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Red blood cell transfusion and the use of intravenous iron in iron-deficient patients presenting to the emergency department
Pub Date : 2024-12-10 DOI: 10.1002/jha2.1061
Kevin Thomas, Arvand Barghi, Robert Balshaw, Emily Rimmer, Murdoch Leeies, Donald S. Houston, Allan Garland, Ryan Zarychanski, Brett L. Houston

Background and aims

Red blood cell transfusions are often used to treat iron-deficient patients in the emergency department (ED), while treatment with intravenous (IV) iron is preferred, as it increases hemoglobin concentration rapidly and durably. We aim to evaluate the incidence of iron deficiency anemia, frequency of blood transfusion and iron supplementation, and factors associated with blood transfusion in the ED.

Methods

We conducted a retrospective cohort study of adult patients presenting to the St. Boniface Hospital (Winnipeg, Canada) ED from 2014 to 2018. Electronic data obtained from the Emergency Department Information System and Laboratory Information Services databases identified patients presenting with iron deficiency anemia, defined as microcytic (mean corpuscular volume < 75 fL) anemia (hemoglobin < 120 g/L) with either a transferrin saturation <20% or ferritin < 30 µmol/L. Ferritin > 100 µmol excluded iron deficiency anemia. The use of blood transfusions or iron supplementation was determined for each patient. Factors associated with blood transfusion were determined using logistic regression analyses.

Results

Of 39,222 patients, 17,945 (45%) were anemic. In anemic patients, iron parameters were ordered in 1848 (10.3%) and iron deficiency anemia was diagnosed in 910 (5.1%). Ninety-five patients (10.4%) received one red blood cell unit, and 197 patients (21.6%) received ≥2 units. Oral iron and IV iron were prescribed for 64 (7.0%) and 14 (1.5%) patients, respectively. Hemoglobin concentration was the main determinant for treatment with blood transfusion.

Conclusions

Iron deficiency is underinvestigated among anemic patients presenting to the ED. The only clinical factor associated with red blood cell transfusion in the ED was hemoglobin level, irrespective of symptoms or clinical stability.

背景和目的:在急诊科(ED)治疗缺铁性贫血患者时通常会输注红细胞,而静脉注射(IV)铁剂是首选,因为它能快速、持久地提高血红蛋白浓度。我们的目的是评估缺铁性贫血的发病率、输血和补铁的频率以及与急诊科输血相关的因素:我们对 2014 年至 2018 年期间前往圣博尼法斯医院(加拿大温尼伯)急诊科就诊的成年患者进行了一项回顾性队列研究。从急诊科信息系统和实验室信息服务数据库中获取的电子数据确定了缺铁性贫血患者的身份,缺铁性贫血定义为小细胞性(平均血球容积 100 µmol)缺铁性贫血。确定了每位患者输血或补铁的情况。使用逻辑回归分析确定了与输血相关的因素:在 39,222 名患者中,有 17,945 人(45%)贫血。贫血患者中有 1848 人(10.3%)接受了铁参数检查,910 人(5.1%)确诊为缺铁性贫血。95 名患者(10.4%)接受了一个红细胞单位的治疗,197 名患者(21.6%)接受了≥2 个单位的治疗。口服铁剂和静脉注射铁剂的患者分别为 64 人(7.0%)和 14 人(1.5%)。血红蛋白浓度是决定输血治疗的主要因素:结论:在急诊室就诊的贫血患者中,对铁缺乏症的调查不足。结论:在急诊室就诊的贫血患者中,铁缺乏症的检查率较低,而与急诊室输注红细胞相关的唯一临床因素是血红蛋白水平,与症状或临床稳定性无关。
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引用次数: 0
Increased serum B-cell maturation antigen levels evaluated with an Elecsys-based serum B-cell maturation antigen assay have a negative prognostic value in patients with newly diagnosed multiple myeloma
Pub Date : 2024-12-09 DOI: 10.1002/jha2.889
Evangelos Terpos, Ioannis Ntanasis-Stathopoulos, Panagiotis Malandrakis, Despina Fotiou, Magdalini Migkou, Evangelos Eleutherakis-Papaiakovou, Foteini Theodorakakou, Maria Roussou, Maria Gavriatopoulou, Meletios A Dimopoulos, Efstathios Kastritis

Background: Serum B-cell maturation antigen (sBCMA) levels have emerged as a potential biomarker for disease monitoring in multiple myeloma (MM) with prognostic value.

Methods: Herein, we evaluated the sBCMA levels in 166 patients with newly diagnosed MM with an Elecsys-based sBCMA assay.

Results: Increased sBCMA levels at diagnosis were correlated with inferior survival outcomes in terms of both progression-free and overall survival. In a subset of patients with available samples at the time of disease progression, there was a trend for decreasing sBCMA values.

Conclusion: Sequential evaluation of sBCMA in prospective studies will determine the value of incorporating sBCMA measurement in clinical practice.

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引用次数: 0
Real-world characteristics and outcomes of patients with multiple myeloma receiving second-line treatment in England
Pub Date : 2024-12-05 DOI: 10.1002/jha2.1058
Sally Moore, Laura Cornic, Christina-Jane Crossman-Barnes, Sophie Jose, Zeyad Khalaf, Kwee Yong, Megan Soutar, Philip Woods

Introduction

Despite recent advances in first-line therapies for multiple myeloma (MM), most patients relapse or become refractory, underscoring the need for effective second-line (2L) regimens for relapsed/refractory MM (RRMM).

Methods

This study describes the real-world baseline characteristics, treatment patterns and clinical outcomes of adult patients diagnosed with MM between 2013 and 2020 using data collated by the National Cancer Registration and Analysis Service (NCRAS) of the National Health Service in England. The study cohorts were broadly aligned to the eligibility criteria of the ongoing DREAMM-7 (D7) and DREAMM-8 (D8) clinical trials. We focus on lenalidomide-exposed/refractory patients who received daratumumab–bortezomib–dexamethasone (DaraVd) at 2L in both cohorts.

