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Ruggeri A, Santoro N, Galimard JE, Kalwak K, Algeri M, Zubarovskaya L, Czyzewski K, Skorobogatova E, Sedlacek P, Besley C, Balduzzi A, Bertrand Y, Peristeri J, Fagioli F, Ifversen M, Gozdzik J, Peters C, Versluijs B, Biffi A, Prete A, Faraci M, Ghemlas I, Bodova I, Aleinikova O, Dalissier A, Rocha V, Corbacioglu S. Matched unrelated donor transplantation versus haploidentical transplantation with post-transplant cyclophosphamide in children with acute myeloid leukemia: a PDWP-EBMT study. Haematologica 2024. [PMID: 38186346 DOI: 10.3324/haematol.2023.284445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Indexed: 01/09/2024] Open
Abstract
In children with acute myeloid leukemia (AML) who lack an HLA identical sibling, the donor can be replaced with an HLA matched unrelated donor (MUD) or a haploidentical donor (haplo). We compared outcomes of patients <18 years with AML in first and second complete remission (CR1 and CR2) undergoing a hematopoietic stem cell transplantation (HCT) either with a MUD with anti-thymocyte globuline (ATG) (n=420) or a haplo HCT with PT-CY (n=96) after a myeloablative conditioning regimen (MAC) between 2011 and 2021, reported to EBMT. A matched pair analysis was performed to adjust for differences among groups. The final analysis was performed on 253 MUD and 95 haplo-HCTs. In the matched cohort, median age at HCT was 11.2 and 10 years and median year of HCT was 2017 and 2018, in MUD and haplo- HCT recipients, respectively. The risk of grade III-IV aGvHD was significantly higher in the haplo group (HR=2.33, 95%CI1.18-4.58, p=0.03). No significant differences were found in 2 years overall survival (OS; 78.4%vs71.5%; HR 1.39, 0.84-2.31, p=0.19), leukemia-free-survival (LFS; 72.7%vs69.5%; HR1.22, 0.76-1.95, p=0.41), CI of relapse (RI; 19.3%vs19.5%; HR=1.14, 0.62-2.08, p=0.68) non-relapse-mortality (NRM; 8%vs11%; HR=1.39, 0.66-2.93, p=0.39) and graft versus host free-relapse free survival (GRFS; 60.7%vs54.5%, HR=1.38, 0.95-2.02, p=0.09) after MUD and haplo-HCT respectively. Our study suggests that haplo-HCT with PT-CY is a suitable option to transplant children with AML lacking a matched related donor.
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Affiliation(s)
| | - Nicole Santoro
- Hematology Unit, Department of Oncology and Hematology, Santo Spirito Hospital, 65124 Pescara
| | | | - Krzysztof Kalwak
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw
| | - Mattia Algeri
- Department of Pediatric Hematology Oncology, IRCCS Bambino Gesu Children' s Hospital, Rome, Italy; Department of Health Sciences, Magna Graecia University, Catanzaro
| | | | - Krzysztof Czyzewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz
| | - Elena Skorobogatova
- The Russian Children' s Research Hospital, Department of Bone Marrow Transplantation, Moscow
| | - Petr Sedlacek
- University Hospital Motol Department of Paediatric Haematology and Oncology, Prague, Czech Republic
| | - Caroline Besley
- Bristol Royal Hospital for Children Dept. of Paediatric Oncology/BMT, Bristol
| | - Adriana Balduzzi
- Hematopoietic Stem Cell Transplantation Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Department of Medicine and Surgery, Milano-Bicocca University, Monza
| | - Yves Bertrand
- Institut d'Hematologie et d'Oncologie Pediatrique, Lyon
| | | | - Franca Fagioli
- Onco-Ematologia Pediatrica Centro Trapianti Cellule Staminali, Torino
| | - Mariane Ifversen
- Copenhagen University Hospital, Rigshospitalet, Dept of Children and Adolescents Medicine Copenhagen, Denmark
| | - Jolanta Gozdzik
- Department of Clinical Immunology and Transplantation Jagiellonian University Medical College, Children's Hospital in Krakow
| | - Christina Peters
- St. Anna Children's Hospital, Department of Pediatrics, Medical University of Vienna, Vienna
| | | | - Alessandra Biffi
- Clinica di Oncoematologia Pediatrica, Dipartimento di Pediatria, Padova
| | | | - Maura Faraci
- HSCT Unit, Department Hemato-Oncology, IRCSS Istituto G. Gaslini; Genova
| | - Ibrahim Ghemlas
- Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ivana Bodova
- Pediatric University Teaching Hospital BMT Unit, II Children's Clinic Bratislava, Slovakia
| | - Olga Aleinikova
- Belorussian Centre for Paediatric Oncology and Hematology Minsk
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Ayas M, Al-Hashim F, Siddiqui K, Al-Jefri A, Al-Ahmari A, Ghemlas I, Al-Saedi H, Al-Anazi A, Khan S, Qattan D, Al-Seraihi A. Hematopoietic stem cell transplantation in patients with Fanconi anemia: a report of late effects and psychosocial adjustment in life. Bone Marrow Transplant 2024; 59:141-143. [PMID: 37880411 DOI: 10.1038/s41409-023-02133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Fatima Al-Hashim
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen Al-Saedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif Al-Anazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saadiya Khan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Donya Qattan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Seraihi
