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Šimkovič M, Turcsányi P, Špaček M, Mihályová J, Ryznerová P, Maco M, Vodárek P, Écsiová D, Poul H, Móciková H, Zuchnická J, Panovská A, Lekaa M, Oršulová M, Prchlíková A, Stejskal L, Mašlejová S, Brychtová Y, Bezděková L, Papajík T, Lysák D, Trněný M, Smolej L, Doubek M. COVID-19 in patients with chronic lymphocytic leukemia: a multicenter analysis by the Czech CLL study group. Ann Hematol 2023; 102:811-817. [PMID: 36847805 PMCID: PMC9969021 DOI: 10.1007/s00277-023-05147-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/15/2022] [Indexed: 03/01/2023]
Abstract
Patients with chronic lymphocytic leukemia (CLL) have a high risk of poor outcomes related to coronavirus disease 2019 (COVID-19). This multicenter cohort study evaluated the impact of COVID-19 infection on the population of CLL patients in the Czech Republic. Between March 2020 and May 2021, 341 patients (237 males) with CLL and COVID-19 disease were identified. The median age was 69 years (range 38-91). Out of the 214 (63%) patients with the history of therapy for CLL, 97 (45%) were receiving CLL-directed treatment at diagnosis of COVID-19: 29% Bruton tyrosine kinase inhibitor (BTKi), 16% chemoimmunotherapy (CIT), 11% Bcl-2 inhibitor, and 4% phosphoinositide 3-kinase inhibitor. Regarding the severity of COVID-19, 60% pts required admission to the hospital, 21% pts were admitted to the intensive care unit (ICU), and 12% received invasive mechanical ventilation. The overall case fatality rate was 28%. Major comorbidities, age over 72, male gender, CLL treatment in history, CLL-directed treatment at COVID-19 diagnosis were associated with increased risk of death. Of note, concurrent therapy with BTKi compared to CIT was not associated with better outcome of COVID-19.
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Affiliation(s)
- Martin Šimkovič
- 4th Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Prague, Czech Republic.
| | - Peter Turcsányi
- Department of Haematology-Oncology, University Hospital, Olomouc, Czech Republic
| | - Martin Špaček
- First Department of Medicine - Haematology, University General Hospital, Prague, Czech Republic
| | - Jana Mihályová
- Department of Hematooncology, University Hospital, Ostrava, Czech Republic
| | - Pavlína Ryznerová
- Department of Haematology-Oncology, University Hospital, Olomouc, Czech Republic
| | - Mária Maco
- Department of Internal Medicine - Haematology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Pavel Vodárek
- 4th Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Dominika Écsiová
- 4th Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Hynek Poul
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Pelhrimov, Czech Republic
| | - Heidi Móciková
- Department of Internal Medicine - Haematology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Jana Zuchnická
- Department of Hematooncology, University Hospital, Ostrava, Czech Republic
| | - Anna Panovská
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Mohammad Lekaa
- Department of Hematology and Oncology, Medical School and Teaching Hospital in Plzen, Charles University in Prague, Plzen, Czech Republic
| | - Martina Oršulová
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Adéla Prchlíková
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Lukáš Stejskal
- Haematology/Tranfusiology Department, Silesian Hospital Opava, Opava, Czech Republic
| | - Stanislava Mašlejová
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Yvona Brychtová
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Lucie Bezděková
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Tomáš Papajík
- Department of Haematology-Oncology, University Hospital, Olomouc, Czech Republic
| | - Daniel Lysák
- Department of Hematology and Oncology, Medical School and Teaching Hospital in Plzen, Charles University in Prague, Plzen, Czech Republic
| | - Marek Trněný
- First Department of Medicine - Haematology, University General Hospital, Prague, Czech Republic
| | - Lukáš Smolej
- 4th Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Michael Doubek
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
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Špaček M, Smolej L, Šimkovič M, Nekvindová L, Křístková Z, Brychtová Y, Panovská A, Mašlejová S, Bezděková L, Écsiová D, Vodárek P, Zuchnická J, Mihályová J, Urbanová R, Turcsányi P, Lysák D, Novák J, Brejcha M, Líkařová T, Vodička P, Baranová J, Trněný M, Doubek M. Idelalisib plus rituximab versus ibrutinib in the treatment of relapsed/refractory chronic lymphocytic leukaemia: A real‐world analysis from the Chronic Lymphocytic Leukemia Patients Registry (CLLEAR). Br J Haematol 2023. [DOI: 10.1111/bjh.18736] [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] [Received: 12/29/2022] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 03/29/2023]