Results

In the D7-like cohort, the lenalidomide-exposed (= 282) and lenalidomide-refractory (= 143) patients who received DaraVd at 2L had a median (95% confidence interval [CI]) time to next treatment or death (TTNTD) of 15.1 (12.6–22.4) and 10.3 (7.4–13.9) months, respectively. In the D8-like cohort, the lenalidomide-exposed (= 269) and lenalidomide-refractory (= 148) patients who received DaraVd at 2L had a median (95% CI) TTNTD of 14.5 (11.7–19.7) and 10.0 (7.3–13.7) months, respectively.

Conclusion

Patients with RRMM in England receiving DaraVd at 2L have poor clinical outcomes, highlighting the urgent need for new therapies, particularly for lenalidomide-refractory patients.

导言:尽管多发性骨髓瘤(MM)一线疗法取得了最新进展,但大多数患者仍会复发或难治,这凸显出复发/难治性MM(RRMM)需要有效的二线(2L)治疗方案:本研究利用英国国家卫生服务局(National Health Service)国家癌症登记和分析服务(NCRAS)整理的数据,描述了2013年至2020年间确诊为MM的成年患者的真实世界基线特征、治疗模式和临床结果。研究队列与正在进行的DREAMM-7(D7)和DREAMM-8(D8)临床试验的资格标准大体一致。我们的研究重点是来那度胺暴露/难治性患者,他们在两个队列中均接受了达拉单抗-硼替佐米-地塞米松(DaraVd)治疗2L:在D7-like队列中,来那度胺暴露患者(n = 282)和来那度胺难治患者(n = 143)在2L时接受DaraVd治疗,他们接受下一次治疗或死亡(TTNTD)的时间中位数(95%置信区间[CI])分别为15.1(12.6-22.4)个月和10.3(7.4-13.9)个月。在D8-like队列中,来那度胺暴露患者(n = 269)和来那度胺难治患者(n = 148)在2L时接受DaraVd治疗的中位(95% CI)TTNTD分别为14.5(11.7-19.7)个月和10.0(7.3-13.7)个月:在英国,接受2L剂量DaraVd治疗的RRMM患者临床疗效不佳,这凸显了对新疗法的迫切需求,尤其是来那度胺难治性患者。
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引用次数: 0
Terminal deoxynucleotidyl transferase-positive high-grade B-cell lymphoma with MYC and BCL2 rearrangements transformed from follicular lymphoma 末端脱氧核苷酸转移酶阳性的高级别B细胞淋巴瘤,伴有MYC和BCL2重排,由滤泡淋巴瘤转化而来。
Pub Date : 2024-12-02 DOI: 10.1002/jha2.1060
Radu Chiriac, Lucile Baseggio, Marie Donzel
<p>A 48-year-old man with a 2-year history of classical follicular lymphoma (according to the 5th WHO classification) [<span>1</span>] involving the axillary lymph nodes achieved complete remission after six cycles of obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. By the end of the third cycle of maintenance therapy with obinutuzumab, the patient presented with epigastric and left hypochondrial pain while in complete remission for 8 months.</p><p>Laboratory studies revealed a lactate dehydrogenase level of 2000 U/L (reference range: 135–235 U/L) and mild anemia (90 g/L). However, the peripheral blood smear showed 10% atypical intermediate-sized lymphomatous cells, characterized by nuclei with oval to irregular contours, finely stippled chromatin, variable nucleoli, and intensely basophilic cytoplasm with numerous vacuoles (Figure 1A). Staging bone marrow was negative. Peripheral blood flow cytometry showed a kappa-restricted population of mature B-cells that were CD45+, CD19+, CD10+, CD5-, and CD20- (Figure 1B). To evaluate the abdominal pain, <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) positron emission tomography/computed tomography revealed a left retroperitoneal solid mass with increased <sup>18</sup>F-FDG uptake, an SUVmax of 20, and measuring 6 × 16 cm (Figure 1C).</p><p>Mass biopsy revealed a predominance of monomorphic medium-sized blastoid cells with scant basophilic cytoplasm, round nuclei, and conspicuous nucleoli. Mitotic figures were easily observed (Figure 1D). The neoplastic cells were positive for B-cell markers, including PAX5 and CD19, but negative for CD20. They exhibited a germinal center phenotype (CD10+, BCL6-, and MUM1+) and overexpressed both c-MYC and BCL2. Diffuse terminal deoxynucleotidyl transferase (TdT) expression and monotypic surface immunoglobulin light chain expression were also observed. CD5, CD34, P53, and Epstein–Barr virus-encoded RNA in situ hybridization were negative. The Ki-67 proliferation index was 70%. Fluorescence in-situ hybridization performed with break-apart probes on tissue samples showed <i>MYC</i> (80%) and <i>BCL2</i> (90%) rearrangements, with no <i>BCL6</i> rearrangement (Figure 1D, insets).</p><p>Ifosfamide and etoposide-based chemotherapy were initiated, followed by anti-CD19 chimeric antigen receptor T-cell infusion, which was initially well-tolerated; however, a recurrence developed 3 months later. He was switched to dexamethasone, high-dose cytarabine, and oxaliplatin but developed tumor lysis syndrome with renal failure despite prophylaxis. He experienced progressive disease involving the kidney, lower retroperitoneum, extraperitoneal space, and testis, ultimately dying 7 months after diagnosis.</p><p>This case describes a complex example of an aggressive TdT-positive high-grade B-cell lymphoma (HGBCL), with <i>MYC</i> and <i>BCL2</i> rearrangements transformed from follicular lymphoma marked by significant tissue involvement and a concurrent l
