Umera Saleem, Hamza Tariq, Shahroz Alam, Ahmed Faraz Zafar, Urwah Tanveer, Muhammad Hamza Khan
{"title":"Etiological spectrum of pancytopenia in adults based on hematological parameters and bone marrow studies.","authors":"Umera Saleem, Hamza Tariq, Shahroz Alam, Ahmed Faraz Zafar, Urwah Tanveer, Muhammad Hamza Khan","doi":"10.1080/17474086.2024.2421374","DOIUrl":"10.1080/17474086.2024.2421374","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the demographic, clinical, and diagnostic aspects of adult pancytopenia while exploring its etiological spectrum through hematological parameters and bone marrow studies.</p><p><strong>Research design and methods: </strong>This observational study involved 117 adult individuals ranging from 13 to 85 years who presented with pancytopenia. A comprehensive examination of demographic features, hematological parameters, clinical presentations, and physical findings, including liver and spleen characteristics, was conducted. Additionally, serological analyses for HBsAg and Anti HCV were performed. The diagnostic spectrum was determined through bone marrow studies.</p><p><strong>Results: </strong>Pancytopenia manifested with varied clinical symptoms, with generalized weakness (72.65%), fever (64.1%), dyspnea (54.70%), bleeding (34.2%), and weight loss (25.6%) being prominent. Physical examination revealed a range of liver and spleen characteristics, with hepatomegaly observed in 32.48% and splenomegaly in 44.4% of cases. Serological findings indicated HBsAg positivity in 8.5% and Anti HCV positivity in 21.37% of cases. The diagnostic distribution encompassed diverse conditions, with aplastic anemia (17.1%), megaloblastic anemia (12.8%), and myelodysplastic syndromes (12.8%) being prevalent.</p><p><strong>Conclusions: </strong>This study provides a comprehensive overview of the demographic, clinical, and diagnostic aspects of pancytopenia. The observed prevalence of different diagnoses underscores the necessity of a thorough evaluation, including bone marrow studies, for accurate diagnosis and appropriate management.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"861-869"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dina Samir Elsaid, Tamer Abd Elhamid Elbedewy, Mona Ashraf Hamza, Riham Abdel-Hamid Haroun
{"title":"The role of interleukin-20 and vascular endothelial growth factor-A biomarkers in the detection of renal impairment in patients with multiple myeloma.","authors":"Dina Samir Elsaid, Tamer Abd Elhamid Elbedewy, Mona Ashraf Hamza, Riham Abdel-Hamid Haroun","doi":"10.1080/17474086.2024.2417085","DOIUrl":"10.1080/17474086.2024.2417085","url":null,"abstract":"<p><strong>Background: </strong>Multiple myeloma (MM) is a malignant incurable disease characterized by monoclonal plasma cell increase associated with renal impairment. Evaluation of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), hemoglobin/red cell distribution width (HB/RDW), interleukin-20 (IL-20), and vascular endothelial growth factor-A (VEGFA) in patients with MM (with or without renal impairment) as prognostic and severity indicators.</p><p><strong>Research design and methods: </strong>A cross-sectional study was conducted on sixty MM patients with renal impairment, sixty MM patients without renal impairment, and sixty subjects (control group). Complete blood count, IL-20 immunoassay, and gene expression of IL-20, and VEGFA were evaluated.</p><p><strong>Results: </strong>Higher levels of NLR, MLR, and IL-20, and moreover lower levels of PLR, HB/RDW, as well as upregulation of IL-20, and VEGFA gene expression were detected in MM patients, especially those with renal impairment. Receiver operating characteristic curves analysis of NLR, MLR, PLR, and IL-20 showed high sensitivity and specificity in the diagnosis of MM and disease stages.</p><p><strong>Conclusions: </strong>NLR, MLR, PLR, HB/RDW, IL-20, and VEGFA may be implicated in the inflammatory process of MM and renal impairment pathogenesis. NLR, MLR, and IL-20 can be used as prognostic markers in MM stages.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"841-853"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chanukya K Colonne, Erik L Kimble, Cameron J Turtle
