Frontiers in hematology最新文献

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Predicting outcomes of hematological malignancy patients admitted to critical care 预测恶性血液病患者入住重症监护的预后
Frontiers in hematology Pub Date : 2023-03-17 DOI: 10.3389/frhem.2023.1127322
A. Tridente, Nina C Dempsey, M. Khalifa, Jacklyn Goddard, K. Shuker, J. Hall, Y. Sorour, J. Wright, S. Webber, G. Mills, J. Snowden
{"title":"Predicting outcomes of hematological malignancy patients admitted to critical care","authors":"A. Tridente, Nina C Dempsey, M. Khalifa, Jacklyn Goddard, K. Shuker, J. Hall, Y. Sorour, J. Wright, S. Webber, G. Mills, J. Snowden","doi":"10.3389/frhem.2023.1127322","DOIUrl":"https://doi.org/10.3389/frhem.2023.1127322","url":null,"abstract":"Background Critical care (CC) admission has traditionally been viewed as likely to result in a poor outcome for hematological malignancy (HM) patients. Such a view can have implications for decisions surrounding CC admission. Recent studies have challenged this poor prognostication, however, there still remains limited data to support CC admission and escalation decisions and to elucidate risk factors which independently predict short- and longer-term survival outcomes. Methods We retrospectively analyzed a large cohort of adult HM patients (n=437) admitted to CC over a sixteen-year period, with the specific aim of identifying risk factors present at CC unit admission that could help to predict outcome. We assessed all-cause mortality at CC discharge (CC mortality, primary outcome) and at further time points (hospital discharge and 12-months post-discharge from CC). Single variable and multivariate analyses were performed to identify independent predictors of outcome. Results CC unit and hospital mortality rates were 33.4% (146 patients) and 46.2% (202 patients) respectively. At six-month and one-year follow-up, mortality increased to 59.5% and 67.9% respectively. At single variable adjusted regression analysis, eight factors were associated with CC mortality: APACHE II score, the number of organs supported, requirement for continuous renal replacement therapy (CRRT), cardiovascular support, or respiratory support (invasive and non-invasive), the ratio between arterial partial pressure of oxygen (PaO2) and the inspired oxygen concentration (FiO2) (P/F ratio) on CC admission, and the lowest P/F ratio during CC admission. However, only three factors showed independent predictive capacity for CC outcome at multivariate logistic regression analysis; APACHE II score on admission, requirement for ventilation and lowest P/F ratio. Conclusion One third of HM patients admitted to CC died on the unit and, following admission to CC, approximately one-third of HM patients survived over 1 year. Our data show that, while a diagnosis of HM should not preclude admission of patients who might otherwise benefit from CC support, the prognosis of those with a high APACHE II score upon admission, or those requiring IMV remains poor, despite considerable advances in IMV techniques.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134104954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Case report: Sustained complete remission with ivosidenib in a patient with relapsed, IDH1-mutated acute leukemia 病例报告:ivosidenib持续完全缓解患者复发,idh1突变急性白血病
Frontiers in hematology Pub Date : 2023-03-10 DOI: 10.3389/frhem.2023.1134837
Kieran D Sahasrabudhe, Weiqiang Zhao, Miriam Berg, B. Bhatnagar
{"title":"Case report: Sustained complete remission with ivosidenib in a patient with relapsed, IDH1-mutated acute leukemia","authors":"Kieran D Sahasrabudhe, Weiqiang Zhao, Miriam Berg, B. Bhatnagar","doi":"10.3389/frhem.2023.1134837","DOIUrl":"https://doi.org/10.3389/frhem.2023.1134837","url":null,"abstract":"Older patients with acute lymphoblastic leukemia (ALL) have a poor prognosis, with a 5-year overall survival rate of only 10%–20%. This is attributable to patient comorbidities, poor performance status, and high-risk disease biology. The prognosis for patients with relapsed/refractory (R/R) disease remains poor, particularly for patients