72 results on '"Raya JM"'
Search Results
2. Predictors of thrombosis and bleeding in 1613 myelofibrosis patients from the Spanish Registry of Myelofibrosis
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Hernandez-Boluda, JC, Pastor-Galan, I, Arellano-Rodrigo, E, Raya, JM, Perez-Encinas, M, Ayala, R, Ferrer-Marin, F, Velez, P, Mora, E, Fox, ML, Hernandez-Rivas, JM, Xicoy, B, Mata-Vazquez, MI, Garcia-Fortes, M, Perez-Lopez, R, Angona, A, Cuevas, B, Senin, A, Ramirez, MJ, Ramirez-Payer, A, Gomez-Casares, MT, Martinez-Valverde, C, Magro, E, Steegmann, JL, Duran, MA, Garcia-Hernandez, C, Gasior, M, de Villambrosia, SG, Alvarez-Larran, A, and Pereira, A
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treatment ,Primary Myelofibrosis ,Risk Factors ,Humans ,Thrombosis ,Hemorrhage ,myelofibrosis ,Hematology ,Registries ,bleeding ,thrombosis ,Thrombocythemia, Essential - Abstract
Available data have proved insufficient to develop consensus recommendations on the prevention of thrombosis and bleeding in myelofibrosis (MF). We evaluated the incidence and risk factors of vascular complications in 1613 patients from the Spanish Myelofibrosis Registry. Over a total of 6981 patient-years at risk, 6.4% of the study population had at least one thrombotic event after MF diagnosis, amounting to an incidence rate of 1.65 per 100 patient-years. Prior history of thrombosis, the JAK2 mutation, and the intermediate-2/high-risk International Prognostic Scoring System (IPSS) categories conferred an increased thrombotic risk after adjustment for the risk-modifying effect of anti-thrombotic and cytoreductive treatments. History of thrombosis and the JAK2 mutation allowed us to pinpoint a group of patients at higher risk of early thrombosis. No decreased incidence of thrombosis was observed while patients were on anti-thrombotic or cytoreductive treatment. An increased risk of venous thrombosis was found during treatment with immunomodulatory agents. A total of 5.3% of patients had at least one episode of major bleeding, resulting in an incidence rate of 1.5 events per 100 patient-years. Patients in the intermediate-2/high-risk IPSS categories treated with anti-coagulants had an almost sevenfold increased risk of major bleeding. These findings should prove useful for guiding decision-making in clinical practice.
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- 2022
3. INDEPENDENT PROGNOSTIC VALUE OF A DIAGNOSTIC PLATELET COUNT ABOVE 300X109/L IN PATIENTS WITH NON-M3 ACUTE MYELOBLASTIC LEUKEMIA TREATED WITH CURATIVE INTENT
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Rodenas, I, Jerez, A, Ferrer, B, Tormo, M, Ortiz, A, Orna, E, Navarro-Ferrando, JT, Raya, JM, Martin-Santos, T, Ricard, MP, Bermejo, A, Morales, R, Prats, C, Navarrete, M, Roldan-Galiacho, V, Amigo, ML, Vicente, V, and Ortuno, FJ
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- 2021
4. Metabolic syndrome and coronary artery bypass graft surgery
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Brouard, M, Jimenez, JJ, Iribarren, JL, Perez, N, Lorente, L, Machado, P, Raya, JM, Perez, R, Borreguero, JM, Martinez, R, and Mora, ML
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- 2011
- Full Text
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5. Clinical characteristics, prognosis and treatment of myelofibrosis patients with severe thrombocytopenia
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Hernandez-Boluda, JC, Correa, JG, Alvarez-Larran, A, Ferrer-Marin, F, Raya, JM, Martinez-Lopez, J, Velez, P, Perez-Encinas, M, Estrada, N, Garcia-Gutierrez, V, Fox, ML, Luno, E, Kerguelen, A, Cuevas, B, Duran, MA, Ramirez, MJ, Gomez-Casares, M, Mata-Vazquez, MI, Regadera, A, Pereira, A, Cervantes, F, and Grupo Espanol de Enfermedades Mieloproliferativas Filadelfia Negativas (GEMFIN)
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Male ,medicine.medical_specialty ,Disease free survival ,myelofibrosis ,thrombocytopenia ,Gastroenterology ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Registries ,Myelofibrosis ,Survival rate ,Aged ,treatment ,business.industry ,Hematology ,Middle Aged ,bleeding ,medicine.disease ,Thrombocytopenia ,Severe thrombocytopenia ,Survival Rate ,Primary Myelofibrosis ,Spain ,030220 oncology & carcinogenesis ,Female ,prognosis ,business ,030215 immunology - Published
- 2018
6. The role of bone marrow biopsy and FDG-PET/CT in identifying bone marrow infiltration in the initial diagnosis of high grade non-Hodgkin B-cell lymphoma and Hodgkin lymphoma. Accuracy in a multicenter series of 372 patients
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Chen-Liang TH, Martin-Santos T, Jerez A, Senent L, Orero MT, Remigia MJ, Muiña B, Romera M, Fernandez-Muñoz H, Raya JM, Fernandez-Gonzalez M, Lancharro A, Villegas C, Carlos Herrera J, Frutos L, Luis Navarro J, Uña J, Igua C, Sanchez-Vaño R, Cozar Mdel P, Contreras J, Sanchez-Blanco JJ, Perez-Ceballos E, and Ortuño FJ
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INVOLVEMENT ,PROVIDES ,Adult ,Male ,Adolescent ,Biopsy ,Multimodal Imaging ,POSITRON-EMISSION-TOMOGRAPHY ,immune system diseases ,Bone Marrow ,Fluorodeoxyglucose F18 ,hemic and lymphatic diseases ,Humans ,CLINICAL-SIGNIFICANCE ,METAANALYSIS ,Aged ,Neoplasm Staging ,Lymphoma, Non-Hodgkin ,PERFORMANCE ,Middle Aged ,Hodgkin Disease ,Positron-Emission Tomography ,Female ,Neoplasm Grading ,Tomography, X-Ray Computed ,RESPONSE ASSESSMENT ,CT - Abstract
Bone marrow infiltration (BMI), categorized as an extra-nodal site, affects stage and is associated with poor prognosis in newly diagnosed lymphoma patients. We have evaluated the accuracy of PET/CT and bone marrow biopsy (BMB) to assess BMI in 372 lymphoma patients [140 Hodgkin Lymphoma (HL) and 232 High Grade B-cell non-Hodgkin Lymphoma (HG B-NHL), among them 155 Diffuse Large B-Cell Lymphoma (DLCL)]. For HL cases, and taking into account PET/CT, sensitivity, negative predictive value (NPV) and accuracy were 96.7, 99.3, and 99.3% while those of BMB were 32.3, 83.8, and 85%, respectively. For HG B-NHL and considering PET/CT, sensitivity, NPV, and accuracy were 52.7, 81.7, and 84.1%, while those of BMB were 77.6, 90.2, and 90.7%, respectively. In the HG B-NHL group, 25 patients would have been under-staged without BMB. These results lead us to recommend PET/CT and the avoidance of BMB to assess BMI in HL. In the case of HG B-NHL, bone marrow status should be assessed firstly by means of PET/CT; only in either focal or diffuse PET/CT with low borderline SUV max values or in negative cases, should BMB be carried out afterwards. In the HG B-NHL setting and at the present moment, both techniques are complementary. Am. J. Hematol. 90:686-690, 2015. (c) 2015 Wiley Periodicals, Inc.
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- 2015
7. The International Prognostic Scoring System does not accurately discriminate different risk categories in patients with post-essential thrombocythemia and post-polycythemia vera myelofibrosis
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Hernández-Boluda JC, Pereira A, Gómez M, Boqué C, Ferrer-Marín F, Raya JM, García-Gutiérrez V, Kerguelen A, Xicoy B, Barba P, Martínez J, Luño E, Alvarez-Larrán A, Martínez-López J, Arbelo E, Besses C, and Grupo Español de Enfermedades Mieloproliferativas Filadelfia Negativas
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IPSS, post-ET myelofibrosis, post-PV myelofibrosis, prognostic factors, survival ,IPSS ,post-ET myelofibrosis ,post-PV myelofibrosis ,prognostic factors ,survival - Published
- 2014
8. Prognostic value of trisomy 8 as a single anomaly and the influence of additional cytogenetic aberrations in primary myelodysplastic syndromes
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Saumell S, Florensa L, Luño E, Sanzo C, Cañizo C, Hernández JM, Cervera J, Gallart MA, Carbonell F, Collado R, Arenillas L, Pedro C, Bargay J, Nomdedeu B, Xicoy B, Vallespí T, Raya JM, Belloch L, Sanz GF, and Solé F
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hemic and lymphatic diseases - Abstract
Trisomy 8 is the most common chromosomal gain in myelodysplastic syndromes (MDS), however, little is known about the features of MDS with isolated trisomy 8 and the influence of additional cytogenetic aberrations. We determined the characteristics and prognostic factors of 72 patients with trisomy 8 as a single anomaly and analysed also the impact of other aberrations added to trisomy 8 in another 62 patients. According to our study, MDS with isolated trisomy 8 was more frequent in men, with more than one cytopenia in most patients (62%) and having about 4% bone marrow blasts. The multivariate analysis demonstrated that platelet count and percentage bone marrow blasts had the strongest impact on overall survival (OS). The median OS for isolated trisomy 8, trisomy 8 plus one aberration (tr8 + 1), plus two (tr8 + 2) and plus three or more aberrations (tr8 + =3) was 34·3, 40, 23·4 and 5·8 months, respectively (P
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- 2012
9. Impact of Individual Comorbidities on Survival of Patients with Myelofibrosis
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García-Fortes, María, Hernández-Boluda, Juan Carlos, Alvarez-Larrán, Alberto, Raya, José M., Angona Figueras, Anna, Estrada, Natalia, Fox, Laura, Cuevas, Beatriz, García-Hernández, María C., Gómez-Casares, Maria-Teresa, Ferrer-Marín, Francisca, Saavedra, Silvana, Cervantes, Francisco, García-Delgado, Regina, Grupo Español de Enfermedades Mieloproliferativas Filadelfia Negativas Gemfin, Institut Català de la Salut, [García-Fortes M] Hematology Department, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain. Facultad de Medicina, Universidad de Málaga, 29010 Málaga, Spain. [Hernández-Boluda JC] Hematology Department, Hospital Clínico, INCLIVA, 46010 Valencia, Spain. [Álvarez-Larrán A] Hematology Department, Hospital Clínic, 08036 Barcelona, Spain. [Raya JM] Hematology Department, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain. [Angona A] Hematology Department, Hospital del Mar, 08003 Barcelona, Spain. [Estrada N] Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, 08916 Badalona, Spain. [Fox L] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Cancer Research ,Survival ,Myelofibrosis ,myelofibrosis ,Mielofibrosi - Prognosi ,Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Survival Analysis [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,comorbidities ,Prognosis ,survival ,Comorbidities ,técnicas de investigación::métodos epidemiológicos::estadística como asunto::análisis de supervivencia [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Comorbiditat ,epidemiología y bioestadística::epidemiología::proceso salud-enfermedad::comorbilidad [SALUD PÚBLICA] ,Oncology ,Anàlisi de supervivència (Biometria) ,Hemic and Lymphatic Diseases::Hematologic Diseases::Bone Marrow Diseases::Myeloproliferative Disorders::Primary Myelofibrosis [DISEASES] ,enfermedades hematológicas y linfáticas::enfermedades hematológicas::enfermedades de la médula ósea::trastornos mieloproliferativos::mielofibrosis primaria [ENFERMEDADES] ,prognosis ,Epidemiology and Biostatistics::Epidemiology::Health-Disease Process::Comorbidity [PUBLIC HEALTH] - Abstract
Conflicts of Interest: M.G.-F. provided consultancy services to Pfizer, Novartis, Jazz Pharmaceuticals and Astellas. R.G.-D. provided consultancy services to Abbie, Novartis, Bristol-Myers Squibb, and Janssen, and received research funding from Bristol-Myers Squibb. F.F.-M. received a grant from Incyte Corporation (FFIS-CNT-2020-8) and from CTI Biophama Corp (CFE/BI/72-19; FFIS-CNT-2019-4). The remaining authors declare no competing financial interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Funding: This research was supported by an unrestricted grant from Novartis Pharmaceutical. The opinions expressed in this article are those of the authors and do not necessarily reflect those of Novartis. Acknowledgments: The authors thank all of the patients and their families who contributed to this study and the participating site study data coordinators. This article was produced through the collaborative efforts of the Spanish Group of Ph-negative Myeloproliferative Neoplasms (GEMFIN). The study was sponsored by Novartis Pharmaceuticals, Inc. The comorbidity burden is an important risk factor for overall survival (OS) in several hematological malignancies. This observational prospective study was conducted to evaluate the impact of individual comorbidities on survival in a multicenter series of 668 patients with primary myelofibrosis (PMF) or MF secondary to polycythemia vera (PPV-MF) or essential thrombocythemia (PET-MF). Hypertension (hazard ratio (HR) = 4.96, p < 0.001), smoking (HR = 5.08, p < 0.001), dyslipidemia (HR = 4.65, p < 0.001) and hepatitis C virus (HCV) (HR = 4.26, p = 0.015) were most adversely associated with OS. Diabetes (HR = 3.01, p < 0.001), pulmonary disease (HR = 3.13, p < 0.001) and renal dysfunction (HR = 1.82, p = 0.037) were also associated with an increased risk of death. Multivariate analysis showed that pulmonary disease (HR = 2.69, p = 0.001), smoking (HR = 3.34, p < 0.001), renal dysfunction (HR = 2.08, p = 0.043) and HCV (HR = 11.49, p = 0.001) had a negative impact on OS. When ruxolitinib exposure was included in the model, the effect of each comorbidity on survival was modified. Therefore, individual comorbidities should be taken into account in determining the survival prognosis for patients with MF.