1例48岁男性,有2年经典滤泡性淋巴瘤(根据WHO第5分类)[1]累及腋窝淋巴结病史,经6个周期的binutuzumab联合环磷酰胺、阿霉素、vincristine和强的松治疗后完全缓解。在obinutuzumab维持治疗的第三个周期结束时,患者出现上腹部和左侧线粒体疼痛,并完全缓解了8个月。实验室研究显示乳酸脱氢酶水平为2000 U/L(参考范围:135-235 U/L),轻度贫血(90 g/L)。然而,外周血涂片显示10%的非典型中等大小的淋巴瘤细胞,其特征是细胞核卵圆形到不规则轮廓,染色质精细点状,核仁可变,细胞质嗜碱性强烈,有大量液泡(图1A)。骨髓分期呈阴性。外周血流式细胞术显示kappa限制的成熟b细胞群为CD45+、CD19+、CD10+、CD5-和CD20-(图1B)。为了评估腹痛,18f -氟氧葡萄糖(18F-FDG)正电子发射断层扫描/计算机断层扫描显示左侧腹膜后固体肿块,18F-FDG摄取增加,SUVmax为20,尺寸为6 × 16 cm(图1C)。肿块活检显示单形中型囊胚细胞为主,嗜碱性细胞质少,核圆,核仁明显。很容易观察到有丝分裂图(图1D)。肿瘤细胞b细胞标志物PAX5、CD19阳性,CD20阴性。他们表现出生发中心表型(CD10+, BCL6-和MUM1+)和过表达c-MYC和BCL2。观察弥漫性末端脱氧核苷酸转移酶(TdT)表达和单型表面免疫球蛋白轻链表达。CD5、CD34、P53和Epstein-Barr病毒编码RNA原位杂交均为阴性。Ki-67增殖指数为70%。用断裂探针对组织样品进行荧光原位杂交显示MYC(80%)和BCL2(90%)重排,没有BCL6重排(图1D,插图)。开始以异环磷酰胺和依托泊苷为基础的化疗,随后进行抗cd19嵌合抗原受体t细胞输注,最初耐受良好;然而,3个月后复发。他转而使用地塞米松、大剂量阿糖胞苷和奥沙利铂,尽管进行了预防,但仍出现肿瘤溶解综合征并肾功能衰竭。他经历了累及肾脏、下腹膜后、腹膜外间隙和睾丸的进行性疾病,最终在诊断后7个月死亡。这个病例描述了一个复杂的侵袭性tdt阳性高级b细胞淋巴瘤(HGBCL)的例子,MYC和BCL2重排从滤泡性淋巴瘤转变而来,其特征是明显的组织累及和并发白血病期。tdt阳性HGBCL是一种罕见的侵袭性成熟BCL,被WHO第5类分类[1]认可。区分成熟和未成熟的b细胞肿瘤是很重要的,因为它们需要不同的治疗策略。没有明确不成熟特征的表达TdT的b细胞肿瘤可能提出诊断挑战。与b淋巴母细胞淋巴瘤/白血病相比,tdt阳性的HGBCL通常表现为成熟的b细胞免疫表型,其特征是表面免疫球蛋白轻链限制,CD34阴性,CD38和CD45强阳性。此外,应注意少数表现表面轻链表达[2]的b淋巴母细胞白血病/淋巴瘤病例。该病例表明,TdT在成熟的bcl中可能很少表达,通常发生在疾病进展或复发时。Radu Chiriac和Marie Donzel撰写了手稿并进行了细胞形态学检查。Lucile Baseggio做了免疫学检查。所有作者都对定稿做出了贡献。作者声明无利益冲突。作者所提交的工作没有得到任何组织的支持。本文尊重CHU Lyon对待人类研究参与者的伦理政策。没有使用患者识别数据。作者没有获得患者的书面知情同意,但患者不反对将其数据用于研究目的(根据CHU Lyon的伦理政策要求)。作者已确认该提交不需要临床试验注册。
{"title":"Terminal deoxynucleotidyl transferase-positive high-grade B-cell lymphoma with MYC and BCL2 rearrangements transformed from follicular lymphoma","authors":"Radu Chiriac,&nbsp;Lucile Baseggio,&nbsp;Marie Donzel","doi":"10.1002/jha2.1060","DOIUrl":"10.1002/jha2.1060","url":null,"abstract":"&lt;p&gt;A 48-year-old man with a 2-year history of classical follicular lymphoma (according to the 5th WHO classification) [&lt;span&gt;1&lt;/span&gt;] involving the axillary lymph nodes achieved complete remission after six cycles of obinutuzumab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. By the end of the third cycle of maintenance therapy with obinutuzumab, the patient presented with epigastric and left hypochondrial pain while in complete remission for 8 months.&lt;/p&gt;&lt;p&gt;Laboratory studies revealed a lactate dehydrogenase level of 2000 U/L (reference range: 135–235 U/L) and mild anemia (90 g/L). However, the peripheral blood smear showed 10% atypical intermediate-sized lymphomatous cells, characterized by nuclei with oval to irregular contours, finely stippled chromatin, variable nucleoli, and intensely basophilic cytoplasm with numerous vacuoles (Figure 1A). Staging bone marrow was negative. Peripheral blood flow cytometry showed a kappa-restricted population of mature B-cells that were CD45+, CD19+, CD10+, CD5-, and CD20- (Figure 1B). To evaluate the abdominal pain, &lt;sup&gt;18&lt;/sup&gt;F-fluorodeoxyglucose (&lt;sup&gt;18&lt;/sup&gt;F-FDG) positron emission tomography/computed tomography revealed a left retroperitoneal solid mass with increased &lt;sup&gt;18&lt;/sup&gt;F-FDG uptake, an SUVmax of 20, and measuring 6 × 16 cm (Figure 1C).&lt;/p&gt;&lt;p&gt;Mass biopsy revealed a predominance of monomorphic medium-sized blastoid cells with scant basophilic cytoplasm, round nuclei, and conspicuous nucleoli. Mitotic figures were easily observed (Figure 1D). The neoplastic cells were positive for B-cell markers, including PAX5 and CD19, but negative for CD20. They exhibited a germinal center phenotype (CD10+, BCL6-, and MUM1+) and overexpressed both c-MYC and BCL2. Diffuse terminal deoxynucleotidyl transferase (TdT) expression and monotypic surface immunoglobulin light chain expression were also observed. CD5, CD34, P53, and Epstein–Barr virus-encoded RNA in situ hybridization were negative. The Ki-67 proliferation index was 70%. Fluorescence in-situ hybridization performed with break-apart probes on tissue samples showed &lt;i&gt;MYC&lt;/i&gt; (80%) and &lt;i&gt;BCL2&lt;/i&gt; (90%) rearrangements, with no &lt;i&gt;BCL6&lt;/i&gt; rearrangement (Figure 1D, insets).&lt;/p&gt;&lt;p&gt;Ifosfamide and etoposide-based chemotherapy were initiated, followed by anti-CD19 chimeric antigen receptor T-cell infusion, which was initially well-tolerated; however, a recurrence developed 3 months later. He was switched to dexamethasone, high-dose cytarabine, and oxaliplatin but developed tumor lysis syndrome with renal failure despite prophylaxis. He experienced progressive disease involving the kidney, lower retroperitoneum, extraperitoneal space, and testis, ultimately dying 7 months after diagnosis.&lt;/p&gt;&lt;p&gt;This case describes a complex example of an aggressive TdT-positive high-grade B-cell lymphoma (HGBCL), with &lt;i&gt;MYC&lt;/i&gt; and &lt;i&gt;BCL2&lt;/i&gt; rearrangements transformed from follicular lymphoma marked by significant tissue involvement and a concurrent l","PeriodicalId":72883,"journal":{"name":"EJHaem","volume":"5 6","pages":"1351-1353"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848238","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