who are not candidates for therapies targeting CD19 or CD22. Additional treatment options are needed for these patient populations. The patient presented here is a 76-year-old man diagnosed with precursor B-cell ALL with aberrant expression of myeloid markers and lacking significant CD19 or CD22 expression. A 3-year remission was achieved with one cycle of CVP (cyclophosphamide, vincristine, and prednisone) followed by 22 months of maintenance DOMP (dexamethasone, vincristine, methotrexate, and 6-mercaptopurine) prior to relapse. He was then treated with one cycle of salvage CVP, which was complicated by a stroke resulting in hemiparesis. Next-generation sequencing (NGS) was performed on the relapsed bone marrow, which revealed the presence of an R132H mutation in the isocitrate dehydrogenase 1 (IDH1) gene. He was subsequently treated with the IDH1 inhibitor ivosidenib and remained in a second remission for nearly 1 year. IDH1 mutations are present in up to 14% of acute myeloid leukemia (AML) cases but are also seen more rarely in ALL, particularly in cases involving aberrant expression of myeloid markers. Ivosidenib has demonstrated efficacy in patients with IDH1-mutated AML but has not been extensively studied in other hematologic malignancies. This case demonstrates the role of NGS in revealing treatment options in patients with otherwise limited available therapies.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131335576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Identification factors to adjust early combination regimens in adult primary immune thrombocytopenia: An 8-year data analysis 调整成人原发性免疫性血小板减少症早期联合方案的识别因素:一项8年数据分析
Frontiers in hematology Pub Date : 2023-03-07 DOI: 10.3389/frhem.2023.1135261
Kunapa Iam-arunthai, Supat Chamnanchanunt, Pravinwan Thungthong, Chajchawan Nakhahes, T. Suwanban, P. Rojnuckarin
{"title":"Identification factors to adjust early combination regimens in adult primary immune thrombocytopenia: An 8-year data analysis","authors":"Kunapa Iam-arunthai, Supat Chamnanchanunt, Pravinwan Thungthong, Chajchawan Nakhahes, T. Suwanban, P. Rojnuckarin","doi":"10.3389/frhem.2023.1135261","DOIUrl":"https://doi.org/10.3389/frhem.2023.1135261","url":null,"abstract":"Purpose Recent studies suggested that adding other agents to corticosteroids as a first-line treatment for immune thrombocytopenia (ITP) could improve outcomes. However, combination regimens may increase side effects and costs. To determine clinical factors associated with responses to the first-line steroid at 1 month. Materials and methods We retrospectively reviewed the medical records of patients with ITP aged ≥ 18 years, who were treated at Rajavithi Hospital between 2012 and 2020. Clinical data, laboratory results, treatment regimens, and responses to therapy were analyzed. Results Of the 226 patients, 76.6% were female. The mean age was 46.5 ± 18.1 years, and the median follow-up duration was 40 months. The proportion of chronic ITP was 97.3%. The complete response and response rates to first-line therapy were 65.5% and 88.9%, respectively. The age over 26 years, presentation clinically non-significant bleeding and a difference in platelet count of >50 x 109/L between days 1 and 7 after initial treatment were associated with the response to first-line treatment (adjusted odds ratio [OR] 5.09, 95% confidence interval [CI] 1.50-17.28, p = 0.009); OR 5.87, 95%CI 1.19-28.91, p = 0.029, and OR 3.60, 95%CI 1.10-11.73, p = 0.034, respectively. Younger patients and a difference in platelet count between day 1 and 7 ≤ 50 x 109/L were more likely to require second-line treatments. There were significant increases in the median platelet counts after prescribing azathioprine (baseline vs. 3 months, p = 0.001), cyclophosphamide (baseline vs. 6 months, p = 0.021), or danazol (baseline vs. 12 months, p = 0.039). Conclusion Adult, severity of bleeding at presentation, and rapid platelet increases within 1 week were related to excellent corticosteroid responses in ITP patients. These patients may not need combination regimens.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114776987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Red blood cells from patients with sitosterolemia exhibit impaired membrane lipid composition and distribution and decreased deformability 谷甾醇血症患者的红细胞表现为膜脂组成和分布受损,可变形性降低
