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LETTERS TO THE EDITORTurk J Hematol 2021;38:228-245Table 1. Continued.OS(months)Durationofremission(months)RemissionstatusBone marrowcellularityMarrow blasts(%) before theapplication ofthe regimenStatusNCCN riskcategoryFABtypingGene mutationKaryotypeat firstdiagnosisAge(years)No. SexFLT3-ITD M2b High Second relapse 9.8% Normocellular CR 14 5346,XY,t(8;21)(q22;q22)12 M 6813 M 59 Normal FLT3-ITD M4 High First relapse 4.8% Hypocellular NR - 2214 M 67 47,XY,+8[10] (-) M4 Intermediate First relapse 12.4% Normocellular NR - 28M5 High First relapse 27.2% Normocellular NR - 20FLT3-TKD, DNMT3A,NPM115 M 55 Normal16 F 58 Normal TET2 M5b Intermediate First relapse 48% Hyperactive CR 2 1817 F 43 Normal FLT3-ITD, NPM1 M7 High First relapse 12.2% Normocellular CR 9 20Hypocellular CR 22 370%, AML-ETO/ABL 0.010%(-) M2a Low CR with MRD+46,XY,t(8;21)(q22;q22)[10]18 M 28©Copyright 2021 by Turkish Society of HematologyTurkish Journal of Hematology, Published by Galenos Publishing HouseNormocellular CR 23 510.2%, AML-ETO/ABL 0.082%(-) M2b Low CR with MRD+46,XX,t(8,21)(q22,q22)[20]19 M 38Normocellular CR - 410%, CBFB-MYH11A/ABL0.016%M4 Low CR with MRD+IKZF1, ERG, MLL-PTD46,XY,inv(16)(p13q22)[17]20 M 47Hypocellular CR 28 520.8%, WT1/ABL0.40%IDH2, TET2 M5b High CR with MRD+46,XY,add(12)(q24)(8)/47,idm,+8(2)21 M 58FAB: French-American-British; NCCN: National Comprehensive Cancer Network; OS: overall survival; CR: complete remission; MRD: minimal residual disease; CRi: CR with incomplete recovery of blood cells; NR: noremission.Authorship ContributionsConcept: C.C., R.M. D.L., L.C., X.W.; Writing: C.C., R.M.Conflict of Interest: No conflict of interest wasdeclared by the authors.Financial Disclosure: This study was supportedby the Henan Science and Technology ResearchProject (No. 192102310056; No. 202102310053).References1. Dohner H, Weisdorf DJ, Bloomfield CD. Acute myeloidleukemia. N Engl J Med 2015;373:1136-1152.2. Schuurhuis GJ, Heuser M, Freeman S, Béné M-C, BuccisanoF, Cloos J, Grimwade D, Haferlach T, Hills RK, Hourigan CS,Jorgensen JL, Kern W, Lacombe F, Maurillo L, PreudhommeC, van der Reijden BA, Thiede C, Venditti A, Vyas P, Wood BL,Walter RB, Döhner K, Roboz GJ, Ossenkoppele GJ. Minimal/measurable residual disease in AML: a consensus documentfrom the European LeukemiaNet MRD Working Party. Blood2018;131:1275-1291.3. Wei XD, Ai H, Mi RH, Chen L, Yuan FF, Hao QM, Yin QS,Wang P, Song YP. Thalidomide combined with interferonand interleukin-2 in treatment of relapsed or refractoryacute myelogenous leukemia. Zhonghua Nei Ke Za Zhi2016;5511:875-877.4. Mi RH, Chen L, Wei XD, Yin QS, Wang MF, Liang LJ, YuanFF, Li MJ, Ji XJ, Song YP. Therapeutic effect of combineduse of interferon alpha-1b, interleukin-2 and thalidomideon reversing minimal residual disease in acute myeloidleukemia. Zhonghua Xue Ye Xue Za Zhi 2019;40:111-116.5. Anguille S, Lion E, Willemen Y, Van Tendeloo VF, BernemanZN, Smits EL. Interferon-α in acute myeloid leukemia: anold drug revisited. Leukemia 2011;25:739-748.6. Ferrantini M, Capone I, Belardelli F. Interferon-α and cancer:mechanisms of action and new perspectives of clinical use.Biochimie 2007;89:884-893.7. Inamoto Y, Fefer A, Sandmaier BM, Gooley TA, WarrenEH, Petersdorf SH, Sanders JE, Storb RF, Appelbaum FR,Martin PJ, Flowers ME. A phase I/II study of chemotherapyfollowed by donor lymphocyte infusion plus interleukin-2for relapsed acute leukemia after allogeneic hematopoieticcell transplantation. Biol Blood Marrow Transplant2011;17:1308-1315.8. Skarbnik