{"title":"Evolving strategies to overcome barriers in CAR-T cell therapy for acute myeloid leukemia.","authors":"Chanukya K Colonne, Erik L Kimble, Cameron J Turtle","doi":"10.1080/17474086.2024.2420614","DOIUrl":"10.1080/17474086.2024.2420614","url":null,"abstract":"<p><strong>Introduction: </strong>Acute myeloid leukemia (AML) is a complex and heterogeneous disease characterized by an aggressive clinical course and limited efficacious treatment options in the relapsed/refractory (R/R) setting. Chimeric antigen receptor (CAR)-modified T (CAR-T) cell immunotherapy is an investigational treatment strategy for R/R AML that has shown some promise. However, obstacles to successful CAR-T cell immunotherapy for AML remain.</p><p><strong>Areas covered: </strong>In analyses of clinical trials of CAR-T cell therapy for R/R AML, complete responses without measurable residual disease have been reported, but the durability of those responses remains unclear. Significant barriers to successful CAR-T cell therapy in AML include the scarcity of suitable tumor-target antigens (TTA), inherent T cell functional deficits, and the immunoinhibitory and hostile tumor microenvironment (TME). This review will focus on these barriers to successful CAR-T cell therapy in AML, and discuss scientific advancements and evolving strategies to overcome them.</p><p><strong>Expert opinion: </strong>Achieving durable remissions in R/R AML will likely require a multifaceted approach that integrates advancements in TTA selection, enhancement of the intrinsic quality of CAR-T cells, and development of strategies to overcome inhibitory mechanisms in the AML TME.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"797-818"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tadeusz Robak, Magdalena Witkowska, Anna Wolska-Washer, Paweł Robak
{"title":"BCL-2 and BTK inhibitors for chronic lymphocytic leukemia: current treatments and overcoming resistance.","authors":"Tadeusz Robak, Magdalena Witkowska, Anna Wolska-Washer, Paweł Robak","doi":"10.1080/17474086.2024.2410003","DOIUrl":"10.1080/17474086.2024.2410003","url":null,"abstract":"<p><strong>Introduction: </strong>In the last decade, BTK inhibitors and the BCL-2 inhibitor venetoclax have replaced immunochemotherapy in the treatment of CLL.</p><p><strong>Areas covered: </strong>This review describes the use of BTK inhibitors and BCL2 inhibitors in the treatment of naive and relapsed or refractory CLL, with particular attention to the mechanisms of resistance. It also addresses the management of double-refractory patients, and the discovery of novel drugs. The corpus of papers was obtained by a search of the PubMed and Google Scholar databases for articles in English.</p><p><strong>Expert opinion: </strong>Covalent BTK inhibitors and venetoclax are commonly recommended for previously-untreated and relapsed/refractory CLL. However, resistance to both drug classes can develop over time. As such, double-refractory patients are difficult to manage and novel approaches are urgently needed.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"781-796"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Combination therapy of dexamethasone, rituximab, and cyclosporine for adults with primary immune thrombocytopenia: a prospective observational study.","authors":"Ying Liang, Cong Tang, Chunyu Liu, Lu Zhang, Yongguang Fang, Aixiang Zhao, Nannan Chen","doi":"10.1080/17474086.2024.2420633","DOIUrl":"10.1080/17474086.2024.2420633","url":null,"abstract":"<p><strong>Background: </strong>To assess the effectiveness of the combination of dexamethasone, rituximab, and cyclosporine in treating adults with primary immune thrombocytopenia (ITP).</p><p><strong>Research design and methods: </strong>This prospective study enrolled consecutive adult patients diagnosed with ITP at the 967th Hospital of the Chinese People's Liberation Army Joint Service Support Force Hospital between November 2019 and February 2023.</p><p><strong>Results: </strong>Twenty-eight patients (13 males, median age 43.5 years) were included. All patients previously experienced ineffective or relapsed ITP, with a median disease duration of 26.5 (range, 7-72) months. At baseline, the median platelet (PLT) count was 13.5 × 10<sup>9</sup>/L (8.25-20 × 10<sup>9</sup>/L). Following treatment, the PLT counts were significantly increased at weeks 1, 3, and 4. The early response rates at weeks 1 and 4 were 82.1% (23/28 patients) and 71.4% (20/28 patients), respectively. The 1-, 3-, and 6-month response rates were 71.4% (20/28), 67.9% (19/28), and 75% (21/28). The treatment-free survival rates at 12 and 24 months were 82.35% (14/17) and 71.43% (10/14), respectively. Six patients experienced transient adverse reactions.</p><p><strong>Conclusions: </strong>The combination of dexamethasone, rituximab, and cyclosporine may present a promising therapeutic option for patients with refractory ITP, with good tolerability and mild adverse reactions.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"855-860"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahesh Swaminathan, Akhil Jain, Sungchul Daniel Choi, Naveen Pemmaraju