Frontiers in hematology Pub Date : 2023-03-07 DOI: 10.3389/frhem.2023.1055086
Anne-Sophie Cloos, M. Rab, P. van der Smissen, B. V. van Oirschot, E. Mignolet, J. B. van der Net, A. Koster, Kelly Kleinen, Y. Larondelle, Romano Terrasi, G. Muccioli, R. van Wijk, D. Tyteca
{"title":"Red blood cells from patients with sitosterolemia exhibit impaired membrane lipid composition and distribution and decreased deformability","authors":"Anne-Sophie Cloos, M. Rab, P. van der Smissen, B. V. van Oirschot, E. Mignolet, J. B. van der Net, A. Koster, Kelly Kleinen, Y. Larondelle, Romano Terrasi, G. Muccioli, R. van Wijk, D. Tyteca","doi":"10.3389/frhem.2023.1055086","DOIUrl":"https://doi.org/10.3389/frhem.2023.1055086","url":null,"abstract":"Sitosterolemia is a metabolic disorder leading to excessive accumulation of phytosterols. Hemolytic stomatocytosis and macrothrombocytopenia are part of the clinical picture. However, the impact of phytosterols on red blood cell (RBC) deformability, membrane lipid composition and distribution and the efficiency of the reference treatment, Ezetimibe, are largely unknown. This study addresses these issues using RBCs from three patients with sitosterolemia and healthy RBCs exposed to β-sitosterol. Patients presented an increased proportion of stomatocytes, decreased RBC deformability and increased RBC hydration and osmotic fragility compared to healthy donors. At the membrane level, patient RBCs showed (i) very high content in β-sitosterols, (ii) increased proportions of saturated fatty acids and polyunsaturated fatty acid species with long and unsaturated carbon chains, and (iii) decreased content in phosphatidylethanolamine species. These lipid changes were accompanied by an almost complete abrogation of cholesterol-enriched domains, which could result from: (i) the reduced phosphatidylethanolamine content which positively correlated with domain abundance; and (ii) the fatty acid modifications and increased phytosterol content, both compatible with higher membrane stiffness. The role of β-sitosterol was supported by comparable changes in RBC morphology and cholesterol-enriched domains upon β-sitosterol integration at the healthy RBC membrane. Finally, Ezetimibe treatment combined with a sterol restricted diet lowered phytosterols and improved anemia and RBC deformability and hydration. However, this treatment had no or limited effect on RBC morphology and cholesterol-enriched domain abundance. This study reveals for the first time that phytosterols affect RBC membrane lipid composition and distribution but also RBC morphology, hydration, deformability and fragility.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126963034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Highly-sensitive chimerism analysis in blood after allogeneic hematopoietic cell transplantation in childhood leukemia: Results from the Nordic Microchimerism Study 儿童白血病异体造血细胞移植后血液中高度敏感的嵌合分析:来自北欧微嵌合研究的结果
Frontiers in hematology Pub Date : 2023-02-06 DOI: 10.3389/frhem.2023.1055484
A. K. Haugaard, H. Madsen, T. Masmas, K. Vettenranta, J. Buechner, K. Mellgren, D. Turkiewicz, S. Rosthøj, H. Marquart, C. Heilmann, Klaus Gottlob Müller, M. Ifversen
{"title":"Highly-sensitive chimerism analysis in blood after allogeneic hematopoietic cell transplantation in childhood leukemia: Results from the Nordic Microchimerism Study","authors":"A. K. Haugaard, H. Madsen, T. Masmas, K. Vettenranta, J. Buechner, K. Mellgren, D. Turkiewicz, S. Rosthøj, H. Marquart, C. Heilmann, Klaus Gottlob Müller, M. Ifversen","doi":"10.3389/frhem.2023.1055484","DOIUrl":"https://doi.org/10.3389/frhem.2023.1055484","url":null,"abstract":"Analysis of chimerism in blood post‐HCT using STR‐PCR is routinely applied in parallel with quantification of MRD to predict relapse of leukemia. Real time quantitative PCR (RQ-PCR) chimerism is 10‐ to 100‐fold more sensitive, but clinical studies in children are sparse. In a prospective multicenter study, we analyzed increasing mixed chimerism (IMC) in blood samples following transplantation for leukemia in 64 children. IMC was defined as a minimum increase of either 0.1% or 0.05% recipient DNA between two samples or a ≥10-fold increase. Samples closer than 30 days to diagnosis of relapse were omitted. The risk of relapse was higher in children with IMC of both 0.1% and 0.05% compared to children without IMC (27.8 (95% CI 4.4-175.8; P<.001), and 18.4 (95% CI 2.8-120.5; P=0.002), respectively). From the date of IMC, the 3-year CI of relapse or MRD-positivity was 26.7% (CI 9.4-47.0) and 18.5% (6.4-35.3) for IMC ≥ 0.1% (n=27) and ≥ 0.05% (n= 40), respectively. In the subset of children without an IMC ≥ 0.1% or ≥ 0.05%, CI of relapse or molecular relapse were 16.7% (5.0 -34.1) and 10.8% (3.4 -23.3), respectively. In all cases with a relapse undetectable by IMC, MRD remained undetectable prior to relapse and standard chimerism negative. In a landmark analysis, neither an IMC ≥ 0.1% nor ≥ 0.05% prior to 90 days post‐HCT was significantly associated with an increased relapse incidence. These results indicate that the serial monitoring of RQ‐PCR chimerism in peripheral blood post-HCT may be a valuable supplement to the minimal residual disease analysis for an early detection of relapse in acute childhood leukemia.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124786031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Benefits and limitations of humanized mouse models for human red blood cell-related disease research 人源化小鼠模型用于人类红细胞相关疾病研究的益处和局限性
Frontiers in hematology Pub Date : 2023-01-16 DOI: 10.3389/frhem.2022.1062705
Bing Chen, Haochuan Liu, Zhengang Liu, Fan Yang
{"title":"Benefits and limitations of humanized mouse models for human red blood cell-related disease research","authors":"Bing Chen, Haochuan Liu, Zhengang Liu, Fan Yang","doi":"10.3389/frhem.2022.1062705","DOIUrl":"https://doi.org/10.3389/frhem.2022.1062705","url":null,"abstract":"Humanized mouse models with functional human genes, cells, and tissues are typically used for in vivo studies of diseases. Decades of studies on humanized mouse models have improved our understanding of hematopoiesis, infectious diseases, cancer biology, innate and adaptive immunity, and regenerative medicine. This review discusses the establishment and development of humanized mouse models and how they are used to model red blood cell-related diseases facilitating research in several biomedical disciplines. Furthermore, we provide approaches to overcome the limitations of these models.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128154513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Innovative and Needs-led research on β-thalassemia treatment methods β-地中海贫血治疗方法的创新和需求导向研究
Frontiers in hematology Pub Date : 2023-01-04 DOI: 10.3389/frhem.2022.1085952
Mihaiescu Dan, Bianca-Ioana Gutu, E. Severin, Vlad Tanase
{"title":"Innovative and Needs-led research on β-thalassemia treatment methods","authors":"Mihaiescu Dan, Bianca-Ioana Gutu, E. Severin, Vlad Tanase","doi":"10.3389/frhem.2022.1085952","DOIUrl":"https://doi.org/10.3389/frhem.2022.1085952","url":null,"abstract":"Beta-thalassemia is a well-known blood genetic disorder inherited in an autosomal recessive manner. Beta-thalassemia is found everywhere in the world as a rare, relatively rare, or common disease depending on the ethnic population. Affected individuals have chronic anemia associated with delayed growth, pale skin, weakness, fatigue, and more serious complications resulting in early death. Those with the severe form need frequent lifelong transfusions and depend on blood donations to survive. This literature mini-review highlights the healthcare needs that are not optimally met by people living with beta-thalassemia. The needs-led research can help to improve clinical outcomes through more appropriate management of the disease, increase provider satisfaction, and reduce the cost of care.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133301122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Depletion of tet2 results in age-dependent changes in DNA methylation and gene expression in a zebrafish model of myelodysplastic syndrome. tet2的缺失导致骨髓增生异常综合征斑马鱼模型中DNA甲基化和基因表达的年龄依赖性变化。
