015. [DOI: 10.12891/ceog1891.2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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22
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Miljkovic M, Kotur-Stevuljevic J, Stefanovic A, Zeljkovic A, Vekic J, Gojkovic T, Bogavac- Stanojevic N, Nikolic M, Simic-Ogrizovic S, Spasojevic-Kalimanovska V, Jelic-Ivanovic Z. Potential markers in the assessment of risk for development of atherosclerosis in patients with chronic renal disease. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Hosein PJ, Sandoval-Sus JD, Goodman D, Arteaga AG, Reis I, Hoffman J, Stefanovic A, Rosenblatt JD, Lossos IS. Updated survival analysis of two sequential prospective trials of R-MACLO-IVAM followed by maintenance for newly diagnosed mantle cell lymphoma. Am J Hematol 2015; 90:E111-6. [PMID: 25737247 DOI: 10.1002/ajh.23996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/06/2015] [Accepted: 02/27/2015] [Indexed: 11/11/2022]
Abstract
A phase II trial of R-MACLO-IVAM followed by thalidomide maintenance for mantle cell lymphoma (MCL) demonstrated promising progression-free survival (PFS) and overall survival (OS) rates. Thalidomide maintenance was associated with significant toxicity and was subsequently modified to rituximab maintenance. Herein, we present updated results and follow-up. Two sequential phase II trials included chemotherapy-naïve patients with MCL up to 75 years old. Four cycles of R-MACLO-IVAM chemotherapy were delivered as previously described. Patients who achieved complete responses (CR) were eligible for thalidomide or rituximab maintenance therapy. Among 36 patients enrolled, the MCL International Prognostic Index (MIPI) was low in 53%, intermediate in 36% and high in 11%. Thirty-five patients completed at least 2 cycles of chemotherapy; 34 (94%) achieved a CR. After a median follow-up of 74.4 months, the 5-year PFS was 51% (95% CI 33-68%) and the 5-year OS was 85% (95% CI 73-97%). Two deaths occurred during the chemotherapy phase due to disease progression and neutropenic sepsis, respectively. One patient developed secondary acute myeloid leukemia after 7 years. R-MACLO-IVAM chemotherapy is effective for patients with newly diagnosed MCL.
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Affiliation(s)
- Peter J. Hosein
- Department of Medicine; Markey Cancer Center; University of Kentucky; Lexington Kentucky
- Division of Medical Oncology, Markey Cancer Center; University of Kentucky; Lexington Kentucky
| | - Jose D. Sandoval-Sus
- Division of Hematological Malignancies; H. Lee Moffitt Cancer Center; Tampa Florida
| | - Deborah Goodman
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Alexandra Gomez Arteaga
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Isildinha Reis
- Department of Public Health Sciences; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Biostatistics, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - James Hoffman
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Alexandra Stefanovic
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Joseph D. Rosenblatt
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Izidore S. Lossos
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Department of Molecular and Cellular Pharmacology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
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Pantovic S, Kadija S, Dotlic J, Stojnic J, Jeremic K, Sparic R, Stefanovic A. Treatment of pregnant patient with disseminated intravascular coagulation (DIC) due to placental abruption--a case report. CLIN EXP OBSTET GYN 2015; 42:692-695. [PMID: 26524829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A primigravid woman at 29th gestational week with placental abruption causing fetal death, that underwent instant cesarean section, developed a disseminated intravascular coagulation (DIC), revealed by hemoperitoneum and hematoma of the abdominal wall. After re-laparotomy and transfusion of blood, fresh plasma, and platelets, the patient was discharged from hospital on the 14th postoperative day completely recovered. To conclude, conservative surgical approach for DIC treatment is possible and safe. Novel antifibrinolitic drugs are recommended for obstetrical patients with DIC to enable a healthy subsequent pregnancy.