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- 2022
10. The International Prognostic Scoring System does not accurately discriminate different risk categories in patients with post-essential thrombocythemia and post-polycythemia vera myelofibrosis
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Francisca Ferrer-Marín, Valentín García-Gutiérrez, Juan Carlos Hernández-Boluda, Ana Kerguelen, Elisa Luño, Elisa Arbelo, Concepción Boqué, Joaquin Martinez-Lopez, Blanca Xicoy, Carles Besses, Jesús Martínez, Pere Barba, Arturo Pereira, J. M. Raya, Montse Gómez, Alberto Alvarez-Larrán, Grupo Español de Enfermedades Mieloproliferativas Filadelfia Negativas (GEMFIN), [Hernández-Boluda,JC, and Gómez,M] Hematology and Medical Oncology Department, Hospital Clínico Universitario, Valencia, España. [Pereira,A] Hemotherapy and Hemostasis Department, Hospital Clínic, Barcelona, España. [Boqué,C] Hematology Department, Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona,España. [Ferrer-Marín,F] Hematology and Medical Oncology Department, Hospital Morales Meseguer, Murcia, España. [Raya,JM] Hematology Department, Hospital Universitario de Canarias, La Laguna, España. [García-Gutiérrez,V] Hematology Department, Hospital Ramón y Cajal, Madrid, España. [Kerguelen,A] Hematology Department, Hospital La Paz, Madrid, España. [Xicoy,B] Clinical Hematology Department, Institut Català d’Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research, Badalona, España. [Barba,P] Hematology Department, Hospital Vall d’Hebron, Barcelona, España. [Martínez,J] Hematology Department, Hospital La Fe, Valencia, España. [Luño,E] Hematology Department, Hospital Universitario Central de Asturias, Oviedo, España. [Alvarez-Larrán,A] Hematology Department, Hospital del Mar-IMIM, Barcelona España. [Arbelo,E] Hematology Department, Hospital 12 de Octubre, Madrid, España. [Besses,C] Hematology Department, Hospital Virgen de la Macarena, Sevilla, Spain.
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Oncology ,medicine.medical_specialty ,Survival ,Prognostic factors ,Mielofibrosis primaria ,Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Bone Marrow Diseases::Myeloproliferative Disorders::Primary Myelofibrosis [Medical Subject Headings] ,Risk category ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Polycythemia vera ,Internal medicine ,Post-ET myelofibrosis ,medicine ,Humans ,In patient ,Psychiatry and Psychology::Behavior and Behavior Mechanisms::Motivation::Drive [Medical Subject Headings] ,Myelofibrosis ,Online Only Articles ,Trombocitemia esencial ,Polycythemia Vera ,Prognostic models ,ComputingMilieux_THECOMPUTINGPROFESSION ,Essential thrombocythemia ,business.industry ,IPSS ,Post-PV myelofibrosis ,Policitemia vera ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Life Expectancy [Medical Subject Headings] ,Hematology ,Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation Disorders::Thrombocythemia, Essential [Medical Subject Headings] ,medicine.disease ,Prognosis ,Impulso ,TheoryofComputation_MATHEMATICALLOGICANDFORMALLANGUAGES ,International Prognostic Scoring System ,Primary Myelofibrosis ,Chemicals and Drugs::Enzymes and Coenzymes::Enzymes::Transferases::Phosphotransferases::Phosphotransferases (Alcohol Group Acceptor)::Protein Kinases::Protein-Tyrosine Kinases::Janus Kinases::Janus Kinase 2 [Medical Subject Headings] ,Janus quinasa 2 ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis [Medical Subject Headings] ,Complication ,business ,Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Bone Marrow Diseases::Myeloproliferative Disorders::Polycythemia Vera [Medical Subject Headings] ,Thrombocythemia, Essential - Abstract
Myelofibrotic transformation is a well-recognized complication of essential thrombocythemia (ET) and polycythemia vera (PV).[1][1],[2][2] However, information is scarce on the life expectancy and prognostic factors of patients developing this complication.[1][1],[3][3]–[5][4] Prognostic models
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- 2014
11. Safety and Effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dose-dependent, phase IV clinical trial
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Beatriz Martín, José Luis Iribarren, JJ Jimenez, Patricia Machado, R Perez, M Brouard, Juan M Borreguero, Leonardo Lorente, José María Raya, Alejandro Jiménez, Domingo Hernández, Rafael Martínez, María L. Mora, S Palmero, [Jimenez,JJ, Iribarren,JL, Brouard,M, Palmero,S, Lorente,L, Pérez,R, Mora,ML] Critical Care Department, Hospital Universitario de Canarias. [Hernández,D] Departamento de Nefrología, Hospital Universitario Carlos Haya, Málaga, España. [Jiménez,A] Mixed Research Unit, Hospital Universitario de Canarias. [Machado,P, Raya,JM] Hematology Laboratory, Hospital Universitario de Canarias. [Borreguero,JM, and Martín,B] Biochemical laboratory. Hospital Universitario de Canarias. [Martínez,R] Cardiac Surgery Department. Hospital Universitario de Canarias.
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Male ,Tranexamic acid ,medicine.medical_treatment ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Extracorporeal Circulation::Cardiopulmonary Bypass [Medical Subject Headings] ,Phenomena and Processes::Circulatory and Respiratory Physiological Phenomena::Blood Physiological Phenomena::Blood Physiological Processes::Hemostasis::Blood Coagulation::Fibrinolysis [Medical Subject Headings] ,Body Temperature ,law.invention ,Placebos ,Norepinephrine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Surgical Procedures, Elective [Medical Subject Headings] ,law ,Antifibrinolytic agent ,Creatine Kinase, MB Form ,Creatine Kinase ,Cardiopulmonary bypass ,Fibrinolysis ,Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Research Design::Double-Blind Method [Medical Subject Headings] ,General Medicine ,Middle Aged ,Cardiac surgery ,Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Coagulants::Hemostatics::Antifibrinolytic Agents [Medical Subject Headings] ,Antifibrinolytic Agents ,Treatment Outcome ,Chemicals and Drugs::Organic Chemicals::Carboxylic Acids::Acids, Carbocyclic::Cyclohexanecarboxylic Acids::Tranexamic Acid [Medical Subject Headings] ,Elective Surgical Procedures ,Anesthesia ,Female ,Inflammation Mediators ,Cardiology and Cardiovascular Medicine ,Research Article ,medicine.drug ,Pulmonary and Respiratory Medicine ,Antifibrinolytic ,medicine.drug_class ,lcsh:Surgery ,Placebo ,Lower risk ,Statistics, Nonparametric ,Fibrin Fibrinogen Degradation Products ,lcsh:RD78.3-87.3 ,Double-Blind Method ,medicine ,Humans ,Lactic Acid ,Dialysis ,Aged ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings] ,Analysis of Variance ,Interleukin-6 ,business.industry ,Bleeding ,Inflammatory response ,lcsh:RD1-811 ,Logistic Models ,lcsh:Anesthesiology ,Surgery ,business - Abstract
Background In cardiopulmonary bypass (CPB) patients, fibrinolysis may enhance postoperative inflammatory response. We aimed to determine whether an additional postoperative dose of antifibrinolytic tranexamic acid (TA) reduced CPB-mediated inflammatory response (IR). Methods We performed a randomized, double-blind, dose-dependent, parallel-groups study of elective CPB patients receiving TA. Patients were randomly assigned to either the single-dose group (40 mg/Kg TA before CPB and placebo after CPB) or the double-dose group (40 mg/Kg TA before and after CPB). Results 160 patients were included, 80 in each group. The incident rate of IR was significantly lower in the double-dose-group TA2 (7.5% vs. 18.8% in the single-dose group TA1; P = 0.030). After adjusting for hypertension, total protamine dose and temperature after CPB, TA2 showed a lower risk of IR compared with TA1 [OR: 0.29 (95% CI: 0.10-0.83), (P = 0.013)]. Relative risk for IR was 2.5 for TA1 (95% CI: 1.02 to 6.12). The double-dose group had significantly lower chest tube bleeding at 24 hours [671 (95% CI 549-793 vs. 826 (95% CI 704-949) mL; P = 0.01 corrected-P significant] and lower D-dimer levels at 24 hours [489 (95% CI 437-540) vs. 621(95% CI: 563-679) ng/mL; P = 0.01 corrected-P significant]. TA2 required lower levels of norepinephrine at 24 h [0.06 (95% CI: 0.03-0.09) vs. 0.20(95 CI: 0.05-0.35) after adjusting for dobutamine [F = 6.6; P = 0.014 corrected-P significant]. We found a significant direct relationship between IL-6 and temperature (rho = 0.26; P < 0.01), D-dimer (rho = 0.24; P < 0.01), norepinephrine (rho = 0.33; P < 0.01), troponin I (rho = 0.37; P < 0.01), Creatine-Kinase (rho = 0.37; P < 0.01), Creatine Kinase-MB (rho = 0.33; P < 0.01) and lactic acid (rho = 0.46; P < 0.01) at ICU arrival. Two patients (1.3%) had seizure, 3 patients (1.9%) had stroke, 14 (8.8%) had acute kidney failure, 7 (4.4%) needed dialysis, 3 (1.9%) suffered myocardial infarction and 9 (5.6%) patients died. We found no significant differences between groups regarding these events. Conclusions Prolonged inhibition of fibrinolysis, using an additional postoperative dose of tranexamic acid reduces inflammatory response and postoperative bleeding (but not transfusion requirements) in CPB patients. A question which remains unanswered is whether the dose used was ideal in terms of safety, but not in terms of effectiveness. Current Controlled Trials number ISRCTN: ISRCTN84413719
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- 2011
12. Impact of somatic gene mutations on the risk of thrombosis in myelofibrosis.
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Pastor-Galán I, Pereira A, Arellano-Rodrigo E, Martín I, Mosquera-Orgueira A, Gómez-Casares MT, Hernández-Sánchez A, Ferrer-Marín F, Mora E, Velez P, Ayala R, Angona A, de Las Heras N, Magro E, Mata-Vázquez MI, Fox ML, González de Villambrosía S, Ramírez MJ, García A, García-Gutiérrez V, Cáceres A, Durán MA, Senín MA, Raya JM, González JA, Cuevas B, Xicoy B, Garrote M, Ferrer B, Pérez-Encinas M, Hernández-Rivas JM, Bellosillo B, Álvarez-Larrán A, and Hernández-Boluda JC
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- 2024
- Full Text
- View/download PDF
13. Sickle Cell Anemia Screening in Newborns and Analysis of Haplotypes in Patients from Santiago Island, Cape Verde.
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Freire A, Charola-Ramos L, González-Guerra E, Gonçalves J, Rocha V, Afreixo V, Martínez-Carretero E, and Raya JM
- Abstract
Sickle cell anemia (SCA) results from a mutation in the β -globin gene, leading to the production of mutant hemoglobin, known as hemoglobin S (HbS). Despite being a genetic disorder, the phenotype of SCA can be influenced by the level of fetal hemoglobin (HbF), which is associated with beta S-globin haplotypes. In this study, we conducted newborn screening (NBS) using samples collected from umbilical cord blood in two hospitals on Santiago Island, Cape Verde. In newborns, HbS was detected using high-performance liquid chromatography (HPLC) on dried blood spot, with confirmation through polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). In addition, we assessed the hematological and clinical characteristics of a second population group consisting of patients diagnosed with SCA. Haplotype determination was performed on both newborns with HbS and patients with SCA. Beta S-globin haplotypes were determined using PCR-RFLP. Hematological values were analyzed using standard methods. Out of 346 newborns, 21 (6%) were carriers of the sickle cell trait (HbAS) while none were identified as homozygous for sickle cell disease (HbSS). Among both groups of individuals, four haplotypes were identified: Senegal, Arabi-Indian, Bantu, and Benin. The Senegal haplotype was the most prevalent, possibly reflecting the ethnic origin of the mutations observed. Hematological values did not differ significantly among haplotypes. However, higher levels of HbF were associated with better hematological values. These findings suggest a positive impact of elevated HbF levels on reducing the severity of SCA. Finally, we demonstrated how the combination of technics, HPLC and molecular analysis, provided a consistent and reproducible results that can be used for NBS for SCA., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2024 Ariana Freire et al.)
