Daniel Wang, Manraj Sra, Samira Glaeser-Khan, Daniel Y. Wang, Ranya Moshashaian-Asl, Satoko Ito, Adam Cuker, George Goshua
{"title":"Cost-Effectiveness of Ferritin Screening Thresholds for Iron Deficiency in Reproductive-Age Women","authors":"Daniel Wang, Manraj Sra, Samira Glaeser-Khan, Daniel Y. Wang, Ranya Moshashaian-Asl, Satoko Ito, Adam Cuker, George Goshua","doi":"10.1002/ajh.27686","DOIUrl":"https://doi.org/10.1002/ajh.27686","url":null,"abstract":"Iron deficiency (ID) is a top five leading cause of disability-adjusted life-years in women of reproductive age around the world. Despite its enormous health burden, no screening guidelines exist for the detection and treatment of ID in women of reproductive age. We sought to determine the cost-effectiveness of screening versus no screening for ID in women of reproductive age in the United States. A lifetime simulation of women of reproductive age was conducted using a Markov cohort model under three strategies: (1) no screening, (2) screening at a ferritin threshold of 15 μg/L, and (3) screening at a ferritin threshold of 25 μg/L, from the US health system perspective, and at a willingness-to-pay threshold of $100 000/quality-adjusted life year (QALY). Epidemiologically informed ID prevalence estimates sourced from the National Health and Nutrition Examination Survey were employed for model parameterization. The primary outcome was the incremental cost-effectiveness ratio (ICER, in $/QALY). Base-case results for the three strategies accrued $209 700, $210 200, and $210 200 discounted lifetime costs and 23.6, 24.0, and 24.4 discounted lifetime QALYs, respectively. Screening at a ferritin threshold of 25 μg/L was the cost-effective intervention with an ICER of $680/QALY (95% credible interval $350–$750/QALY). In dual base-case analyses examining intravenous rather than oral iron repletion for treatment, screening at a ferritin threshold of 25 μg/L remained the cost-effective intervention with an ICER of $2300/QALY (95% CI $1800–$3800/QALY). In probabilistic sensitivity analyses, screening at a ferritin threshold of 25 μg/L was the cost-effective intervention in 100% of 10 000 s order Monte Carlo iterations.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"1 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fateeha Furqan, Kwang W. Ahn, Manmeet Kaur, Jinalben Patel, Stephen Ansell, Farrukh T. Awan, John Baird, Evandro Bezerra, Umar Farooq, Henry Fung, Arushi Khurana, Lazaros Lekakis, Forat Lutfi, John McCarty, Akash Mukherjee, Rajneesh Nath, Jason Romancik, Stephen J. Schuster, Melody Smith, Allison Winter, Cameron Turtle, Craig Sauter, Mazyar Shadman, Alex Herrara, Mehdi Hamadani
{"title":"Autologous Transplant or CAR-T as Consolidation Options in MYC Rearranged Large B-Cell Lymphoma Patients in Remission After Salvage Treatments","authors":"Fateeha Furqan, Kwang W. Ahn, Manmeet Kaur, Jinalben Patel, Stephen Ansell, Farrukh T. Awan, John Baird, Evandro Bezerra, Umar Farooq, Henry Fung, Arushi Khurana, Lazaros Lekakis, Forat Lutfi, John McCarty, Akash Mukherjee, Rajneesh Nath, Jason Romancik, Stephen J. Schuster, Melody Smith, Allison Winter, Cameron Turtle, Craig Sauter, Mazyar Shadman, Alex Herrara, Mehdi Hamadani","doi":"10.1002/ajh.27687","DOIUrl":"https://doi.org/10.1002/ajh.27687","url":null,"abstract":"Although recent studies have demonstrated the efficacy of chimeric antigen receptor T-cell (CAR-T) therapy in relapsed large B-cell lymphoma (LBCL) with MYC rearrangement (R-MYC), the data comparing CAR-T to autologous hematopoietic cell transplant (auto-HCT) in such patients who achieve a complete or partial response (CR/PR) after salvage therapies are limited. We compared the clinical outcomes of patients with R-MYC LBCL (including double and triple hit lymphomas) who underwent CAR-T or auto-HCT after achieving a CR/PR with salvage therapies using the Center for International Blood & Marrow Transplant Research registry. Among the 252 patients (auto-HCT = 98, CAR-T = 154), relative to auto-HCT, CAR-T was associated with significantly lower overall survival (OS) (Hazard Ratio [HR] 2.09, 95% CI 1.38–3.15, <i>p</i> < 0.001) on multivariate analysis. There were no differences in progression-free survival (PFS) (HR 1.21, 