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Khan S, AlSaif Z, Siddiqui K, AlSaedi H, Al-Ahmari A, Al-Jefri A, Ghemlas I, AlAnazi A, Ayas M. Is Mixed Chimerism Post-allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Acute Lymphoid Leukemia a Prognostic Factor for Relapse? Hematol Oncol Stem Cell Ther 2023; 17:72-78. [PMID: 37581467 DOI: 10.56875/2589-0646.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/11/2023] [Indexed: 08/16/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has been considered curative for children with high-risk acute leukemia (ALL), offering better survival. Short tandem repeat has been used as a marker of chimerism status after HSCT. The appearance of recipient cells >1% post-allogeneic stem cell transplant is defined as mixed chimerism (MC). Chimeric studies post-HSCT are dynamic. This study aimed to investigate the significance of recipient cells in post-HSCT pediatric ALL patients as a predictor of relapse of their primary disease. The rate of MC was 51.4% (19 out of 37 recipients). It was 48.6% (n = 18) during Day+100 and 12.9% (4 out of 31 recipients) during post-Day+100 follow-up until two years. No significant association was noted between MC and all grade overall acute graft-versus-host disease. A mortality rate of 35.1% (n = 13) and a median follow-up of 56.9 months (95% CI: 39.7-74.2) were observed for all but four (16.7%) of the survivors in remission. Regarding causes of death, transplant-related mortality was recorded in only 2 of 13 expired patients (15.4%); both succumbed to sepsis. No significant association was found between MC and primary causes of death. The cumulative probability of five-year overall survival and event-free survival was not found to be statistically significantly different for MC (≤1.0% vs. > 1.0%). In conclusion, our data did not show MC testing alone as an effective prognostic marker for detecting relapse; molecular and flow cytometric analyses should be considered in children with ALL post-HSCT for monitoring relapse.
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Affiliation(s)
- Saadiya Khan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zainab AlSaif
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Amao AT, Saleh M, Ayas M, Jafri R, Alqahtani S, AlAseri A, Sahabi M, Zulfiqar M, AlKofide A, Khan S, AlAhmari A, AlJefri A, Alsaedi HS, Alanazi A, Ghemlas I, Qattan D, AlShorman K, Ramadan L, Mohammed V. Implementing Web-Based Pre-Transplant Essential Data (TED) Collection Module for Centralized Access: Performance Improvement Project during COVID-19 Pandemic. Transplant Cell Ther 2023. [PMCID: PMC9899538 DOI: 10.1016/s2666-6367(23)00656-5] [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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Ramiz S, Elhaj O, Siddiqui K, Khan S, AlSaedi H, AlAnazi A, Al-Ahmari A, Al-Jefri A, Sahvan O, Ayas M, Ghemlas I. Clofarabine in Pediatric Acute Relapsed or Refractory Leukemia: Where Do We Stand on the Bridge to Hematopoietic Stem Cell Transplantation? J Hematol 2023; 12:16-26. [PMID: 36895294 PMCID: PMC9990710 DOI: 10.14740/jh1065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/12/2023] [Indexed: 02/26/2023] Open
Abstract
Background Despite pronounced improvement in overall survival (OS) in pediatric leukemia, a proportion of patients continue to suffer from lack of response or relapse, and the management of such patients is exceedingly difficult. Immunotherapy and engineered chimeric antigen receptor (CAR) T-cell therapy have shown promising results in the course of relapsed or refractory acute lymphoblastic leukemia (ALL). However, conventional chemotherapy continues to be utilized for re-induction purposes whether independently or in combination with immunotherapy. Methods Forty-three pediatric leukemia patients (age < 14 years at diagnosis) consecutively diagnosed at our institution and got treated with clofarabine based regimen at a single tertiary care hospital between January 2005 and December 2019 were enrolled in this study. ALL comprised of 30 (69.8%) patients of the cohort while the remaining 13 (30.2%) were with acute myeloid leukemia (AML). Results Post-clofarabine bone marrow (BM) was negative in 18 (45.0%) cases. Overall clofarabine failure rate was 58.1% (n = 25) with 60.0% (n = 18) in ALL and 53.8% (n = 7) in AML (P = 0.747). Eighteen (41.9%) patients eventually underwent hematopoietic stem cell transplantation (HSCT); 11 (61.1%) were from ALL group and remaining seven (38.9%) were AML (P = 0.332). Three- and 5-year OS of our patients was 37.7±7.6% and 32.7±7.3%. There was a trend of better OS for ALL patients compared to AML (40.9±9.3% vs. 15.4±10.0%, P = 0.492). Cumulative probability of 5-year OS was significantly better in transplanted patients (48.1±12.1% vs. 21.4±8.4%, P = 0.024). Conclusions Though almost 90% of our patients proceeded to HSCT with complete response post-clofarabine treatment, yet clofarabine-based regimens are associated with the significant burden of infectious complications and sepsis-related deaths.