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- 2024
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14. The prognostic impact of non-driver gene mutations and variant allele frequency in primary myelofibrosis.
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Hernández-Sánchez A, Villaverde-Ramiro Á, Arellano-Rodrigo E, Garrote M, Martín I, Mosquera-Orgueira A, Gómez-Casares MT, Ferrer-Marín F, Such E, Velez P, Ayala R, Angona A, de Las Heras N, Magro E, Mata-Vázquez MI, Fox ML, de Villambrosía SG, Ramírez MJ, García A, García-Gutiérrez V, Cáceres A, Durán MA, Senín A, Raya JM, González JA, Cuevas B, Xicoy B, Pérez-Encinas M, Bellosillo B, Álvarez-Larrán A, Hernández-Rivas JM, and Hernández-Boluda JC
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- Humans, Prognosis, Mutation, Janus Kinase 2 genetics, Gene Frequency, Primary Myelofibrosis diagnosis, Primary Myelofibrosis genetics
- Abstract
Prognostic impact of non-MPN driver gene mutations in primary myelofibrosis. MIPSS70: Mutation-Enhanced International Prognostic Score System., (© 2024 Wiley Periodicals LLC.)
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- 2024
- Full Text
- View/download PDF
15. Integrating AIPSS-MF and molecular predictors: A comparative analysis of prognostic models for myelofibrosis.
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Mosquera-Orgueira A, Arellano-Rodrigo E, Garrote M, Martín I, Pérez-Encinas M, Gómez-Casares MT, Hernández-Sánchez A, Ferrer-Marín F, Mora E, Velez P, Ayala R, Angona A, Heras NL, Magro E, Pérez-Míguez C, Crucitti D, Mata-Vázquez MI, Fox ML, González de Villambrosía S, Ramírez MJ, García A, García-Gutiérrez V, Cáceres A, Durán MA, Senín MA, Raya JM, González JA, Cuevas B, Xicoy B, Nangalia J, Hernández-Rivas JM, Bellosillo B, Álvarez-Larrán A, and Hernández-Boluda JC
- Abstract
Competing Interests: The authors declare no conflict of interest.
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- 2024
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16. Diffusion tensor imaging of the physis: the ABC's.
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Santos LA, Sullivan B, Kvist O, Jambawalikar S, Mostoufi-Moab S, Raya JM, Nguyen J, Marin D, Delgado J, Tokaria R, Nelson RR Jr, Kammen B, and Jaramillo D
- Subjects
- Child, Adolescent, Humans, Bone and Bones, Anisotropy, Water, Diffusion Tensor Imaging methods, Growth Plate diagnostic imaging
- Abstract
The physis, or growth plate, is the primary structure responsible for longitudinal growth of the long bones. Diffusion tensor imaging (DTI) is a technique that depicts the anisotropic motion of water molecules, or diffusion. When diffusion is limited by cellular membranes, information on tissue microstructure can be acquired. Tractography, the visual display of the direction and magnitude of water diffusion, provides qualitative visualization of complex cellular architecture as well as quantitative diffusion metrics that appear to indirectly reflect physeal activity. In the growing bones, DTI depicts the columns of cartilage and new bone in the physeal-metaphyseal complex. In this "How I do It", we will highlight the value of DTI as a clinical tool by presenting DTI tractography of the physeal-metaphyseal complex of children and adolescents during normal growth, illustrating variation in qualitative and quantitative tractography metrics with age and skeletal location. In addition, we will present tractography from patients with physeal dysfunction caused by growth hormone deficiency and physeal injury due to trauma, chemotherapy, and radiation therapy. Furthermore, we will delineate our process, or "DTI pipeline," from image acquisition to data interpretation., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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17. CNL and aCML should be considered as a single entity based on molecular profiles and outcomes.
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Carreño-Tarragona G, Álvarez-Larrán A, Harrison C, Martínez-Ávila JC, Hernández-Boluda JC, Ferrer-Marín F, Radia DH, Mora E, Francis S, González-Martínez T, Goddard K, Pérez-Encinas M, Narayanan S, Raya JM, Singh V, Gutiérrez X, Toth P, Amat-Martínez P, Mcilwaine L, Alobaidi M, Mayani K, McGregor A, Stuckey R, Psaila B, Segura A, Alvares C, Davidson K, Osorio S, Cutting R, Sweeney CP, Rufián L, Moreno L, Cuenca I, Smith J, Morales ML, Gil-Manso R, Koutsavlis I, Wang L, Mead AJ, Rozman M, Martínez-López J, Ayala R, and Cross NCP
- Subjects
- Humans, Epigenesis, Genetic, Mutation, Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative diagnosis, Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative genetics, Leukemia, Neutrophilic, Chronic diagnosis, Leukemia, Neutrophilic, Chronic genetics, Myelodysplastic-Myeloproliferative Diseases genetics
- Abstract
Chronic neutrophilic leukemia (CNL) and atypical chronic myeloid leukemia (aCML) are rare myeloid disorders that are challenging with regard to diagnosis and clinical management. To study the similarities and differences between these disorders, we undertook a multicenter international study of one of the largest case series (CNL, n = 24; aCML, n = 37 cases, respectively), focusing on the clinical and mutational profiles (n = 53 with molecular data) of these diseases. We found no differences in clinical presentations or outcomes of both entities. As previously described, both CNL and aCML share a complex mutational profile with mutations in genes involved in epigenetic regulation, splicing, and signaling pathways. Apart from CSF3R, only EZH2 and TET2 were differentially mutated between them. The molecular profiles support the notion of CNL and aCML being a continuum of the same disease that may fit best within the myelodysplastic/myeloproliferative neoplasms. We identified 4 high-risk mutated genes, specifically CEBPA (β = 2.26, hazard ratio [HR] = 9.54, P = .003), EZH2 (β = 1.12, HR = 3.062, P = .009), NRAS (β = 1.29, HR = 3.63, P = .048), and U2AF1 (β = 1.75, HR = 5.74, P = .013) using multivariate analysis. Our findings underscore the relevance of molecular-risk classification in CNL/aCML as well as the importance of CSF3R mutations in these diseases., (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
- Published
- 2023
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18. Philadelphia-negative chronic myeloproliferative neoplasm follow-up: when the phone rings. Changes during the COVID-19 pandemic and patient satisfaction. Experience in 30 health centers in Spain.
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Ortuzar A, Fox ML, Vera JA, Lorenzo Vizcaya Á, Marín Sánchez A, Llopis Calatayud I, Carbonell S, Álvarez-Larrán A, Mata Serna R, Marco Buades JE, Quiroz Cervantes K, Martínez Hellín Á, Blum Domínguez A, Caballero Navarro G, Cáceres Sansaloni A, Guerrero Fernández L, Muñoz Linares C, Gasior Kabat M, Pérez López R, Fernández Rodríguez Á, Martínez Bilbao C, Cobo Rodríguez MT, Díaz Á, Durán MA, Santaliestra Tomas M, García-Gutierrez V, Magro Mazo E, Hernández-Boluda JC, Segura A, Raya JM, Navas Elorza B, and Osorio S
- Subjects
- Humans, Aged, Pandemics, Retrospective Studies, Patient Satisfaction, Spain epidemiology, SARS-CoV-2, COVID-19, Myeloproliferative Disorders epidemiology, Myeloproliferative Disorders therapy, Polycythemia Vera epidemiology, Primary Myelofibrosis epidemiology, Thrombocythemia, Essential epidemiology
- Abstract
The SARS-CoV-2 pandemic has favored the expansion of telemedicine. Philadelphia-negative chronic myeloproliferative neoplasms (Ph-MPN) might be good candidates for virtual follow-up. In this study, we aimed to analyze the follow-up of patients with Ph-MPN in Spain during COVID-19, its effectiveness, and acceptance among patients. We present a multicenter retrospective study from 30 centers. Five hundred forty-one patients were included with a median age of 67 years (yr). With a median follow-up of 19 months, 4410 appointments were recorded. The median of visits per patient was 7 and median periodicity was 2.7 months; significantly more visits and a higher frequency of them were registered in myelofibrosis (MF) patients. 60.1% of visits were in-person, 39.5% were by telephone, and 0.3% were videocall visits, with a predominance of telephone visits for essential thrombocythemia (ET) and polycythemia vera (PV) patients over MF, as well as for younger patients (< 50 yr). The proportion of phone visits significantly decreased after the first semester of the pandemic. Pharmacological modifications were performed only in 25.7% of the visits, and, considering overall management, ET patients needed fewer global treatment changes. Telephone contact effectiveness reached 90% and only 5.4% required a complementary in-person appointment. Although 56.2% of the cohort preferred in-person visits, 90.5% of our patients claimed to be satisfied with follow-up during the pandemic, with an 83% of positive comments. In view of our results, telemedicine has proven effective and efficient, and might continue to play a complementary role in Ph-MPN patients' follow-up., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2023
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19. Machine Learning Improves Risk Stratification in Myelofibrosis: An Analysis of the Spanish Registry of Myelofibrosis.
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Mosquera-Orgueira A, Pérez-Encinas M, Hernández-Sánchez A, González-Martínez T, Arellano-Rodrigo E, Martínez-Elicegui J, Villaverde-Ramiro Á, Raya JM, Ayala R, Ferrer-Marín F, Fox ML, Velez P, Mora E, Xicoy B, Mata-Vázquez MI, García-Fortes M, Angona A, Cuevas B, Senín MA, Ramírez-Payer A, Ramírez MJ, Pérez-López R, González de Villambrosía S, Martínez-Valverde C, Gómez-Casares MT, García-Hernández C, Gasior M, Bellosillo B, Steegmann JL, Álvarez-Larrán A, Hernández-Rivas JM, and Hernández-Boluda JC
- Abstract
Myelofibrosis (MF) is a myeloproliferative neoplasm (MPN) with heterogeneous clinical course. Allogeneic hematopoietic cell transplantation remains the only curative therapy, but its morbidity and mortality require careful candidate selection. Therefore, accurate disease risk prognostication is critical for treatment decision-making. We obtained registry data from patients diagnosed with MF in 60 Spanish institutions (N = 1386). These were randomly divided into a training set (80%) and a test set (20%). A machine learning (ML) technique (random forest) was used to model overall survival (OS) and leukemia-free survival (LFS) in the training set, and the results were validated in the test set. We derived the AIPSS-MF (Artificial Intelligence Prognostic Scoring System for Myelofibrosis) model, which was based on 8 clinical variables at diagnosis and achieved high accuracy in predicting OS (training set c-index, 0.750; test set c-index, 0.744) and LFS (training set c-index, 0.697; test set c-index, 0.703). No improvement was obtained with the inclusion of MPN driver mutations in the model. We were unable to adequately assess the potential benefit of including adverse cytogenetics or high-risk mutations due to the lack of these data in many patients. AIPSS-MF was superior to the IPSS regardless of MF subtype and age range and outperformed the MYSEC-PM in patients with secondary MF. In conclusion, we have developed a prediction model based exclusively on clinical variables that provides individualized prognostic estimates in patients with primary and secondary MF. The use of AIPSS-MF in combination with predictive models that incorporate genetic information may improve disease risk stratification., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Hematology Association.)
