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de Pablo JG, Zubicaray J, Iriondo J, Pérez Maroto F, Azorín D, de la Cruz Benito A, Sanz A, Madero L, González-Vicent M, Sevilla J, Sebastián E. Diagnostic yield of bone marrow aspiration in paediatric primary immune thrombocytopenia: impact of evolution and adherence to medical guidelines over the last 25 years. Eur J Pediatr 2024:10.1007/s00431-024-05583-7. [PMID: 38771372 DOI: 10.1007/s00431-024-05583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/03/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
The aim of this study is to analyse the diagnostic value of bone marrow aspiration (BMA) in a retrospective cohort of patients with suspected immune thrombocytopaenia (ITP). We further measure changes in the percentage of patients who underwent this study and whether testing or not was in accordance with current guidelines at the time of diagnosis. We conducted a chart review of 243 patients with ITP who underwent follow-up in our institution between 1995 and 2022. The patients were divided into historical cohorts based on the practice guidelines of the Spanish Society of Pediatric Hematology and Oncology (SEHOP) and the American Society of Hematology (ASH) in place at the time of follow-up. For each case, time of disease presentation or initial diagnosis was defined as that which occurred in the first 72 h following disease onset. Based on data from the historical cohorts studied, we observed a lower total number of BMAs at diagnosis over time (p < 0.005). A gradual reduction was seen in the number of BMAs with the introduction of guidelines, including a progressively lower number of BMAs performed without indication (p < 0.05). Subsequent to the initial diagnosis, the procedure played a decisive role in only 2 patients (0.58%), allowing for a diagnosis of acquired aplastic anaemia in both cases. In both of them on diagnosis, BMA did not appear to be indicated, although subsequent analysis after 72 h raised suspicion of bone marrow failure. CONCLUSION BMA at presentation did not significantly alter the diagnosis in our cohort of patients with an initial suspicion of ITP, although the procedure was decisive in diagnosing 2 cases of acquired aplastic anaemia during the subsequent course of the disease. Regarding the number of aspirations performed, our findings show that increased physician compliance with current guidelines reduced the rate of unnecessary BMAs. WHAT IS KNOWN • BMA is a supplementary test for the diagnosis of ITP. • The usefulness of this invasive diagnostic procedure is not clearly stated in current guidelines. WHAT IS NEW • Adjustments to scientific guidelines have led to a reduction in the number of BMAs performed on our patients with suspected ITP in the last 27 years. • While the risks and benefits of BMA at the time of diagnosis are unclear in patients with suspected ITP, the procedure does not contribute significant information to support the diagnosis.
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Affiliation(s)
- Jesús González de Pablo
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
- Foundation for Biomedical Research, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Josune Zubicaray
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - June Iriondo
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
- Foundation for Biomedical Research, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Florencio Pérez Maroto
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Daniel Azorín
- Servicio de Antomía Patológica, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Ana de la Cruz Benito
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Alejandro Sanz
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Luis Madero
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Marta González-Vicent
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Julián Sevilla
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain.
| | - Elena Sebastián
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
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2
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Marco Sánchez JM, Bardón Cancho EJ, Benéitez D, Payán-Pernía S, Collado Gimbert A, Ruiz-Llobet A, Salinas JA, Sebastián E, Argilés B, Bermúdez M, Vázquez MÁ, Ortega MJ, López Rubio M, Gondra A, Uriz JJ, Morado M, Coll MT, López Duarte M, Baro M, Cervera Á, Recasens V, García Blanes C, Del Carcavilla MP, Tallon M, González Espín A, Olteanu Olteanu FC, González P, Del Mañú Pereira MM, Cela E. Haemoglobinopathies and other rare anemias in Spain: ten years of a nationwide registry (REHem-AR). Ann Hematol 2024:10.1007/s00277-024-05788-8. [PMID: 38763941 DOI: 10.1007/s00277-024-05788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/02/2024] [Indexed: 05/21/2024]
Abstract
REHem-AR was created in 2013. The progressive implementation of neonatal screening for haemoglobinopathies in Spanish autonomous communities where the registry had not been implemented, as well as the addition of new centres during this period, has considerably increased the sample of patients covered. In this study, we update our previous publication in this area, after a follow-up of more than 5 years. An observational, descriptive, multicentre and ambispective study of adult and paediatric patients with haemoglobinopathies and rare anaemias registered in REHem was performed. The data are from a cross-sectional analysis performed on 1 June, 2023. The study population comprised 1,756 patients, of whom 1,317 had SCD, 214 had thalassaemia and 224 were diagnosed with another condition. Slightly more than one third of SCD patients (37%) were diagnosed based on neonatal bloodspot screening, and the mean age at diagnosis was 2.5 years; 71% of thalassaemia patients were diagnosed based on the presence of anaemia. Vaso-occlusive crisis and acute chest syndrome continue to be the most frequent complications in SCD. HSCT was performed in 83 patients with SCD and in 50 patients with thalassaemia. Since the previous publication, REHem-AR has grown in size by more than 500 cases. SCD and TM are less frequent in Spain than in other European countries, although the data show that rare anaemias are frequent within rare diseases. REHem-AR constitutes an important structure for following the natural history of rare anaemias and enables us to calculate investment needs for current and future treatments.
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Affiliation(s)
- José Manuel Marco Sánchez
- Data Manager of the Spanish Registry of Rare Haemoglobinopathies and Rare Anaemias (REHem-AR), Gregorio Marañón Health Research Institute. Section of Pediatric Hemato-Oncology.Pediatrics Service, Hospital General Universitario Gregorio Marañón, O'Donnell, 48, Madrid, Spain
- CSUR Erithropathology. ERN-EuroBloodNet. CIBERER, Universidad Complutense de Madrid, Madrid, Spain
| | - Eduardo Jesús Bardón Cancho
- CSUR Erithropathology. ERN-EuroBloodNet. CIBERER, Universidad Complutense de Madrid, Madrid, Spain.
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital General, Universitario Gregorio Marañón, O'Donnell, 48, Madrid, Spain.
| | - David Benéitez
- Hematology Service. Hospital Universitario Vall d'Hebron. Barcelona. ERN-Eurobloodnet, Universitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, Barcelona, Spain
| | - Salvador Payán-Pernía
- Hematology Service. Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Av. Manuel Siurot, S/N, 41013, Seville, Spain
| | - Anna Collado Gimbert
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Universitario Vall d'Hebron. Barcelona, Passeig de La Vall d'Hebron, 119-129, Barcelona, Spain
| | - Anna Ruiz-Llobet
- Hematology Service. Hospital Sant Joan de DéuUniversitat de Barcelona. Institut de Recerca Hospital Sant Joan de Déu. CSUR Eritropatología. ERN-EuroBloodNet, Passeig de Sant Joan de Déu, 2Esplugues de Llobregat, Barcelona, Spain
| | - José Antonio Salinas
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma, Illes Balears, Spain
| | - Elena Sebastián
- Section of Pediatric Hemato-Oncology. Hospital Infantil Universitario Niño Jesús. Foundation for Biomedical Research of the Niño Jesús University Childrens Hospital, Av. de Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Bienvenida Argilés
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital, Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, Valencia, Spain
| | - Mar Bermúdez
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital Clínico, Universitario Virgen de La Arrixaca, Ctra. Madrid-Cartagena, S/N, 30120El Palmar, Murcia, Spain
| | - María Ángeles Vázquez
- Section of Pediatric Hematology. Hospital Materno-Infantil Torrecárdenas, Calle Hermandad de Donantes Sangre S/N, 04009, Almería, Spain
| | - María José Ortega
- Section of Pediatric Hematology. Hospital, Universitario Virgen de Las Nieves, Av. de Las Fuerzas Armadas, 2, 18014, Granada, Spain
| | - Montserrat López Rubio
- Hematology Service. Hospital Universitario Príncipe de Asturias, Carretera de Alcalá Meco S/N, 28805, Alcalá de Henares, Madrid, Spain
| | - Ainhoa Gondra
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Universitario de Basurto, Universidad del País Vasco UPV/EHU, Montevideo Etorb, 18, 48013, Bilbao, Bizkaia, Spain
| | - José Javier Uriz
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Universitario Donostia, , Begiristain Doktorea Pasealekua, S/N, 20014, Donostia, Gipuzkoa, Spain
| | - Marta Morado
- Hematology Service. Hospital Universitario La Paz, Paseo de La Castellana 261, 28046 , Madrid, Spain