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Pantovic S, Stefanovic A, Stojnic J, Jeremic K, Sparic R, Kadija S, Milenkovic S. Spindle-cell epithelioma of the vagina diagnosed during pregnancy--a case report. EUR J GYNAECOL ONCOL 2015; 36:223-225. [PMID: 26050367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Spindle-cell epithelioma or "mixed tumor" of the vagina is an unusual and intriguing vaginal tumor consisting of both epithelial and mesenchymal components. A case of spindle-cell epithelioma of the vagina diagnosed at delivery of a 31-year-old primiparous woman is described. The excision of the mass was performed immediately after the delivery, which was uneventful. The patient was regularly followed up and no evidence of local recurrence or dissemination was found 40 months after surgery. The presentation and the diagnosis of this kind of tumor in pregnancy, and its effect on the pregnancy and delivery are still largely unknown. Since it is unlikely that any institution will have a large number of patients with this rare disease, case reports add further information to this entity. As the number of cases studied is small, close follow-up is recommended although there has been no report in the literature of metastasis so far.
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Lossos IS, Fabregas JC, Koru-Sengul T, Miao F, Goodman D, Serafini AN, Hosein PJ, Stefanovic A, Rosenblatt JD, Hoffman JE. Phase II study of90Y Ibritumomab tiuxetan (Zevalin) in patients with previously untreated marginal zone lymphoma. Leuk Lymphoma 2014; 56:1750-5. [DOI: 10.3109/10428194.2014.975801] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Stojanov M, Stefanovic A, Ivanisevic J. Do gender differences exist in total untioxidant capacity in young population? Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stefanovic A, Jeremic K, Kadija S, Mitrovic M, Filimonovic D, Jankovic-Raznatovic S, Tavcar J. Uterine tumor resembling ovarian sex cord tumor. Case report and review of literature. EUR J GYNAECOL ONCOL 2013; 34:275-277. [PMID: 23967565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A uterine tumor resembling an ovarian sex cord tumor (UTROSCT) shows a poly phenotypic immunophenotype with coexpression of epithelial, myoid, and sex cord markers, as well as hormone receptors. The authors present a case of a 59-year-old multiparous woman admitted to the Institute of Gynecology and Obstetrics Clinical Centre of Serbia in January 2010 due to prolonged vaginal bleeding and abdominal discomfort. The vaginal ultrasound showed an enlarged uterus size of 100 x 74 x 81 mm, with extended cavity with an unhomogenic content and myomas sized 54 x 69 mm located in fundus with secondary changes. She underwent abdominal hysterectomy with adnexectomy. Microscopic examination revealed submucosal uterine tumor with variabile histological organization that had anastomotic trabeculae with solid cellular grupations. Rare mitotic figures (2/10 HPF) were found. Additional imunohistochemistry showed immunophenotype: the sex cord areas were positive for vimentin(++), aSMA(++), AE1/AE3(+), PR(+), and ER(+). The poly phenotypic immunophenotype can be useful in differential diagnosis from other neoplasms but also suggests an origin of UTROSCT from uncommitted stem cell enabling for multidirectional differentiation.
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Affiliation(s)
- A Stefanovic
- Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Medical School University of Belgrade, Belgrade, Serbia.
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Jeremic K, Stefanovic A, Ljubic A, Miljic P, Stojnic J, Kastratovic B, Arsenijevic LJ. Multiorgan thrombotic disorder in a young patient with primary antiphospholipid syndrome (APS) and ovarian tumor. EUR J GYNAECOL ONCOL 2013; 34:273-274. [PMID: 23967564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening condition with high mortality rate besides aggressive multimodal treatment. Underlying triggers of "thrombotic and cytokine storm" include pregnancy, inflammation, trauma, surgery, and infection. The authors present a case of a young female patient with primary antiphospholipid syndrome (APS) who was admitted to the hospital due to abdominal pain caused by ovarian tumor with elevated tumor markers. After the prophylactic anticoagulants and antibiotic treatment, surgery was performed. Suddenly after treatment, her clinical status deteriorated and she died regardless of intensive immunosupresive and anticoagulant therapy attempts. This condition requires all clinical awareness, timely diagnosis, and therapeutical approach, including a better understanding of the pathophysiology that leads to CAPS.
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Affiliation(s)
- K Jeremic
- Clinic of Gynecology and Obstetrics , Clinical Centre of Serbia, Medical School University of Belgrade, Serbia.