- Published
- 2022
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20. Hb Nivaria: A New Hemoglobin Variant with a Shortened α -Globin Chain [ α 139(HC1)Lys → Stop; HBA1 : c.418A>T].
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Ropero Gradilla P, Raya JM, González FA, Rochas S, Ferrer-Benito S, Nieto JM, Martín-Santos T, Barrios M, Gutiérrez-Murillo L, Villegas A, and Benavente C
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- Male, Humans, Adult, Glycated Hemoglobin, Chromatography, High Pressure Liquid, Electrophoresis, Capillary, Lysine, Hemoglobins
- Abstract
We report a novel hemoglobin (Hb) variant found in a Spanish individual from Santa Cruz de Tenerife, the Canary Islands in Spain. The proband was a 39-year-old male. High performance liquid chromatography (HPLC) displayed an unknown peak (19.3%) at a retention time of 1.3 min. eluting before Hb A
0 . Capillary zone electrophoresis (CZE) showed an abnormal peak (20.0%) in zone 12. Direct DNA sequencing of the α-globin genes revealed heterozygosity for a nonsense mutation at codon 139 ( A AA> T AA), causing a lysine to stop codon substitution [α139(HC1)Lys→Stop; HBA1 : c.418A>T]. We decided to name the variant Hb Nivaria (Tenerife) for the place of birth and residence of the proband.- Published
- 2022
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21. Predictors of thrombosis and bleeding in 1613 myelofibrosis patients from the Spanish Registry of Myelofibrosis.
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Hernández-Boluda JC, Pastor-Galán I, Arellano-Rodrigo E, Raya JM, Pérez-Encinas M, Ayala R, Ferrer-Marín F, Velez P, Mora E, Fox ML, Hernández-Rivas JM, Xicoy B, Mata-Vázquez MI, García-Fortes M, Pérez-López R, Angona A, Cuevas B, Senín A, Ramírez MJ, Ramírez-Payer A, Gómez-Casares MT, Martínez-Valverde C, Magro E, Steegmann JL, Durán MA, García-Hernández C, Gasior M, de Villambrosia SG, Alvarez-Larrán A, and Pereira A
- Subjects
- Humans, Hemorrhage diagnosis, Registries, Risk Factors, Primary Myelofibrosis complications, Primary Myelofibrosis drug therapy, Primary Myelofibrosis genetics, Thrombocythemia, Essential genetics, Thrombosis epidemiology, Thrombosis etiology, Thrombosis diagnosis
- Abstract
Available data have proved insufficient to develop consensus recommendations on the prevention of thrombosis and bleeding in myelofibrosis (MF). We evaluated the incidence and risk factors of vascular complications in 1613 patients from the Spanish Myelofibrosis Registry. Over a total of 6981 patient-years at risk, 6.4% of the study population had at least one thrombotic event after MF diagnosis, amounting to an incidence rate of 1.65 per 100 patient-years. Prior history of thrombosis, the JAK2 mutation, and the intermediate-2/high-risk International Prognostic Scoring System (IPSS) categories conferred an increased thrombotic risk after adjustment for the risk-modifying effect of anti-thrombotic and cytoreductive treatments. History of thrombosis and the JAK2 mutation allowed us to pinpoint a group of patients at higher risk of early thrombosis. No decreased incidence of thrombosis was observed while patients were on anti-thrombotic or cytoreductive treatment. An increased risk of venous thrombosis was found during treatment with immunomodulatory agents. A total of 5.3% of patients had at least one episode of major bleeding, resulting in an incidence rate of 1.5 events per 100 patient-years. Patients in the intermediate-2/high-risk IPSS categories treated with anti-coagulants had an almost sevenfold increased risk of major bleeding. These findings should prove useful for guiding decision-making in clinical practice., (© 2022 British Society for Haematology and John Wiley & Sons Ltd.)
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- 2022
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22. Low-risk polycythemia vera treated with phlebotomies: clinical characteristics, hematologic control and complications in 453 patients from the Spanish Registry of Polycythemia Vera.
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Triguero A, Pedraza A, Pérez-Encinas M, Mata-Vázquez MI, Vélez P, Fox L, Gómez-Calafat M, García-Delgado R, Gasior M, Ferrer-Marín F, García-Gutiérrez V, Angona A, Gómez-Casares MT, Cuevas B, Martínez C, Pérez R, Raya JM, Guerrero L, Murillo I, Bellosillo B, Hernández-Boluda JC, Sanz C, and Álvarez-Larrán A
- Subjects
- Humans, Middle Aged, Phlebotomy adverse effects, Registries, Leukemia, Myeloid, Acute complications, Polycythemia Vera complications, Polycythemia Vera diagnosis, Polycythemia Vera surgery, Primary Myelofibrosis diagnosis, Thrombosis complications, Thrombosis etiology
- Abstract
Hematological control, incidence of complications, and need for cytoreduction were studied in 453 patients with low-risk polycythemia vera (PV) treated with phlebotomies alone. Median hematocrit value decreased from 54% at diagnosis to 45% at 12 months, and adequate hematocrit control over time (< 45%) was observed in 36%, 44%, and 32% of the patients at 6, 12, and 24 months, respectively. More than 5 phlebotomies per year in the maintenance phase were required in 19% of patients. Worsening thrombocytosis, age > 60 years, and microvascular symptoms constituted the main indications for starting cytoreduction. Median duration without initiating cytoreduction was significantly longer in patients younger than 50 years (< 0.0001). The incidence rate of thrombosis under phlebotomies alone was 0.8% per year and the estimated probability of thrombosis at 10 years was 8.5%. The probability of arterial thrombosis was significantly higher in patients with arterial hypertension whereas there was a trend to higher risk of venous thrombosis in cases with high JAK2V617F allele burden. Rates of major bleeding and second primary neoplasm were low. With a median follow-up of 9 years, survival probability at 10 years was 97%, whereas the probability of myelofibrosis at 10 and 20 years was 7% and 20%, respectively. Progression to acute myeloid leukemia was documented in 3 cases (1%). Current management of low-risk PV patients is associated with low rate of thrombosis and long survival. New treatment strategies are needed for improving hematological control and, in the long term, reducing progression to myelofibrosis., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2022
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23. The importance of administrative data in the evaluation of the incidence of social housing allowance programmes.
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Raya JM and Torres-Pruñonosa J
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- Adolescent, Aged, Female, Hispanic or Latino, Humans, Incidence, Program Evaluation, Housing, Income
- Abstract
The aim of this work is to assess the rental assistance programme that was implemented by the Catalan regional government in the 2010s using administrative data provided by the Catalonia Housing Agency to analyse whether it achieved its aims to enhance the design of similar programmes. Linear probability models to explain the probability of receiving the grant were estimated and some significant variables were identified: age; rent price; expertise; being a woman; non-EU citizenship and the number of old, young or disabled members. Multiple regressions were estimated in regard to the grant's rate in relation to the rent price and the effort required to pay relative to income after having received the grant. The results suggest that rental assistance facilitates access to housing to groups that face more difficulties and that the revenue captured by landlords, although statistically significant, is small, since they capture approximately 3% by raising prices. This aid, despite being controlled by different variables, benefits elderly people more than young people, which must be addressed because, theoretically, when access requirements are met, no group should benefit more than others., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2022
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24. Real-world analysis of main clinical outcomes in patients with polycythemia vera treated with ruxolitinib or best available therapy after developing resistance/intolerance to hydroxyurea.
- Author
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Alvarez-Larrán A, Garrote M, Ferrer-Marín F, Pérez-Encinas M, Mata-Vazquez MI, Bellosillo B, Arellano-Rodrigo E, Gómez M, García R, García-Gutiérrez V, Gasior M, Cuevas B, Angona A, Gómez-Casares MT, Martínez CM, Magro E, Ayala R, Del Orbe-Barreto R, Pérez-López R, Fox ML, Raya JM, Guerrero L, García-Hernández C, Caballero G, Murillo I, Xicoy B, Ramírez MJ, Carreño-Tarragona G, Hernández-Boluda JC, and Pereira A
- Subjects
- Hemorrhage chemically induced, Humans, Hydroxyurea adverse effects, Nitriles, Pyrazoles, Pyrimidines, Retrospective Studies, Leukemia, Myeloid, Acute drug therapy, Neoplasms, Second Primary drug therapy, Polycythemia Vera drug therapy, Primary Myelofibrosis drug therapy, Thrombosis chemically induced, Thrombosis drug therapy, Thrombosis prevention & control
- Abstract
Background: Ruxolitinib is approved for patients with polycythemia vera (PV) who are resistant/intolerant to hydroxyurea, but its impact on preventing thrombosis or disease-progression is unknown., Methods: A retrospective, real-world analysis was performed on the outcomes of 377 patients with resistance/intolerance to hydroxyurea from the Spanish Registry of Polycythemia Vera according to subsequent treatment with ruxolitinib (n = 105) or the best available therapy (BAT; n = 272). Survival probabilities and rates of thrombosis, hemorrhage, acute myeloid leukemia, myelofibrosis, and second primary cancers were calculated according to treatment. To minimize biases in treatment allocation, all results were adjusted by a propensity score for receiving ruxolitinib or BAT., Results: Patients receiving ruxolitinib had a significantly lower rate of arterial thrombosis than those on BAT (0.4% vs 2.3% per year; P = .03), and this persisted as a trend after adjustment for the propensity to have received the drug (incidence rate ratio, 0.18; 95% confidence interval, 0.02-1.3; P = .09). There were no significant differences in the rates of venous thrombosis (0.8% and 1.1% for ruxolitinib and BAT, respectively; P = .7) and major bleeding (0.8% and 0.9%, respectively; P = .9). Ruxolitinib exposure was not associated with a higher rate of second primary cancers, including all types of neoplasia, noncutaneous cancers, and nonmelanoma skin cancers. After a median follow-up of 3.5 years, there were no differences in survival or progression to acute leukemia or myelofibrosis between the 2 groups., Conclusions: The results suggest that ruxolitinib treatment for PV patients with resistance/intolerance to hydroxyurea may reduce the incidence of arterial thrombosis., Lay Summary: Ruxolitinib is better than other available therapies in achieving hematocrit control and symptom relief in patients with polycythemia vera who are resistant/intolerant to hydroxyurea, but we still do not know whether ruxolitinib provides an additional benefit in preventing thrombosis or disease progression. We retrospectively studied the outcomes of 377 patients with resistance/intolerance to hydroxyurea from the Spanish Registry of Polycythemia Vera according to whether they subsequently received ruxolitinib (n = 105) or the best available therapy (n = 272). Our findings suggest that ruxolitinib could reduce the incidence of arterial thrombosis, but a disease-modifying effect could not be demonstrated for ruxolitinib in this patient population., (© 2022 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)
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- 2022
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25. Relevance of early diagnosis in polycythemia vera and essential thrombocythemia: A single center's experience.
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Lakhwani S, Pardina-Echevarría M, Arcas-Vega R, Díaz-Sánchez OR, Hernández-García MT, and Raya JM
- Subjects
- Early Diagnosis, Humans, Polycythemia Vera diagnosis, Polycythemia Vera therapy, Thrombocythemia, Essential diagnosis, Thrombocythemia, Essential therapy, Thrombocytosis diagnosis, Thrombocytosis etiology, Thrombocytosis therapy, Thrombosis diagnosis, Thrombosis etiology
- Abstract
Objectives: This work aims to describe the proportion of patients with polycythemia vera (PV) or essential thrombocythemia (ET) and thrombosis prior to the diagnosis who had erythrocytosis or thrombocytosis prior to the thrombosis., Patients and Methods: This is a retrospective review of 63 patients with PV and 130 with ET., Results: In regard to PV, we found prior erythrocytosis in 7 (11.1%) of the 17 cases (27%) with thrombosis prior to diagnosis. In ET, we found prior thrombocytosis in 10 (7.7%) of the 25 cases (19.2%) with thrombosis prior to diagnosis. The median time between the laboratory finding and thrombosis was 8.2 months and 11.8 months for PV and TE, respectively. In both entities, patients with thrombosis prior to diagnosis had significantly lower survival., Conclusion: A significant proportion of patients with thrombosis prior to the diagnosis of PV and ET present with erythrocytosis or thrombocytosis prior to the episode of thrombosis. This could allow for anticipating diagnosis and treatment., (Copyright © 2021 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)
- Published
- 2022
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26. The economic and social value of spa tourism: The case of balneotherapy in Maresme, Spain.