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Smolej L, Brychtová Y, Cmunt E, Doubek M, Špaček M, Belada D, Šimkovič M, Stejskal L, Zygulová I, Urbanová R, Brejcha M, Zuchnická J, Móciková H, Kozák T. Low-dose fludarabine and cyclophosphamide combined with rituximab in the first-line treatment of elderly/comorbid patients with chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL): long-term results of project Q-lite by the Czech CLL Study Group. Br J Haematol 2021; 193:769-778. [PMID: 33618437 DOI: 10.1111/bjh.17373] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 12/29/2022]
Abstract
Therapeutic options used to be very limited for treatment-naïve elderly/comorbid patients with chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) before the introduction of chemo-immunotherapy. Because dose-reduced fludarabine-based regimens yielded promising results, the Czech CLL Study Group initiated a prospective observational study to assess safety and efficacy of low-dose fludarabine and cyclophosphamide combined with rituximab (FCR) in elderly/comorbid patients. Between March 2009 and July 2012, we enrolled 107 patients considered ineligible for full-dose FCR (median age, 70 years; median Cumulative Illness Rating Scale score, 5; median creatinine clearance, 69 ml/min). Notably, 77% patients had unfavourable biological prognosis [unmutated immunoglobulin heavy-chain variable-region gene (IGHV), 74%; deletion 17p, 9%). Fludarabine was reduced to 12 mg/m2 intravenously (iv) or 20 mg/m2 orally on days 1-3 and cyclophosphamide to 150 mg/m2 iv/orally on days 1-3. Grade 3-4 neutropenia occurred in 56% of the patients, but there were serious infections in only 15%. The median progression-free survival was 29 months, but was markedly longer in patients with mutated IGHV (median 53 months), especially in absence of del 11q or 17p (median 74 months). Low-dose FCR is a well-tolerated and effective first-line regimen for selected elderly/comorbid patients with CLL/SLL with favourable biology. The study was registered at clinicaltrials.gov (NCT02156726).
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Affiliation(s)
- Lukáš Smolej
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine, University Hospital, Hradec Králové, Czech Republic
| | - Yvona Brychtová
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Eduard Cmunt
- First Department of Medicine - Haematology, General University Hospital, Prague, Czech Republic
| | - Michael Doubek
- Department of Internal Medicine - Haematology and Oncology, University Hospital, Brno, Czech Republic
| | - Martin Špaček
- First Department of Medicine - Haematology, General University Hospital, Prague, Czech Republic
| | - David Belada
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine, University Hospital, Hradec Králové, Czech Republic
| | - Martin Šimkovič
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine, University Hospital, Hradec Králové, Czech Republic
| | - Lukáš Stejskal
- Haematology/Tranfusiology Department, Silesian Hospital Opava, Opava, Czech Republic
| | - Irena Zygulová
- Haematology/Tranfusiology Department, Silesian Hospital Opava, Opava, Czech Republic
| | - Renata Urbanová
- Department of Haematology - Oncology, University Hospital, Olomouc, Czech Republic
| | | | - Jana Zuchnická
- Department of Haematology, University Hospital, Ostrava, Czech Republic
| | - Heidi Móciková
- Department of Haematology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Tomáš Kozák
- Department of Haematology, University Hospital Královské Vinohrady, Prague, Czech Republic
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Smolej L, Turcsányi P, Kubová Z, Zuchnická J, Mihályová J, Šimkovič M, Vodárek P, Krčméryová M, Móciková H, Brejcha M, Špaček M. External validation of International Prognostic Score for asymptomatic early stage chronic lymphocytic leukaemia and proposal of an alternative score. Br J Haematol 2020; 193:133-137. [PMID: 33280081 DOI: 10.1111/bjh.17074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022]
Abstract