Frontiers in hematology Pub Date : 2023-01-01 Epub Date: 2023-09-14 DOI: 10.3389/frhem.2023.1235170
Yaseswini Neelamraju, Evisa Gjini, Sagar Chhangawala, Hao Fan, Shuning He, Chang-Bin Jing, Ashley T Nguyen, Subhash Prajapati, Caroline Sheridan, Yariv Houvras, Ari Melnick, A Thomas Look, Francine E Garrett-Bakelman
{"title":"Depletion of <i>tet2</i> results in age-dependent changes in DNA methylation and gene expression in a zebrafish model of myelodysplastic syndrome.","authors":"Yaseswini Neelamraju, Evisa Gjini, Sagar Chhangawala, Hao Fan, Shuning He, Chang-Bin Jing, Ashley T Nguyen, Subhash Prajapati, Caroline Sheridan, Yariv Houvras, Ari Melnick, A Thomas Look, Francine E Garrett-Bakelman","doi":"10.3389/frhem.2023.1235170","DOIUrl":"10.3389/frhem.2023.1235170","url":null,"abstract":"<p><strong>Introduction: </strong>Myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematopoietic disorders characterized by ineffective hematopoiesis, cytopenias, and dysplasia. The gene encoding ten-eleven translocation 2 (<i>tet</i>2), a dioxygenase enzyme that catalyzes the conversion of 5-methylcytosine (5mC) to 5-hydroxymethylcytosine, is a recurrently mutated tumor suppressor gene in MDS and other myeloid malignancies. Previously, we reported a stable zebrafish line with a loss-of-function mutation in the <i>tet2</i> gene. The <i>tet2</i><sup><i>m/m</i></sup>-mutant zebrafish developed a pre-MDS state with kidney marrow dysplasia, but normal circulating blood counts by 11 months of age and accompanying anemia, signifying the onset of MDS, by 24 months of age.</p><p><strong>Methods: </strong>In the current study, we collected progenitor cells from the kidney marrows of the adult <i>tet2</i><sup><i>m/m</i></sup> and <i>tet2</i><sup><i>wt/wt</i></sup> fish at 4 and 15 months of age and conducted enhanced reduced representation of bisulfite sequencing (ERRBS) and bulk RNA-seq to measure changes in DNA methylation and gene expression of hematopoietic stem and progenitor cells (HSPCs).</p><p><strong>Results and discussion: </strong>A global increase in DNA methylation of gene promoter regions and CpG islands was observed in <i>tet2</i><sup><i>m/m</i></sup> HSPCs at 4 months of age when compared with the wild type. Furthermore, hypermethylated genes were significantly enriched for targets of SUZ12 and the metal-response-element-binding transcription factor 2 (MTF2)-involved in the polycomb repressive complex 2 (PRC2). However, between 4 and 15 months of age, we observed a paradoxical global decrease in DNA methylation in <i>tet2</i><sup><i>m/m</i></sup> HSPCs. Gene expression analyses identified upregulation of genes associated with mTORC1 signaling and interferon gamma and alpha responses in <i>tet2</i><sup><i>m/m</i></sup> HSPCs at 4 months of age when compared with the wild type. Downregulated genes in HSPCs of <i>tet2</i>-mutant fish at 4 months of age were enriched for cell cycle regulation, heme metabolism, and interleukin 2 (IL2)/signal transducer and activator of transcription 5 (STAT5) signaling, possibly related to increased self-renewal and clonal advantage in HSPCs with <i>tet2</i> loss of function. Finally, there was an overall inverse correlation between overall increased promoter methylation and gene expression.</p>","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10629367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71490973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Case Report: A unique case of secondary hemophagocytic lymphohistiocytosis from ehrlichiosis infection 病例报告:一个独特的病例继发性噬血细胞淋巴组织细胞症从埃立克体感染
Frontiers in hematology Pub Date : 2022-12-19 DOI: 10.3389/frhem.2022.1039821
S. Hlaing, Christine J. Kurian, J. Tan, E. Behling, A. Hussein