| | - María Teresa Coll
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital General de Granollers. , Carrer de Francesc Ribas, S/N, 08402, Barcelona, Granollers, Spain
| | - Mónica López Duarte
- Hematology Service, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Cantabria, Spain
| | - María Baro
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Doce de Octubre, Avenida Córdoba S/n2, 28041, Madrid, Spain
| | - Áurea Cervera
- Pediatric Service, Hospital Universitario Móstoles, C. Dr. Luis Montes, S/N, 28935, Madrid, Móstoles, Spain
| | - Valle Recasens
- Hematology Service. Hospital Miguel Servet, P.º de Isabel La Católica, 1-3, 50009, Zaragoza, Spain
| | - Carmen García Blanes
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Clínico Valencia, Av Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - María Pozo Del Carcavilla
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Complejo Hospitalario Albacete, C. Hermano Falco, 37, 02006, Albacete, Spain
| | - María Tallon
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, 36312, Vigo, Spain
| | - Ana González Espín
- Section of Pediatric Hemato-Oncology. Pediatrics Service, Complejo Hospitalario Jaén, Av Ejército Español, 10, 23007, Jaén, Spain
| | - Filip Camil Olteanu Olteanu
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital, Universitario de Guadalajara, C Donante de Sangre, S/N, 19002, Guadalajara, Spain
| | - Pablo González
- Hospital General Universitario Gregorio Marañón, Calle O'Donnell, 48, Madrid, Spain
| | - María Mar Del Mañú Pereira
- Hospital Universitario Vall d'Hebron. BarcelonaERN-EurobloodnetUniversitat Autònoma de Barcelona, Passeig de La Vall d'Hebron, 119-129, Barcelona, Spain
| | - Elena Cela
- CSUR Erithropathology. ERN-EuroBloodNet. CIBERER, Universidad Complutense de Madrid, Madrid, Spain
- Section of Pediatric Hemato-Oncology. Pediatrics Service. Hospital General, Universitario Gregorio Marañón, O'Donnell, 48, Madrid, Spain
- Coordinator of REHem-AR. Erythropathology Working Group of the Spanish Society of Pediatric Hematology and Oncology (SEHOP), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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3
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Molina YL, Blasco-Santana L, Sanz A, Blázquez Gómez CJ, Zubicaray J, Iriondo J, González de Pablo J, Sevilla J, Sebastián E. Myelofibrosis associated with immune cytopenia in an infant: a diagnostic and therapeutic challenge. Pediatr Hematol Oncol 2024:1-6. [PMID: 38712347 DOI: 10.1080/08880018.2024.2350424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Yessenia L Molina
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Luis Blasco-Santana
- Pathology Department. Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Alejandro Sanz
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Josune Zubicaray
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - June Iriondo
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Jesús González de Pablo
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Julián Sevilla
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elena Sebastián
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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4
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Iriondo J, Gómez A, Zubicaray J, Garcia-Martinez J, Abad L, Matesanz C, Giménez R, Galán A, Sanz A, Sebastián E, González de Pablo J, de la Cruz A, Ramírez M, Sevilla J. Optical Genome Mapping as a New Tool to Overcome Conventional Cytogenetics Limitations in Patients with Bone Marrow Failure. Genes (Basel) 2024; 15:559. [PMID: 38790188 DOI: 10.3390/genes15050559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Cytogenetic studies are essential in the diagnosis and follow up of patients with bone marrow failure syndromes (BMFSs), but obtaining good quality results is often challenging due to hypocellularity. Optical Genome Mapping (OGM), a novel technology capable of detecting most types chromosomal structural variants (SVs) at high resolution, is being increasingly used in many settings, including hematologic malignancies. Herein, we compared conventional cytogenetic techniques to OGM in 20 patients with diverse BMFSs. Twenty metaphases for the karyotype were only obtained in three subjects (15%), and no SVs were found in any of the samples. One patient with culture failure showed a gain in chromosome 1q by fluorescence in situ hybridization, which was confirmed by OGM. In contrast, OGM provided good quality results in all subjects, and SVs were detected in 14 of them (70%), mostly corresponding to cryptic submicroscopic alterations not observed by standard techniques. Therefore, OGM emerges as a powerful tool that provides complete and evaluable results in hypocellular BMFSs, reducing multiple tests into a single assay and overcoming some of the main limitations of conventional techniques. Furthermore, in addition to confirming the abnormalities detected by conventional techniques, OGM found new alterations beyond their detection limits.
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Affiliation(s)
- June Iriondo
- Hematology and Hemotherapy Unit, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Biomedical Research Foundation, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Ana Gómez
- Laboratory and Clinical Analysis Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Josune Zubicaray
- Hematology and Hemotherapy Unit, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Biomedical Research Foundation, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Jorge Garcia-Martinez
- Pediatric Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Health Research Institute at Hospital de La Princesa (IIS-Princesa), 28006 Madrid, Spain
| | - Lorea Abad
- Laboratory and Clinical Analysis Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Carmen Matesanz
- Laboratory and Clinical Analysis Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Reyes Giménez
- Laboratory and Clinical Analysis Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Almudena Galán
- Biomedical Research Foundation, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Laboratory and Clinical Analysis Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Alejandro Sanz
- Hematology and Hemotherapy Unit, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Biomedical Research Foundation, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Elena Sebastián
- Hematology and Hemotherapy Unit, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Biomedical Research Foundation, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Jesús González de Pablo
- Biomedical Research Foundation, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Ana de la Cruz
- Biomedical Research Foundation, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Laboratory and Clinical Analysis Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Manuel Ramírez
- Laboratory and Clinical Analysis Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Pediatric Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Health Research Institute at Hospital de La Princesa (IIS-Princesa), 28006 Madrid, Spain
| | - Julián Sevilla
- Hematology and Hemotherapy Unit, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
- Biomedical Research Foundation, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
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5
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García-Morin M, Bardón-Cancho EJ, Beléndez C, Dulín E, Blanco-Soto P, Puertas-López C, Prieto-Medina M, Cervera-Bravo Á, Llorente-Otones L, Pérez-Alonso V, San-Román S, Vecilla-Rivelles C, López-Rubio M, Sebastián E, Bellón JM, Cela E. Madrid Newborn Sickle Cell Disease Cohort: clinical outcomes, stroke prevention and survival. Ann Hematol 2024; 103:373-383. [PMID: 37980280 DOI: 10.1007/s00277-023-05539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
In May 2003, Madrid established the universal newborn screening (NBS) for sickle cell disease (SCD). However, there are no studies resembling the evolution of a SCD neonate cohort followed according to national guidelines in Spain. The aim of this study is to describe the morbimortality and the stroke prevention programme in patients diagnosed by SCD NBS in Madrid. This is a multicentre, observational, prospective cohort study between 2003 and 2018; 187 patients diagnosed with SCD were included (151 HbSS, 6 HbSβ0, 27 HbSC, 3 HbSβ +), and median follow-up was 5.2 years (0.03-14.9). There were 5 deaths: 2 related to SCD in patients with severe genotype (HbSS/HbSβ0). Overall survival reached 95% and SCD-related survival 96.8%. The most frequent events were fever without focus, vaso-occlusive crises and acute chest syndromes. Eight strokes occurred in 5 patients which led to a 90.7% stroke-free survival in severe genotype patients (first stroke rate, 0.54 per 100 patient-years). Transcranial Doppler (TCD) was performed in 95% of eligible patients; 75% of children with pathological TCD remained stroke-free. Regarding HbSS/HbSβ0 patients, 50.1% received hydroxyurea and 9.5% haematopoietic stem cell transplantation. This study reflects the evolution of Madrid SCD cohort and provides morbimortality data similar to other developed countries.
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Affiliation(s)
- Marina García-Morin
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Eduardo J Bardón-Cancho
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain.