95% CI 0.81–1.8 <i>p</i> = 0.36), risk of relapse (HR 1.1, 95% CI 0.71–1.69 <i>p</i> = 0.68), nonrelapse mortality (NRM) (HR 1.74, 95% CI 0.64–4.7 <i>p</i> = 0.28) while the post-relapse survival was longer in auto-HCT relative to CAR-T (HR 1.93, 95% CI 1.21–3.06 <i>p</i> = 0.01). On propensity score matched analysis accounting for differences in characteristics across the two cohorts, we detected no significant differences in OS (HR 1.72, 95% CI 0.92–3.21 <i>p</i> = 0.09), PFS (HR 1.04, 95% CI 0.64–1.68 <i>p</i> = 0.88), NRM (HR 1.22, 95% CI 0.35–4.2 <i>p</i> = 0.76), relapse (HR = 0.93, 95% CI 0.54–1.6 <i>p</i> = 0.8) and post-relapse survival (HR 2.25, 95% CI 0.98–5.17, <i>p</i> = 0.06). These data, although retrospective, support consideration for auto-HCT in patients with R-MYC LBCL who achieve a CR/PR after salvage therapies, particularly in regions with no or limited access to CAR-T.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"27 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eli Muchtar, Vaishali Sanchorawala, Hamza Hassan, Ute Hegenbart, Stefan Schönland, Hans C. Lee, Muzaffar Qazilbash, Andrew Kin, Jeffrey Zonder, Eapen Jacob, Francis Buadi, Angela Dispenzieri, David Dingli, Sally Arai, Michelle Chin, Rajshekhar Chakraborty, Suzanne Lentzsch, Hila Magen, Eden Shkury, Caitlin Sarubbi, Heather Landau, Morie Gertz
{"title":"The Impact of Melphalan Conditioning and CD34+ Cell Dose and Schedule on Post-Transplant Outcomes in AL Amyloidosis","authors":"Eli Muchtar, Vaishali Sanchorawala, Hamza Hassan, Ute Hegenbart, Stefan Schönland, Hans C. Lee, Muzaffar Qazilbash, Andrew Kin, Jeffrey Zonder, Eapen Jacob, Francis Buadi, Angela Dispenzieri, David Dingli, Sally Arai, Michelle Chin, Rajshekhar Chakraborty, Suzanne Lentzsch, Hila Magen, Eden Shkury, Caitlin Sarubbi, Heather Landau, Morie Gertz","doi":"10.1002/ajh.27685","DOIUrl":"https://doi.org/10.1002/ajh.27685","url":null,"abstract":"The optimal conditioning schedule and CD34+ cell dose for autologous stem cell transplantation (ASCT) for AL amyloidosis is unknown. Patients (<i>n</i> = 1704) who underwent ASCT for AL amyloidosis between 2003 and 2020 in 9 centers were included. Data on melphalan conditioning dose, number of conditioning days, whether a rest day between conditioning and stem cell infusion was given or not, and infused CD34<sup>+</sup> cell dose were collected. Full-dose melphalan (≥ 180 mg/m<sup>2</sup>) was administered in 63.7% of the patients, and 80.4% had melphalan split into 2-day conditioning. A rest day (day −1) between the conditioning regimen and stem cell infusion was provided in 52.5% of patients. The median infused CD34<sup>+</sup> cell count was 4.7 × 10<sup>6</sup>/kg. An infused CD34<sup>+</sup> cell count ≥ 4.5 × 10<sup>6</sup>/kg was associated with a shorter time to neutrophil and platelet engraftment. In a nominal regression analysis, full-dose melphalan, 1-day melphalan conditioning, and omitting a rest day between conditioning and stem cell infusion were independent predictors of post-ASCT higher deep hematological response. The median follow-up was 8.6 years, and 38% of patients died. Independent predictors of superior overall survival in multivariate Cox regression analysis included full-dose melphalan, having no rest day, and infused CD34<sup>+</sup> cells ≥ 4.5 × 10<sup>6</sup>/kg. Independent predictors of higher day-100 transplant-related mortality (TRM) in nominal logistic regression analysis included poorer performance status, NT-proBNP/BNP ≥ 1800/400 pg/mL, serum albumin < 2.5 g/dL, CD34<sup>+</sup> cells < 4.5 × 10<sup>6</sup>/kg, and not having a rest day. In conclusion, 1 day of melphalan conditioning and administration of CD34<sup>+</sup> cells ≥ 4.5 × 10<sup>6</sup>/kg are recommended for ASCT in AL amyloidosis.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"183 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jacob Jendro, Jule Ussmann, Dominic Brauer, Donata Backhaus, Lara Bischof, Maximilian Merz, Vladan Vucinic, Georg‐Nikolaus Franke, Marco Herling, Klaus H. Metzeler, Uwe Platzbecker, Sebastian Schwind, Madlen Jentzsch