Low-dose nivolumab for extranodal natural killer/T-cell lymphoma, nasal type 低剂量纳武单抗用于鼻型结外自然杀伤/ t细胞淋巴瘤。
Pub Date : 2024-11-29 DOI: 10.1002/jha2.1059
Satish Maharaj, Simone Chang
<p>Natural killer (NK)/T-cell lymphoma is a rare subtype of non-Hodgkin lymphoma that is associated with poor outcomes. Efforts to improve treatment are urgently needed and immune checkpoint inhibitor therapies have shown promise in a series of relapsed/refractory diseases. A 59-year-old Hispanic male presented with near-total obstruction of his left nasal airway. Computed tomography imaging showed left greater than right sinusitis with near-total airway obstruction on the left side. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scan showed a hypermetabolic primary mass in the left nasal cavity measuring 3.5 cm in length by 1.7 cm in width, SUV max 10.99. Nasal endoscopy showed a highly vascular exophytic tumor filling the nasal airway and sinuses; debulking and surgical biopsy were performed.</p><p>Pathology from this showed extranodal NK/T-cell lymphoma, nasal-type (ENKTL). Tumor cells were positive for LCA, CD2, CD3 and CD56 immunostains; negative for CD5, CD4, CD8, CD10, CD20, MUM1, CD21, BCL2, BCL6, CD79A, Cyclin D1, CD30, ALK1, Pan-keratin, HV8, CD57, and c-Myc immunostains. Karyotyping was normal, 46, XY[20], and bone marrow biopsy showed normocellular bone marrow without involvement and active maturing trilinear hematopoiesis. Flow cytometry analysis of the nasal mass demonstrated relatively increased natural killer cells, 66% of lymphocytes CD3-/CD56+ with normal expression of CD16 and no immunophenotypic aberrancies without diminished or loss of CD2, CD7, and/or CD57, or abnormal uniform expression of CD8. Epstein-Barr virus (EBV) was positive by RNA in situ hybridization (EBER Positive). Peripheral blood also was positive with EBV DNA Quantitative polymerase chain reaction level 705 copies/mL.</p><p>Using these evaluations, the patient was determined to have Stage II disease using the Chinese Southwest Oncology Group and Asia Lymphoma Study Group (CA) staging system (CASS) established in 2020 [<span>1</span>]. CASS Stage II is defined as a primary tumor localized to the nasal cavity or nasopharynx involving local structures, without regional lymph node involvement. Research has shown that the Ann Arbor staging system (AASS), established for Hodgkin Lymphoma, has limited predictive ability and poor prognostication for ENKTL with CASS better in discriminating survival than AASS [<span>2, 3</span>]. Unlike most other lymphomas, ENKTL is primarily extranodal, and therefore using the AASS, the majority of ENKTL (70%–90%) appears early (stage I/II) leading to unbalanced distribution and poor predictive accuracy.</p><p>Another model developed for patients treated with non-anthracycline-containing regimens is the prognostic index for NK/T-cell lymphomas (PINK-E) (negative scoring parameters: age  >60 years, stage III/IV disease, distant lymph node involvement, non-nasal subtype, and detectable presentation EBV DNA) [<span>4</span>]. Using PINK-E, this patient would be classified as low-risk. Using the PINK-E model,
自然杀伤(NK)/ t细胞淋巴瘤是一种罕见的非霍奇金淋巴瘤亚型,预后较差。迫切需要努力改善治疗,免疫检查点抑制剂治疗在一系列复发/难治性疾病中显示出希望。一位59岁的西班牙裔男性表现为左鼻导气管几乎完全阻塞。计算机断层成像显示左侧鼻窦炎大于右侧鼻窦炎,左侧气道几乎完全阻塞。磁共振成像(MRI)和正电子发射断层扫描(PET)显示左鼻腔高代谢原发性肿块,长3.5 cm,宽1.7 cm, SUV最大10.99。鼻内窥镜显示一个高度血管性的外生性肿瘤,填满鼻气道和鼻窦;行减体积和手术活检。病理显示结外NK/ t细胞淋巴瘤,鼻型(ENKTL)。肿瘤细胞LCA、CD2、CD3、CD56免疫染色阳性;CD5、CD4、CD8、CD10、CD20、MUM1、CD21、BCL2、BCL6、CD79A、Cyclin D1、CD30、ALK1、Pan-keratin、HV8、CD57和c-Myc免疫染色均阴性。核型正常,46,XY[20],骨髓活检显示正常细胞骨髓未受累,活跃成熟的三线造血。鼻肿块的流式细胞术分析显示自然杀伤细胞相对增加,66%的淋巴细胞CD3-/CD56+ CD16表达正常,无免疫表型异常,CD2、CD7和/或CD57表达减少或缺失,CD8表达异常均匀。RNA原位杂交显示eb病毒(EBV)阳性。外周血EBV DNA定量聚合酶链反应水平为705拷贝/mL。根据这些评估,根据中国西南肿瘤学会和亚洲淋巴瘤研究学会(CA)于2020年建立的分期系统(CASS),确定患者为II期疾病。CASS II期定义为原发肿瘤局限于鼻腔或鼻咽部,累及局部结构,未累及区域淋巴结。研究表明,针对霍奇金淋巴瘤建立的安娜堡分期系统(Ann Arbor分期system, AASS)对ENKTL的预测能力有限且预后较差,而CASS在区分生存方面优于AASS[2,3]。与大多数其他淋巴瘤不同,ENKTL主要发生在结外,因此使用AASS,大多数ENKTL(70%-90%)出现在早期(I/II期),导致分布不平衡,预测准确性较差。另一个为接受非蒽环类药物治疗的患者开发的模型是NK/ t细胞淋巴瘤的预后指数(PINK-E)(阴性评分参数:年龄60岁,III/IV期疾病,远处淋巴结累及,非鼻亚型和可检测的EBV DNA)[4]。使用PINK-E,该患者将被归类为低风险。使用PINK-E模型,低危组和高危组之间存在差异,但低危组和中危组的总生存期和无进展生存期无显著差异(p = 0.068和p = 0.079)[4]。如前所述,患者开始使用mSMILE方法进行前期治疗,包括地塞米松、甲氨蝶呤、异环磷酰胺、l -天冬酰胺酶和依托泊苷进行两个周期的修饰,随后进行调强放疗(IMRT)[5]。鉴于疾病的侵袭性和延迟的表现,第1周期紧急给予治疗,并使用支持性药物,包括肉碱和熊二醇。他耐受两个周期的mSMILE,没有任何剂量限制性毒性,诱导后达到最终IMRT的30分。放疗后3个月,治疗后的PET扫描显示左鼻腔原发部分缓解,多维尔评分为4分;重新检查显示残留病变。EBV水平重新检测显示,从700拷贝/mL到200拷贝/mL有所改善,但在外周血中仍可检测到。患者讨论了造血细胞移植或进一步化疗,但拒绝了这些方法,决定再观察3个月。放疗后6个月发现双侧颈部淋巴结受累。