- Author
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Torres-Pruñonosa J, Raya JM, Crespo-Sogas P, and Mur-Gimeno E
- Subjects
- Female, Humans, Male, Middle Aged, Spain, Balneology economics, Natural Resources supply & distribution, Social Values, Tourism
- Abstract
The aim of this article is to assess both the economic and social value of balneotherapy and spa tourism, being the first paper in carrying out this analysis. The study has been conducted in Maresme, a region of Catalonia, Spain. On the one hand, an Input-Output (IO) model with a Social Accounting Matrix (SAM) has been carried out to assess the economic value. On the other hand, a Cost-Benefit Analysis (CBA) has been used to monetise the social value in this region, taking into account, among other concepts, direct and indirect health profits, given that balneotherapy helps to alleviate various diseases. The results show that whereas the economic multiplier is 1.529 considering the direct and indirect effects and 1.712 taking into account also the induced effects, which are similar to health and medical tourism multipliers, social value generates additional positive value, given that the cost-benefit ratio is 1.858. The theoretical implications of the paper as well as the findings' implications for policy so as to encourage investments in spa tourism are discussed., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2022
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27. Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry.
- Author
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Hernández-Boluda JC, Pereira A, Kröger N, Cornelissen JJ, Finke J, Beelen D, de Witte M, Wilson K, Platzbecker U, Sengeloev H, Blaise D, Einsele H, Sockel K, Krüger W, Lenhoff S, Salaroli A, Martin H, García-Gutiérrez V, Pavone V, Alvarez-Larrán A, Raya JM, Zinger N, Gras L, Hayden P, Czerw T, P McLornan D, and Yakoub-Agha I
- Subjects
- Age Factors, Aged, Cohort Studies, Female, Humans, Male, Primary Myelofibrosis epidemiology, Registries, Spain epidemiology, Survival Analysis, Transplantation, Homologous, Hematopoietic Stem Cell Transplantation, Primary Myelofibrosis therapy
- Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly used in older myelofibrosis (MF) patients, but its risk/benefit ratio compared to non-transplant approaches has not been evaluated in this population. We analyzed the outcomes of allo-HCT in 556 MF patients aged ≥65 years from the EBMT registry, and determined the excess mortality over the matched general population of MF patients ≥65 years managed with allo-HCT (n = 556) or conventional drug treatment (n = 176). The non-transplant cohort included patients with intermediate-2 or high risk DIPSS from the Spanish Myelofibrosis Registry. After a median follow-up of 3.4 years, the estimated 5-year survival rate, non-relapse mortality (NRM), and relapse incidence after transplantation was 40%, 37%, and 25%, respectively. Busulfan-based conditioning was associated with decreased mortality (HR: 0.7, 95% CI: 0.5-0.9) whereas the recipient CMV+/donor CMV- combination (HR: 1.7, 95% CI: 1.2-2.4) and the JAK2 mutated genotype (HR: 1.9, 95% CI: 1.1-3.5) predicted higher mortality. Busulfan-based conditioning correlated with improved survival due to less NRM, despite its higher relapse rate when compared with melphalan-based regimens. Excess mortality was higher in transplanted patients than in the non-HCT cohort in the first year of follow-up (ratio: 1.93, 95% CI: 1.13-2.80), whereas the opposite occurred between the fourth and eighth follow-up years (ratio: 0.31, 95% CI: 0.18-0.53). Comparing the excess mortality of the two treatments, male patients seemed to benefit more than females from allo-HCT, mainly due to their worse prognosis with non-transplant approaches. These findings could potentially enhance counseling and treatment decision-making in elderly transplant-eligible MF patients., (© 2021 The Authors. American Journal of Hematology published by Wiley Periodicals LLC.)
- Published
- 2021
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28. The risk of thrombosis in essential thrombocythemia is associated with the type of CALR mutation: A multicentre collaborative study.
- Author
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Pérez Encinas MM, Sobas M, Gómez-Casares MT, Abuin Blanco A, Noya Pereira MS, Raya JM, Andrade-Campos MM, Álvarez Larrán A, Lewandowski K, Łukasz S, Hernández Boluda JC, Ferrer-Marín F, Fox ML, Gołos A, Gasior Kabat M, Magro Mazo E, Czyż A, Martín Martín A, Bellosillo Paricio B, Quinteiro García C, González Martín JM, and Stuckey R
- Subjects
- Follow-Up Studies, Genetic Association Studies, Humans, Incidence, Janus Kinase 2 genetics, Odds Ratio, Prognosis, Retrospective Studies, Thrombocythemia, Essential diagnosis, Thrombocythemia, Essential mortality, Thrombosis diagnosis, Thrombosis mortality, Calreticulin genetics, Genetic Predisposition to Disease, Mutation, Thrombocythemia, Essential complications, Thrombocythemia, Essential genetics, Thrombosis etiology
- Abstract
Objectives: In patients with essential thrombocythemia (ET), after the JAK2V617F driver mutation, mutations in CALR are common (classified as type 1, 52-bp deletion or type 2, 5-bp insertion). CALR mutations have generally been associated with a lower risk of thrombosis. This study aimed to confirm the impact of CALR mutation type on thrombotic risk., Methods: We retrospectively investigated 983 ET patients diagnosed in Spanish and Polish hospitals., Results: With 7.5 years of median follow-up from diagnosis, 155 patients (15.8%) had one or more thrombotic event. The 5-year thrombosis-free survival (TFS) rate was 83.8%, 91.6% and 93.9% for the JAK2V617F, CALR-type 1 and CALR-type 2 groups, respectively (P = .002). Comparing CALR-type 1 and CALR-type 2 groups, TFS for venous thrombosis was lower in CALR-type 1 (P = .046), with no difference in TFS for arterial thrombosis observed. The cumulative incidence of thrombosis was significantly different comparing JAK2V617F vs CALR-type 2 groups but not JAK2V617F vs CALR-type 1 groups. Moreover, CALR-type 2 mutation was a statistically significant protective factor for thrombosis with respect to JAK2V617F in multivariate logistic regression (OR: 0.45, P = .04) adjusted by age., Conclusions: Our results suggest that CALR mutation type has prognostic value for the stratification of thrombotic risk in ET patients., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2021
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29. The Economic and Social Value of Science and Technology Parks. The Case of Tecnocampus.
- Author
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Torres-Pruñonosa J, Raya JM, and Dopeso-Fernández R
- Abstract
This article aims to measure both the economic and social value of Tecnocampus, a Science and Technology Park in its region of influence (Mataró city in the Maresme region of Catalonia, Spain). Our results show that the impact of Tecnocampus has a socioeconomic cost-benefit ratio of 2.39. Measuring the impact of this multifaceted centre requires a diverse approach. Although the methods used are not new, the combination of them presents a novel approach to measure the impact of an institution of this nature. We have measured the economic value with the Input-Output model, including the Social Accounting Matrix. On the other hand, for social value calculations, we have used cost-benefit analysis adding measurements of firm localisation to estimate externality effects. Our main results present an economic value of more than 0.054% of the Catalan GDP, whereas the employment impact represents almost 0.37% of total employment in the region. The total economic multiplier of Tecnocampus activity is estimated to be 1.89. Social value generates an additional 0.50 euros to the multiplier according with our analysis. This additional social value represents an increase of productivity estimated in 20 million euros of operational income for Catalan firms and the creation of seven additional firms in the Maresme region as a result of knowledge spillovers. The social value also includes reduction of over-education caused by a better matching between graduates and enterprises, a more direct application of research, and an increase in consumer surplus. Finally, we discuss the policy implications of our findings to promote investments in this kind of infrastructures., Competing Interests: The authors are employees of Fundació Tecnocampus Mataró-Maresme., (Copyright © 2020 Torres-Pruñonosa, Raya and Dopeso-Fernández.)
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- 2020
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30. Clinico-biological characteristics of patients with myelofibrosis: an analysis of 1,000 cases from the Spanish Registry of Myelofibrosis.
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Pastor-Galán I, Hernández-Boluda JC, Correa JG, Alvarez-Larrán A, Ferrer-Marín F, Raya JM, Ayala R, Velez P, Pérez-Encinas M, Estrada N, García-Gutiérrez V, Fox ML, Payer A, Kerguelen A, Cuevas B, Durán MA, Ramírez MJ, Gómez-Casares MT, Mata-Vázquez MI, Mora E, Martínez-Valverde C, Arbelo E, Angona A, Magro E, Antelo ML, Somolinos N, and Cervantes F
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- Aged, Humans, Prognosis, Registries, Spain epidemiology, Splenomegaly, Primary Myelofibrosis diagnosis, Primary Myelofibrosis epidemiology
- Abstract
BACKGROUND AND OBJECTIVE MYELOFIBROSIS: is an infrequent chronic myeloproliferative neoplasm. We aimed to describe the clinico-biological characteristics, treatment, and evolutive course of myelofibrosis patients in Spain., Material and Methods: A total of 1,000 patients from the Spanish Registry of Myelofibrosis diagnosed with primary (n=641) or secondary (n=359) myelofibrosis were analysed., Results: Median age was 68 years. The frequency of constitutional symptoms, moderate to severe anaemia (Hb<10g/dL), and symptomatic splenomegaly was 35%, 36%, and 17%, respectively. The rate of thrombosis and haemorrhage was 1.96 and 1.6 events per 100 patient-years, respectively. The cumulative incidence of leukaemia at 10 years was 15%. The most frequent therapies for the anaemia were the erythropoiesis stimulating agents and danazol. From 2010, a progressive increase in the use of ruxolitinib was noticed. A total of 7.5% of patients were transplanted. During the observation period, 42% of patients died mainly due to the clinical deterioration caused by myelofibrosis or leukaemic transformation. The median survival of the series was 5.7 years. Four different risk categories were identified by the IPSS: median survival was not reached in the low risk group and was 8.8 years, 5.3 years, and 2.8 years in the intermediate-1, intermediate-2, and high-risk groups, respectively., Conclusions: Myelofibrosis is a disabling condition mainly affecting elderly people. Its treatment is mostly driven by symptom control. Despite its clinical heterogeneity, several prognostic models are useful to select candidates for transplantation., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)
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- 2020
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31. Prognostic risk models for transplant decision-making in myelofibrosis.
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Hernández-Boluda JC, Pereira A, Correa JG, Alvarez-Larrán A, Ferrer-Marín F, Raya JM, Martínez-López J, Velez P, Pérez-Encinas M, Estrada N, García-Gutiérrez V, Fox ML, Payer A, Kerguelen A, Cuevas B, Durán MA, Ramírez MJ, Gómez-Casares MT, Mata-Vázquez MI, Mora E, Gómez M, and Cervantes F
- Subjects
- Aged, Female, Humans, Longitudinal Studies, Male, Middle Aged, Primary Myelofibrosis epidemiology, Prognosis, Registries, Risk Factors, Spain epidemiology, Transplantation, Homologous methods, Clinical Decision-Making methods, Primary Myelofibrosis diagnosis, Primary Myelofibrosis therapy, Stem Cell Transplantation methods
- Abstract
Prognostic models are widely used in clinical practice for transplant decision-making in myelofibrosis (MF). We have compared the performance of the International Prognostic Scoring System (IPSS), dynamic IPSS (DIPSS), and DIPSS-plus in a series of 544 patients with primary or secondary MF aged ≤ 70 years at the time of diagnosis. The median projected survival of the overall series was 9.46 years (95% confidence interval 7.44-10.59). Median survival for the highest risk groups was less than 4 years in the three prognostic models. By contrast, the projected survival for patients in the intermediate-2 categories by the IPSS, DIPSS, and DIPSS-plus was 6.6, 5.6, and 6.5 years, respectively. The number of patients in the intermediate-2 and high-risk categories was smaller in the DIPSS than in the IPSS or the DIPSS-plus. The IPSS and DIPSS-plus were the best models to discriminate between the intermediate-1 and intermediate-2 risk categories, which is a critical cut-off point for patient selection to transplant. Among patients assigned at diagnosis to the intermediate-2 or high-risk groups by the IPSS, DIPSS, and DIPSS-plus, only 17, 21, and 20%, respectively, were subsequently transplanted. In conclusion, in our contemporary series of younger MF patients only the highest risk categories of the current prognostication systems have a median survival below the 5-year threshold recommended for considering transplantation. Patient selection for transplantation can significantly differ depending on which prognostication model is used for disease risk stratification.