{"title":"Janus kinase inhibitor monotherapy and combination therapies for myelofibrosis: what's the current standard of care?","authors":"Mahesh Swaminathan, Akhil Jain, Sungchul Daniel Choi, Naveen Pemmaraju","doi":"10.1080/17474086.2024.2409438","DOIUrl":"10.1080/17474086.2024.2409438","url":null,"abstract":"<p><strong>Introduction: </strong>JAK inhibitors (JAKi) have changed the treatment paradigm of myelofibrosis (MF). Currently, 4 JAKis are approved in the US as monotherapy (mono) to treat patients with MF. JAKis are also being studied in combination (combo) with novel agents. Herein, we review some of the key studies that evaluated JAKi as mono and combo in MF.</p><p><strong>Areas covered: </strong>We performed a Pubmed search for 'JAK inhibitors' and 'myelofibrosis' from 1/2010 to 12/2023. For mono, we included only the unique phase II/III studies of the approved JAKi. Selective studies that evaluated JAKi in combo with the novel agents were also included.</p><p><strong>Expert opinion: </strong>JAKis aim to provide clinical benefit to patients via spleen size reduction and MPN symptom improvement. In order to potentially increase clinical benefit for patients with MF, several novel agents are being partnered with ruxolitinib (RUX) with the ongoing hypothesis to augment greater measures of MF disease modification. The novel agents are either 'added-on' to RUX or as a combo in JAKi naïve patients. Also, the mutant-targeting era of therapies is now beginning with novel CALR-mutated, novel <i>JAK2</i> V617F mutation-specific and type II JAK2i in the initial stages of drug development, representing a new approach to treatment.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"769-780"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Circulating levels of vitamins and risk of lymphoma: insights from a two-sample Mendelian randomization.","authors":"Yan-Yan Rong, Peng-Cheng Liu, Xian-Bao Huang, Guo-An Chen","doi":"10.1080/17474086.2024.2410009","DOIUrl":"10.1080/17474086.2024.2410009","url":null,"abstract":"<p><strong>Background: </strong>To explore the genetic causal association between lymphoma and the circulating levels of vitamins through Mendelian randomization (MR).</p><p><strong>Research design and methods: </strong>We performed MR analysis using publicly available genome-wide association study (GWAS) summary data. Seven indicators related to the circulating levels of vitamins (vitamin D, vitamin C, vitamin B6, vitamin B12, folic acid, vitamin E, and carotene) served as exposures, while lymphoma was the outcome. The genetic causal association between these circulating levels of vitamin indicators and lymphoma was assessed using the inverse variance weighted (IVW) method.</p><p><strong>Results: </strong>Based on IVW method, vitamin B12 (OR = 0.48; 95% CI: 0.28-5.19; <i>p</i> = 0.018) and folic acid (OR = 0.62; 95% CI: 0.40-0.96; <i>p</i> = 0.032) both showed substantial evidence of a relationship with lymphoma. Moreover, the Weighted median method similarly indicated potential evidence of an association between vitamin B12 (OR = 0.40; 95% CI: 0.18-0.90; <i>p</i> = 0.027) and lymphoma. The Simple mode, and Weighted mode methods showed no potential genetic causal association (<i>p</i> > 0.05 in the two analyses).</p><p><strong>Conclusions: </strong>This study suggests a potential association between folic acid and vitamin B12 and lymphoma. Further research is required to assess the reproducibility of this finding in different contexts and to gain deeper insights into the potential underlying mechanisms.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"833-839"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuping Qian, Jingwei Huang, Huanhuan Cheng, Juan Wang
{"title":"Effect of days of age at first blood transfusion on intraventricular hemorrhage in very low and extremely low birth weight infants.","authors":"Yuping Qian, Jingwei Huang, Huanhuan Cheng, Juan Wang","doi":"10.1080/17474086.2024.2422017","DOIUrl":"10.1080/17474086.2024.2422017","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants are a group cohort of transfusion recipients due to their low blood volume and underdeveloped hematopoietic system. The objective of this study was to probe the effect of days of age at first blood transfusion on intraventricular hemorrhage (IVH) in very low and extremely low birth weight VLBW and ELBW infants.