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Cristina Beléndez
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Dulín
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Paula Blanco-Soto
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Carolina Puertas-López
- Newborn Screening Laboratory, Hospital General Universitario Gregorio Marañón, C/Maiquez, 9, 28007, Madrid, Spain
| | - Mar Prieto-Medina
- Nursery, Sickle Cell Disease Newborn Screening, Pediatric Department, Pediatric Oncology/Hematology/BMT Unit, Madrid, Spain
| | - Áurea Cervera-Bravo
- Hematology Unit, Pediatric Department, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - Lucía Llorente-Otones
- Hematology Unit, Pediatric Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Vanesa Pérez-Alonso
- Pediatric Oncology and Hematology Unit, Pediatric Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sonsoles San-Román
- Pediatric Oncology and Hematology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Cruz Vecilla-Rivelles
- Hematology Unit, Pediatric Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Montserrat López-Rubio
- Hematology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Elena Sebastián
- Pediatric Oncology and Hematology Department, Hospital Infantil Niño Jesús, Madrid, Spain
| | - José M Bellón
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elena Cela
- Pediatric Oncology/Hematology/BMT Unit, Pediatric Department, Facultad de Medicina, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, C/ Maiquez, 9, 28007, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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6
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Sebastián E, Andrés-Zallo L, González-Vicent M, Jara M, Molina B, Zubicaray J, Gálvez E, Orfao A, Sevilla J. Lymphocytic variant hypereosinophilic syndrome successfully treated with hematopoietic stem cell transplantation: A treatment challenge. Pediatr Blood Cancer 2023; 70:e30698. [PMID: 37771280 DOI: 10.1002/pbc.30698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Affiliation(s)
- Elena Sebastián
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Laura Andrés-Zallo
- Oncology Department, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Marta González-Vicent
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - María Jara
- DNA Sequencing Service (NUCLEUS), University of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Blanca Molina
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Josune Zubicaray
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Eva Gálvez
- Hematology Department, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - Alberto Orfao
- Cancer Research Center (IBMCC, CSIC - University of Salamanca), Department of Medicine, Cytometry Service, NUCLEUS, University of Salamanca (Universidad de Salamanca), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Julián Sevilla
- Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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7
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Czechowicz A, Sevilla J, Booth C, Agarwal R, Zubicaray J, Río P, Navarro S, Chetty K, O’Toole G, Xu-Bayford J, Ancliff P, Sebastián E, Choi G, Zeini M, Nicoletti E, Wagner JE, Rao G, Thrasher AJ, Schwartz J, Roncarolo MG, Bueren J. Lentiviral-Mediated Gene Therapy for Patients with Fanconi Anemia [Group A]: Updated Results from Global RP-L102 Clinical Trials. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00182-3] [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: 02/07/2023]
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8
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Sebastián E, Andrés Esteban EM, González‐Vicent M, González de Pablo J, Zubicaray J, Gálvez E, Guillén M, Ruiz Pato J, Molina B, Albi G, Ramírez M, Castillo A, Pérez Maroto F, Madero L, Díaz MÁ, Sevilla J. Extracorporeal photopheresis in paediatric patients: A retrospective comparison between different ‘off‐line’ protocols. Vox Sang 2022; 117:1220-1229. [DOI: 10.1111/vox.13346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Elena Sebastián
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - Eva María Andrés Esteban
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
- Applied Economics Department Universidad Rey Juan Carlos Madrid Spain
| | | | | | - Josune Zubicaray
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - Eva Gálvez
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - María Guillén
- Hematology Department Hospital Universitario Miguel Servet Zaragoza Spain
| | - Julia Ruiz Pato
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Blanca Molina
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Gustavo Albi
- Radiology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Manuel Ramírez
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Ana Castillo
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Florencio Pérez Maroto
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Luis Madero
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Miguel Ángel Díaz
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Julián Sevilla
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
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9
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Mingot Castellano ME, Pascual Izquierdo C, González A, Viejo Llorente A, Valcarcel Ferreiras D, Sebastián E, García Candel F, Sarmiento Palao H, Gómez Seguí I, de la Rubia J, Cid J, Martínez Nieto J, Hernández Mateo L, Goterris Viciedo R, Fidalgo T, Salinas R, Del Rio-Garma J. Recommendations for the diagnosis and treatment of patients with thrombotic thrombocytopenic purpura. Med Clin (Barc) 2022; 158:630.e1-630.e14. [PMID: 34266669 DOI: 10.1016/j.medcli.2021.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy (TMA) characterized by the development of microangiopathic haemolytic anaemia, thrombocytopenia, and ischaemic organ dysfunction associated with ADAMTS13 levels lower than 10% in most cases. Recently there have been numerous advances in the field of PTT, new, rapid and accessible techniques capable of quantifying ADAMTS13 activity and inhibitors. The massive sequencing systems facilitate the identification of polymorphisms in the ADAMTS13 gene. In addition, new drugs such as caplacizumab have appeared and relapse prevention strategies are being proposed with the use of rituximab. The existence of TTP patient registries allow a deeper understanding of this disease but the great variability in the diagnosis and treatment makes it necessary to elaborate guidelines that homogenize terminology and clinical practice. The recommendations set out in this document were prepared following the AGREE methodology. The research questions were formulated according to the PICO format. A search of the literature published during the last 10 years was carried out. The recommendations were established by consensus among the entire group, specifying the existing strengths and limitations according to the level of evidence obtained. In conclusion, this document contains recommendations on the management, diagnosis, and treatment of TTP with the ultimate objective of developing guidelines based on the evidence published to date that allow healthcare professionals to optimize TTP treatment.
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Affiliation(s)
| | | | - Ataulfo González
- Servicio de Hematología y Hemoterapia, Hospital Universitario de San Carlos, Madrid, España
| | - Aurora Viejo Llorente
- Servicio de Hematología, Área de Hemoterapia, Hospital Universitario La Paz, Madrid, España
| | - David Valcarcel Ferreiras
- Unidad de Hematología Intensiva y Terapia Celular, Departamento de Hematología, Instituto de Oncología Vall d'Hebron (VHIO), Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Elena Sebastián
- Servicio de Hematología y Hemoterapia, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Faustino García Candel
- Sección de Hemostasia y Trombosis, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - Inés Gómez Seguí
- Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Javier de la Rubia
- Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Joan Cid
- Unidad de Aféresis y Terapia Celular, Servicio de Hemoterapia y Hemostasia, Institut Clínic de Malalties Hematològiques i Oncològiques (ICMHO). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Hospital Clínic i Provincial de Barcelona, Barcelona, España
| | - Jorge Martínez Nieto
- Servicio de Hematología y Hemostasia, Hospital Universitario Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdissC), Madrid, España
| | - Luis Hernández Mateo
- Servicio de Hematología y Hemoterapia, Hospital General de Alicante, Valencia, España
| | - Rosa Goterris Viciedo
- Servicio de Hematología y Hemoterapia, Hospital Clínico Valencia. INCLIVA, Valencia, España
| | - Teresa Fidalgo
- Departamento de Hematología Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ramon Salinas
- Banc de Sang i Teixits de Catalunya, Barcelona, España
| | - Julio Del Rio-Garma
- Servicio de Transfusión. Servicio de Hematología. Complexo Hospitalario Universitario de Ourense, Galicia, España.
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10
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Gonzalez-Vicent M, Molina B, Lopez I, Zubicaray J, Ruiz J, Vicario JL, Sebastián E, Iriondo J, Castillo A, Abad L, Ramirez M, Sevilla J, Diaz MA. T-Cell Depleted Haploidentical Transplantation in Children With Hematological Malignancies: A Comparison Between CD3+/CD19+ and TCRαβ+/CD19+ Depletion Platforms. Front Oncol 2022; 12:884397. [PMID: 35795036 PMCID: PMC9251308 DOI: 10.3389/fonc.2022.884397] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundT-cell depleted (TCD) haploidentical transplantation using CD3+/CD19+ and TCRαβ+/CD19+ depletion techniques has been increasingly used in children with hematological malignancies. We present a retrospective study aimed to compare transplant outcomes in children with leukemia receiving a TCD haploidentical transplant using either CD3+/CD19+ or TCRαβ+/CD19+ platforms.MethodsA total of 159 children with leukemia (ALL=80) (AML=79) that received a TCD haploidentical transplantation using either CD3+/CD19+ (n=79) or TCRαβ+/CD19+ (n=80) platforms between 2005 and 2020 were included. Median age was 9 years in both groups. There were no differences in patient, donor, and transplant characteristics between groups except for donor KIR B genotype more frequent in the TCRαβ+/CD19+ group (91%) than in the CD3+/CD19+ group (76%) (p=0.009) and a high number of NK+ cells and lower CD19+ cells infused in the TCRαβ+/CD19+ group (35.32x106/kg and 0.06 x106/Kg) than in the CD3+/CD19 group (24.6x106/Kg and 0.25 x106/Kg) (p=0.04 and p=0.0001), respectively. Conditioning was based on TBF. Median follow-up for survivors was 11 years (range; 8-16 y) in CD3+/CD19+ group and 5 years (range; 2-9 y) in the TCRαβ+/CD19+ group.ResultsEngraftment kinetics were similar in both groups (13 days for neutrophils and 10 days for platelets). There was no difference in the incidence of acute GvHD II-IV (29 ± 5% in the CD3+/CD19+ group vs 38 ± 5% in the TCRαβ+/CD19+ group) and chronic GvHD (32 ± 5% vs 23 ± 4%, respectively). NRM was 23 ± 5% in the CD3+/CD19+group vs 21 ± 4% in the TCRαβ+/CD19+group. Relapse incidence was also similar, 32 ± 5% vs 34 ± 6%, respectively. DFS and OS were not different (45 ± 5% vs 45 ± 6% and 53 ± 6% vs 58 ± 6% respectively). As there were no differences on transplant outcomes between groups, we further analyzed all patients together for risk factors associated with transplant outcomes. On multivariate analysis, we identified that early disease status at transplant (HR: 0.16; 95%CI (0.07-0.35) (p=0.0001), presence of cGvHD (HR: 0.38; 95%CI (0.20-0.70) (p= 0.002), and donor KIR-B genotype (HR: 0.50; 95%CI (0.32-0.90) (p=0.04) were associated with better DFS.ConclusionsOur data suggest that there are no advantages in transplant outcomes between TCD platforms. Risk factors for survival are dependent on disease characteristic, donor KIR genotype, and chronic GvHD rather than the TCD platform used.