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- 2018
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32. Clinical characteristics, prognosis and treatment of myelofibrosis patients with severe thrombocytopenia.
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Hernández-Boluda JC, Correa JG, Alvarez-Larrán A, Ferrer-Marín F, Raya JM, Martínez-López J, Velez P, Pérez-Encinas M, Estrada N, García-Gutiérrez V, Fox ML, Luño E, Kerguelen A, Cuevas B, Durán MA, Ramírez MJ, Gómez-Casares M, Mata-Vázquez MI, Regadera A, Pereira A, and Cervantes F
- Subjects
- Aged, Disease-Free Survival, Female, Humans, Male, Middle Aged, Spain epidemiology, Survival Rate, Primary Myelofibrosis blood, Primary Myelofibrosis diagnosis, Primary Myelofibrosis mortality, Primary Myelofibrosis therapy, Registries, Thrombocytopenia blood, Thrombocytopenia diagnosis, Thrombocytopenia mortality, Thrombocytopenia therapy
- Published
- 2018
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33. Bone marrow trephine biopsy in Hodgkin's lymphoma. Comparison with PET-CT scan in 65 patients.
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Lakhwani S, Cabello-García D, Allende-Riera A, Cárdenas-Negro C, Raya JM, and Hernández-Garcia MT
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- Adolescent, Adult, Aged, Biopsy, Female, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Bone Marrow pathology, Hodgkin Disease diagnostic imaging, Hodgkin Disease pathology, Positron Emission Tomography Computed Tomography
- Abstract
Background and Objectives: To compare bone marrow biopsy (BMB) and PET/CT in detecting bone marrow involvement in Hodgkin's lymphoma MATERIAL AND METHODS: Retrospective analysis of 65 patients with both tests in the initial staging or in relapse with special attention to the PET/CT uptake pattern., Results: In 3 patients (4.6%), the BMB showed bone marrow involvement with the PET/CT being positive in them all: 2 with diffuse+multifocal pattern and one diffuse only. In 11 additional patients (total 14/65, 21%), bone marrow involvement was diagnosed by PET/CT because bone marrow uptake was above hepatic one. The pattern was focal only in 2 cases, multifocal in 5, diffuse in 3 and diffuse+multifocal in one. In these last 4 cases the BMB showed an unspecific myelopathy., Conclusions: PET/CT detects all cases with BMB affected and many that escape to biopsy, however when the uptake pattern is diffuse it could be by involvement or reactive hyperplasia and in those cases the BMB should be done., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)
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- 2018
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34. Performance of the myelofibrosis secondary to PV and ET-prognostic model (MYSEC-PM) in a series of 262 patients from the Spanish registry of myelofibrosis.
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Hernández-Boluda JC, Pereira A, Correa JG, Alvarez-Larrán A, Ferrer-Marín F, Raya JM, Martínez-López J, Pérez-Encinas M, Estrada N, Velez P, Fox ML, García-Gutiérrez V, Payer A, Kerguelen A, Cuevas B, Durán MA, Ramírez MJ, Gómez-Casares MT, Mata-Vázquez MI, Mora E, Martínez-Valverde C, Gómez M, and Cervantes F
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prognosis, Registries, Polycythemia Vera pathology, Primary Myelofibrosis pathology, Thrombocythemia, Essential pathology
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- 2018
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35. Bone marrow biopsy superiority over PET/CT in predicting progression-free survival in a homogeneously-treated cohort of diffuse large B-cell lymphoma.
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Chen-Liang TH, Martín-Santos T, Jerez A, Rodríguez-García G, Senent L, Martínez-Millán C, Muiña B, Orero M, Teruel A, Martín A, Gómez-Espuch J, Kennedy K, Benet C, Raya JM, Fernández-González M, de la Cruz F, Guinot M, Villegas C, Ballester I, Baile M, Moya M, López-Jiménez J, Frutos L, Navarro JL, Uña J, Fernández-López R, Igua C, Contreras J, Sánchez-Vañó R, Cozar MDP, Tamayo P, Mucientes J, Sánchez-Blanco JJ, Pérez-Ceballos E, and Ortuño FJ
- Subjects
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Antibodies, Monoclonal, Murine-Derived therapeutic use, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biopsy, Cyclophosphamide therapeutic use, Disease-Free Survival, Doxorubicin therapeutic use, Female, Follow-Up Studies, Health Status, Humans, Lymphoma, Large B-Cell, Diffuse drug therapy, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Prednisone therapeutic use, Retrospective Studies, Rituximab administration & dosage, Survival Rate, Vincristine therapeutic use, Young Adult, beta 2-Microglobulin blood, Bone Marrow diagnostic imaging, Bone Marrow pathology, Lymphoma, Large B-Cell, Diffuse diagnostic imaging, Lymphoma, Large B-Cell, Diffuse pathology, Positron Emission Tomography Computed Tomography
- Abstract
Several studies have reported uneven results when evaluating the prognostic value of bone marrow biopsy (BMB) and PET/CT as part of the staging of diffuse large B-cell lymphoma (DLBCL). The heterogeneity of the inclusion criteria and not taking into account selection and collinearity biases in the analysis models might explain part of these discrepancies. To address this issue we have carried a retrospective multicenter study including 268 DLBCL patients with a BMB and a PET/CT available at diagnosis where we estimated both the prognosis impact and the diagnostic accuracy of each technique. Only patients treated with R-CHOP/21 as first line (n = 203) were included in the survival analysis. With a median follow-up of 25 months the estimated 3-year progression-free survival (PFS) and overall survival (OS) were 76.3% and 82.7% respectively. In a multivariate analysis designed to avoid a collinearity bias with IPI categories, BMB-BMI [bone marrow involvement](+) (HR: 3.6) and ECOG PS > 1 (HR: 2.9) were independently associated with a shorter PFS and three factors, age >60 years old (HR: 2.4), ECOG PS >1 (HR: 2.4), and abnormally elevated B2-microglobulin levels (HR: 2.2) were independently associated with a shorter OS. In our DLBCL cohort, treated with a uniform first-line chemotherapy regimen, BMI by BMB complemented performance status in predicting those patients with a higher risk for relapse or progression. In this cohort BMI by PET/CT could not independently predict a shorter PFS and/or OS., (© 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
- Published
- 2017
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36. Thrombopoietin receptor agonist switch in adult primary immune thrombocytopenia patients: A retrospective collaborative survey involving 4 Spanish centres.
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Lakhwani S, Perera M, Fernández-Fuertes F, Ríos de Paz MA, Torres M, Raya JM, and Hernández MT
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- Adolescent, Adult, Aged, Aged, 80 and over, Benzoates administration & dosage, Female, Humans, Hydrazines administration & dosage, Male, Middle Aged, Platelet Count, Purpura, Thrombocytopenic, Idiopathic blood, Purpura, Thrombocytopenic, Idiopathic metabolism, Pyrazoles administration & dosage, Receptors, Fc administration & dosage, Recombinant Fusion Proteins administration & dosage, Thrombopoietin administration & dosage, Time Factors, Treatment Outcome, Young Adult, Benzoates therapeutic use, Drug Substitution, Hydrazines therapeutic use, Purpura, Thrombocytopenic, Idiopathic drug therapy, Pyrazoles therapeutic use, Receptors, Fc therapeutic use, Receptors, Thrombopoietin agonists, Recombinant Fusion Proteins therapeutic use, Thrombopoietin therapeutic use
- Abstract
Objective: To describe the reasons for and result of thrombopoietin receptor agonists (TPO-RA) switching in adult immune thrombocytopenia (ITP) patients of 4 Spanish centres., Methods: We retrospectively analysed all patients who received sequential treatment with both TPO-RA between 2010 and 2015 recording clinical and biological parameters., Results: Twenty-six patients were included; 17 received first romiplostim and 9 received first eltrombopag. Reasons for switching were inefficacy (n = 10), patient preference (n = 8), side effects (n = 5) and excessive platelet count fluctuation (n = 3). When the switch was due to inefficacy, 100% of patients who received romiplostim first and 66% who received eltrombopag first responded to the second drug. It is significant that none of the patients who received romiplostim first reached the maximum recommended dose before switching. When the change was due to patient preference or because of side effects, 100% of the patients responded to both TPO-RA. Three patients changed from romiplostim to eltrombopag due to platelet count fluctuation; one did not respond and the fluctuation persisted in the remaining 2 patients. We also found 4 sustained remissions after administering the second TPO-RA, 2 of these with inefficacy of the first drug., Conclusion: TPO-RA switching is a feasible strategy in different scenarios with high probability of success., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2017
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37. Predictive factors for anemia response to erythropoiesis-stimulating agents in myelofibrosis.
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Hernández-Boluda JC, Correa JG, García-Delgado R, Martínez-López J, Alvarez-Larrán A, Fox ML, García-Gutiérrez V, Pérez-Encinas M, Ferrer-Marín F, Mata-Vázquez MI, Raya JM, Estrada N, García S, Kerguelen A, Durán MA, Albors M, and Cervantes F
- Subjects
- Aged, Disease-Free Survival, Erythropoietin blood, Female, Ferritins blood, Hematinics adverse effects, Humans, Leukocyte Count, Male, Middle Aged, Sex Factors, Spain epidemiology, Survival Rate, Thrombosis blood, Thrombosis chemically induced, Thrombosis mortality, Anemia blood, Anemia drug therapy, Anemia mortality, Hematinics administration & dosage, Primary Myelofibrosis blood, Primary Myelofibrosis drug therapy, Primary Myelofibrosis mortality
- Abstract
Objective: Erythropoiesis-stimulating agents (ESAs) are commonly used to treat the anemia of myelofibrosis (MF), but information on the predictors of response is limited., Methods: Results of ESA therapy were analyzed in 163 MF patients with severe anemia, most of whom had inadequate erythropoietin (EPO) levels (<125 U/L) at treatment start., Results: According to the revised criteria of the International Working Group for Myelofibrosis Treatment and Research, anemia response was achieved in 86 patients (53%). Median response duration was 19.3 months. In multivariate analysis, baseline factors associated with a higher response rate were female sex (P=.007), leukocyte count ≥10×10
9 /L (P=.033), and serum ferritin <200 ng/mL (P=.002). Patients with 2 or 3 of the above features had a significantly higher response rate than the remainder (73% vs 28%, respectively; P<.001). Over the 373 patient-years of follow-up on ESA treatment, nine patients developed thrombotic complications (six arterial, three venous), accounting for 2.41 events per 100 patient-years. Survival time from ESA start was longer in anemia responders than in non-responders (P=.011)., Conclusion: Besides the already established predictive value of EPO levels, these data can help to identify which MF patients are more likely to benefit from ESA treatment., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)- Published
- 2017
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38. Risk of thrombosis according to need of phlebotomies in patients with polycythemia vera treated with hydroxyurea.