血清EBV仍可检测到,使用肿瘤信息Signatera检测的循环肿瘤DNA (ctdNA)也呈阳性(图1)。在讨论治疗方案后,患者选择继续使用标准剂量240mg静脉注射纳沃单抗,计划每2周注射一次。在第1周期,他在输注后半段经历了严重的背部疼痛和潮红,这与药物引起的反应一致。 这是一种支持治疗,他再次接受第2周期的治疗,使用地塞米松和苯海拉明预用药,但在标准剂量下,他在注射后半期再次出现输液反应,出现严重的背部疼痛和低血压。考虑到这些反应,他决定试验低剂量的纳武单抗,每2周给药40毫克。这种方法是从香港bbb报道的3例患者中推断出来的。患者对这种低剂量方法耐受良好,临床、放射学和ctDNA均得到缓解(图1)。治疗1年后,患者持续缓解,目前为放疗后18个月。该病例与先前报道的3例病例相比,显示了低剂量纳武单抗治疗结外NK/ t细胞淋巴瘤的疗效,随访时间比先前报道的病例报告更长。低剂量nivolumab在同种异体移植后急性淋巴细胞白血病复发、难治性经典霍奇金淋巴瘤和晚期头颈部鳞状细胞癌中均有疗效[6-9]。虽然在目前的病例中,低剂量治疗是出于必要而使用的,但越来越多的证据表明,免疫治疗的剂量-反应相关性与化疗截然不同,免疫治疗可以以比目前使用的剂量低得多的剂量施用,而不会影响疗效bb0。NK/ t细胞淋巴瘤是一种高死亡率的侵袭性疾病,尽管病例数量有限,但合并低剂量免疫治疗似乎很有希望。与标准剂量免疫疗法相比,需要进一步的研究来验证这种方法。稿件经过了所有作者的阅读和认可,符合作者身份要求,每位作者都认为稿件代表了诚实的工作。作者声明无利益冲突。作者未获得本工作的特定资助,作者已确认本提交不需要伦理批准声明。作者已确认本次提交不需要患者同意声明。作者已确认该提交不需要临床试验注册。
{"title":"Low-dose nivolumab for extranodal natural killer/T-cell lymphoma, nasal type","authors":"Satish Maharaj,&nbsp;Simone Chang","doi":"10.1002/jha2.1059","DOIUrl":"10.1002/jha2.1059","url":null,"abstract":"&lt;p&gt;Natural killer (NK)/T-cell lymphoma is a rare subtype of non-Hodgkin lymphoma that is associated with poor outcomes. Efforts to improve treatment are urgently needed and immune checkpoint inhibitor therapies have shown promise in a series of relapsed/refractory diseases. A 59-year-old Hispanic male presented with near-total obstruction of his left nasal airway. Computed tomography imaging showed left greater than right sinusitis with near-total airway obstruction on the left side. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scan showed a hypermetabolic primary mass in the left nasal cavity measuring 3.5 cm in length by 1.7 cm in width, SUV max 10.99. Nasal endoscopy showed a highly vascular exophytic tumor filling the nasal airway and sinuses; debulking and surgical biopsy were performed.&lt;/p&gt;&lt;p&gt;Pathology from this showed extranodal NK/T-cell lymphoma, nasal-type (ENKTL). Tumor cells were positive for LCA, CD2, CD3 and CD56 immunostains; negative for CD5, CD4, CD8, CD10, CD20, MUM1, CD21, BCL2, BCL6, CD79A, Cyclin D1, CD30, ALK1, Pan-keratin, HV8, CD57, and c-Myc immunostains. Karyotyping was normal, 46, XY[20], and bone marrow biopsy showed normocellular bone marrow without involvement and active maturing trilinear hematopoiesis. Flow cytometry analysis of the nasal mass demonstrated relatively increased natural killer cells, 66% of lymphocytes CD3-/CD56+ with normal expression of CD16 and no immunophenotypic aberrancies without diminished or loss of CD2, CD7, and/or CD57, or abnormal uniform expression of CD8. Epstein-Barr virus (EBV) was positive by RNA in situ hybridization (EBER Positive). Peripheral blood also was positive with EBV DNA Quantitative polymerase chain reaction level 705 copies/mL.&lt;/p&gt;&lt;p&gt;Using these evaluations, the patient was determined to have Stage II disease using the Chinese Southwest Oncology Group and Asia Lymphoma Study Group (CA) staging system (CASS) established in 2020 [&lt;span&gt;1&lt;/span&gt;]. CASS Stage II is defined as a primary tumor localized to the nasal cavity or nasopharynx involving local structures, without regional lymph node involvement. Research has shown that the Ann Arbor staging system (AASS), established for Hodgkin Lymphoma, has limited predictive ability and poor prognostication for ENKTL with CASS better in discriminating survival than AASS [&lt;span&gt;2, 3&lt;/span&gt;]. Unlike most other lymphomas, ENKTL is primarily extranodal, and therefore using the AASS, the majority of ENKTL (70%–90%) appears early (stage I/II) leading to unbalanced distribution and poor predictive accuracy.&lt;/p&gt;&lt;p&gt;Another model developed for patients treated with non-anthracycline-containing regimens is the prognostic index for NK/T-cell lymphomas (PINK-E) (negative scoring parameters: age  &gt;60 years, stage III/IV disease, distant lymph node involvement, non-nasal subtype, and detectable presentation EBV DNA) [&lt;span&gt;4&lt;/span&gt;]. Using PINK-E, this patient would be classified as low-risk. Using the PINK-E model,","PeriodicalId":72883,"journal":{"name":"EJHaem","volume":"5 6","pages":"1363-1365"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11647695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848601","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
Enteropathy-associated T-cell lymphoma: A population-based cohort study on incidence, treatment, and outcome in the Netherlands 肠病相关t细胞淋巴瘤:荷兰发病率、治疗和结果的一项基于人群的队列研究
Pub Date : 2024-11-29 DOI: 10.1002/jha2.1049
Frederik O. Meeuwes, Mirian Brink, Wouter J. Plattel, Joost S. P. Vermaat, Marie José Kersten, Mariëlle Wondergem, Otto Visser, Marjolein W. M. van der Poel, Rimke Oostvogels, F. J. Sherida H. Woei-A-Jin, Lara Böhmer, Tjeerd J. F. Snijders, Gerwin A. Huls, Marcel Nijland