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Stefanovic A, Jeremic K, Kadija S, Gojnic M, Stojnic J, Miljic P, Djordjevic S, Jevdjic L, Petkovic S. W080 CATASTROPHIC ANTIPHOSPHOLPID SYNDROME IN GYNECOLOGY - INFECTION AS A PRECIPITATING EVENT. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gojnic M, Jeremic K, Stefanovic A, Pervulov M, Kadija S, Fazlagic A. M233 HISTORICAL ASPECTS OF BIRTHRATE AND MORTALITY IN SERBIA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61425-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Djordjevic B, Baralic I, Kotur-Stevuljevic J, Stefanovic A, Ivanisevic J, Radivojevic N, Andjelkovic M, Dikic N. Effect of astaxanthin supplementation on muscle damage and oxidative stress markers in elite young soccer players. J Sports Med Phys Fitness 2012; 52:382-392. [PMID: 22828460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The purpose of the current study was to examine the effect of Astaxanthin (Asx) supplementation on muscle enzymes as indirect markers of muscle damage, oxidative stress markers and antioxidant response in elite young soccer players. METHODS Thirty-two male elite soccer players were randomly assigned in a double-blind fashion to Asx and placebo (P) group. After the 90 days of supplementation, the athletes performed a 2 hour acute exercise bout. Blood samples were obtained before and after 90 days of supplementation and after the exercise at the end of observational period for analysis of thiobarbituric acid-reacting substances (TBARS), advanced oxidation protein products (AOPP), superoxide anion (O2•¯), total antioxidative status (TAS), sulphydril groups (SH), superoxide-dismutase (SOD), serum creatine kinase (CK) and aspartate aminotransferase (AST). RESULTS TBARS and AOPP levels did not change throughout the study. Regular training significantly increased O2•¯ levels (main training effect, P<0.01). O2•¯ concentrations increased after the soccer exercise (main exercise effect, P<0.01), but these changes reached statistical significance only in the P group (exercise x supplementation effect, P<0.05). TAS levels decreased significantly post- exercise only in P group (P<0.01). Both Asx and P groups experienced increase in total SH groups content (by 21% and 9%, respectively) and supplementation effect was marginally significant (P=0.08). Basal SOD activity significantly decreased both in P and in Asx group by the end of the study (main training effect, P<0.01). All participants showed a significant decrease in basal CK and AST activities after 90 days (main training effect, P<0.01 and P<0.001, respectively). CK and AST activities in serum significantly increased as result of soccer exercise (main exercise effect, P<0.001 and P<0.01, respectively). Postexercise CK and AST levels were significantly lower in Asx group compared to P group (P<0.05) CONCLUSION The results of the present study suggest that soccer training and soccer exercise are associated with excessive production of free radicals and oxidative stress, which might diminish antioxidant system efficiency. Supplementation with Asx could prevent exercise induced free radical production and depletion of non-enzymatic antioxidant defense in young soccer players.
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Affiliation(s)
- B Djordjevic
- Institute for Bromatology, University of Belgrade, Belgrade, Serbia
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Ivanisevic M, Barac M, Stefanovic A, Kadija S, Jeremic K, Vujovic S. 59 PREMATURE OVARIAN FAILURE AND TESTOSTERONE. Maturitas 2012. [DOI: 10.1016/s0378-5122(12)70170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Joo SH, Acun Z, Stefanovic A, Blieden CR, Ikpatt OF, Moon J. Post-transplant lymphoproliferative disorder presented as small bowel intussusception in adult liver transplant patient. J Korean Surg Soc 2012; 82:50-3. [PMID: 22324047 PMCID: PMC3268144 DOI: 10.4174/jkss.2012.82.1.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/06/2011] [Accepted: 07/13/2011] [Indexed: 11/30/2022]
Abstract
Intestinal obstruction after liver transplant is a rare complication, with diverse clinical manifestations. Intestinal adhesion is the most common cause. However, internal hernia, abdominal wall hernia, and neoplasm are also reported. Intussusception is another rare cause of intestinal obstruction, which has been reported primarily in pediatric patients. Herein, we report a case of intestinal obstruction from intussusception in an adult liver transplant patient associated with post-transplant lymphoproliferative disorder.