{"title":"Impact of Evolving WHO and ICC Classifications on Prognosis and Outcomes in AML Patients Undergoing Allogeneic Stem Cell Transplantation","authors":"Jacob Jendro, Jule Ussmann, Dominic Brauer, Donata Backhaus, Lara Bischof, Maximilian Merz, Vladan Vucinic, Georg‐Nikolaus Franke, Marco Herling, Klaus H. Metzeler, Uwe Platzbecker, Sebastian Schwind, Madlen Jentzsch","doi":"10.1002/ajh.27676","DOIUrl":"https://doi.org/10.1002/ajh.27676","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"23 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clonal Hematopoiesis and Thrombosis","authors":"Cornelia Englisch, Cihan Ay","doi":"10.1002/ajh.27682","DOIUrl":"https://doi.org/10.1002/ajh.27682","url":null,"abstract":"Clonal hematopoiesis (CH) has been the focus of many research efforts in the last years and has emerged as a risk modifier for cardiovascular disease morbidity and mortality. While substantial evidence has accumulated regarding its impact on arterial system diseases, the connection with venous thrombosis has only recently been explored. Both clinical and preclinical evidence suggest that the magnitude and mechanism underlying the association of CH with cardiovascular events vary depending on the specific mutated gene involved, indicating a causal link between CH and thrombosis development, not only in the arterial system, particularly in the context of atherosclerosis, but also in venous thrombosis. Although this growing body of knowledge has driven translational research and provided insights for improving clinical management, several questions remain unanswered. This review aims to summarize the available evidence on the link between CH and thrombosis, while highlighting the gaps that need to be addressed in future research.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"70 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yishan Ye, Allain Thibeault Ferhat Berland, Myriam Labopin, Jia Chen, Depei Wu, Didier Blaise, Carmen Di Grazia, Edouard Forcade, Xiao-jun Huang, Ibrahim Yakoub-Agha, Urpu Salmenniemi, Patrice Chevallier, Ali Bazarbachi, Arnon Nagler, Eolia Brissot, Lin Li, Yi Luo, Yanmin Zhao, Mohamad Mohty, He Huang, Fabio Ciceri, Norbert Claude Gorin
{"title":"Better Outcome Following Younger Haploidentical Donor Versus Older Matched Unrelated Donor Transplant for Fit Patients With Acute Myeloid Leukemia Transplanted in First Remission: A Study From the Global Committee and the Acute Leukemia Working Party of the EBMT","authors":"Yishan Ye, Allain Thibeault Ferhat Berland, Myriam Labopin, Jia Chen, Depei Wu, Didier Blaise, Carmen Di Grazia, Edouard Forcade, Xiao-jun Huang, Ibrahim Yakoub-Agha, Urpu Salmenniemi, Patrice Chevallier, Ali Bazarbachi, Arnon Nagler, Eolia Brissot, Lin Li, Yi Luo, Yanmin Zhao, Mohamad Mohty, He Huang, Fabio Ciceri, Norbert Claude Gorin","doi":"10.1002/ajh.27681","DOIUrl":"https://doi.org/10.1002/ajh.27681","url":null,"abstract":"<p>Donor selection has a major impact on the results of allo-HCT. Human leukocyte antigen (HLA)-matched sibling donors (MSD) are considered preferred donors, but they are available for only a minority of patients. 10/10 HLA fully-matched unrelated donors (MUDs) or haploidentical donors (HAPLOs) are both important alternatives in the absence of MSDs, with growing evidence indicating comparable transplant outcomes between these two [<span>1</span>]. Older donor age has been associated with inferior transplant outcomes in either MUD [<span>2</span>] or HAPLO [<span>3</span>] settings essentially due to a higher rate of non-relapse mortality (NRM). In a recent EBMT study focusing on donor selection in the unrelated donor setting, older donor age but not HLA mismatch was associated with a higher relapse incidence (RI) and poorer survival outcomes [<span>4</span>].</p>\u0000<p>In order to compare the transplant outcomes of younger HAPLO and older MUD allo-HCT and provide rational suggestions for donor selection, we compared in an EBMT global multi-center registry-based analysis the outcomes following allo-HCT from younger HAPLO or older MUD.</p>\u0000<p>Data of 3296 adult AML patients receiving a first allo-HCT in CR1 from between 2010 and 2022 were analyzed. Transplants from mismatched UD (< 10/10) were excluded. The young HAPLO group was identified as transplants with haploidentical donors aged between 15 and 40 years old. The older MUD group was identified as transplants with 10/10 HLA fully-MUDs aged between 40 and 65 years old.