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Affiliation(s)
- Sarah Ramiz
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Osama Elhaj
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Saadiya Khan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Oudai Sahvan
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
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AlAnazi A, Nadeem A, Siddiqui K, AlAhmari A, Ghemlas I, AlJefri A, AlSaedi H, Khan S, Ayas M. Can the bone marrow harvest volume be reduced safely in hematopoietic stem cell transplantation with pediatric sibling donors? Blood Res 2023; 58:28-35. [PMID: 36632685 PMCID: PMC10063592 DOI: 10.5045/br.2023.2022167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Background Reduced harvest volumes in pediatric donors appear to have the potential to reduce donorassociated risks while maintaining engraftment in recipients; however, the allowable harvest volume reduction remains undefined. Methods We retrospectively analyzed the data pairs of 553 bone marrow (BM) harvests from pediatric (age at harvest <18 yr) sibling donors and clinical outcomes of 553 pediatric (age at infusion <14 yr) transplant-naïve recipients to assess the optimal BM harvest volume needed from pediatric donors to obtain the desired CD34+ cell count (≥3.0×106 per kg of recipient weight) and to study its impact on the clinical outcomes of transplantation in pediatric recipients. Results 506 (95.3%) donor-recipient pairs met the median CD34+ cell count of 6.4×106 per kg of recipient weight (range, 1.2-33.8×106) in donors younger than 5 years at harvest, 4.7×106 (range, 0.3-28.5×106) in donors aged 5-10 years and 2.1×106 (range, 0.3-11.3×106) in donors older than 10 years (P<0.001). Conclusion The infused CD34+ cell dose (×106 cells/kg of recipient weight) had no impact on GRFS; however, a CD34+ cell dose of >7×106 cells/kg of recipient weight did not improve hematopoietic recovery.
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Affiliation(s)
- Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amer Nadeem
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali AlAhmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah AlJefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saadiya Khan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Khan S, Siddiqui K, ElSolh H, AlJefri A, AlAhmari A, Ghemlas I, AlSaedi H, AlEnazi A, AlSeraihi A, Ayas M. Outcomes of blood and marrow transplantation in children less than 2-years of age: 23 years of experience at a single center. Int J Pediatr Adolesc Med 2022; 9:190-195. [PMID: 36937328 PMCID: PMC10019952 DOI: 10.1016/j.ijpam.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/28/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
Objectives Allogeneic hematopoietic cell transplantation (Allo-HCT) is a curative option for children with various malignant and non-malignant diseases. Most reports studied all age groups amongst children. Herein we analyzed our data in children transplanted at or less than 2-years of age. Patients and methods We reviewed medical charts of 618 patients who underwent 666 transplantation at our center between 1993 and 2015. There were 340 boys and 278 girls. Median age was 0.7 years (range 0.04-2). Stem cell source was bone marrow (BM) in 492 (73.9%), unrelated umbilical cord blood (UCB) in 161 (24.2%) followed by peripheral blood stem cell (PBSC) in 13 (2%) patients. Matched siblings were the most common donors (n = 356, 53.5%), followed by unrelated (n = 161, 24.2%) with haploidentical family member donors in 29 (4.4%) transplants. Disease groups were categorized as benign hematology (Thalassemia, Fanconi, Aplastic anemia etc.), benign neoplasm (Langerhans cell histiocytosis, Hemophagocytic Lymphohistiocytosis etc.), non-neoplasms (metabolic disorders, immunodeficiency disorders etc.) and Leukemia/lymphomas (myeloid and lymphoid malignancies etc.). Results Cumulative incidence of acute GvHD (I-IV) was 31.5% (n = 210) and grade III-IV GvHD was 8.7% (n = 58). At median follow-up of 115.1 months, the cumulative probability of overall survival (OS) at 5 years was 70.0% ± 1.9%. Our mortality rate was 31.2% (n = 193). The five-year OS was significantly better in patients transplanted for benign hematological disorders (P = .001). Patients transplanted using BM/PBSC as source of stem cells fared significantly better compared to those in which CB was used (P<.001). Post-transplant graft failure remains the leading cause requiring further transplants in this age group. In conclusion, the cumulative probability of OS at 5 years was about 70.0% for all with an OS of 61% in our haploidentical recipients. Conclusion Analyzing our institutional data over time has enabled us to develop tentative strategies to minimize transplant related toxicities in very young children who are candidates for allo-HCT.
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AlSaedi H, Mohammed R, Siddiqui K, Al-Ahmari A, AlSaud B, Almousa H, Al-Jefri A, Ghemlas I, AlAnazi A, Al-Seraihy A, El-Solh H, Ayas M. HLA-haploidentical donor transplants with post-transplant cyclophosphamide in children with primary immune deficiency disorders. Bone Marrow Transplant 2022; 57:668-670. [PMID: 35121808 DOI: 10.1038/s41409-022-01589-7] [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: 12/15/2020] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Hawazen AlSaedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Reem Mohammed
- Department of Pediatrics King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Bandar AlSaud
- Department of Pediatrics King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hamoud Almousa
- Department of Pediatrics King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif AlAnazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Seraihy
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hassan El-Solh
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Al-Jefri A, Siddiqui K, Al-Oraibi A, Al-Seraihy A, Al Ahmari A, Ghemlas I, Al Anazi A, Al Saedi H, Ayas M. Hematopoietic Stem Cell Transplantation Stabilizes Cerebral Vasculopathy in High-Risk Pediatric Sickle Cell Disease Patients: Evidence From a Referral Transplant Center. J Hematol 2022; 11:8-14. [PMID: 35356638 PMCID: PMC8929199 DOI: 10.14740/jh949] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/04/2021] [Accepted: 12/28/2021] [Indexed: 11/11/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Abdullah Al-Jefri
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Corresponding Author: Abdullah Al-Jefri, Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia.