{"title":"Case Report: A unique case of secondary hemophagocytic lymphohistiocytosis from ehrlichiosis infection","authors":"S. Hlaing, Christine J. Kurian, J. Tan, E. Behling, A. Hussein","doi":"10.3389/frhem.2022.1039821","DOIUrl":"https://doi.org/10.3389/frhem.2022.1039821","url":null,"abstract":"Hemophagocytic lymphohistiocytosis (HLH) is a highly detrimental syndrome that can progress to multiorgan failure, necessitating the resources of an intensive care unit, with a mortality rate as high as 40%. Secondary HLH is usually triggered by infection, most often from a viral infection or malignancy. Management of HLH in adults is challenging as treatment algorithms targeting hyperinflammation are based on pediatric protocols, such as HLH-94 and HLH-2004. To our knowledge, there are only a few reported cases of HLH secondary to ehrlichiosis infection and none in elderly patients with multiple comorbidities. Here, we present a unique case of HLH secondary to ehrlichiosis infection in an 82-year-old female successfully treated with antibiotics and steroids.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123533033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of insurance status and distance from residence to treatment center on the outcomes of patients diagnosed with acute myeloid leukemia 保险状况和居住地到治疗中心距离对急性髓系白血病患者预后的影响
Frontiers in hematology Pub Date : 2022-12-15 DOI: 10.3389/frhem.2022.1060029
M. Mahmoud, L. Al Mahmasani, M. Charafeddine, A. Zahreddine, N. Moukalled, J. El Cheikh, A. Bazarbachi, I. Abou Dalle
{"title":"Impact of insurance status and distance from residence to treatment center on the outcomes of patients diagnosed with acute myeloid leukemia","authors":"M. Mahmoud, L. Al Mahmasani, M. Charafeddine, A. Zahreddine, N. Moukalled, J. El Cheikh, A. Bazarbachi, I. Abou Dalle","doi":"10.3389/frhem.2022.1060029","DOIUrl":"https://doi.org/10.3389/frhem.2022.1060029","url":null,"abstract":"Purpose Numerous factors may affect the survival outcomes of patients with acute myeloid leukemia (AML), mainly disease-related and treatment-related factors. The impact of other factors, such as the insurance status and the distance to healthcare facilities, are still unclear and may differ between different healthcare systems. We investigated the effects of insurance status and distance to the treatment center on the survival of AML patients. Materials and methods This is a single-center, observational, retrospective study of patients diagnosed with AML (2015–2020) and treated at the American University of Beirut Medical Center in Lebanon. Data regarding patient baseline characteristics, disease-related factors, insurance status, and area of residence were collected. Multivariate Cox regression analysis was used to identify main independent predictors of overall survival (OS). Results We identified 142 AML patients with a median age of 52 years (range 18–86). Of them, 91 (64%) were males, 77 (54%) had ELN intermediate risk, and 88 (62%) patients received intensive chemotherapy. After a median follow-up of 22.4 months, the median RFS and OS were 37.4 months and not reached, respectively. A Cox regression model for OS was done using the following variables: age, gender, body mass index, comorbidities, smoking status, insurance status, distance from the center, ELN classification, treatment used, and allotransplant. A higher risk of death was seen among the uninsured patients and those living beyond 40 km from the treatment center compared with fully insured patients and those living in proximity to the center (hazard ratio [HR]: 3.65; 95% CI [1.79, 7.45], p-value <0.0001; HR: 4.38; 95% CI [1.75, 10.95], p-value 0.002, respectively). Conclusions The outcome of patients with AML does not depend only on disease-related factors, as the insurance status and the distance from the area of residence to the treatment center were found to be independent predictors of survival in AML patients.","PeriodicalId":101407,"journal":{"name":"Frontiers in hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115012230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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