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Affiliation(s)
- Marta Gonzalez-Vicent
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
- *Correspondence: Marta Gonzalez-Vicent,
| | - Blanca Molina
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Ivan Lopez
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Josune Zubicaray
- Division of Hematology, Blood Bank and Graft Manipulation Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Julia Ruiz
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Jose Luis Vicario
- Histocompatibility Lab, Community Transfusion Center of Madrid, Madrid, Spain
| | - Elena Sebastián
- Division of Hematology, Blood Bank and Graft Manipulation Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - June Iriondo
- Division of Hematology, Blood Bank and Graft Manipulation Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Ana Castillo
- Oncology/Hematology Lab, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Lorea Abad
- Oncology/Hematology Lab, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Manuel Ramirez
- Oncology/Hematology Lab, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Julian Sevilla
- Division of Hematology, Blood Bank and Graft Manipulation Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
| | - Miguel A. Diaz
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Unit, Hospital Infantil Universitario “Niño Jesus” Madrid, Madrid, Spain
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11
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Iriondo J, Zubicaray J, Sebastián E, González de Pablo J, González-Vicent M, Molina B, López-Torija I, Castillo A, Ramírez M, Madero L, Díaz MÁ, Sevilla J. Mobilization with high-dose granulocyte colony-stimulating factor alone at 12 μg/kg twice a day in high-risk pediatric patients: A retrospective analysis of the experience in a single center. J Clin Apher 2022; 37:420-429. [PMID: 35662241 DOI: 10.1002/jca.21994] [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: 09/24/2021] [Revised: 04/15/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Mobilization regimes in pediatric patients at high risk for poor mobilization are not standardized across different institutions. We present a retrospective analysis of our experience with a high-dose granulocyte colony-stimulating factor (G-CSF) regime of 12 μg/Kg per body weight (BW) twice a day for 4 days used in high-risk patients. MATERIAL AND METHODS We report the results of all pediatric patients mobilized with high-dose G-CSF between January 1999 and February 2021 in our center. A successful mobilization was defined as a peripheral blood (PB) CD34+ cell count of ≥10 CD34+ cells/μl on the fifth day of mobilization immediately before leukapheresis. A minimum cell yield of ≥2 × 106 CD34+ cells/Kg of BW was required for a successful collection. RESULTS Of the 262 patients included in the analysis, mobilization failure was found in 27 (10.3%). In a univariate analysis, this was associated with age, weight, baseline diagnosis, and having undergone a previous mobilization cycle, the latter being the only factor that remained significantly associated in a multivariate analysis (P = 0.03). The 54 patients (20.6%) did not reach the minimum required CD34+ cell yield. 50.4% of the patients reported adverse events (AEs) during the mobilization period, and 23 (9.1%) reported 3 or more concomitant AEs. However, all of them were mild and did not affect the mobilization schedule. CONCLUSIONS Although most high-risk pediatric patients are successfully mobilized with the high-dose G-CSF regime, this approach does not salvage all of them and significantly increases the presence of AEs in comparison to standard-dose regimes.
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Affiliation(s)
- June Iriondo
- Hematology and Hemotherapy Unit, Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.,Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain
| | - Josune Zubicaray
- Hematology and Hemotherapy Unit, Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.,Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain
| | - Elena Sebastián
- Hematology and Hemotherapy Unit, Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.,Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain
| | - Jesús González de Pablo
- Hematology and Hemotherapy Unit, Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.,Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain
| | - Marta González-Vicent
- Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain.,Hematopoietic Stem Cell Transplantation Unit, Pediatric Hematology and Oncology department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Blanca Molina
- Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain.,Hematopoietic Stem Cell Transplantation Unit, Pediatric Hematology and Oncology department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ivan López-Torija
- Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain.,Hematopoietic Stem Cell Transplantation Unit, Pediatric Hematology and Oncology department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ana Castillo
- Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain.,Hematology and Oncology Laboratory Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Manuel Ramírez
- Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain.,Hematology and Oncology Laboratory Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Luis Madero
- Hematology and Hemotherapy Unit, Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.,Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain.,Hematopoietic Stem Cell Transplantation Unit, Pediatric Hematology and Oncology department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.,Hematology and Oncology Laboratory Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Miguel Ángel Díaz
- Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain.,Hematopoietic Stem Cell Transplantation Unit, Pediatric Hematology and Oncology department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Julián Sevilla
- Hematology and Hemotherapy Unit, Hematology and Oncology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.,Fundación para la Investigación Biomédica Hospital Infantil Universitario, Niño Jesús, Madrid, Spain
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12
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Sevilla J, Navarro S, Rio P, Sánchez-Domínguez R, Zubicaray J, Gálvez E, Merino E, Sebastián E, Azqueta C, Casado JA, Segovia JC, Alberquilla O, Bogliolo M, Román-Rodríguez FJ, Giménez Y, Larcher L, Salgado R, Pujol RM, Hladun R, Castillo A, Soulier J, Querol S, Fernández J, Schwartz J, García de Andoín N, López R, Catalá A, Surralles J, Díaz-de-Heredia C, Bueren JA. Improved collection of hematopoietic stem cells and progenitors from Fanconi anemia patients for gene therapy purposes. Mol Ther Methods Clin Dev 2021; 22:66-75. [PMID: 34485595 PMCID: PMC8390450 DOI: 10.1016/j.omtm.2021.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/21/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022]
Abstract
Difficulties in the collection of hematopoietic stem and progenitor cells (HSPCs) from Fanconi anemia (FA) patients have limited the gene therapy in this disease. We have investigated (ClinicalTrials.gov, NCT02931071) the safety and efficacy of filgrastim and plerixafor for mobilization of HSPCs and collection by leukapheresis in FA patients. Nine of eleven enrolled patients mobilized beyond the threshold level of 5 CD34+ cells/μL required to initiate apheresis. A median of 21.8 CD34+ cells/μL was reached at the peak of mobilization. Significantly, the oldest patients (15 and 16 years old) were the only ones who did not reach that threshold. A median of 4.27 million CD34+ cells/kg was collected in 2 or 3 aphereses. These numbers were markedly decreased to 1.1 million CD34+ cells/kg after immunoselection, probably because of weak expression of the CD34 antigen. However, these numbers were sufficient to facilitate the engraftment of corrected HSPCs in non-conditioned patients. No procedure-associated serious adverse events were observed. Mobilization of CD34+ cells correlated with younger age, higher leukocyte counts and hemoglobin values, lower mean corpuscular volume, and higher proportion of CD34+ cells in bone marrow (BM). All these values offer crucial information for the enrollment of FA patients for gene therapy protocols.