</p>\u0000<p>Overall survival (OS) was defined as the duration from transplant to death from any cause. Leukemia-free survival (LFS) was defined as the time to either relapse or death. GVHD-free-relapse-free survival (GRFS) was measured as the duration from transplantation to the earliest occurrence of one of the following events: grade III–IV aGVHD, extensive cGVHD, relapse, or death due to any cause. The diagnosis and grading of acute and chronic GVHD were conducted according to the revised criteria of the Mount Sinai International Consortium and the National Institutes of Health (NIH), respectively. Neutrophil recovery was characterized by maintaining an absolute neutrophil count above 0.5 × 10<sup>9</sup>/L for at least three consecutive days, while platelet recovery required maintaining a platelet count above 20 × 10<sup>9</sup>/L for the same duration, without the need for transfusion. To compare patient characteristics between groups, quantitative variables were analyzed using the Mann–Whitney <i>U</i> test, while categorical variables were assessed through chi-squared or Fisher's exact tests. The Kaplan–Meier estimator was utilized to calculate OS, LFS, and GRFS. Cumulative incidence calculations were used to determine RI, NRM, and the recovery rates of neutrophils and platelets, as well as GVHD outcomes. RI and NRM were treated as mutually competing events. Relapse and death were considered competing events for GVHD outcomes, w","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"59 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christin B. DeStefano, Matthew D. Wilkerson, Joaquin Villar, Sarah Darmon, Clifton L. Dalgard, Wendy B. Bernstein
{"title":"Clonal Hematopoiesis in Gulf War Veterans","authors":"Christin B. DeStefano, Matthew D. Wilkerson, Joaquin Villar, Sarah Darmon, Clifton L. Dalgard, Wendy B. Bernstein","doi":"10.1002/ajh.27680","DOIUrl":"https://doi.org/10.1002/ajh.27680","url":null,"abstract":"<p>Veterans of the 1990–1991 Gulf War (GW) endured exposures from oil well fire smoke, pesticides, burn pits, depleted uranium, jet fuel, chemical warfare, and nerve agents [<span>1</span>]. The National Academies of Science, Engineering, and Medicine have reported sufficient data to associate GW deployment with chronic multisystem illness and post-traumatic stress disorder, but owing to latency there are insufficient data to associate GW deployment with hematologic malignancies [<span>1</span>]. Given the difficulty attributing adverse health outcomes to wartime exposures, the Veterans Health Administration (VHA) expanded healthcare to veterans with presumptive conditions following burn pit exposure, and myeloid neoplasms (MN) were recently added as a presumptive condition. Clonal hematopoiesis (CH) is a precursor to MN and may be an indicator of clinically significant toxin exposure. Exposures to chemotherapy, cigarette smoke, and ionizing radiotherapy are known to heighten the risk of CH of indeterminate potential (CHIP) [<span>2-5</span>], and data suggest that toxic exposures to World Trade Center particulate matter after 9/11 can also increase CHIP [<span>6</span>]. Therefore, there is rationale that GW exposures could also increase the risk of CH. Unlike Agent Orange-exposed Vietnam veterans and atomic veterans who have already declared their long-term comorbidities [<span>7</span>], GW veterans are at an age that CH could be detected but clinical comorbidities including MN may not have begun to manifest.</p>\u0000<p>A pilot study was performed to describe and characterize CH in a group of exposed and unexposed GW veterans enrolled in the VHA Gulf War Era Cohort and Biorepository (GWECB) [<span>8</span>]. At about 25 years post exposure between 2014 and 2016, GWECB collected a blood sample and administered a survey that included demographics, military service history, exposure to pesticides, oil well fire smoke, and subsequent deployments to Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Exposure was reported in durations of days (1–6, 7–30, or ≥ 31 days), and was characterized in three levels: level 1 (≥ 31 days exposure to oil well fire smoke, < 31 