Introduction

Enteropathy-associated T-cell lymphoma (EATL) is a peripheral T-cell lymphoma (PTCL) with a poor prognosis. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with or without etoposide consolidated by autologous stem cell transplantation (ASCT) are recommended for fit PTCL patients. The role of etoposide and ASCT in EATL is unclear.

Methods

This study reports the incidence, treatment, and outcome of EATL patients using the Netherlands Cancer Registry, with nationwide coverage of >95%.

Results

All patients diagnosed in 1989–2021 (n = 351, 77% treated) were identified (median age 67 years, 56% male, 50% limited stage). Time period analysis assessed trends in primary therapy and overall survival (OS). Treatment included chemotherapy (CT) (34%), surgery (18%), surgery and CT (19%) or CT followed by ASCT (7%). The 5-year OS for treated patients with limited versus advanced stage was 19% and 9% respectively. The 2-year OS improved over time (21%–33%, p = 0.06). Surgery only (hazard ratio [HR] 2.16; 95% confidence interval [CI] 1.55–3.01, p < 0.01) and advanced-stage disease (HR 1.67; 95% CI 1.25–2.23, p = 0.01) were predictors of poor prognosis. ASCT (HR 0.31; 95% CI 0.18–0.56) was associated with improved OS.

Conclusion

There was no statistical difference in OS between patients treated with or without etoposide. Current first-line treatment is ineffective.

肠病相关t细胞淋巴瘤(Enteropathy-associated T-cell lymphoma, EATL)是一种预后较差的外周t细胞淋巴瘤(PTCL)。环磷酰胺、阿霉素、长春新碱和强的松(CHOP)联合或不联合依托泊苷合并自体干细胞移植(ASCT)适合PTCL患者。依托泊苷和ASCT在EATL中的作用尚不清楚。方法:本研究使用荷兰癌症登记处报告了EATL患者的发病率、治疗和结局,全国覆盖率为95%。结果:1989-2021年确诊的所有患者(n = 351, 77%接受治疗)均被确定(中位年龄67岁,56%为男性,50%为限期)。时间段分析评估了初始治疗和总生存期(OS)的趋势。治疗包括化疗(CT)(34%)、手术(18%)、手术+ CT(19%)或CT + ASCT(7%)。有限期和晚期患者的5年OS分别为19%和9%。2年OS随着时间的推移而改善(21%-33%,p = 0.06)。仅手术(风险比[HR] 2.16;95%可信区间[CI] 1.55 ~ 3.01, p 0.01)和晚期疾病(HR 1.67;95% CI 1.25 ~ 2.23, p = 0.01)为不良预后的预测因子。Asct (hr 0.31;95% CI 0.18-0.56)与OS改善相关。结论:使用依托泊苷治疗与不使用依托泊苷治疗的OS无统计学差异。目前的一线治疗是无效的。
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引用次数: 0
IFN-α treatment may enable discontinuation of TKIs in NK cell-licensed patients with CML-CP IFN-α治疗可使NK细胞许可的CML-CP患者停用TKIs。
Pub Date : 2024-11-26 DOI: 10.1002/jha2.1053
Hiroshi Ureshino, Kazuharu Kamachi, Keisuke Kidoguchi, Shinya Kimura