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Affiliation(s)
- Julián Sevilla
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Susana Navarro
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Paula Rio
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Rebeca Sánchez-Domínguez
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Josune Zubicaray
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Eva Gálvez
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Eva Merino
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Elena Sebastián
- Servicio Hematología y Oncología Pediátrica, Fundación Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain
| | - Carmen Azqueta
- Banc de Sang i Teixits de Catalunya, 08005 Barcelona, Spain
| | - José A Casado
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - José C Segovia
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Omaira Alberquilla
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Massimo Bogliolo
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Servicio de Genética e Institut de Reserca, IIB-Sant Pau, Hospital Sant Pau, 08041 Barcelona, Spain.,Departmento de Genética y Microbiología, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
| | - Francisco J Román-Rodríguez
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Yari Giménez
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Lise Larcher
- Université de Paris, Institut de Recherche Saint-Louis, 75010 Paris, France
| | - Rocío Salgado
- Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
| | - Roser M Pujol
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Servicio de Genética e Institut de Reserca, IIB-Sant Pau, Hospital Sant Pau, 08041 Barcelona, Spain.,Departmento de Genética y Microbiología, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
| | - Raquel Hladun
- Servicio de Oncología y Hematología Pediátrica, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Ana Castillo
- Análisis Clínicos Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | - Jean Soulier
- Université de Paris, Institut de Recherche Saint-Louis, 75010 Paris, France
| | - Sergi Querol
- Banc de Sang i Teixits de Catalunya, 08005 Barcelona, Spain
| | | | | | | | | | - Albert Catalá
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Department of Hematology/Oncology, Hospital Sant Joan de Déu, 08950 Barcelona, Spain.,Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
| | - Jordi Surralles
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Servicio de Genética e Institut de Reserca, IIB-Sant Pau, Hospital Sant Pau, 08041 Barcelona, Spain.,Departmento de Genética y Microbiología, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
| | - Cristina Díaz-de-Heredia
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Servicio de Oncología y Hematología Pediátrica, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Juan A Bueren
- Centro de Investigación Biomédica en Red de Enfermedades Raras, 28029 Madrid, Spain.,Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avenida Complutense 40, 28040 Madrid, Spain.,Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain
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13
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López-Nevado M, González-Granado LI, Ruiz-García R, Pleguezuelo D, Cabrera-Marante O, Salmón N, Blanco-Lobo P, Domínguez-Pinilla N, Rodríguez-Pena R, Sebastián E, Cruz-Rojo J, Olbrich P, Ruiz-Contreras J, Paz-Artal E, Neth O, Allende LM. Primary Immune Regulatory Disorders With an Autoimmune Lymphoproliferative Syndrome-Like Phenotype: Immunologic Evaluation, Early Diagnosis and Management. Front Immunol 2021; 12:671755. [PMID: 34447369 PMCID: PMC8382720 DOI: 10.3389/fimmu.2021.671755] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/16/2021] [Indexed: 12/26/2022] Open
Abstract
Primary immune regulatory disorders (PIRD) are associated with autoimmunity, autoinflammation and/or dysregulation of lymphocyte homeostasis. Autoimmune lymphoproliferative syndrome (ALPS) is a PIRD due to an apoptotic defect in Fas-FasL pathway and characterized by benign and chronic lymphoproliferation, autoimmunity and increased risk of lymphoma. Clinical manifestations and typical laboratory biomarkers of ALPS have also been found in patients with a gene defect out of the Fas-FasL pathway (ALPS-like disorders). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), we identified more than 600 patients suffering from 24 distinct genetic defects described in the literature with an autoimmune lymphoproliferative phenotype (ALPS-like syndromes) corresponding to phenocopies of primary immunodeficiency (PID) (NRAS, KRAS), susceptibility to EBV (MAGT1, PRKCD, XIAP, SH2D1A, RASGRP1, TNFRSF9), antibody deficiency (PIK3CD gain of function (GOF), PIK3R1 loss of function (LOF), CARD11 GOF), regulatory T-cells defects (CTLA4, LRBA, STAT3 GOF, IL2RA, IL2RB, DEF6), combined immunodeficiencies (ITK, STK4), defects in intrinsic and innate immunity and predisposition to infection (STAT1 GOF, IL12RB1) and autoimmunity/autoinflammation (ADA2, TNFAIP3,TPP2, TET2). CTLA4 and LRBA patients correspond around to 50% of total ALPS-like cases. However, only 100% of CTLA4, PRKCD, TET2 and NRAS/KRAS reported patients had an ALPS-like presentation, while the autoimmunity and lymphoproliferation combination resulted rare in other genetic defects. Recurrent infections, skin lesions, enteropathy and malignancy are the most common clinical manifestations. Some approaches available for the immunological study and identification of ALPS-like patients through flow cytometry and ALPS biomarkers are provided in this work. Protein expression assays for NKG2D, XIAP, SAP, CTLA4 and LRBA deficiencies and functional studies of AKT, STAT1 and STAT3 phosphorylation, are showed as useful tests. Patients suspected to suffer from one of these disorders require rapid and correct diagnosis allowing initiation of tailored specific therapeutic strategies and monitoring thereby improving the prognosis and their quality of life.
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Affiliation(s)
- Marta López-Nevado
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain
| | - Luis I González-Granado
- Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,Immunodeficiency Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain
| | - Raquel Ruiz-García
- Immunology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - Daniel Pleguezuelo
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain
| | - Oscar Cabrera-Marante
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain
| | - Nerea Salmón
- Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,Immunodeficiency Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain
| | - Pilar Blanco-Lobo
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocío, Institute of Biomedicine, Biomedicine Institute (IBiS)/University of Seville/Superior Council of Scientific Investigations (CSIC), Seville, Spain
| | - Nerea Domínguez-Pinilla
- Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,Pediatric Hematology and Oncology Unit, Toledo Hospital Complex, Toledo, Spain and University Hospital 12 de Octubre, Madrid, Spain
| | | | - Elena Sebastián
- Hematology and Hemotherapy Unit, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Jaime Cruz-Rojo
- Endocrine Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain
| | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocío, Institute of Biomedicine, Biomedicine Institute (IBiS)/University of Seville/Superior Council of Scientific Investigations (CSIC), Seville, Spain
| | - Jesús Ruiz-Contreras
- Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,Immunodeficiency Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Estela Paz-Artal
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocío, Institute of Biomedicine, Biomedicine Institute (IBiS)/University of Seville/Superior Council of Scientific Investigations (CSIC), Seville, Spain
| | - Luis M Allende
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
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14
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Vuelta E, Ordoñez JL, Alonso-Pérez V, Méndez L, Hernández-Carabias P, Saldaña R, Sevilla J, Sebastián E, Muntión S, Sánchez-Guijo F, Hernández-Rivas JM, García-Tuñón I, Sánchez-Martín M. CRISPR-Cas9 Technology as a Tool to Target Gene Drivers in Cancer: Proof of Concept and New Opportunities to Treat Chronic Myeloid Leukemia. CRISPR J 2021; 4:519-535. [PMID: 34406033 DOI: 10.1089/crispr.2021.0009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a hematopoietic malignancy produced by a unique oncogenic event involving the constitutively active tyrosine-kinase (TK) BCR/ABL1. TK inhibitors (TKI) changed its prognosis and natural history. Unfortunately, ABL1 remains unaffected by TKIs. Leukemic stem cells (LSCs) remain, and resistant mutations arise during treatment. To address this problem, we have designed a therapeutic CRISPR-Cas9 deletion system targeting BCR/ABL1. The system was efficiently electroporated to cell lines, LSCs from a CML murine model, and LSCs from CML patients at diagnosis, generating a specific ABL1 null mutation at high efficiency and allowing the edited leukemic cells to be detected and tracked. The CRISPR-Cas9 deletion system triggered cell proliferation arrest and apoptosis in murine and human CML cell lines. Patient and murine-derived xenografts with CRISPR-edited LSCs in NOD SCID gamma niches revealed that normal multipotency and repopulation ability of CRISPR edited LSCs were fully restored. Normal hematopoiesis was restored, avoiding myeloid bias. To the best of our knowledge, we show for the first time how a CRISPR-Cas9 deletion system efficiently interrupts BCR/ABL1 oncogene in primary LSCs to bestow a therapeutic benefit. This study is a proof of concept for genome editing in all those diseases, like CML, sustained by a single oncogenic event, opening up new therapeutic opportunities.
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Affiliation(s)
- Elena Vuelta
- Unidad de Diagnóstico Molecular y Celular del Cáncer, Instituto Biología Molecular y Celular del Cáncer (USAL/CSIC), Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- Servicio de Transgénesis, NUCLEUS, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - José Luis Ordoñez
- Unidad de Diagnóstico Molecular y Celular del Cáncer, Instituto Biología Molecular y Celular del Cáncer (USAL/CSIC), Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- IBSAL, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - Verónica Alonso-Pérez
- Unidad de Diagnóstico Molecular y Celular del Cáncer, Instituto Biología Molecular y Celular del Cáncer (USAL/CSIC), Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- IBSAL, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - Lucía Méndez
- Servicio de Transgénesis, NUCLEUS, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - Patricia Hernández-Carabias
- Servicio de Transgénesis, NUCLEUS, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - Raquel Saldaña
- Servicio de Hematología, Hospital de Jerez, Cádiz, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - Julián Sevilla
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - Elena Sebastián
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - Sandra Muntión
- Unidad de Diagnóstico Molecular y Celular del Cáncer, Instituto Biología Molecular y Celular del Cáncer (USAL/CSIC), Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- RETIC TerCel y CIBERONC, ISCIII, Madrid, Spain; and Hospital Universitario de Salamanca, Salamanca, Spain
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Fermín Sánchez-Guijo
- Unidad de Diagnóstico Molecular y Celular del Cáncer, Instituto Biología Molecular y Celular del Cáncer (USAL/CSIC), Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- RETIC TerCel y CIBERONC, ISCIII, Madrid, Spain; and Hospital Universitario de Salamanca, Salamanca, Spain
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Jesús María Hernández-Rivas
- Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- IBSAL, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ignacio García-Tuñón
- Unidad de Diagnóstico Molecular y Celular del Cáncer, Instituto Biología Molecular y Celular del Cáncer (USAL/CSIC), Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- IBSAL, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
| | - Manuel Sánchez-Martín
- Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- Servicio de Transgénesis, NUCLEUS, Universidad de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
- IBSAL, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain
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15
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Berrueco R, Sebastián E, Solsona M, González de Pablo J, Ruiz‐Llobet A, Mesegué M, Gálvez E, Sevilla J. Secondary immune thrombocytopenia in children: Characteristics and outcome of a large cohort from two Spanish centres. Acta Paediatr 2021; 110:1952-1958. [PMID: 33460494 DOI: 10.1111/apa.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the incidence and outcome of secondary immune thrombocytopenia (ITP) in a large cohort of paediatric Spanish patients. METHODS A retrospective observational study was conducted in two paediatric University hospitals in Spain between 2009 and 2019, which included children from 4 months to 18 years old diagnosed with ITP. Data were recorded from clinical charts: gender, age at diagnosis, coexisting condition and associated characteristics, outcome and treatment. RESULTS Secondary ITP was diagnosed in 87 out of 442 patients (19.6%). Post-immunisation ITP was seen in younger children. The onset of secondary ITP to autoimmune diseases (AD) and immunodeficiencies (ID) was at an older age and had more tendency to be insidious, and platelet level was higher than primary ITP. Mean time from ITP onset to AD diseases or ID diagnosis was 1.2 and 2.6 years, respectively. Whereas the cumulative incidence of remission was significantly higher in post-immunisation and post-viral infection (compared with primary ITP patients), it was worse in AD and ID patients. CONCLUSIONS Identification of secondary ITP is important as it predicts outcome. Most of them are diagnosed at ITP onset, but AD diseases and ID should be ruled out periodically as they are usually identified later.