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Affiliation(s)
- Sun Hyung Joo
- Department of Surgery, University of Miami School of Medicine, Miami, FL, USA
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Talebi T, Fernandez-Castro G, Montero AJ, Stefanovic A, Lian E. A case of severe thrombotic thrombocytopenic purpura with concomitant Legionella pneumonia: review of pathogenesis and treatment. Am J Ther 2012; 18:e180-5. [PMID: 20216382 DOI: 10.1097/mjt.0b013e3181d1b4a1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Thrombotic thrombocytopenia purpura (TTP) is a severe multisystem disorder characterized by fever, microangiopathic hemolytic anemia, thrombocytopenia, neurologic symptoms, and impaired renal function. Platelet counts are usually diminished, whereas the bone marrow shows a large number of megakaryocytes indicating peripheral destruction and consumption of platelets. Coagulation studies in patients with TTP are normal or slightly elevated, which helps differentiate this entity from disseminated intravascular coagulation. The peripheral smear shows an abundance of schistocytes, reticulocytes, and, at times, nucleated red blood cells. Serum lactate dehydrogenase and indirect bilirubin are elevated as a result of mechanical destruction of red blood cells. Legionella pneumophila has been identified as a relatively common cause of both community-acquired and hospital-acquired pneumonia. An association between Legionella and TTP has only been cited once in the literature. Here we present a case of severe TTP with concurrent Legionella infection. Our patient presented with the classic clinical findings of TTP and an ADAMTS13 level of less than 5% associated with an inhibitor. After a 3-week treatment course with plasma exchange, steroids, and antibiotics, he had complete clinical recovery and his ADAMTS13 level increased to greater than 75%.
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Affiliation(s)
- Tony Talebi
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA.
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Stefanovic A, Stojnic J, Jeremic K, Jeftovic M, Arsenijevic L, Zecevic N, Atanackovic J. Malignant fibrous histiocytoma of the ovary: a case report. EUR J GYNAECOL ONCOL 2012; 33:236-239. [PMID: 22611974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life occurring predominantly in the extremities and the retroperitoneum. MFH of the ovary is very rare, with only six cases previously reported. A 67-year-old woman with a right pelvic tumor highly suspicious of ovarian carcinoma was submitted to exploratory laparotomy. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy with right hemicolectomy along with permanent cutaneous ileostomy were performed. Since a storiform-pleomorphic type of MHF was diagnosed from histopathological and immunohistochemical findings, chemotherapy was proposed as the postoperative treatment. Despite extensive surgery with negative surgical margins, the patient had recurrence of the tumor within four months, and was submitted to secondary surgery. A combination of chemo- and radiotherapy was performed postoperatively, but the patient developed respiratory problems and died one year later from the primary diagnosis.
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Affiliation(s)
- A Stefanovic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia.
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Stojnic J, Stefanovic A, Jeremic K, Kadija S, Jeftovic M, Jeremic J. Krukenberg tumor of gastric origin in pregnancy with dismal outcome. EUR J GYNAECOL ONCOL 2011; 32:356-358. [PMID: 21797136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Krukenberg tumors are mostly found as metastatic signet-ring cell adenomucinous carcinomas in young, premenopausal women. They are bilateral in 80% of the cases, and thus can be expected in pregnancy. A 31-year-old female was diagnosed by explorative laparotomy at 27 weeks of gestation with a Krukenberg tumor due to bilateral adnexal masses and a large amount of ascites. At surgery cesarean section with total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy and pelvic lymphadenectomy was performed. The neonate died 24 hours later due to prematurity and respiratory distress syndrome. The primary site of the cancer was detected metachronously two months after surgery and postoperative chemotherapy, as stomach adenomucinous carcinoma. In spite of surgery and postoperative multiagent chemotherapy, the patient died six months from the diagnosis of Krukenberg.
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Affiliation(s)
- J Stojnic
- Institute of Gynecology and Obstetrics, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia.
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Bayraktar S, Bayraktar UD, Stefanovic A, Lossos IS. Primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (MALT): single institution experience in a large cohort of patients. Br J Haematol 2010; 152:72-80. [PMID: 21083656 DOI: 10.1111/j.1365-2141.2010.08429.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extranodal marginal zone B-cell lymphoma is the most common orbital tumour. We conducted a retrospective analysis to examine: (i) the impact of initial presentation and staging on outcome and (ii) response to various treatment modalities and the effect of the latter on recurrence. Ninety patients with primary ocular adnexal marginal zone lymphoma (POAML) diagnosed at our institution between 1984 and 2009 were studied. POAML was associated with monoclonal gammopathy (13%) at presentation. Most POAML patients (86%) presented with Ann-Arbor stage I disease. Radiotherapy led to excellent local control, but relapses occurred in 18% of Ann-Arbor stage I patients during a median follow-up of 5 years. Local relapses, including secondary central nervous system (CNS) involvement, were observed in patients receiving radiation doses <30·6 Gy. No differences in relapse rate and survival were observed between patients who did or did not undergo staging bone marrow biopsy. Ann-Arbor stage II-IV disease and high lactate dehydrogenase levels were associated with shorter freedom from progression. In conclusion, POAML is an indolent lymphoma with continuous risk for relapse. Radiation doses of at least 30·6 Gy should be given in Ann-Arbor stage I disease, since lower doses may be more frequently associated with relapses, including CNS relapses.