The magnitude of the natural killer (NK) cell response contributes to the achievement of treatment-free remission (TFR) in patients with chronic myeloid leukemia (CML) and is regulated by the interaction between killer immunoglobulin-like receptors (KIRs) on NK cells and human leukocyte antigen (HLA) class I molecules on target cells. The abundant combination between KIR and HLA through genetic polymorphisms determines the functional diversity of NK cells. We previously reported that KIR3DL1-HLA-Bw status is associated with achievement of TFR by reflecting NK cell potential. Patients with strong interaction between KIR3DL1/HLA-Bw were identified as having a higher molecular relapse risk, based on the “missing self” hypothesis which suggests that the lack of cognate ligands for KIRs may induce target cell lysis. However, all the patients with strong interaction between KIR3DL1/HLA-Bw who received prior IFN-α therapy achieved TFR (p = 0.007), explained by the “NK cell licensing” concept, whereby NK cells become more functional through the recognition “self” HLA class I molecules by KIRs. NK cell licensing may contribute to the potential efficacy of IFN-α treatment in patients with CML. We defined high-risk molecular relapse patients and suggest that KIR3DL1/HLA-Bw status may help detect patients who could benefit from IFN-α for maintaining TFR.

自然杀伤(NK)细胞反应的强度有助于慢性髓性白血病(CML)患者实现无治疗缓解(TFR),并受NK细胞上的杀伤免疫球蛋白样受体(KIRs)和靶细胞上的人白细胞抗原(HLA) I类分子之间的相互作用调节。KIR与HLA通过遗传多态性的丰富结合决定了NK细胞功能的多样性。我们之前报道过KIR3DL1-HLA-Bw状态通过反映NK细胞电位与TFR的实现相关。KIR3DL1/HLA-Bw之间相互作用强的患者被认为具有更高的分子复发风险,基于“缺失自我”假说,该假说表明缺乏KIRs的同源配体可能导致靶细胞裂解。然而,所有接受过IFN-α治疗的KIR3DL1/HLA- bw之间强相互作用的患者均实现了TFR (p = 0.007),这可以用“NK细胞许可”概念来解释,即NK细胞通过KIRs识别“自身”HLA I类分子而变得更有功能。NK细胞许可可能有助于IFN-α治疗CML患者的潜在疗效。我们定义了高危分子复发患者,并建议KIR3DL1/HLA-Bw状态可能有助于检测可能受益于IFN-α维持TFR的患者。
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引用次数: 0
Incidence and risk factors of graft failure in allogeneic hematopoietic stem cell transplantation for mucopolysaccharidosis in a nationwide pediatric cohort. A study on behalf of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy 在一项全国儿童队列中,治疗粘多糖病的异基因造血干细胞移植移植失败的发生率和危险因素。代表法语国家骨髓移植和细胞治疗协会进行的一项研究。
Pub Date : 2024-11-26 DOI: 10.1002/jha2.1056
Laura Danhardt, Arnaud Wiedemann, Gerard Michel, Jean-Hugues Dalle, Fanny Rialland, Cécile Renard, Charlotte Jubert, Johan Maertens, Anne Sirvent, Nimrod Buchbinder, Christine Devalck, Bénédicte Brichard, Catherine Paillard, Stephanie Nguyen, Angelo Paci, David Combarel, Martin Castelle, Simona Pagliuca, Cecile Pochon

Context

Mucopolysaccharidosis (MPS) requires urgent treatment to prevent neurological damage. While gene therapy holds promise for effectively treating these diseases with minimal toxicity, access remains limited for most patients. Consequently, advancing allogeneic hematopoietic stem cell transplantation (HSCT) for young children is crucial. Since the 2010s, cord blood (CB) transplants with reduced-toxicity conditioning (RTC) have become the standard of care.

Patients and methods

Recent reports in France indicate a significant incidence of graft failures (GF), prompting a large-scale retrospective study from the French-speaking bone marrow transplantation society's registry, to understand GF risks, guide clinicians in selecting transplant platforms, and describe outcomes of second HSCT in young patients.

Results

This report analyses 93 children who underwent HSCT for MPS between 2000 and 2020. The GF rate was notably high (22.6% at day 100), primarily associated with the donor's HLA compatibility and the recipient's age. Well-matched CB and RTC were not found to be risk factors for GF. This study also details the procedures for second and third transplants in patients who rejected their first HSCT.

Conclusion

In the era of RTC, CB remains a viable and expedient option for MPS transplantation.

背景:粘多糖病(MPS)需要紧急治疗以防止神经损伤。虽然基因疗法有望以最小的毒性有效治疗这些疾病,但对大多数患者来说,获得这些疾病的途径仍然有限。因此,推进幼儿同种异体造血干细胞移植(HSCT)至关重要。自2010年代以来,带有低毒性调节(RTC)的脐带血(CB)移植已成为护理标准。患者和方法:法国最近的报道表明移植失败(GF)的发生率很高,促使法语骨髓移植协会登记处进行了大规模的回顾性研究,以了解GF风险,指导临床医生选择移植平台,并描述年轻患者第二次HSCT的结果。结果:本报告分析了2000年至2020年期间93名因MPS接受HSCT治疗的儿童。GF率显著高(第100天22.6%),主要与供者的HLA相容性和受体的年龄有关。匹配良好的CB和RTC未被发现是GF的危险因素。本研究还详细介绍了拒绝第一次移植的患者进行第二次和第三次移植的程序。结论:在RTC时代,CB仍然是MPS移植的一种可行和方便的选择。
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引用次数: 0
Real-world practitioner perceptions of CARTITUDE-4 results for patients with previously treated multiple myeloma 从业人员对曾接受过治疗的多发性骨髓瘤患者的 CARTITUDE-4 结果的真实看法。
Pub Date : 2024-11-25 DOI: 10.1002/jha2.1047
Alexandrina Balanean, Samuel Baird, Brooke Dulka, Luke Jennings-Zhang, Robert N. Bone, Yolaine Jeune-Smith, Bruce Feinberg, Muhamed Baljevic

Introduction

Initially approved for the fifth-line or later therapeutic setting, the chimeric antigen receptor (CAR) T-cell regimen ciltacabtagene autoleucel (cilta-cel) was recently approved for second-line (2L) treatment in relapsed/refractory multiple myeloma (RRMM). Oncology practitioners use clinical trials to inform treatment, but real-world impressions and impact on practice are lacking. We aimed to determine whether presenting CARTITUDE-4 clinical trial data would impact real-world preferences/perceptions around CAR T-cell therapy.