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amira Al-Oraibi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Seraihy
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Al Ahmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Awatif Al Anazi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hawazen Al Saedi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Khan S, AlSayyad K, Siddiqui K, AlAnazi A, AlSeraihy A, AlAhmari A, ElSolh H, Ghemlas I, AlSaedi H, AlJefri A, Ali A, AlFawaz I, AlKofide A, Ayas M. Pediatric high risk neuroblastoma with autologous stem cell transplant - 20 years of experience. Int J Pediatr Adolesc Med 2021; 8:253-257. [PMID: 34401451 PMCID: PMC8356102 DOI: 10.1016/j.ijpam.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Neuroblastoma is the most common extracranial solid tumor found in pediatric patients. High-risk neuroblastoma (HR-NBL) can be characterized by metastasis, age, and other tumor characteristics that result in an adverse outlook for this patient cohort. The standard of care includes induction chemotherapy, surgery, followed by stem cell autologous transplant (ASCT), and later, antidisialoganglioside (anti-GD2) antibodies. In this study, we provide the survival and toxicity data of our HR-NBL patients treated with a single ASCT. METHODS We retrospectively analyzed pediatric HR-NBL patients treated with single ASCT after a carboplatin, etoposide, and melphalan (CEM) regimen in our institution between January 1993 and December 2014. RESULTS There were 99 evaluable patients with male predominance. The median age at diagnosis was 3 years. Most of our HR-NBL patients were stage 4 (88%). All patients received ASCT. Peripheral blood was the graft source in 58% of the patients. Time for hematological count recovery with bone marrow as a graft source was prolonged but not statistically significant when compared with PBSCs. Of all the patients, 58% received radiation therapy to residual disease. Overt secondary leukemia was not seen in any of these patients. Three-year overall survival (OS) was 68.5% ± 5.2% and the 3-year event-free survival (EFS) was (48.3% ± 5.2%). CONCLUSION Our HR-NBL patients tolerated high-dose chemotherapy well followed by single autologous stem cell transplant. Tandem transplant is a feasible option in our patient cohort. Apart from secondary solid tumors, there were no long-term complications seen.
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Alsaedi HS, Alseraihy A, Ayas M, Ghemlas I, Alahmari A, AlJefri A, Alanazi A, Lacson F, AlMeshari N, AlNafee K, Jafri R, Mohammed V. Minimizing Hospital Acquired Infections in Post- Hematopoietic Stem Cell Transplant Pediatric Recipients: Impact on Hospital - Metrics of a Tertiary Care Centre. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Alsaedi HS, Mohammed R, Ayas M, Siddiqui K, Ghemlas I, AlMusa H, AlSaud B, Arnaout R, AlDhekri H, Jafri R, Alahmari A, AlJefri A, Alseraihy A. HLA-Haploidentical Transplantation in Children with Primary Immunodeficiency Using Post Cyclophosphamide. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Monies D, Abouelhoda M, Assoum M, Moghrabi N, Rafiullah R, Almontashiri N, Alowain M, Alzaidan H, Alsayed M, Subhani S, Cupler E, Faden M, Alhashem A, Qari A, Chedrawi A, Aldhalaan H, Kurdi W, Khan S, Rahbeeni Z, Alotaibi M, Goljan E, Elbardisy H, ElKalioby M, Shah Z, Alruwaili H, Jaafar A, Albar R, Akilan A, Tayeb H, Tahir A, Fawzy M, Nasr M, Makki S, Alfaifi A, Akleh H, Yamani S, Bubshait D, Mahnashi M, Basha T, Alsagheir A, Khaled MA, Alsaleem K, Almugbel M, Badawi M, Bashiri F, Bohlega S, Sulaiman R, Tous E, Ahmed S, Algoufi T, Al-Mousa H, Alaki E, Alhumaidi S, Alghamdi H, Alghamdi M, Sahly A, Nahrir S, Al-Ahmari A, Alkuraya H, Almehaidib A, Abanemai M, Alsohaibaini F, Alsaud B, Arnaout R, Abdel-Salam GMH, Aldhekri H, AlKhater S, Alqadi K, Alsabban E, Alshareef T, Awartani K, Banjar H, Alsahan N, Abosoudah I, Alashwal A, Aldekhail W, Alhajjar S, Al-Mayouf S, Alsemari A, Alshuaibi W, Altala S, Altalhi A, Baz S, Hamad M, Abalkhail T, Alenazi B, Alkaff A, Almohareb F, Al Mutairi F, Alsaleh M, Alsonbul A, Alzelaye S, Bahzad S, Manee AB, Jarrad O, Meriki N, Albeirouti B, Alqasmi A, AlBalwi M, Makhseed N, Hassan S, Salih I, Salih MA, Shaheen M, Sermin S, Shahrukh S, Hashmi S, Shawli A, Tajuddin A, Tamim A, Alnahari A, Ghemlas I, Hussein M, Wali S, Murad H, Meyer BF, Alkuraya FS. Lessons Learned from Large-Scale, First-Tier Clinical Exome Sequencing in a Highly Consanguineous Population. Am J Hum Genet 2019; 105:879. [PMID: 31585110 DOI: 10.1016/j.ajhg.2019.