days exposure to pesticides, and subsequent OEF/OIF deployment), level 2 (< 31 days exposure to oil well fire smoke, ≥ 31 days exposure to pesticides and subsequent OEF/OIF deployment), and level 3 (≥ 31 days exposure to oil well fire smoke and pesticides during the GW but no OEF/OIF deployment). The exposed cohort included 30 male veterans who deployed to the GW and reported levels 1, 2, or 3 exposures. The unexposed cohort included 30 male veterans who served during the GW era but did not deploy. All veterans were ages 55–65 at the time of blood collection, and veterans in each cohort were matched by year of birth and smoking history.</p>\u0000<p>Genomic DNA was used as input at 50 ng into the Archer VariantPlex Myeloid library preparation workflow following the manufacturer","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"217 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Generating Off‐the‐Shelf Hematopoietic Stem Cells by “Stretching” Induced Pluripotent Stem Cells","authors":"Lei Han, John D. Crispino","doi":"10.1002/ajh.27683","DOIUrl":"https://doi.org/10.1002/ajh.27683","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"183 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rima S. Zahr, Guolian Kang, Xu Zhang, Sara R. Rashkin, Csaba P. Kovesdy, Clifford Takemoto, Mitch Weiss, Jeffrey Lebensburger, Kenneth I. Ataga, Santosh L. Saraf
{"title":"Development of Polygenic Risk Score for Persistent Albuminuria in Children and Adults With Sickle Cell Anemia","authors":"Rima S. Zahr, Guolian Kang, Xu Zhang, Sara R. Rashkin, Csaba P. Kovesdy, Clifford Takemoto, Mitch Weiss, Jeffrey Lebensburger, Kenneth I. Ataga, Santosh L. Saraf","doi":"10.1002/ajh.27678","DOIUrl":"https://doi.org/10.1002/ajh.27678","url":null,"abstract":"Albuminuria is associated with high-risk apolipoprotein-L1 variants (<i>APOL1</i> G1/G2) in patients with sickle cell anemia (SCA). However, this gene variant does not account for all chronic kidney disease (CKD) risk. We hypothesized that we could develop a polygenic risk score (PRS) for CKD in SCA, combining <i>APOL1 G1/G2</i> with other candidate genes that modify SCA severity and further stratify patients into risk categories based on this risk score. Variants in <i>APOL1</i>, <i>HMOX1</i> (rs743811), <i>BCL11A</i> (rs1424407), and α-thalassemia (<i>α</i><sup>−3.7</sup>) were identified in children with SCA enrolled in the Sickle Cell Clinical Research and Intervention Program longitudinal cohort (SCCRIP). We individually tested the association of these variants with persistent albuminuria, tested a three-variant PRS (PRS-3) (<i>APOL1</i>, <i>BCL11A</i> (rs1424407), and α<sup>−3.7</sup>), and developed a four-variant PRS (PRS-4) after adding <i>HMOX1</i> (rs743811) to PRS-3 using the summation of high-risk alleles. An adult SCA cohort from the University of Illinois, Chicago (UIC), was used for validation. Persistent albuminuria was defined as having a urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g on at least 2 of 3 consecutive measurements. In both cohorts, <i>APOL1</i> risk variants increased the risk while α-thalassemia protected against persistent albuminuria. PRS-4 was significantly associated with persistent albuminuria (SCCRIP: <i>p</i> = 0.004; UIC: <i>p</i> = 0.00016). When stratifying patients into three and four risk categories based on the PRS, 58% and 86% of the high-risk (PRS-3) and 54% and 89% of very high-risk (PRS-4) categories developed persistent albuminuria cases in the SCCRIP and UIC cohorts, respectively. A PRS may identify high-risk SCA patients for albuminuria. Applying this PRS to guide the early implementation of disease modifiers and renoprotective therapies may help reduce the burden of SCA-related CKD.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"23 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zeni Kharel, Nicole Jean Rubin, Rachel J. David, Peter Kouides
{"title":"Diagnosis of Duffy Null‐Associated Neutropenia During Chemotherapy","authors":"Zeni Kharel, Nicole Jean Rubin, Rachel J. David, Peter Kouides","doi":"10.1002/ajh.27679","DOIUrl":"https://doi.org/10.1002/ajh.27679","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"20 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}