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Robertson HF, Milojkovic D, Butt N, Byrne J, Claudiani S, Copland M, Gallipoli P, Innes AJ, Knight K, Mahdi AJ, Parker J, Virchis A, Apperley JF. Expectations and outcomes of varying treatment strategies for CML presenting during pregnancy. Br J Haematol 2024. [PMID: 38698705 DOI: 10.1111/bjh.19491] [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: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
Diagnosing chronic myeloid leukaemia (CML) during pregnancy is rare. Tyrosine kinase inhibitors (TKIs) have traditionally been contraindicated owing to their teratogenicity. Management decisions should consider the risks to mother and foetus of uncontrolled disease and teratogenic medications. Further cases are required to build upon the paucity of current literature. We report 22 cases of CML diagnosed during pregnancy from 2002 to date. Twenty-one pregnancies resulted in healthy babies and one patient miscarried. Some patients remained untreated throughout pregnancy but the majority received one or both of interferon-α and leucapheresis. One patient was started on imatinib at Week 26, and one on hydroxycarbamide in the third trimester. We report haematological parameters during pregnancy to provide clinicians with realistic expectations of management. There were no fetal abnormalities related to treatment during pregnancy. Seventeen patients achieved at least major molecular response on first-line TKI. A diagnosis of CML during pregnancy can be managed without significant consequences for mother or child. Leucapheresis and interferon-α are generally safe throughout pregnancy. Despite having been avoided previously, there is growing evidence that certain TKIs may be used in particular circumstances during the later stages of pregnancy. Future work should aim to further elucidate this safety profile.
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Affiliation(s)
- H F Robertson
- Centre for Haematology, Imperial College London, London, UK
- Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - D Milojkovic
- Centre for Haematology, Imperial College London, London, UK
- Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - N Butt
- Royal Liverpool and Broadgreen University Teaching Hospitals NHS Trust, Liverpool, UK
| | - J Byrne
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - S Claudiani
- Centre for Haematology, Imperial College London, London, UK
- Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M Copland
- Paul O'Gorman Leukaemia Research Centre, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - P Gallipoli
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A J Innes
- Centre for Haematology, Imperial College London, London, UK
- Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - K Knight
- Royal Liverpool and Broadgreen University Teaching Hospitals NHS Trust, Liverpool, UK
| | - A J Mahdi
- Department of Haematology, Aneurin Bevan University Health Board, Newport, UK
| | - J Parker
- Northampton General Hospital, Northampton, UK
| | - A Virchis
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J F Apperley
- Centre for Haematology, Imperial College London, London, UK
- Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Mahdi AJ, Gosrani D, Chakraborty M, Rees A, Conner C, Wilson K, Rayment R, Alvares C. Successful molecular targeted treatment of AML in pregnancy with Azacitidine and Sorafenib with no adverse fetal outcomes. Br J Haematol 2016; 180:603-604. [PMID: 27766617 DOI: 10.1111/bjh.14417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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)
- Ali J Mahdi
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Deepan Gosrani
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | | | - Alexandra Rees
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Christine Conner
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Keith Wilson
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Rachel Rayment
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Caroline Alvares
- Department of Haematology, University Hospital of Wales, Cardiff, UK
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Abstract
Treatment of congenital haemophilia with factor VIII and IX concentrates often requires frequent infusions. This has obvious implications in establishing effective administration strategies and, in turn, adherence. To overcome these issues, three main technologies--polyethylene-glycol, Fc-neonatal IgG1 and albumin fusion products--have emerged into various stages of clinical development. Published data indicates an approximately 1·5- and fivefold increase in half-life of factor VIII and IX, respectively, compared to standard recombinant concentrates. Studies into efficacy and safety are starting to be published. Monitoring and optimal use of these new concentrates remains unknown. Weekly factor IX prophylaxis appears to be a feasible prophylactic regimen in haemophilia B patients. Weekly longer-acting FVIII is unlikely to provide adequate prophylaxis in most patients with haemophilia A but may reduce the frequency of infusions. Ongoing clinical trials and real life experience will help shape how these products can be used in practice and their cost effectiveness. The drive for convenience however should not overshadow the ultimate goal of prophylaxis, namely, preventing bleeding and arthropathy.