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Alsaleh M, Alkofide A, Ali A, Ghemlas I, Aljefri A, Ayas M, Alseraihy A, Elenazi A, Alahmari A, Alfawaz I, Bushnak D, Hazeem M, Ahmad A, Farhan N, Alhmouz A. Incidence of venous thromboembolism (VTE) in childhood cancers from a tertiary care centre: a unique registry initiative with an open invitation. Leuk Res 2019. [DOI: 10.1016/s0145-2126(19)30270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Monies D, Abouelhoda M, Assoum M, Moghrabi N, Rafiullah R, Almontashiri N, Alowain M, Alzaidan H, Alsayed M, Subhani S, Cupler E, Faden M, Alhashem A, Qari A, Chedrawi A, Aldhalaan H, Kurdi W, Khan S, Rahbeeni Z, Alotaibi M, Goljan E, Elbardisy H, ElKalioby M, Shah Z, Alruwaili H, Jaafar A, Albar R, Akilan A, Tayeb H, Tahir A, Fawzy M, Nasr M, Makki S, Alfaifi A, Akleh H, Yamani S, Bubshait D, Mahnashi M, Basha T, Alsagheir A, Abu Khaled M, Alsaleem K, Almugbel M, Badawi M, Bashiri F, Bohlega S, Sulaiman R, Tous E, Ahmed S, Algoufi T, Al-Mousa H, Alaki E, Alhumaidi S, Alghamdi H, Alghamdi M, Sahly A, Nahrir S, Al-Ahmari A, Alkuraya H, Almehaidib A, Abanemai M, Alsohaibaini F, Alsaud B, Arnaout R, Abdel-Salam GMH, Aldhekri H, AlKhater S, Alqadi K, Alsabban E, Alshareef T, Awartani K, Banjar H, Alsahan N, Abosoudah I, Alashwal A, Aldekhail W, Alhajjar S, Al-Mayouf S, Alsemari A, Alshuaibi W, Altala S, Altalhi A, Baz S, Hamad M, Abalkhail T, Alenazi B, Alkaff A, Almohareb F, Al Mutairi F, Alsaleh M, Alsonbul A, Alzelaye S, Bahzad S, Manee AB, Jarrad O, Meriki N, Albeirouti B, Alqasmi A, AlBalwi M, Makhseed N, Hassan S, Salih I, Salih MA, Shaheen M, Sermin S, Shahrukh S, Hashmi S, Shawli A, Tajuddin A, Tamim A, Alnahari A, Ghemlas I, Hussein M, Wali S, Murad H, Meyer BF, Alkuraya FS. Lessons Learned from Large-Scale, First-Tier Clinical Exome Sequencing in a Highly Consanguineous Population. Am J Hum Genet 2019; 104:1182-1201. [PMID: 31130284 DOI: 10.1016/j.ajhg.2019.04.011] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/11/2019] [Indexed: 12/16/2022] Open
Abstract
We report the results of clinical exome sequencing (CES) on >2,200 previously unpublished Saudi families as a first-tier test. The predominance of autosomal-recessive causes allowed us to make several key observations. We highlight 155 genes that we propose to be recessive, disease-related candidates. We report additional mutational events in 64 previously reported candidates (40 recessive), and these events support their candidacy. We report recessive forms of genes that were previously associated only with dominant disorders and that have phenotypes ranging from consistent with to conspicuously distinct from the known dominant phenotypes. We also report homozygous loss-of-function events that can inform the genetics of complex diseases. We were also able to deduce the likely causal variant in most couples who presented after the loss of one or more children, but we lack samples from those children. Although a similar pattern of mostly recessive causes was observed in the prenatal setting, the higher proportion of loss-of-function events in these cases was notable. The allelic series presented by the wealth of recessive variants greatly expanded the phenotypic expression of the respective genes. We also make important observations about dominant disorders; these observations include the pattern of de novo variants, the identification of 74 candidate dominant, disease-related genes, and the potential confirmation of 21 previously reported candidates. Finally, we describe the influence of a predominantly autosomal-recessive landscape on the clinical utility of rapid sequencing (Flash Exome). Our cohort's genotypic and phenotypic data represent a unique resource that can contribute to improved variant interpretation through data sharing.