Methods

Recruiting from the Cardinal Health Oncology Provider Extended Network (OPEN), we surveyed hematologists/oncologists to investigate fourth-line (4L) preferences in a hypothetical patient with triple-class–refractory MM. We posed the same questions and answers before and after the trial presentation and compared pre-/post-preferences toward cilta-cel and sequencing relative to bispecific antibodies (BsAbs). Using the same methodology as described above, we also performed a secondary analysis comparing pre-/post-perceptions on the use of CAR T-cell therapy in earlier lines for patients with triple-class–refractory MM.

Results

Among 50 respondents, decision-making factors before the trial presentation included CAR T-cell center availability (58%), comorbidities (52%), and center locations (34%). Additionally, 48% of 46 respondents chose 4L cilta-cel. Among 47, 40% wanted more real-world/long-term CAR T-cell therapy outcomes in any line, 38% wanted more 2L data, and 34% favored 2L/third-line (3L) use. After the presentation, the preference for cilta-cel doubled from 48% to 88% (< 0.001) among 50 respondents and rose from 34% to 55% (= 0.001) for earlier-line CAR T-cell therapy among 49. Moreover, 55% of 49 respondents preferred CAR T-cell therapy prior to BsAbs.

Discussion

We have shown that making oncology practitioners aware of trials precipitated decision-making factors and led to notable, significant shifts in future intended practice patterns. Being aware of trial data enables practitioners to make more informed decisions, tailor therapies to individual patients, and ultimately improve outcomes.

嵌合抗原受体(CAR) t细胞方案ciltacabtagene autoeucel (cilta-cel)最初被批准用于第五线或更晚的治疗环境,最近被批准用于复发/难治性多发性骨髓瘤(RRMM)的二线(2L)治疗。肿瘤学从业者使用临床试验来告知治疗,但缺乏现实世界的印象和对实践的影响。我们的目的是确定提交CARTITUDE-4临床试验数据是否会影响现实世界对CAR - t细胞治疗的偏好/看法。方法:从红衣主教健康肿瘤提供者扩展网络(OPEN)招募,我们调查了血液学家/肿瘤学家,调查了一名假设的三级难治性MM患者的第四线(4L)偏好。我们在试验报告前后提出了相同的问题和答案,并比较了相对于双特异性抗体(BsAbs), cilta- cell和测序的前后偏好。使用与上述相同的方法,我们还进行了二次分析,比较了在早期治疗中对三级难治性mm患者使用CAR - t细胞治疗的前后看法。结果:在50名受访者中,试验提出前的决策因素包括CAR - t细胞中心可用性(58%)、合并症(52%)和中心位置(34%)。此外,46名受访者中有48%选择了4L cilta-cel。在47名患者中,40%希望在任何一线获得更多真实世界/长期CAR -t细胞治疗结果,38%希望获得更多2L数据,34%支持使用2L/三线(3L)。在报告之后,49名早期CAR - t细胞治疗中,cilta- cell的偏好从48%增加到88% (p p = 0.001)。此外,49名受访者中55%的人更倾向于在bsab之前进行CAR - t细胞治疗。讨论:我们已经表明,让肿瘤学从业者意识到试验可以促成决策因素,并导致未来预期的实践模式发生显著的重大变化。了解试验数据使从业者能够做出更明智的决定,为个体患者量身定制治疗方法,并最终改善结果。
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引用次数: 0
Successful treatment of low-risk myelodysplastic syndrome-related anemia in patients with chronic kidney disease with daprodustat: A report of two cases 使用达泊司他(daprodustat)成功治疗慢性肾病患者的低风险骨髓增生异常综合征相关贫血:两个病例的报告。
Pub Date : 2024-11-25 DOI: 10.1002/jha2.1057
Hiroyoshi Kunimoto, Takayuki Sakuma, Takuma Ohashi, Mayoko Shirafuta, Hiroshi Teranaka, Hideaki Nakajima

Anemia is a major clinical manifestation seen in myelodysplastic syndromes (MDS). Treatment options for anemia in low-risk MDS are limited. Especially, oral medication which is uniformly effective for anemia in low-risk MDS is required. Hypoxia-inducible factor (HIF) prolyl hydroxylase (HIF-PH) inhibitors, such as daprodustat, are oral tablets effective for renal anemia. Pharmacological restoration of HIF activity by HIF-PH inhibitors may be beneficial for MDS-related anemia as well. Yet, their efficacy and safety against low-risk MDS are unclear. Here, we report two cases of low-risk MDS complicated with chronic kidney disease whose anemia responded to daprodustat treatment.

贫血是骨髓增生异常综合征(MDS)的主要临床表现。低风险MDS患者贫血的治疗选择有限。特别是需要口服药物,这种药物对低风险MDS患者的贫血一致有效。低氧诱导因子(HIF)脯氨酰羟化酶(HIF- ph)抑制剂,如达普达司他,是治疗肾性贫血有效的口服片剂。HIF- ph抑制剂对HIF活性的药理学恢复可能对mds相关性贫血也有益。然而,它们对低风险MDS的疗效和安全性尚不清楚。在这里,我们报告了两例低风险MDS合并慢性肾脏疾病,其贫血对达生产司他治疗有反应。
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引用次数: 0
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EJHaem
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