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Affiliation(s)
- Soley Bayraktar
- Department of Medicine, Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Avenue, Miami, FL 33136, USA
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Hansra D, Montague N, Stefanovic A, Akunyili I, Harzand A, Natkunam Y, de la Ossa M, Byrne GE, Lossos IS. Oral and extraoral plasmablastic lymphoma: similarities and differences in clinicopathologic characteristics. Am J Clin Pathol 2010; 134:710-9. [PMID: 20959653 DOI: 10.1309/ajcpjh6keusecqlu] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Plasmablastic lymphoma (PBL), initially characterized as an aggressive lymphoma arising in the jaw and oral mucosa in HIV-infected patients, was recently reported to occur with extraoral manifestations, heterogeneous histologic findings, and variable association with immunodeficiency states. We reviewed clinical, morphologic, and immunophenotypic features of 13 cases of PBL to determine whether these different subtypes represent distinct morphologic and clinical entities. Two distinct subtypes of PBL were identified and classified as oral and extraoral PBL. The oral PBLs were strongly associated with HIV infection and commonly demonstrated plasmablastic morphologic features without plasmacytic differentiation. Extraoral PBLs tended to occur in patients with underlying non-HIV-related immunosuppression and universally demonstrated plasmacytic differentiation. The patients with oral PBL demonstrated better overall survival compared with patients with extraoral PBL (P = .02). Our findings suggest that PBL with oral and extraoral manifestation represent 2 distinct clinicopathologic entities.
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Stefanovic A, Davis J, Murray T, Markoe A, Lossos IS. Treatment of isolated primary intraocular lymphoma with high-dose methotrexate-based chemotherapy and binocular radiation therapy: a single-institution experience. Br J Haematol 2010; 151:103-6. [PMID: 20629657 DOI: 10.1111/j.1365-2141.2010.08321.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bayraktar S, Bayraktar UD, Ramos JC, Stefanovic A, Lossos IS. Primary CNS lymphoma in HIV positive and negative patients: comparison of clinical characteristics, outcome and prognostic factors. J Neurooncol 2010; 101:257-65. [DOI: 10.1007/s11060-010-0252-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
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Vukasinovic A, Kotur-Stevuljevic J, Stefanovic A, Spasic S, Spasojevic-Kalimanovska V, Ristic D. MS433 TOTAL ANTIOXIDANT STATUS IN CORONARY ARTERY DISEASE PATIENTS. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stefanovic A, Hansra DM, Montague N, Akunyili I, Harzand A, Natkunam Y, de la Ossa M, Byrne GE, Lossos IS. Oral and extraoral plasmablastic lymphoma: Similarities and differences in clinicopathological characteristics. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bayraktar S, Bayraktar UD, Stefanovic A, Lossos IS. Primary CNS lymphoma in HIV-positive and -negative patients: Comparison of clinical characteristics, outcome, and prognostic factors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Stefanovic A, Lossos IS. Rare PTCLs: treatment lagging behind pathobiologic advances. Oncology (Williston Park) 2010; 24:101-102. [PMID: 20187329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Alexandra Stefanovic
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center, Department of Molecular and Cellular Pharmacology, [corrected] University of Miami, Miami, Florida, USA
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Martinovic J, Dopsaj V, Dopsaj MJ, Kotur-Stevuljevic J, Vujovic A, Stefanovic A, Nesic G. Long-term Effects of Oxidative Stress in Volleyball Players. Int J Sports Med 2009; 30:851-6. [DOI: 10.1055/s-0029-1238289] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jeremic K, Stefanovic A, Petkovic S, Kadija S, Mitrovic M, Jeftovic M. P1030 Paget's disease of the vulva - a review of our experience. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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