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Affiliation(s)
- Dorota Monies
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Mohammed Abouelhoda
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Mirna Assoum
- Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Nabil Moghrabi
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Rafiullah Rafiullah
- Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Naif Almontashiri
- Clinical Molecular and Biochemical Genetics, Taibah University, Madinah 42353, Saudi Arabia
| | - Mohammed Alowain
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Hamad Alzaidan
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Moeen Alsayed
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Shazia Subhani
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Edward Cupler
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Jeddah 23433, Saudi Arabia
| | - Maha Faden
- Genetics and Metabolism, King Saud Medical Complex, Riyadh 12746, Saudi Arabia
| | - Amal Alhashem
- Pediatrics Department, Prince Sultan Military Medical Complex, Riyadh 12233, Saudi Arabia
| | - Alya Qari
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Aziza Chedrawi
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Hisham Aldhalaan
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Wesam Kurdi
- Obstetrics and Gynecology Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Sameena Khan
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Zuhair Rahbeeni
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Maha Alotaibi
- Genetics and Metabolism, King Saud Medical Complex, Riyadh 12746, Saudi Arabia
| | - Ewa Goljan
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Hadeel Elbardisy
- Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Mohamed ElKalioby
- Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Zeeshan Shah
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Hibah Alruwaili
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Amal Jaafar
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ranad Albar
- Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia
| | - Asma Akilan
- Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Hamsa Tayeb
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Asma Tahir
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Mohammed Fawzy
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Mohammed Nasr
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Shaza Makki
- Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Abdullah Alfaifi
- Pediatrics Department, Security Forces Hospital, Riyadh 11481, Saudi Arabia
| | - Hanna Akleh
- Academic and Training Affairs, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Suad Yamani
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Dalal Bubshait
- Pediatrics Department, King Fahad Hospital of the University, Al-Khobar 31952, Saudi Arabia
| | - Mohammed Mahnashi
- Genetics and Medicine, King Fahd Central Hospital, Gizan 82666, Saudi Arabia
| | - Talal Basha
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Jeddah 23433, Saudi Arabia
| | - Afaf Alsagheir
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Musad Abu Khaled
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Khalid Alsaleem
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Maisoon Almugbel
- Obstetrics and Gynecology Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Manal Badawi
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Fahad Bashiri
- Department of Pediatrics, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia
| | - Saeed Bohlega
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Raashida Sulaiman
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ehab Tous
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Syed Ahmed
- Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Talal Algoufi
- Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Hamoud Al-Mousa
- Allergy - Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Emadia Alaki
- Allergy - Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Susan Alhumaidi
- Pediatrics Department, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Hadeel Alghamdi
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Jeddah 23433, Saudi Arabia
| | - Malak Alghamdi
- Pediatrics Department, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Ahmed Sahly
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Shapar Nahrir
- Pediatrics Department, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Ali Al-Ahmari
- Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Hisham Alkuraya
- Vitreoretinal Surgery, Specialized Medical Centre, Riyadh 11564, Saudi Arabia
| | - Ali Almehaidib
- Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Mohammed Abanemai
- Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Fahad Alsohaibaini
- Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Bandar Alsaud
- Allergy - Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Rand Arnaout
- Allergy - Immunology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | | | - Hasan Aldhekri
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Suzan AlKhater
- Pediatrics Department, King Fahad Hospital of the University, Al-Khobar 31952, Saudi Arabia; Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Khalid Alqadi
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Essam Alsabban
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Turki Alshareef
- Pediatric Nephrology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Khalid Awartani
- Obstetrics and Gynecology Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Hanaa Banjar
- Pediatric Pulmonology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Nada Alsahan
- Obstetrics and Gynecology Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ibraheem Abosoudah
- Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah 23433, Saudi Arabia
| | - Abdullah Alashwal
- Pediatric Endocrine and Metabolism, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Wajeeh Aldekhail
- Gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Sami Alhajjar
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Sulaiman Al-Mayouf
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Abdulaziz Alsemari
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Walaa Alshuaibi
- Pediatrics Department, King Khalid University Hospital, Riyadh 12372, Saudi Arabia
| | - Saeed Altala
- Pediatrics Department, Armed Forces Hospital, Khamis Mushait 62451, Saudi Arabia
| | - Abdulhadi Altalhi
- Pediatric Nephrology, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Salah Baz
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Muddathir Hamad
- Pediatrics Department, King Khalid University Hospital, Riyadh 12372, Saudi Arabia
| | - Tariq Abalkhail
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Badi Alenazi
- Pediatrics Department, Alyamama Hospital, Riyadh 14222, Saudi Arabia
| | - Alya Alkaff
- Obstetrics and Gynecology Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Fahad Almohareb
- Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Fuad Al Mutairi
- King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11564, Saudi Arabia; Medical Genetic Division, Department of Pediatrics, King Abdulaziz Medical City, Riyadh 14611, Saudi Arabia
| | - Mona Alsaleh
- Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Abdullah Alsonbul
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Somaya Alzelaye
- Pediatric Endocrine and Diabetes, Al Qunfudah General Hospital, Al Qunfudhah 28821, Saudi Arabia
| | - Shakir Bahzad
- Kuwait Medical Genetics Center, Kuwait City 65000, Kuwait
| | - Abdulaziz Bin Manee
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ola Jarrad
- Pediatrics Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Neama Meriki
- Maternal and Fetal Medicine, King Khalid University Hospital, Riyadh 12372, Saudi Arabia
| | - Bassem Albeirouti
- Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah 23433, Saudi Arabia
| | - Amal Alqasmi
- Pediatrics Department, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Mohammed AlBalwi
- Department of Pathology and Laboratory Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Nawal Makhseed
- Pediatrics Department, Alsoor Clinic, Kuwait City 65000, Kuwait
| | - Saeed Hassan
- Pediatrics Department, King Khalid University Hospital, Riyadh 12372, Saudi Arabia
| | - Isam Salih
- Hepatic-Pancreatic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Mustafa A Salih
- Department of Pediatrics, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia
| | - Marwan Shaheen
- Hematology and Bone Marrow Transplant, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Saadeh Sermin
- Pediatric Nephrology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Shamsad Shahrukh
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Jeddah 23433, Saudi Arabia
| | - Shahrukh Hashmi
- Hematology and Bone Marrow Transplant, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ayman Shawli
- Department of Pediatrics, King Abdulaziz Medical City, Jeddah 9515, Saudi Arabia
| | - Ameen Tajuddin
- Neurology, King Fahad Hospital, Medina 59046, Saudi Arabia
| | - Abdullah Tamim
- Pediatrics Neurology, King Faisal Specialist Hospital and Research Centre, Jeddah 23433, Saudi Arabia
| | - Ahmed Alnahari
- Pediatric Department, King Fahad Central Hospital, Gizan, 82666, Saudi Arabia
| | - Ibrahim Ghemlas
- Pediatric Hematology and Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Maged Hussein
- Nephrology Department, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Sami Wali
- Pediatrics Department, Prince Sultan Military Medical Complex, Riyadh 12233, Saudi Arabia
| | - Hatem Murad
- Neurosciences Department, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
| | - Brian F Meyer
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; Saudi Diagnostic Laboratories, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Fowzan S Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh 12354, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia.