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Affiliation(s)
- Ali J Mahdi
- Department of Haematology, University Hospital of Wales and School of Medicine Cardiff University, Cardiff, UK
| | - Samya G Obaji
- Department of Haematology, University Hospital of Wales and School of Medicine Cardiff University, Cardiff, UK
| | - Peter W Collins
- Department of Haematology, University Hospital of Wales and School of Medicine Cardiff University, Cardiff, UK
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Abstract
The association of metastatic breast cancer presenting as thrombocytopenia and anaemia is demonstrated in the following case of a 79-year-old woman. Her main symptoms were abdominal pain, altered bowel habit and weight loss. Without a clear causative pathology, she underwent a CT scan which demonstrated multiple sclerotic bone lesions. With a raised CA15-3 and strong oestrogen receptor positivity on immunohistochemistry on a trephine bone marrow biopsy, a diagnosis of metastatic lobular breast cancer was made. Interestingly, only a small breast mass was noted on mammography. The patient was managed conservatively and initiated on supportive therapy. This case report summarises the varying presentation of bone marrow suppression secondary to metastatic infiltration, especially in the absence of classical symptoms associated with primary solid tumour. Accurate bone marrow analysis is also vital in establishing the final diagnosis.
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Affiliation(s)
- E J Mahdi
- Cardiff University School of Medicine, Cardiff, UK
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Mahdi AJ, Elmusharaf N, Osman H, Thompson I. Atypical blood and bone marrow lymphocytes in ALK-positive anaplastic T-cell lymphoma: important lessons. BMJ Case Rep 2013; 2013:bcr-2013-200982. [PMID: 24038295 DOI: 10.1136/bcr-2013-200982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 42-year-old man presented with a short history of fever, significant weight loss and bilateral neck swelling. A CT scan revealed widespread lymphadenopathy and hepatosplenomegaly. Lymph node morphology and immunohistochemistry confirmed a diagnosis of anaplastic lymphoma kinase (ALK)-positive anaplastic T-cell non-Hodgkin's lymphoma. Both the peripheral blood (PB) and bone marrow (BM) revealed atypical lymphocytes with cleaved nuclei, vacuolation and granulation, suggestive of disease involvement at both sites. However, BM and PB immunophenotyping and immunohistochemistry did not reveal typical markers (ALK and CD30) at either site. All features resolved with a short remission after conventional chemotherapy. Despite salvage chemotherapy and an autologous stem cell transplant, a relapse of the PB and BM features with stable radiological findings was noted. Rapid decline followed with pancytopenia resulting in death 12 months after the initial diagnosis.
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Affiliation(s)
- A J Mahdi
- Department of Haematology, Royal Gwent Hospital, Newport, UK
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Pepper C, Mahdi JG, Buggins AGS, Hewamana S, Walsby E, Mahdi E, Al-Haza'a A, Mahdi AJ, Lin TT, Pearce L, Morgan L, Bowen ID, Brennan P, Fegan C. Two novel aspirin analogues show selective cytotoxicity in primary chronic lymphocytic leukaemia cells that is associated with dual inhibition of Rel A and COX-2. Cell Prolif 2011; 44:380-90. [PMID: 21645153 DOI: 10.1111/j.1365-2184.2011.00760.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Non-steroidal anti-inflammatory drugs have been shown to induce apoptosis in primary B-cell chronic lymphocytic leukaemia (CLL) cells, but the molecular mechanisms that underpin this observation have not been fully elucidated. Here, we have analysed the effect two novel aspirin analogues, 2-hydroxy benzoate zinc (2HBZ) and 4-hydroxy benzoate zinc (4HBZ), on primary CLL samples. MATERIALS AND METHODS Cytotoxic effects of 2HBZ and 4HBZ were analysed in primary CLL cells derived from 52 patients, and normal B- and T-lymphocytes. Mechanisms of action of these agents were also elucidated. RESULTS Both analogues induced apoptosis in a dose-dependent and time-dependent manner. Apoptosis was associated with activation of caspase-3 that could be partially abrogated by the caspase-9 inhibitor (Z-LEHD.fmk). Importantly, both agents demonstrated preferential cytotoxicity in CLL cells when compared to normal B- and T-lymphocytes. In terms of their molecular mechanisms of action, 4HBZ and 2HBZ inhibited COX-2 transcription and protein expression and this was associated with upstream inhibition of transcription factor Rel A. Co-culture of CLL cells with CD40 ligand-expressing mouse fibroblasts significantly increased COX-2 expression and inhibited spontaneous apoptosis. Importantly, the most potent analogue, 4HBZ, overcame pro-survival effects of the co-culture system and significantly repressed COX-2. Finally, elevated COX-2 expression was associated with poor prognostic subsets and increased sensitivity to 4HBZ. CONCLUSIONS Our results demonstrate therapeutic potential of 4HBZ and are consistent with a mechanism involving suppression of Rel A nuclear translocation and inhibition of COX-2 transcription.
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Affiliation(s)
- C Pepper
- Department of Haematology, School of Medicine, Cardiff University, Heath Park, UK.