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Affiliation(s)
- Rubén Berrueco
- Pediatric Hematology Department Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat Barcelona Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP‐HSJD0) Barcelona Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III Madrid Spain
| | - Elena Sebastián
- Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - María Solsona
- Pediatric Hematology Department Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat Barcelona Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP‐HSJD0) Barcelona Spain
| | | | - Anna Ruiz‐Llobet
- Pediatric Hematology Department Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat Barcelona Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP‐HSJD0) Barcelona Spain
| | - Montse Mesegué
- Pediatric Hematology Department Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat Barcelona Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP‐HSJD0) Barcelona Spain
| | - Eva Gálvez
- Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - Julián Sevilla
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III Madrid Spain
- Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
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16
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Carreño-Tarragona G, Varghese LN, Sebastián E, Gálvez E, Marín-Sánchez A, López-Muñoz N, Nam-Cha S, Martínez-López J, Constantinescu SN, Sevilla J, Ayala R. A typical acute lymphoblastic leukemia JAK2 variant, R683G, causes an aggressive form of familial thrombocytosis when germline. Leukemia 2021; 35:3295-3298. [PMID: 33846542 DOI: 10.1038/s41375-021-01239-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Gonzalo Carreño-Tarragona
- Haematology and Haemotherapy Department, Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain
| | - Leila N Varghese
- Université Catholique de Louvain and de Duve Institute, Brussels, Belgium.,Ludwig Institute for Cancer Research, Brussels, Belgium.,WELBIO (Walloon Excellence in Life Sciences and Biotechnology), Brussels, Belgium
| | - Elena Sebastián
- Hematology and Hemotherapy Department, Hospital Infantil Universitario Niño Jesús, Fundación para la investigación Biomédica HIUNJ, CIBERER, Madrid, Spain
| | - Eva Gálvez
- Hematology and Hemotherapy Department, Hospital Infantil Universitario Niño Jesús, Fundación para la investigación Biomédica HIUNJ, CIBERER, Madrid, Spain
| | - Alberto Marín-Sánchez
- Haematology and Haemotherapy Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Nieves López-Muñoz
- Haematology and Haemotherapy Department, Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain
| | - Syonghyun Nam-Cha
- Pathology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Joaquín Martínez-López
- Haematology and Haemotherapy Department, Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain
| | - Stefan N Constantinescu
- Université Catholique de Louvain and de Duve Institute, Brussels, Belgium. .,Ludwig Institute for Cancer Research, Brussels, Belgium. .,WELBIO (Walloon Excellence in Life Sciences and Biotechnology), Brussels, Belgium.
| | - Julián Sevilla
- Hematology and Hemotherapy Department, Hospital Infantil Universitario Niño Jesús, Fundación para la investigación Biomédica HIUNJ, CIBERER, Madrid, Spain
| | - Rosa Ayala
- Haematology and Haemotherapy Department, Hospital Universitario 12 de Octubre, I+12, CNIO, Complutense University, CIBERONC, Madrid, Spain.
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17
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Sánchez MN, Zubicaray J, Sebastián E, Gálvez E, Sevilla J. Autoimmune hemolytic anemia: Case review. Anales de Pediatría (English Edition) 2021. [DOI: 10.1016/j.anpede.2020.07.014] [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: 12/01/2022] Open
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18
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Sánchez N, Zubicaray J, Sebastián E, Gálvez E, Sevilla J. [Autoimmune hemolytic anemia: Case review]. An Pediatr (Barc) 2020; 94:206-212. [PMID: 32972857 DOI: 10.1016/j.anpedi.2020.07.012] [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: 04/28/2020] [Revised: 07/12/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Autoimmune hemolytic anemia (AIHA) is a rare and generally self-limiting disease in children. MATERIAL AND METHODS A descriptive cross-sectional study was performed in children under 18 years diagnosed with AIHA from January/1997 to July/2019. Clinical variables were collected and AIHA was classified according to the direct antiglobulin test (DAT) in warm AIHA (IgG+/-C3d) and cold AIHA (C3d). Response to treatment and evolution were analyzed. RESULTS 25 patients were included and 72% were males. The median age at diagnosis was 2 years (range 0.4 to 9). Fever (72%), pallor (68%), jaundice (64%), hepatosplenomegaly and coluria (48%) were the most common presenting symptoms. The median hemoglobin at diagnosis was 5.4 g/dl. DAT was positive in 96%, with detection of IgG antibodies in 76%. A single case presented negative DAT. 20% of the patients associated another cytopenia, one of which was subsequently diagnosed with common variable immunodeficiency. Concomitant viral infection was suspected or documented in 32%. Most of the cases were self-limiting and responded to corticosteroid treatment (72%). Those with partial response (24%), mainly those associated with other cytopenias, required other lines of treatment (rituximab, mycophenolate, immunoglobulins). Complications (32%) and relapses (26%) were detected only in warm AIHA. CONCLUSIONS Our case series confirms that AIHA is a very rare disease in childhood. Most cases evolve favorably, although up to a quarter of them require second lines of treatment and, in exceptional cases, they need very aggressive treatments. These latter cases generally correspond to patients who present more than one cytopenia in the course of the disease.
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Affiliation(s)
- Nazaret Sánchez
- Servicio de Pediatría, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Josune Zubicaray
- Servicio de Hematología y Hemoterapia, Hematología y Oncología Pediátricas, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Elena Sebastián
- Servicio de Hematología y Hemoterapia, Hematología y Oncología Pediátricas, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Eva Gálvez
- Servicio de Hematología y Hemoterapia, Hematología y Oncología Pediátricas, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Julián Sevilla
- Servicio de Hematología y Hemoterapia, Hematología y Oncología Pediátricas, Hospital Infantil Universitario Niño Jesús, Fundación para la Investigación Biomédica del Hospital Infantil Universitario Niño Jesús, Madrid, España
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19
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Orbe Jaramillo IA, De Lucas Collantes C, Martínez de Azagra A, Sebastián E. Systemic lupus erythematosus presenting as thrombotic thrombocytopaenic purpura in a child: a diagnostic challenge. BMJ Case Rep 2020; 13:13/9/e232002. [PMID: 32878846 DOI: 10.1136/bcr-2019-232002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thrombotic thrombocytopaenic purpura (TTP) is a life-threatening thrombotic microangiopathy characterised by microangiopathic haemolytic anaemia, thrombocytopaenia and organ ischaemia. TTP is caused by a severe functional deficiency of ADAMTS13 activity. We describe a 10-year-old girl presenting anaemia and thrombocytopaenia with schistocytes. Urine protein to creatinine ratio was within nephrotic range. ADAMTS13 activity was 0%, and no anti-ADAMTS13 antibodies were found. A renal biopsy showed deposits of IgG, C3 and C1q in the capillary membrane, compatible with class V lupus nephritis. Therapeutic plasma exchange (TPE) was performed in conjunction with therapy consisting of steroids and mycophenolate mofetil. After 11 months of follow-up, the patient remains in remission with normal ADAMTS13 activity. Although acquired TTP is a rare finding in children, differential diagnosis of thrombotic microangiopathy should include ADAMTS13 and the assay should be performed early. TTP treatment is based on TPE, although the underlying disease must be ruled out to optimise treatment and prevent relapse.