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Ayas MF, Al-Seraihi A, Al-Agil A, Al-Ahmari A, Ghemlas I, Ayas M. Successful hematopoietic cell transplantation in Fanconi anemia patients with renal impairment using ultra-reduced doses of cyclophosphamide and fludarabine. Pediatr Blood Cancer 2018; 65:e27371. [PMID: 30070008 DOI: 10.1002/pbc.27371] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 11/11/2022]
Abstract
Hematopoietic cell transplantation (HCT) remains until now the only curative modality for hematological manifestations in patients with Fanconi anemia (FA). The doses of alkylating agents used in the conditioning of this patient population before HCT are usually significantly decreased due to the genomic instability of the FA cells. FA patients with renal impairment represent a dilemma because of the need to further modify the conditioning regimen according to the degree of renal impairment to avoid additional toxicity. At our institution, we successfully transplanted three FA patients using an ultra-modified regimen.
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Affiliation(s)
| | - Amal Al-Seraihi
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amal Al-Agil
- Department of Pharmaceutical Care, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ali Al-Ahmari
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Ghemlas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Arbiv OA, Cuvelier G, Klaassen RJ, Fernandez CV, Robitaille N, Steele M, Breakey V, Abish S, Wu J, Sinha R, Silva M, Goodyear L, Jardine L, Lipton JH, Corriveau-Bourque C, Brossard J, Michon B, Ghemlas I, Waespe N, Zlateska B, Sung L, Cada M, Dror Y. Molecular analysis and genotype-phenotype correlation of Diamond-Blackfan anemia. Clin Genet 2017; 93:320-328. [PMID: 29044489 DOI: 10.1111/cge.13158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 02/03/2023]
Abstract
Diamond-Blackfan anemia (DBA) features hypoplastic anemia and congenital malformations, largely caused by mutations in various ribosomal proteins. The aim of this study was to characterize the spectrum of genetic lesions causing DBA and identify genotypes that correlate with phenotypes of clinical significance. Seventy-four patients with DBA from across Canada were included. Nucleotide-level mutations or large deletions were identified in 10 ribosomal genes in 45 cases. The RPS19 mutation group was associated with higher requirement for chronic treatment for anemia than other DBA groups. Patients with RPS19 mutations, however, were more likely to maintain long-term corticosteroid response without requirement for further chronic transfusions. Conversely, patients with RPL11 mutations were less likely to need chronic treatment. Birth defects, including cardiac, skeletal, hand, cleft lip or palate and genitourinary malformations, also varied among the various genetic groups. Patients with RPS19 mutations had the fewest number of defects, while patients with RPL5 had the greatest number of birth defects. This is the first study to show differences between DBA genetic groups with regards to treatment. Previously unreported differences in the rate and types of birth defects were also identified. These data allow better patient counseling, a more personalized monitoring plan, and may also suggest differential functions of DBA genes on ribosome and extra-ribosomal functions.