Most patients with chronic lymphocytic leukaemia (CLL) are nowadays diagnosed without any symptoms and do not require therapy. A prognostic score identifying patients within this large group who are at high risk of disease progression would be highly beneficial. The recently published International Prognostic Score for Early asymptomatic patients (IPS-E) uses combination of absolute lymphocyte count (ALC) >15 × 109 /l, palpable lymphadenopathy, and unmutated immunoglobulin heavy-chain variable-region (IGHV) gene to predict the time to first-line therapy (TTFT). Patients at low, intermediate, and high risk had estimated 5-year TTFT of 8%, 28%, and 61%. We performed an external validation of the IPS-E score using an unselected, consecutive group of 130 Binet A patients. The 5-year TTFT was 11%, 36%, and 78% (C-statistic 0·74). Furthermore, we propose an alternative system (AIPS-E) using cytogenetic aberrations instead of palpable lymphadenopathy. This system yielded 5-year TTFT of 14%, 40%, and 72%. These results were externally validated in 388 Binet A patients from five Czech centres; the 5-year TTFT was 16%, 37%, and 80% (C-statistic 0·74). In conclusion, we have successfully validated the IPS-E score for patients with early stage CLL. In addition, we propose a modified scoring system, the AIPS-E, combining IGHV, fluorescence in situ hybridisation, and ALC.
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Affiliation(s)
- Lukáš Smolej
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Peter Turcsányi
- Department of Haematology-Oncology, University Hospital, Olomouc, Czech Republic
| | - Zuzana Kubová
- Department of Haematology-Oncology, University Hospital, Olomouc, Czech Republic
| | - Jana Zuchnická
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Jana Mihályová
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Martin Šimkovič
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Pavel Vodárek
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Mária Krčméryová
- Department of Internal Medicine - Haematology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Heidi Móciková
- Department of Internal Medicine - Haematology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Martin Brejcha
- Department of Haematology, Oncology Center, Nový Jičín, Czech Republic, Prague, Czech Republic
| | - Martin Špaček
- First Department of Medicine - Haematology, University General Hospital, Prague, Czech Republic
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Panovská A, Němcová L, Nekvindová L, Špaček M, Šimkovič M, Papajík T, Brejcha M, Lysák D, Zuchnická J, Novák J, Starostka D, Poul H, Vrbacký F, Vodárek P, Urbanová R, Plevová K, Pospíšilová Š, Mašlejová S, Brychtová Y, Koriťáková E, Smolej L, Doubek M. Real-world data on efficacy and safety of obinutuzumab plus chlorambucil, rituximab plus chlorambucil, and rituximab plus bendamustine in the frontline treatment of chronic lymphocytic leukemia: The GO-CLLEAR Study by the Czech CLL Study Group. Hematol Oncol 2020; 38:509-516. [PMID: 32400885 DOI: 10.1002/hon.2744] [Citation(s) in RCA: 4] [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: 02/01/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/08/2022]
Abstract
Until recently, a combination of anti-CD20 antibody plus less intensive chemotherapy was a standard of care in elderly population with previously untreated chronic lymphocytic leukemia (CLL). The aim of this observational study was to retrospectively assess efficacy and safety of obinutuzumab + chlorambucil (G-Clb), rituximab + chlorambucil (R-Clb), and bendamustine + rituximab (BR) given as the frontline therapy within routine practice. The final analyzed dataset included 398 consecutive CLL patients from 10 hematology centers cooperating within the Czech CLL Study Group: 63 treated with G-Clb, 78 with R-Clb, and 257 with BR. There were no significant differences in prognostic and predictive markers among the groups. On the contrary, median age at the start of therapy and cumulative illness rating scale (CIRS) score was significantly higher in R-Clb group. Obinutuzumab plus chlorambucil regimen was preferably offered to elderly patients (compared to BR) with less severe comorbidities and lower CIRS score (compared to R-Clb). A time period when a treatment was indicated had also a strong impact on the choice of the regimen. The overall response rate reached 76% (30% complete remissions, CRs) in G-Clb, 75% (22% CRs) in R-Clb, and 85% (47% CRs) in BR group. Median event-free survival was 49.0 months for G-Clb, 20.3 months for R-Clb, and 37.0 months for BR group. Neutropenia grade ≥ 3 developed in 43% of G-Clb, 31% of R-Clb and in 49% of BR patients, grade ≥ 3 infections were recorded in 17% of G-Clb, 6.4% of R-Clb, and 17% of BR patients. In conclusion, real-world therapeutic activity of G-Clb appears to be at least comparable to prospective clinical trial data. R-Clb yields relatively good results in very old and severely comorbid patients.