AP, Goy AH. Lenalidomide for mantle celllymphoma. Expert Rev Hematol 2015;8:257-264.9. Ruan J, Martin P, Shah B, Schuster SJ, Smith SM, FurmanRR, Christos P, Rodriguez A, Svoboda J, Lewis J, Katz O,Coleman M, Leonard JP. Lenalidomide plus rituximab asinitial treatment for mantle-cell lymphoma. N Engl J Med2015;373:1835-1844.10. Luo J, Gagne JJ, Landon J, Avorn J, Kesselheim AS.Comparative effectiveness and safety of thalidomide andlenalidomide in patients with multiple myeloma in theUnited States of America: a population-based cohort study.Eur J Cancer 2017;70:22-33.232Address for Correspondence/Yazışma Adresi: Xudong Wei, Prof., Affiliated Tumor Hospital of ZhengzhouUniversity, Henan Cancer Hospital, Department of Hematology, Zhengzhou, ChinaPhone : 0371-65587358E-mail : xudongwei@zzu.edu.cn ORCID: orcid.org/0000-0002-6289-2011Received/Geliş tarihi: January 19, 2021Accepted/Kabul tarihi: May 17, 2021DOI: 10.4274/tjh.galenos.2021.2020.0050
Turk J Hematol 2021;38:228-245LETTERS TO THE EDITORShoulder-Pad Sign in a Case of Amyloidosis Associated withMyelomaMyelom ile İlişkili Sistemik Amiloidoz Olgusunda Omuz-Yastığı IşaretiCeren Uzunoğlu 1 , Tayfur Toptaş 2 , Yıldız İpek 2 , Fatma Arıkan 2 , Fergün Yılmaz 2 , Tülin Tuğlular 21Marmara University Training and Research Hospital, Clinic of Internal Disease, İstanbul, Turkey2Marmara University Training and Research Hospital, Clinic of Hematology, İstanbul, TurkeyTo the Editor,A 78-year-old female was admitted with the complaints ofmultiple joint swellings that had progressed over 8 months,involving the shoulders, elbows, wrists, knees, and ankles.On physical examination, she had generalized edema. Thetongue was enlarged. Joint examination revealed swelling andtenderness of the bilateral anterior parts of the shoulders,elbows, wrists, knees, and ankles (Figure 1).“Shoulder-pad sign” is the prominent appearance of the bilateralanterior deltoid area. It is rare but suggestive for amyloidlight-chain amyloidosis. It is mostly associated with the kappalight chain, which has a predilection for amyloid deposition inperiarticular tissues [1].Her complete blood count and calcium levels were as follows:leukocytes, 5100/µL; hemoglobin, 5.2 g/dL; hematocrit,16%; platelets, 313,000/µL; serum calcium, 11.9 mg/dL.Serum total protein and albumin levels were 4.6 g/dL and3.0 g/dL, respectively. Serum free light chain kappa, lambda, andkappa/lambda ratio were 6792 mg/L, 7.31 mg/L, and 929,respectively. Serum immunofixation electrophoresis wasconsistent with the kappa monoclonal band. Proteinuria (5 g)was identified upon 24-h urine analysis.Bone marrow biopsy showed plasma cells infiltrating 86% ofbone marrow (Figure 2). No lytic bone lesions were detected onpositron emission tomography-computed tomography, but therewere joint involvements compatible with inflammatory processes.Significant thickening of the subdeltoid bursa was evident uponshoulder magnetic resonance imaging (Figure 3). Bone marrowbiopsy with Congo red staining revealed a green birefringentcolor representing amyloid deposition. A diagnosis of systemicamyloidosis associated with multiple myeloma was made.Figure 2. Bone marrow biopsy showed plasma cells infiltrating86% of bone marrow.Figure 1. Joint examination revealed swelling and tenderness ofthe bilateral anterior parts of the shoulders, elbows, wrists, knees,and ankles.Figure 3. Significant thickening of the subdeltoid bursa wasevident upon shoulder magnetic resonance imaging.233
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