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Mahdi JG, Pepper CJ, Alkarrawi MA, Mahdi AJ, Bowen ID. Sub-millimolar concentration of the novel phenol-based compound, 2-hydroxy benzoate zinc, induces apoptosis in human HT-1080 fibrosarcoma cells. Cell Prolif 2009; 43:95-102. [PMID: 19922491 DOI: 10.1111/j.1365-2184.2009.00658.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To examine the effect of a novel phenolic-based compound, 2-hydroxy benzoate zinc (2HBZ), and acetylsalicylic acid (ASA) on human HT-1080 fibrosarcoma cells. MATERIALS AND METHODS MTT assay was used to assess cell proliferation while different methods were used to detect apoptosis morphologically and immunohistochemically in Human HT-1080 fibrosarcoma cells. Apoptosis was determined by Annexine-V labelling, and caspase-3 activation. In addition, western blot was used to analyse p21, p53 and Bax and flow cytometry was to analyse the cell cycle. RESULTS 2HBZ exhibited a more than 5-fold increase in cytotoxic potency when compared with ASA with mean LD50 values of 210 and 1100 lM respectively (P < 0.0001). The cytotoxic effects of 2HBZ were both time- and dosedependent with marked apoptosis being evident only after 24 h at concentrations as low as 200 mM. In contrast, ASA-induced apoptosis was observed only at concentrations in excess of 1000 mM at the same time point. Both 2HBZ and ASA induced caspase-3 activation in the cells, which confirmed that their cytotoxic effects were the result of apoptotic cell death. These findings were further confirmed by immunomorphological studies for the detection of apoptosis including haematoxylineosin, methyl green/pyronin Y staining and scanning electron microscopy. In addition, 2HBZ caused a marked increase in p21, p53 and Bax protein expressions and these effects were associated with an increase in G1 and G2 arrest of the cell cycle and a reduction in S-phase. CONCLUSIONS These results demonstrate that the novel phenolic compound 2HBZ is a potent apoptosis-inducing agent in HT-1080 cells and warrants further investigation as a potential chemotherapeutic agent in primary cancer cell models.
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Affiliation(s)
- J G Mahdi
- King Saud University, Huraimla, Saudi Arabia.
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Abstract
Salicylates are novel biologically active compounds that exhibit multiple therapeutic activities. The anti-cancer effectiveness of calcium salicylate has been investigated on human HT-1080 fibrosarcoma cell lines at relatively low concentrations (predominantly 0.4 mM) compared to those previously reported. Although low calcium salicylate concentrations did not retard tumour growth progression significantly, as measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and time-lapse assays, its cytotoxic characteristics were proven to be prominent by various morphological and immunocytological techniques. The results here demonstrate evidence for approximately 25% apoptosis after treatment with calcium salicylate, which up-regulatd the expression of p53, p21 and Bax, and down-regulated Bcl-2 in HT-1080 cells.
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Affiliation(s)
- J G Mahdi
- School of Biosciences, Cardiff University, PO Box 911, Cardiff CF10 3US, UK.
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Mahdi JG, Mahdi AJ, Mahdi AJ, Bowen ID. The historical analysis of aspirin discovery, its relation to the willow tree and antiproliferative and anticancer potential. Cell Prolif 2006; 39:147-55. [PMID: 16542349 PMCID: PMC6496865 DOI: 10.1111/j.1365-2184.2006.00377.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Accepted: 12/14/2005] [Indexed: 12/12/2022] Open
Abstract
For several millennia, the willow tree and salicin have been associated with salicylic acid, the key precursor molecule that has contributed to the discovery of acetylsalicylic acid, traded as aspirin. These molecules have been shown to possess phyto- and chemotherapeutic activities as analgesic drugs. In recent decades, aspirin has become the focus of extensive investigation into antiproliferative and anticancer activities. The historical steps that led to the discovery of aspirin, and its antiproliferative and anticancer potential are highlighted in this review.
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MESH Headings
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/chemistry
- Anti-Inflammatory Agents, Non-Steroidal/history
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antineoplastic Agents, Phytogenic/chemistry
- Antineoplastic Agents, Phytogenic/history
- Antineoplastic Agents, Phytogenic/therapeutic use
- Aspirin/chemistry
- Aspirin/history
- Aspirin/therapeutic use
- Benzyl Alcohols/chemistry
- Benzyl Alcohols/history
- Benzyl Alcohols/therapeutic use
- Glucosides
- History, 18th Century
- History, 19th Century
- History, 20th Century
- History, 21st Century
- History, Ancient
- History, Medieval
- Humans
- Salicylic Acid/chemistry
- Salicylic Acid/history
- Salicylic Acid/therapeutic use
- Salix/chemistry
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Affiliation(s)
- J G Mahdi
- School of Biosciences, Cardiff University, PO Box 911, Cardiff, CF10 3US, UK.
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