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Alvarez-Larrán A, Pérez-Encinas M, Ferrer-Marín F, Hernández-Boluda JC, Ramírez MJ, Martínez-López J, Magro E, Cruz Y, Mata MI, Aragües P, Fox ML, Cuevas B, Montesdeoca S, Hernández-Rivas JA, García-Gutiérrez V, Gómez-Casares MT, Steegmann JL, Durán MA, Gómez M, Kerguelen A, Bárez A, García MC, Boqué C, Raya JM, Martínez C, Albors M, García F, Burgaleta C, and Besses C
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Cell Count, Combined Modality Therapy, Drug Resistance, Female, Hematocrit, Humans, Hydroxyurea administration & dosage, Male, Middle Aged, Multivariate Analysis, Phenotype, Polycythemia Vera diagnosis, Registries, Risk, Spain epidemiology, Thrombosis diagnosis, Time Factors, Treatment Outcome, Young Adult, Hydroxyurea therapeutic use, Phlebotomy, Polycythemia Vera complications, Polycythemia Vera therapy, Thrombosis epidemiology, Thrombosis etiology
- Abstract
Hematocrit control below 45% is associated with a lower rate of thrombosis in polycythemia vera. In patients receiving hydroxyurea, this target can be achieved with hydroxyurea alone or with the combination of hydroxyurea plus phlebotomies. However, the clinical implications of phlebotomy requirement under hydroxyurea therapy are unknown. The aim of this study was to evaluate the need for additional phlebotomies during the first five years of hydroxyurea therapy in 533 patients with polycythemia vera. Patients requiring 3 or more phlebotomies per year (n=85, 16%) showed a worse hematocrit control than those requiring 2 or less phlebotomies per year (n=448, 84%). There were no significant differences between the two study groups regarding leukocyte and platelet counts. Patients requiring 3 or more phlebotomies per year received significantly higher doses of hydroxyurea than the remaining patients. A significant higher rate of thrombosis was found in patients treated with hydroxyurea plus 3 or more phlebotomies per year compared to hydroxyurea with 0-2 phlebotomies per year (20.5% vs. 5.3% at 3 years; P<0.0001). In multivariate analysis, independent risk factors for thrombosis were phlebotomy dependency (HR: 3.3, 95%CI: 1.5-6.9; P=0.002) and thrombosis at diagnosis (HR: 4.7, 95%CI: 2.3-9.8; P<0.0001). The proportion of patients fulfilling the European LeukemiaNet criteria of resistance/intolerance to hydroxyurea was significantly higher in the group requiring 3 or more phlebotomies per year (18.7% vs. 7.1%; P=0.001) mainly due to extrahematologic toxicity. In conclusion, phlebotomy requirement under hydroxyurea therapy identifies a subset of patients with increased proliferation of polycythemia vera and higher risk of thrombosis., (Copyright© Ferrata Storti Foundation.)
- Published
- 2017
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39. Current opinion and consensus statement regarding the diagnosis, prognosis, and treatment of patients with essential thrombocythemia: a survey of the Spanish Group of Ph-negative Myeloproliferative Neoplasms (GEMFIN) using the Delphi method.
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Besses C, Hernández-Boluda JC, Pérez Encinas M, Raya JM, Hernández-Rivas JM, Jiménez Velasco A, Martínez Lopez J, Vicente V, and Burgaleta C
- Subjects
- Bone Marrow Examination standards, Bone Marrow Examination statistics & numerical data, DNA Mutational Analysis statistics & numerical data, Delphi Technique, Diagnosis, Differential, Disease Management, Humans, Hydroxyurea therapeutic use, Janus Kinase 2 genetics, Mutation, Missense, Platelet Count, Polycythemia Vera diagnosis, Prognosis, Quinazolines therapeutic use, Receptors, Thrombopoietin genetics, Risk Assessment, Surveys and Questionnaires, Thrombocythemia, Essential mortality, Thrombophilia diagnosis, Thrombophilia drug therapy, Thrombophilia etiology, Thrombocythemia, Essential diagnosis, Thrombocythemia, Essential therapy
- Abstract
The current consensus on the diagnosis, prognosis, and treatment of essential thrombocythemia (ET) is based on experts' recommendations. However, several aspects of the diagnosis of, prognosis of, and therapy for ET are still controversial. The Delphi method was employed with an expert panel of members of the Spanish Group of Ph-negative Myeloproliferative Neoplasms in order to identify the degree of agreement on the diagnosis, prognosis, and treatment of ET. Nine leading experts selected a total of 41 clinical hematologists with well-known expertise in ET. An electronic questionnaire was used to collect the questions rated in a four-step scale. The questions were grouped into four blocks: diagnosis, risk stratification, goals of therapy, and treatment strategy. After the first round consisting of 80 questions, a second round including 14 additional questions focused on the recommendations advocated by experts of the European LeukemiaNet in 2011 was analyzed. The median and mean values for the first and second rounds were calculated. A summary of the conclusions considered as the most representative of each block of questions is presented. The Delphi method is a powerful instrument to address the current approaches and controversies surrounding ET.
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- 2016
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40. Management of side effects of BCR/ABL-negative chronic myeloproliferative neoplasm therapies. Focus on anagrelide.
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Antelo ML, de Las Heras N, Gonzalez Porras JR, Kerguelen A, and Raya JM
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- Female, Fibrinolytic Agents administration & dosage, Humans, Male, Quinazolines administration & dosage, Fibrinolytic Agents therapeutic use, Fusion Proteins, bcr-abl adverse effects, Myeloproliferative Disorders drug therapy, Quinazolines therapeutic use
- Abstract
Although hydroxyurea is considered the first-line cytoreductive therapy in high-risk patients with polycythemia vera or essential thrombocythemia, approximately 20-25% of patients develop resistance or intolerance and they need an alternative therapy. Anagrelide is the treatment of choice in patients with essential thrombocythemia intolerant or with resistance to hydroxyurea. Anagrelide is usually well tolerated. Although there is concern about the increased risk of cardiac side effects, in most cases these are mild, and easily manageable. In this paper, the available evidence about the management of patients with myeloproliferative neoplasms, with a special focus on the side effects of drug therapies is reviewed.
- Published
- 2015
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41. Acute myeloid leukemia with inv(3)(q21q26.2) or t(3;3)(q21;q26.2): Clinical and biological features and comparison with other acute myeloid leukemias with cytogenetic aberrations involving long arm of chromosome 3.
- Author
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Raya JM, Martín-Santos T, Luño E, Sanzo C, Perez-Sirvent ML, Such E, Navarro JT, Millá F, Alonso E, Domingo A, Rozman M, Díaz-Beva M, Batlle A, González-de-Villambrosia S, Tuset E, Vallespí T, Ortega M, Bermejo A, Martín-Ramos M, Peri V, Solé F, and Florensa L
- Abstract
Objectives: To compare, from a biological and clinical perspective, a significant group of patients with AML with inv(3)(q21q26.2) or t(3;3)(q21;q26.2) with another group of AML carrying different abnormalities of 3q at q21 or q26, the latter named as the AML abn(3q) group., Methods: We developed a national survey with the participation of 13 Spanish hospitals, and retrospectively reviewed (from 1990 to 2010) these subtypes of AML. Fifty-five patients were collected: 35 with AML inv(3)/t(3;3) and 20 with AML abn(3q). A data collecting page that included main features at diagnosis, therapeutic approach and response, and survival variables, was distributed and completed., Results: We did not find significant differences in sex, age, history of myelodysplastic syndrome or chemo-/radiotherapy, clinical presentation, WBC and platelet counts, hemoglobin level, blasts immunophenotype, serum lactatedehydrogenase, peripheral blood and bone marrow cellular dysplasia, and bone marrow biopsy findings. Although the association with monosomy 7 was significantly more frequent in AML inv(3)/t(3;3), this did not seem to influence outcome. The lack of response to the different modalities of treatment and the aggressive course of the disease were the standard in both cohorts of patients., Discussion: Although not yet recognized by the World Health Organization classification, our results are in agreement with the findings of other authors, who include both subsets of AML together in the same group of adverse prognosis., Conclusion: In an attempt to simplify and bound entities with similar genetic background and clinical behavior, it would be desirable to bring together both subgroups of AML in a single section.
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- 2015
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42. Trisomy 8, a Cytogenetic Abnormality in Myelodysplastic Syndromes, Is Constitutional or Not?
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Saumell S, Solé F, Arenillas L, Montoro J, Valcárcel D, Pedro C, Sanzo C, Luño E, Giménez T, Arnan M, Pomares H, De Paz R, Arrizabalaga B, Jerez A, Martínez AB, Sánchez-Castro J, Rodríguez-Gambarte JD, Raya JM, Ríos E, Rodríguez-Rivera M, Espinet B, and Florensa L
- Subjects
- Case-Control Studies, Chromosomes, Human, Pair 8 genetics, Humans, Myelodysplastic Syndromes genetics, Trisomy genetics
- Abstract
Isolated trisomy 8 is not considered presumptive evidence of myelodysplastic syndrome (MDS) in cases without minimal morphological criteria. One reason given is that trisomy 8 (+8) can be found as a constitutional mosaicism (cT8M). We tried to clarify the incidence of cT8M in myeloid neoplasms, specifically in MDS, and the diagnostic value of isolated +8 in MDS. Twenty-two MDS and 10 other myeloid neoplasms carrying +8 were studied. Trisomy 8 was determined in peripheral blood by conventional cytogenetics (CC) and on granulocytes, CD3+ lymphocytes and oral mucosa cells by fluorescence in situ hybridization (FISH). In peripheral blood CC, +8 was seen in 4/32 patients. By FISH, only one patient with chronic myelomonocytic leukemia showed +8 in all cell samples and was interpreted as a cT8M. In our series +8 was acquired in all MDS. Probably, once discarded cT8M by FISH from CD3+ lymphocytes and non-hematological cells, +8 should be considered with enough evidence to MDS.
- Published
- 2015
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43. Pathology reporting of bone marrow biopsy in myelofibrosis; application of the Delphi consensus process to the development of a standardised diagnostic report.
- Author
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Raya JM, Montes-Moreno S, Acevedo A, Ferrández A, Fraga M, García JF, García M, Mayordomo-Aranda E, Menárguez J, Besses C, Calzada R, and Rozman M
- Subjects
- Consensus, Diagnosis, Differential, Humans, Predictive Value of Tests, Prognosis, Surveys and Questionnaires, Biopsy standards, Bone Marrow Examination standards, Delphi Technique, Medical Records standards, Practice Patterns, Physicians' standards, Primary Myelofibrosis pathology
- Abstract
Aims: The diagnosis of primary myelofibrosis (PMF) strongly relies on the bone marrow biopsy findings, but a report model has not been standardised. Our aim was to establish general recommendations for bone marrow evaluation and standardised reporting in a case suspicious of PMF., Methods: The Delphi method was employed to obtain expert consensus. An advisory panel of 10 leading members identifies a total of 37 haematopathology experts to participate. The first Delphi round included a questionnaire with three main groups of items: minimal clinical and laboratory data considered necessary before reporting, minimal descriptive aspects to record and main histological differential diagnosis. The final report content was based on consensus obtained after the second Delphi round., Results: The minimal data considered necessary were age, splenomegaly, haemoglobin, leucocyte and platelet counts, differential blood cell count, leucoerythroblastic blood picture, lactate dehydrogenase (LDH) level, BCR-ABL and JAK2 mutational status, reticulin stain and the internal control for the reticulin staining. The minimal descriptive aspects to report were cellularity, osteosclerosis, megakaryocytic morphology and localisation, dense megakaryocytic clusters, quantity of granulocytic precursors, grade of myelofibrosis in a scale of 4, and a proposed final diagnostic approach. The entities to be considered for differential diagnosis were mainly the other classical chronic myeloproliferative neoplasms., Conclusions: The Delphi method is a robust tool to determine essential information to be included in a pathology report. A standardised good-quality histopathological report form may help to homogenise PMF diagnosis. A close collaboration between the pathologist and the haematologist is desirable according to our survey., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2014
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44. Cytomegalovirus-associated hemophagocytic syndrome in a patient with Crohn's disease receiving azathioprine.