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Affiliation(s)
- Anna Panovská
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic
| | - Lucie Němcová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic
| | - Lucie Nekvindová
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Martin Špaček
- 1st Department of Medicine-Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Šimkovič
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Tomáš Papajík
- Department of Hematooncology, University Hospital, Olomouc, Czech Republic
| | | | - Daniel Lysák
- Department of Hematology and Oncology, University Hospital, Plzeň, Czech Republic
| | - Jana Zuchnická
- Department of Hematology, University Hospital, Ostrava, Czech Republic
| | - Jan Novák
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Starostka
- Department of Hematology, Havirov Hospital and Polyclinic, Havířov, Czech Republic
| | - Hynek Poul
- Department of Hematology, Hospital Pelhřimov, Pelhřimov, Czech Republic
| | - Filip Vrbacký
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Pavel Vodárek
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Renata Urbanová
- Department of Hematooncology, University Hospital, Olomouc, Czech Republic
| | - Karla Plevová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Šárka Pospíšilová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Stanislava Mašlejová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic
| | - Yvona Brychtová
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic
| | - Eva Koriťáková
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Lukáš Smolej
- 4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Michael Doubek
- Department of Internal Medicine-Hematology and Oncology, University Hospital and Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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Peteja M, Chmelo J, Zuchnická J, Zonča P, Mazur M. [Heparin-induced thrombocytopenia in a patient with acute thrombosis, acute aortic dissection and acute lower limb ischaemia]. Rozhl Chir 2013; 92:650-653. [PMID: 24299288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This case report presents the course of illness, as well as the diagnosis and therapy, of acute thrombosis and abdominal aortic dissection after Fogarty thrombectomy with the symptoms of acute limb ischaemia in a 42-year-old female patient suffering from heparin-induced thrombocytopenia. HIT is a severe iatrogenic complication emerging after unfractionated or low molecular weight heparin administration, with rather easy diagnosis; however, it is often neglected due to the rarity of its occurrence.
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Gumulec J, Brát R, Kolek M, Chrástecký B, Korístka M, Cermáková Z, Nováková L, Sáchová L, Chasáková K, Ranochová A, Ryzí M, Návratová P, Zuchnická J, Bodzásová C, Plonková H, Slezák P. [Pre-operative care for cardiac surgery patients with cold antibody disorder, cryoglobulinaemia and cryofibrinogenemia]. Vnitr Lek 2009; 55:236-241. [PMID: 19378854] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present an example of a patient with confirmed cold agglutinin disease who underwent cardiac surgery in hypothermia to illustrate a known fact that, when exposed to cold, cold agglutinins induce haemolysis of erythrocytes and that cryoglobulins and cryofibrinogens may, upon exposition to cold during a surgery under hypothermia, precipitate or gelify and thus increase plasma viscosity and damage microcirculation. Detailed immunological and haematological investigations in all patients awaiting cardiac surgery with a risk of developing hypothermia is not advantageous considering the low number of patients with clinical and laboratory signs of cold agglutinin disease, autoimmune haemolytic anaemia or paroxysmal cold haemoglobinuria and considering that these investigations, in addition, might not detect cryoglobulinaemia and cryofibrinogenemia. Identification of in-risk patients from the warning signs in the medical history, physical or basal laboratory testing who would subsequently undergo confirmatory investigations to verify the presence of these entities and define them accurately might be a potential solution to this clinical issue. Cardiac surgery strategy and peri-operative care should be tailored to the results of these investigations. Well-structured, practiced and functional cooperation between clinicians and laboratory personnel is a prerequisite for success in these circumstances.
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Affiliation(s)
- J Gumulec
- Hemato-onkologické a transfuzní centrum FN Ostrava.
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