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Affiliation(s)
| | | | | | - Elena Sebastián
- Onco-Hematology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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20
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Faura A, Rives S, Lassaletta Á, Sebastián E, Madero L, Huerta J, García‐Morín M, Martínez AP, Sisinni L, Astigarraga I, Velasco P, Gros L, Moreno L, Carboné A, Rodríguez‐Vigil C, Riesco S, Mendoza MDC, Macias EG, Trabazo M, Torrent M, Badell I, Fuster JL, Dominguez‐Pinilla N, Juan Ribelles A, Pérez‐Alonso V, Fernández Sanmartín M, Baragaño M, Gorostegui M, Perez‐Jaume S, Fernández‐Teijeiro A, Morales La Madrid A, Dapena JL. Initial report on Spanish pediatric oncologic, hematologic, and post stem cell transplantation patients during SARS-CoV-2 pandemic. Pediatr Blood Cancer 2020; 67:e28557. [PMID: 32672895 PMCID: PMC7404582 DOI: 10.1002/pbc.28557] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/18/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Anna Faura
- Pediatric Oncology and Hematology Department, Hospital Sant Joan de DeuBarcelonaSpain
| | - Susana Rives
- Pediatric Oncology and Hematology Department, Hospital Sant Joan de DeuBarcelonaSpain
| | - Álvaro Lassaletta
- Pediatric Hematology‐Oncology DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Elena Sebastián
- Pediatric Hematology‐Oncology DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Luis Madero
- Pediatric Hematology‐Oncology DepartmentHospital Universitario Niño JesúsMadridSpain
| | - Jorge Huerta
- Pediatric Hematology‐Oncology DepartmentHospital Materno‐Infantil Gregorio MarañónMadridSpain
| | - Marina García‐Morín
- Pediatric Hematology‐Oncology DepartmentHospital Materno‐Infantil Gregorio MarañónMadridSpain
| | | | - Luisa Sisinni
- Pediatric Hemato‐Oncology DepartmentHospital Universitario La PazMadridSpain
| | - Itziar Astigarraga
- Department of PediatricsBioCruces Bizkaia Health Research InstituteHospital Universitario CrucesUniversity of the Basque Country UPV/EHUBarakaldoSpain
| | - Pablo Velasco
- Pediatric Oncology and HematologyVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Luis Gros
- Pediatric Oncology and HematologyVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Lucas Moreno
- Pediatric Oncology and HematologyVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | - Ana Carboné
- Pediatric Hemato‐Oncology DepartmentHospital Universitario Miguel ServetZaragozaSpain
| | | | - Susana Riesco
- Pediatric Hemato‐Oncology DepartmentHospital Clínico UniversitarioSalamancaSpain
| | | | - Elena García Macias
- Pediatric Hemato‐Oncology DepartmentHospital Universitario Son EspasesMallorcaSpain
| | - Maria Trabazo
- Pediatric Oncology and Hematology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Montse Torrent
- Pediatric Oncology and Hematology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Isabel Badell
- Pediatric Oncology and Hematology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - José Luis Fuster
- Pediatric Oncology and Hematology DepartmentHospital Clínico Universitario Virgen de la ArrixacaInstituto Murciano de Investigación Biosanitaria (IMIB)MurciaSpain
| | | | - Antonio Juan Ribelles
- Pediatric Oncology and Hematology UnitHospital Universitario La Fe, La ValenciaValenciaSpain
| | - Vanesa Pérez‐Alonso
- Pediatric Oncology and Hematology DepartmentHospital Universitario 12 de OctubreMadridSpain
| | - Manuel Fernández Sanmartín
- Pediatric Oncology and Hematology DepartmentHospital Clinico Universitario de Santiago de CompostelaSantiago de CompostelaSpain
| | - Marta Baragaño
- Pediatric Oncology and Hematology DepartmentHospital Universitario Quiron SaludMadridSpain
| | - Maite Gorostegui
- Pediatric Oncology and Hematology Department, Hospital Sant Joan de DeuBarcelonaSpain
| | - Sara Perez‐Jaume
- Pediatric Oncology and Hematology Department, Hospital Sant Joan de DeuBarcelonaSpain
- Pediatric Oncology UnitHospitales Universitarios Virgen Macarena y Virgen del RocioSevillaSpain
- Developmental Tumor Biology LaboratoryInstitut de Recerca Sant Joan de DéuEsplugues de LlobregatBarcelonaSpain
| | - Ana Fernández‐Teijeiro
- Pediatric Oncology and Hematology DepartmentHospital Universitario Quiron SaludMadridSpain
| | | | - José Luis Dapena
- Pediatric Oncology and Hematology Department, Hospital Sant Joan de DeuBarcelonaSpain
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García-Morín M, Bardón-Cancho EJ, Beléndez C, Zamarro R, Béliz-Mendiola C, González-Rivera M, Vecilla C, Llorente-Otones L, Pérez-Alonso V, Román SS, Sebastián E, Dulín E, Cela E. Fifteen years of newborn sickle cell disease screening in Madrid, Spain: an emerging disease in a European country. Ann Hematol 2020; 99:1465-1474. [DOI: 10.1007/s00277-020-04044-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
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22
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Berrueco R, Dapena JL, Sebastián E, Sastre A. Controversias en el tratamiento de la trombocitopenia inmune pediátrica. An Pediatr (Barc) 2018; 89:189.e1-189.e8. [DOI: 10.1016/j.anpedi.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 01/19/2023] Open
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23
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Berrueco R, Dapena JL, Sebastián E, Sastre A. Controversies in the treatment of paediatric immune thrombocytopenia. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2018.06.004] [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: 01/19/2023] Open
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24
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Sebastián E, Alcoceba M, Martín-García D, Blanco Ó, Sanchez-Barba M, Balanzategui A, Marín L, Montes-Moreno S, González-Barca E, Pardal E, Jiménez C, García-Álvarez M, Clot G, Carracedo Á, Gutiérrez NC, Sarasquete ME, Chillón C, Corral R, Prieto-Conde MI, Caballero MD, Salaverria I, García-Sanz R, González M. High-resolution copy number analysis of paired normal-tumor samples from diffuse large B cell lymphoma. Ann Hematol 2015; 95:253-62. [PMID: 26573278 DOI: 10.1007/s00277-015-2552-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/06/2015] [Indexed: 12/23/2022]
Abstract
Copy number analysis can be useful for assessing prognosis in diffuse large B cell lymphoma (DLBCL). We analyzed copy number data from tumor samples of 60 patients diagnosed with DLBCL de novo and their matched normal samples. We detected 63 recurrent copy number alterations (CNAs), including 33 gains, 30 losses, and nine recurrent acquired copy number neutral loss of heterozygosity (CNN-LOH). Interestingly, 20 % of cases acquired CNN-LOH of 6p21 locus, which involves the HLA region. In normal cells, there were no CNAs but we observed CNN-LOH involving some key lymphoma regions such as 6p21 and 9p24.1 (5 %) and 17p13.1 (2.5 %) in DLBCL patients. Furthermore, a model with some specific CNA was able to predict the subtype of DLBCL, 1p36.32 and 10q23.31 losses being restricted to germinal center B cell-like (GCB) DLBCL. In contrast, 8p23.3 losses and 11q24.3 gains were strongly associated with the non-GCB subtype. A poor prognosis was associated with biallelic inactivation of TP53 or 18p11.32 losses, while prognosis was better in cases carrying 11q24.3 gains. In summary, CNA abnormalities identify specific DLBCL groups, and we describe CNN-LOH in germline cells from DLBCL patients that are associated with genes that probably play a key role in DLBCL development.
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Affiliation(s)
- Elena Sebastián
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group (GELTAMO), Salamanca, Spain
| | - Miguel Alcoceba
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group (GELTAMO), Salamanca, Spain
| | - David Martín-García
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Óscar Blanco
- Department of Pathology, University Hospital of Salamanca, Salamanca, Spain
| | | | - Ana Balanzategui
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Luis Marín
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Santiago Montes-Moreno
- Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group (GELTAMO), Salamanca, Spain
- Department of Pathology, University Hospital of Marqués de Valdecilla/IFIMAV, Santander, Spain
| | - Eva González-Barca
- Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group (GELTAMO), Salamanca, Spain
| | - Emilia Pardal
- Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group (GELTAMO), Salamanca, Spain
| | - Cristina Jiménez
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - María García-Álvarez
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - Guillem Clot
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ángel Carracedo
- Fundación Pública Galega de Medicina Xenómica, IDIS, SERGAS, Santiago de Compostela, Spain
- Grupo de Medicina Xenómica, CIBERER, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Norma C Gutiérrez
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - M Eugenia Sarasquete
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Carmen Chillón
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Rocío Corral
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - M Isabel Prieto-Conde
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - M Dolores Caballero
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group (GELTAMO), Salamanca, Spain
| | - Itziar Salaverria
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ramón García-Sanz
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain.
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.
- Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group (GELTAMO), Salamanca, Spain.