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Hernández-Camba A, Lakhwani S, Ramos L, Raya JM, and Quintero E
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- Adult, Antiviral Agents therapeutic use, Bone Marrow Examination, Crohn Disease diagnosis, Crohn Disease immunology, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections drug therapy, Cytomegalovirus Infections immunology, Humans, Immunocompromised Host, Lymphohistiocytosis, Hemophagocytic diagnosis, Lymphohistiocytosis, Hemophagocytic drug therapy, Lymphohistiocytosis, Hemophagocytic immunology, Male, Treatment Outcome, Anti-Infective Agents adverse effects, Azathioprine adverse effects, Crohn Disease drug therapy, Cytomegalovirus Infections chemically induced, Gastrointestinal Agents adverse effects, Lymphohistiocytosis, Hemophagocytic chemically induced
- Published
- 2013
45. Clinical features and course of refractory anemia with ring sideroblasts associated with marked thrombocytosis.
- Author
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Broseus J, Florensa L, Zipperer E, Schnittger S, Malcovati L, Richebourg S, Lippert E, Cermak J, Evans J, Mounier M, Raya JM, Bailly F, Gattermann N, Haferlach T, Garand R, Allou K, Besses C, Germing U, Haferlach C, Travaglino E, Luno E, Pinan MA, Arenillas L, Rozman M, Perez Sirvent ML, Favre B, Guy J, Alonso E, Ahwij N, Jerez A, Hermouet S, Maynadié M, Cazzola M, and Girodon F
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anemia, Refractory complications, Anemia, Refractory mortality, Anemia, Sideroblastic complications, Anemia, Sideroblastic mortality, Blood Platelets pathology, Europe, Female, Humans, Male, Middle Aged, Mutation, Platelet Count, Retrospective Studies, Risk Factors, Survival Analysis, Thrombocythemia, Essential complications, Thrombocythemia, Essential mortality, Thrombocytosis complications, Thrombocytosis mortality, Anemia, Refractory pathology, Anemia, Sideroblastic pathology, Janus Kinase 2 genetics, Thrombocythemia, Essential pathology, Thrombocytosis pathology
- Abstract
Background: Refractory anemia with ring sideroblasts associated with marked thrombocytosis was proposed as a provisional entity in the 2001 World Health Organization classification of myeloid neoplasms and also in the 2008 version, but its existence as a single entity is contested. We wish to define the clinical features of this rare myelodysplastic/myeloproliferative neoplasm and to compare its clinical outcome with that of refractory anemia with ring sideroblasts and essential thrombocythemia., Design and Methods: We conducted a collaborative retrospective study across Europe. Our database included 200 patients diagnosed with refractory anemia with ring sideroblasts and marked thrombocytosis. For each of these patients, each patient diagnosed with refractory anemia with ring sideroblasts was matched for age and sex. At the same time, a cohort of 454 patients with essential thrombocythemia was used to compare outcomes of the two diseases., Results: In patients with refractory anemia with ring sideroblasts and marked thrombocytosis, depending on the Janus Kinase 2 V617F mutational status (positive or negative) or platelet threshold (over or below 600 × 10(9)/L), no difference in survival was noted. However, these patients had shorter overall survival and leukemia-free survival with a lower risk of thrombotic complications than did patients with essential thrombocythemia (P<0.001) but better survival (P<0.001) and a higher risk of thrombosis (P=0.039) than patients with refractory anemia with ring sideroblasts., Conclusions: The clinical course of refractory anemia with ring sideroblasts and marked thrombocytosis is better than that of refractory anemia with ring sideroblasts and worse than that of essential thrombocythemia. The higher risk of thrombotic events in this disorder suggests that anti-platelet therapy might be considered in this subset of patients. From a clinical point of view, it appears to be important to consider refractory anemia with ring sideroblasts and marked thrombocytosis as a distinct entity.
- Published
- 2012
- Full Text
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46. 3D-MRI of the ankle with optimized 3D-SPACE.
- Author
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Notohamiprodjo M, Kuschel B, Horng A, Paul D, Baer P, Li G, Garcia del Olmo JM, Reiser MF, and Glaser C
- Subjects
- Adolescent, Adult, Female, Humans, Reproducibility of Results, Sensitivity and Specificity, Algorithms, Ankle Joint anatomy & histology, Image Enhancement methods, Image Interpretation, Computer-Assisted methods, Imaging, Three-Dimensional methods, Magnetic Resonance Imaging methods
- Abstract
Purpose: To assess the use of 3-dimensional (3D) MR imaging of the ankle with the 3D-turbo-spin-echo-sequence 3D-"Sampling Perfection with Application optimized Contrast using different flip angle Evolutions" (SPACE), as compared with 2-dimensional-turbo-spin-echo-sequence., Material and Methods: After internal review board's approval and informed consent, 15 healthy volunteers and 45 consecutive patients were examined at 3 T with isotropic fat-saturated moderately T2-weighted 3D-SPACE (voxel size: 0.6(3) mm(3)/acquisition time: 6:43 minutes) featuring radial k-space reordering for optimized contrast. Signal- and contrast-to-noise ratios (SNR; CNR, respectively) were calculated with the subtraction method. Using free 3D reconstructions, 2 radiologists independently assessed depiction of cartilage, ligaments, and tendons, as well as detection and grading of abnormalities of these structures (5-point Likert scale) compared with conventional 2-dimensional-TSE-sequences (voxel size: 0.4 × 0.4 × 3 mm(3)/total acquisition time: 11 minutes). Statistical analysis was performed with Wilcoxon signed rank tests, 95% and 99% confidence intervals and weighted κ coefficients., Results: SNR and CNR of fluid/cartilage were significantly higher for 3D-SPACE (P < 0.05). The isotropic voxel size facilitated improved depiction of the medial and lateral ankle ligaments with significant differences for the calcaneofibular ligament and the anteromedial ligament complex (P < 0.05). In the patient cohort, cartilage and spring ligaments were also significantly better depicted (P < 0.05). However, there were no significant differences in the number or in the diagnostic confidence of detected cartilage, ligament, or tendon abnormalities. Interreader correlation was good (κ = 0.69-0.71) for both sequences. The correlation between the 2 sequences was excellent (κ = 0.84-0.85)., Conclusion: 3D-SPACE allows 3D acquisition and assessment of the ankle and facilitates depiction of the complex ankle anatomy at sufficient SNR and CNR.
- Published
- 2012
- Full Text
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47. The impact of repeated cost containment policies on pharmaceutical expenditure: experience in Spain.
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Moreno-Torres I, Puig-Junoy J, and Raya JM
- Subjects
- Cost Control economics, Economics, Pharmaceutical, Government Regulation, Health Policy, Humans, Public Health, Spain, Cost Control legislation & jurisprudence, Drug Costs, Drug Industry economics, Drug Industry legislation & jurisprudence, Drug Prescriptions economics, Health Expenditures legislation & jurisprudence, Pharmaceutical Preparations economics
- Abstract
The growth in expenditure on the financing of pharmaceuticals is a factor that accounts for a large part of the increase in public health spending in most developed countries. In an attempt to kerb this growth, many health authorities, particularly in Europe, have introduced numerous regulatory measures that have affected the market, especially on the supply side. These measures include the system of reference pricing, the reduction of wholesale distributors' and retailers' markups and compulsory reductions of ex-factory prices. We assess the impact of these cost containment measures on expenditure per capita, prescriptions per capita and the average price of pharmaceuticals financed by the public sector in Catalonia (Spain), from 1995 to 2006. We apply an autoregressive integrated moving average (ARIMA) time series model using dummy variables to represent the various cost containment measures implemented. Twelve of the 16 interventions analysed that were intended to contain the overall pharmaceutical expenditure were not effective in reducing it even in the short term, and the four that were effective were not so in the long term, thus amounting to a moderate annual saving.
- Published
- 2011
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- View/download PDF
48. Safety and effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dose-dependent, phase IV clinical trial.
- Author
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Jiménez JJ, Iribarren JL, Brouard M, Hernández D, Palmero S, Jiménez A, Lorente L, Machado P, Borreguero JM, Raya JM, Martín B, Pérez R, Martínez R, and Mora ML
- Subjects
- Aged, Analysis of Variance, Antifibrinolytic Agents administration & dosage, Antifibrinolytic Agents pharmacology, Body Temperature, Creatine Kinase blood, Creatine Kinase, MB Form blood, Double-Blind Method, Elective Surgical Procedures, Female, Fibrin Fibrinogen Degradation Products metabolism, Fibrinolysis drug effects, Humans, Inflammation Mediators administration & dosage, Inflammation Mediators pharmacology, Interleukin-6 blood, Lactic Acid blood, Logistic Models, Male, Middle Aged, Norepinephrine blood, Placebos, Statistics, Nonparametric, Tranexamic Acid administration & dosage, Tranexamic Acid pharmacology, Treatment Outcome, Antifibrinolytic Agents therapeutic use, Cardiopulmonary Bypass, Inflammation Mediators therapeutic use, Tranexamic Acid therapeutic use
- Abstract
Background: In cardiopulmonary bypass (CPB) patients, fibrinolysis may enhance postoperative inflammatory response. We aimed to determine whether an additional postoperative dose of antifibrinolytic tranexamic acid (TA) reduced CPB-mediated inflammatory response (IR)., Methods: We performed a randomized, double-blind, dose-dependent, parallel-groups study of elective CPB patients receiving TA. Patients were randomly assigned to either the single-dose group (40 mg/Kg TA before CPB and placebo after CPB) or the double-dose group (40 mg/Kg TA before and after CPB)., Results: 160 patients were included, 80 in each group. The incident rate of IR was significantly lower in the double-dose-group TA2 (7.5% vs. 18.8% in the single-dose group TA1; P = 0.030). After adjusting for hypertension, total protamine dose and temperature after CPB, TA2 showed a lower risk of IR compared with TA1 [OR: 0.29 (95% CI: 0.10-0.83), (P = 0.013)]. Relative risk for IR was 2.5 for TA1 (95% CI: 1.02 to 6.12). The double-dose group had significantly lower chest tube bleeding at 24 hours [671 (95% CI 549-793 vs. 826 (95% CI 704-949) mL; P = 0.01 corrected-P significant] and lower D-dimer levels at 24 hours [489 (95% CI 437-540) vs. 621(95% CI: 563-679) ng/mL; P = 0.01 corrected-P significant]. TA2 required lower levels of norepinephrine at 24 h [0.06 (95% CI: 0.03-0.09) vs. 0.20(95 CI: 0.05-0.35) after adjusting for dobutamine [F = 6.6; P = 0.014 corrected-P significant]. We found a significant direct relationship between IL-6 and temperature (rho = 0.26; P < 0.01), D-dimer (rho = 0.24; P < 0.01), norepinephrine (rho = 0.33; P < 0.01), troponin I (rho = 0.37; P < 0.01), Creatine-Kinase (rho = 0.37; P < 0.01), Creatine Kinase-MB (rho = 0.33; P < 0.01) and lactic acid (rho = 0.46; P < 0.01) at ICU arrival. Two patients (1.3%) had seizure, 3 patients (1.9%) had stroke, 14 (8.8%) had acute kidney failure, 7 (4.4%) needed dialysis, 3 (1.9%) suffered myocardial infarction and 9 (5.6%) patients died. We found no significant differences between groups regarding these events., Conclusions: Prolonged inhibition of fibrinolysis, using an additional postoperative dose of tranexamic acid reduces inflammatory response and postoperative bleeding (but not transfusion requirements) in CPB patients. A question which remains unanswered is whether the dose used was ideal in terms of safety, but not in terms of effectiveness.
- Published
- 2011
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49. Reversible bone marrow necrosis after all-trans retinoic acid induction therapy for acute promyelocytic leukaemia.
- Author
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Lakhwani S, Raya JM, González-Brito G, Álvarez-Argüelles H, Brito ML, and Hernández-Nieto L
- Subjects
- Adult, Antineoplastic Combined Chemotherapy Protocols, Enterocolitis, Pseudomembranous complications, Enterocolitis, Pseudomembranous diagnosis, Enterocolitis, Pseudomembranous drug therapy, Humans, Idarubicin therapeutic use, Leukemia, Promyelocytic, Acute complications, Leukemia, Promyelocytic, Acute drug therapy, Male, Mercaptopurine administration & dosage, Methotrexate administration & dosage, Necrosis, Recovery of Function, Remission Induction, Tretinoin therapeutic use, Vancomycin therapeutic use, Bone Marrow Cells pathology, Leukemia, Promyelocytic, Acute diagnosis, Tretinoin adverse effects
- Published
- 2011
- Full Text
- View/download PDF
50. Kell hemolytic disease of the fetus. Combination treatment with plasmapheresis and intrauterine blood transfusion.
- Author
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Lakhwani S, Machado P, Pecos P, Coloma M, Rebollo S, and Raya JM
- Subjects
- Adult, Anemia immunology, Female, Fetal Blood immunology, Fetal Diseases blood, Fetal Diseases immunology, Hematologic Diseases immunology, Humans, Pregnancy, Anemia therapy, Blood Transfusion, Intrauterine methods, Fetal Diseases therapy, Hematologic Diseases therapy, Kell Blood-Group System immunology, Plasmapheresis methods
- Abstract
We report the case of a 36-year old pregnant woman with a Kell alloimmunization (anti-K1), probably secondary to a previous blood transfusion, and a severe hemolytic disease of the fetus. Once the first fetal blood transfusion by cordocentesis was performed, we started treatment with repeated plasmapheresis to maintain anti-K1 titer below 1:32. With this scheme we did not need to perform a second intrauterine fetal blood transfusion and only mild anemia was found in the newborn. Taking into account that the rate of serious complications with plasmapheresis is lower than that related with intrauterine blood transfusion, this could be an alternative approach to repeated transfusions., (Copyright © 2011 Elsevier Ltd. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
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