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Affiliation(s)
- O A Arbiv
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - G Cuvelier
- Division of Haematology/Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - R J Klaassen
- Division of Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - C V Fernandez
- Division of Haematology/Oncology, IWK Health Centre, Halifax, Canada
| | - N Robitaille
- Division of Haematology/Oncology, CHU Sainte Justine, Montreal, Canada
| | - M Steele
- Division of Haematology/Oncology, Alberta Children's Hospital, Calgary, Canada
| | - V Breakey
- Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - S Abish
- Division of Haematology/Oncology, Montreal Children's Hospital, Montreal, Canada
| | - J Wu
- Division of Haematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada
| | - R Sinha
- Division of Haematology/Oncology, University of Saskatchewan, Saskatoon, Canada
| | - M Silva
- Division of Haematology/Oncology, Queen's University, Kingston, Canada
| | - L Goodyear
- Division of Haematology/Oncology, Janeway Child Health Centre, St. John's, Canada
| | - L Jardine
- Division of Haematology/Oncology, Children's Hospital of Western Ontario, London, Canada
| | - J H Lipton
- Department of Haematology and Internal Medicine, Princess Margaret Hospital, Toronto, Canada
| | - C Corriveau-Bourque
- Division of Haematology/Oncology, University of Alberta Health Sciences Centre, Edmonton, Canada
| | - J Brossard
- Division of Haematology/Oncology, Centre Y Sante L'Estrie-Fleur, Sherbrooke, Canada
| | - B Michon
- Division of Haematology/Oncology, Centre Hospitalier de l'Université Laval, Quebec City, Canada
| | - I Ghemlas
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Division of Haematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - N Waespe
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - B Zlateska
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - L Sung
- Program in Child Health and Evaluative Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Lymphoma Leukemia Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - M Cada
- The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Y Dror
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada
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18
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al-Sweedan S, Siddiqui K, Jafri R, Alahmari A, Ghemlas I, Ayas M, Farhan N, Alseraihy A. Stem Cell Transplantation (SCT) in Pediatric Acute Myeloid Leukemia (AML) – Reporting 8 Years of Data From a CIBMTR Member Centre, King Faisal Specialist Hospital and Research Centre, Riaydh, Saudi Arabia. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Ghemlas I, Li H, Zlateska B, Klaassen R, Fernandez CV, Yanofsky RA, Wu J, Pastore Y, Silva M, Lipton JH, Brossard J, Michon B, Abish S, Steele M, Sinha R, Belletrutti M, Breakey VR, Jardine L, Goodyear L, Sung L, Dhanraj S, Reble E, Wagner A, Beyene J, Ray P, Meyn S, Cada M, Dror Y. Improving diagnostic precision, care and syndrome definitions using comprehensive next-generation sequencing for the inherited bone marrow failure syndromes. J Med Genet 2015; 52:575-84. [PMID: 26136524 DOI: 10.1136/jmedgenet-2015-103270] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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: 05/15/2015] [Accepted: 06/07/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Phenotypic overlap among the inherited bone marrow failure syndromes (IBMFSs) frequently limits the ability to establish a diagnosis based solely on clinical features. >70 IBMFS genes have been identified, which often renders genetic testing prolonged and costly. Since correct diagnosis, treatment and cancer surveillance often depend on identifying the mutated gene, strategies that enable timely genotyping are essential. METHODS To overcome these challenges, we developed a next-generation sequencing assay to analyse a panel of 72 known IBMFS genes. Cases fulfilling the clinical diagnostic criteria of an IBMFS but without identified causal genotypes were included. RESULTS The assay was validated by detecting 52 variants previously found by Sanger sequencing. A total of 158 patients with unknown mutations were studied. Of 75 patients with known IBMFS categories (eg, Fanconi anaemia), 59% had causal mutations. Among 83 patients with unclassified IBMFSs, we found causal mutations and established the diagnosis in 18% of the patients. The assay detected mutant genes that had not previously been reported to be associated with the patient phenotypes. In other cases, the assay led to amendments of diagnoses. In 20% of genotype cases, the results indicated a cancer surveillance programme. CONCLUSIONS The novel assay is efficient, accurate and has a major impact on patient care.
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Affiliation(s)
- Ibrahim Ghemlas
- Program in Genetics and Genome Biology, Research Institute, Toronto, Ontario, Canada Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hongbing Li
- Program in Genetics and Genome Biology, Research Institute, Toronto, Ontario, Canada
| | - Bozana Zlateska
- Program in Genetics and Genome Biology, Research Institute, Toronto, Ontario, Canada
| | - Robert Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - John Wu
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Jeff H Lipton
- Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Josee Brossard
- Centre hospitalier universitaire, Sherbrooke, Quebec, Canada
| | - Bruno Michon
- Centre Hospital University Quebec-Pav CHUL, Sainte-Foy, Quebec, Canada
| | - Sharon Abish
- Montreal Children's Hospital, Montreal, Québec, Canada
| | | | - Roona Sinha
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mark Belletrutti
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Vicky R Breakey
- McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Jardine
- Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Lisa Goodyear
- Janeway Child Health Centre, St. John's, Newfoundland, Canada
| | - Lillian Sung
- Population Health Sciences, Research Institute, The Hospital For Sick Children, Toronto, Ontario, Canada
| | - Santhosh Dhanraj
- Program in Genetics and Genome Biology, Research Institute, Toronto, Ontario, Canada Faculty of Medicine, Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Emma Reble
- Program in Genetics and Genome Biology, Research Institute, Toronto, Ontario, Canada
| | - Amanda Wagner
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph Beyene
- Program in Population Genomics, Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Peter Ray
- Program in Genetics and Genome Biology, Research Institute, Toronto, Ontario, Canada Molecular Genetic Laboratory, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen Meyn
- Program in Genetics and Genome Biology, Research Institute, Toronto, Ontario, Canada
| | - Michaela Cada
- Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yigal Dror
- Program in Genetics and Genome Biology, Research Institute, Toronto, Ontario, Canada Marrow Failure and Myelodysplasia Program, Division of Hematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada Faculty of Medicine, Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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