</p><p><strong>Research design and methods: </strong>Data of 150 VLBW and ELBW infants receiving blood transfusions were reviewed. IVH and non-IVH groups were established. General data on infants and their mothers and data related to blood transfusion, IVH risk factors, and the predictive value of the relevant factors for IVH were analyzed.</p><p><strong>Results: </strong>The IVH group had lower birth weight, hemoglobin levels on admission, and days of age at first blood transfusion and higher 5-min Apgar score ≤7 points and early transfusion rate. Spontaneous delivery and 5-min Apgar score ≤7 points were risk factors for IVH. Birth weight and days of age at first blood transfusion had predictive value for IVH in VLBW and ELBW infants.</p><p><strong>Conclusions: </strong>The younger the days of age at first blood transfusion, the higher the IVH risk. It is necessary to delay the days of age at first blood transfusion and reduce early blood transfusion.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"871-875"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nima Ghalehsari, Sofia Zahid, Olivia Main, Soeb Usta, John Patresan, Adina Amin, Farah Ashraf, Anita Mazloom, Andy Huang, Mendel Goldfinger, Jorge Monge
{"title":"Exploring health disparities in diagnosing multiple myeloma.","authors":"Nima Ghalehsari, Sofia Zahid, Olivia Main, Soeb Usta, John Patresan, Adina Amin, Farah Ashraf, Anita Mazloom, Andy Huang, Mendel Goldfinger, Jorge Monge","doi":"10.1080/17474086.2024.2389988","DOIUrl":"10.1080/17474086.2024.2389988","url":null,"abstract":"<p><strong>Background: </strong>Multiple myeloma (MM) is a plasma cell neoplasm, which accounts for 1-2% of cancers and approximately 17% of hematological malignancies in the United States each year. Fifty percent of patients with symptomatic MM have three or more primary care visits before being referred to a specialist, which is greater than any other cancer. A delay in the diagnosis of multiple myeloma has been shown to negatively impact the clinical course of the disease; patients with longer diagnostic intervals have been shown to experience shorter disease-free survival and higher rates of treatment-related complications.</p><p><strong>Research design and methods: </strong>We performed a retrospective analysis of patients diagnosed with MM in our institution, to determine the time from the first detectable lab abnormality to the diagnosis of MM.</p><p><strong>Results: </strong>We included 92 patients in this study. Fifty-two percent of patients had isolated anemia at the time of diagnosis. Twenty-nine percent of patients had a delay in diagnosis of ≥1 year, while 18% had a delay of ≥3 years. Nine patients in our cohort had anemia and an elevated serum total protein (31%). This group had the longest time to diagnosis with a median of 38 months.</p><p><strong>Conclusions: </strong>Our results did not show any difference in time to diagnosis by race, ethnicity, gender, or socioeconomic status.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"749-753"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Chemotherapy-free approaches to newly-diagnosed acute promyelocytic leukaemia: is oral-arsenic trioxide/all-trans retinoic acid/ascorbic acid the answer?","authors":"Harinder Gill","doi":"10.1080/17474086.2024.2391098","DOIUrl":"10.1080/17474086.2024.2391098","url":null,"abstract":"<p><strong>Introduction: </strong>Acute promyelocytic leukemia (APL) is a distinct form of acute myeloid leukemia characterized by the presence of t(15;17)(q24;21) and the <i>PML:RARA</i> gene fusion. Frontline use of intravenous arsenic trioxide (i.v.-ATO) and all-trans retinoic acid (ATRA) has vastly improved cure rates in APL. Researchers in Hong Kong invented the oral formulation of ATO (oral-ATO) and have confirmed a bioavailability comparable to i.v.-ATO. A plethora of studies have confirmed the safety and efficacy of oral-ATO-based regimens in the frontline and relapsed setting.</p><p><strong>Areas covered: </strong>Aspects on the development of oral-ATO-based regimens for APL in the frontline and relapsed setting are discussed. The short-term and long-term safety and efficacy of oral-ATO-based regimens are discussed. The frontline use of oral-ATO in combination with ATRA and ascorbic acid (AAA) induction in a 'chemotherapy-free' is highlighted.</p><p><strong>Expert opinion: </strong>Current and ongoing data on the use of oral-ATO-based regimens in APL support the use of oral-ATO as an alternative to i.v.-ATO allowing a more convenient and economical approach to the management of APL.</p>","PeriodicalId":12325,"journal":{"name":"Expert Review of Hematology","volume":" ","pages":"661-667"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}