- Center for Cancer Research (CIC, IBMCC-USAL-CSIC), Salamanca, Spain.
| | - Marcos González
- Molecular Biology & Histocompatibility Unit, Department of Hematology, IBSAL - University Hospital of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Center for Cancer Research (CIC, IBMCC-USAL-CSIC), Salamanca, Spain
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25
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Puig N, Conde I, Jiménez C, Sarasquete ME, Balanzategui A, Alcoceba M, Quintero J, Chillón MC, Sebastián E, Corral R, Marín L, Gutiérrez NC, Mateos MV, González-Díaz M, San-Miguel JF, García-Sanz R. The predominant myeloma clone at diagnosis, CDR3 defined, is constantly detectable across all stages of disease evolution. Leukemia 2015; 29:1435-7. [DOI: 10.1038/leu.2015.7] [Citation(s) in RCA: 15] [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: 11/09/2022]
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26
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Sarasquete ME, Martínez-López J, Chillón MC, Alcoceba M, Corchete LA, Paiva B, Puig N, Sebastián E, Jiménez C, Mateos MV, Oriol A, Rosiñol L, Palomera L, Teruel AI, González Y, Lahuerta JJ, Bladé J, Gutiérrez NC, Fernández-Redondo E, González M, San Miguel JF, García-Sanz R. Evaluating gene expression profiling by quantitative polymerase chain reaction to develop a clinically feasible test for outcome prediction in multiple myeloma. Br J Haematol 2013; 163:223-34. [PMID: 23952215 DOI: 10.1111/bjh.12519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/05/2013] [Indexed: 11/30/2022]
Abstract
The gene expression profiles (GEPs) of 96 selected genes were analysed by real-time quantitative polymerase chain reaction (qPCR) with a TaqMan low-density array card in isolated tumour plasma cells (PCs) from 157 newly diagnosed multiple myeloma (MM) patients. This qPCR-based GEP correctly classified cases following the Translocation-cyclin D classification. Classic prognostic parameters and qPCR-based GEP predicted MM patient outcome and, although multivariate analyses revealed that cytogenetic risk (standard vs. high risk) was the variable that most strongly predicted prognosis, GEP added significant information for risk stratification. Considering only the standard risk cytogenetic patients, multivariate analyses revealed that high β2-microglobulin, low CDKN1A and high SLC19A1 gene expression levels independently predicted a short time-to-progression (TTP), while high International Staging System stage, low CDKN2B and high TBRG4 gene expression predicted poor overall survival (OS). A gene expression risk score enabled the division of standard risk patients into two groups with different TTPs (83% vs. 38% at 3 years, P < 0·0001) and OS rates (88% vs. 61% at 5 years; P = 0·003). This study demonstrates that quantitative PCR is a robust, accurate and feasible technique for implementing in the daily routine as a surrogate for GEP-arrays.
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Affiliation(s)
- María E Sarasquete
- Servicio de Hematología, Hospital Universitario de Salamanca e Instituto Biosanitario de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain; Centro de Investigación del Cáncer de Salamanca, Salamanca, Spain
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27
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Puig N, Sarasquete ME, Balanzategui A, Martínez J, Paiva B, García H, Fumero S, Jiménez C, Alcoceba M, Chillón MC, Sebastián E, Marín L, Montalbán MA, Mateos MV, Oriol A, Palomera L, de la Rubia J, Vidriales MB, Bladé J, Lahuerta JJ, González M, Miguel JFS, García-Sanz R. Critical evaluation of ASO RQ-PCR for minimal residual disease evaluation in multiple myeloma. A comparative analysis with flow cytometry. Leukemia 2013; 28:391-7. [DOI: 10.1038/leu.2013.217] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/14/2013] [Accepted: 07/10/2013] [Indexed: 11/09/2022]
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28
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Sebastián E, Alcoceba M, Balanzategui A, Marín L, Montes-Moreno S, Flores T, González D, Sarasquete ME, Chillón MC, Puig N, Corral R, Pardal E, Martín A, González-Barca E, Caballero MD, San Miguel JF, García-Sanz R, González M. Molecular characterization of immunoglobulin gene rearrangements in diffuse large B-cell lymphoma: antigen-driven origin and IGHV4-34 as a particular subgroup of the non-GCB subtype. Am J Pathol 2012; 181:1879-88. [PMID: 22982190 DOI: 10.1016/j.ajpath.2012.07.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/19/2012] [Accepted: 07/30/2012] [Indexed: 01/05/2023]
Abstract
The pathogenesis of diffuse large B-cell lymphoma (DLBCL) remains partially unknown. The analysis of the B-cell receptor of the malignant cells could contribute to a better understanding of the DLBCL biology. We studied the molecular features of the immunoglobulin heavy chain (IGH) rearrangements in 165 patients diagnosed with DLBCL not otherwise specified. Clonal IGH rearrangements were amplified according to the BIOMED-2 protocol and PCR products were sequenced directly. We also analyzed the criteria for stereotyped patterns in all complete IGHV-IGHD-IGHJ (V-D-J) sequences. Complete V-D-J rearrangements were identified in 130 of 165 patients. Most cases (89%) were highly mutated, but 12 sequences were truly unmutated or minimally mutated. Three genes, IGHV4-34, IGHV3-23, and IGHV4-39, accounted for one third of the whole cohort, including an overrepresentation of IGHV4-34 (15.5% overall). Interestingly, all IGHV4-34 rearrangements and all unmutated sequences belonged to the nongerminal center B-cell-like (non-GCB) subtype. Overall, we found three cases following the current criteria for stereotyped heavy chain VH CDR3 sequences, two of them belonging to subsets previously described in CLL. IGHV gene repertoire is remarkably biased, implying an antigen-driven origin in DLBCL. The particular features in the sequence of the immunoglobulins suggest the existence of particular subgroups within the non-GCB subtype.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Amino Acid Sequence
- Amino Acids/genetics
- Antigens, Neoplasm/immunology
- Clone Cells
- Complementarity Determining Regions/chemistry
- Complementarity Determining Regions/genetics
- Female
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Germinal Center/immunology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Immunohistochemistry
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Male
- Middle Aged
- Molecular Sequence Data
- Mutation/genetics
- Somatic Hypermutation, Immunoglobulin/genetics
- Somatic Hypermutation, Immunoglobulin/immunology
- V(D)J Recombination/genetics
- V(D)J Recombination/immunology
- Young Adult
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Affiliation(s)
- Elena Sebastián
- Department of Hematology, University Hospital of Salamanca, Spain
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29
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Puig N, Sarasquete ME, Alcoceba M, Balanzategui A, Chillón MC, Sebastián E, Marín LA, Díaz MG, San Miguel JF, Sanz RG. The use of CD138 positively selected marrow samples increases the applicability of minimal residual disease assessment by PCR in patients with multiple myeloma. Ann Hematol 2012; 92:97-100. [DOI: 10.1007/s00277-012-1566-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/24/2012] [Indexed: 11/29/2022]
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30
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Puig N, Sarasquete ME, Alcoceba M, Balanzategui A, Chillón MC, Sebastián E, Díaz MG, San Miguel JF, García-Sanz R. Kappa deleting element as an alternative molecular target for minimal residual disease assessment by real-time quantitative PCR in patients with multiple myeloma. Eur J Haematol 2012; 89:328-35. [PMID: 22805350 DOI: 10.1111/ejh.12000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Minimal residual disease (MRD) assessment by PCR in multiple myeloma (MM) has several shortcomings, including the lack of a suitable target. Kappa deleting element (KDE) rearrangements occur in virtually all Ig-lambda B-cell malignancies and in 1/3 of Ig-kappa are not affected by somatic hypermutation and, as in ALL, could be used as PCR targets. METHODS We have first investigated the incidence, gene segment usage, and CDR3 composition of IGK-KDE rearrangements in 96 untreated myeloma patients. Second, we tested 16 KDE gene rearrangements as molecular targets for MRD assessment by RQ-PCR using a germline reverse primer and a germline Taqman probe in combination with allele-specific oligonucleotides (ASO) as forward primers. RESULTS Monoclonal KDE rearrangements were amplified in 45% (43/96) of cases, monoallelic in 2/3 of them (29 cases), and biallellic in the remaining 14 cases. Overall, 88% of cases were successfully sequenced, KDE being equally frequently rearranged with VK and with intron-Recombination signal sequence (RSS). Median numbers of inserted and deleted nucleotides in the junctional region were one and five, respectively. CONCLUSIONS Using KDE rearrangements as additional PCR target for MRD assessment in MM improves the applicability of these studies in 9% of cases overall and in 20% of lambda cases. Its use in the latter subset could represent a significant advance.
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Affiliation(s)
- Noemí Puig
- Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente, Salamanca, Spain
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31
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Sebastián E, Martín J, McDonald GB, Flores T, Rodríguez A, Blanco A, Vazquez L, de Fuentes I, Caballero MD. Cryptosporidium parvum infection vs GVHD after hematopoietic SCT: diagnosis by PCR with resolution of symptoms. Bone Marrow Transplant 2010; 46:612-4. [DOI: 10.1038/bmt.2010.156] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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32
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Cultrone G, Arizzi A, Sebastián E, Rodriguez-Navarro C. Sulfation of calcitic and dolomitic lime mortars in the presence of diesel particulate matter. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s00254-008-1379-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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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