Safe discontinuation of nilotinib in a patient with chronic myeloid leukemia: a case report

Case presentation. We report the case of a 64-year-old Caucasian man diagnosed with chronic-phase chronic myeloid leukemia in April 2005. After 4 years of treatment with imatinib, he became intolerant to the drug and was switched to nilotinib. Two years later, he decided to stop nilotinib. Undetectable molecular response persisted for 30 months after discontinuation of the drug. Introduction. Although there is a considerable amount of data in the literature on safe discontinuation of first-generation tyrosine kinase inhibitor therapy in patients with chronic myeloid leukemia, little is known about discontinuation of second-generation tyrosine kinase inhibitor therapy. Most previous studies have been focused on dasatinib, and the few cases of nilotinib withdrawal that have been reported had a median follow-up of 12 months. To the best of our knowledge, the present report is the first to describe nilotinib withdrawal with 30 months of follow-up. Conclusion: Our present case suggests that nilotinib withdrawal is safe for patients with chronic myeloid leukemia who achieve a stable undetectable molecular response. Our patient was homozygous for killer immunoglobulin-like receptor haplotype A, previously reported to be a promising immunogenetic marker for undetectable molecular response. We recommend additional studies to investigate patient immunogenetic profiles and their potential role in complete response to therap

Bone marrow homing and engraftment defects of human hematopoietic stem and progenitor cells

Homing of hematopoietic stem cells (HSC) to their microenvironment niches in the bone marrow is a complex process with a critical role in repopulation of the bone marrow after transplantation. This active process allows for migration of HSC from peripheral blood and their successful anchoring in bone marrow before proliferation. The process of engraftment starts with the onset of proliferation and must, therefore, be functionally dissociated from the former process. In this overview, we analyze the characteristics of stem cells (SCs) with particular emphasis on their plasticity and ability to find their way home to the bone marrow. We also address the problem of graft failure which remains a significant contributor to morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Within this context, we discuss non-malignant and malignant hematological disorders treated with reduced-intensity conditioning regimens or grafts from human leukocyte antigen (HLA)-mismatched donor

Arterial Hypertension and Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A Systematic Review and Meta-Analysis

Background: Off-target effects in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs) are associated with cardiovascular toxicity. Hypertension represents an important cardiovascular complication and, if not appropriately managed, can contribute to developing thrombotic events. Third-generation TKI ponatinib is associated with hypertension development, and its use is more restricted than in the past. Few data are reported for second-generation TKI, nilotinib, dasatinib, and bosutinib. The aim of this article was to evaluate with a systematic review and meta-analysis the real incidence of hypertension in CML patients treated with second- or third-generation TKI. Methods: The PubMed database, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for studies published between January 1, 2000, and January 30, 2021; the following terms were entered in the database queries: Cardiovascular, Chronic Myeloid Leukemia, CML, Tyrosine kinases inhibitor, TKI, and Hypertension. The study was carried out according to the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) statement. Results: A pooled analysis of hypertension incidence was 10% for all new-generation TKI, with an even higher prevalence with ponatinib (17%). The comparison with the first-generation imatinib confirmed that nilotinib was associated with a significantly increased risk of hypertension (RR 2; 95% CI; 1.39-2.88, I2=0%, z=3.73, p=0.0002). The greatest risk was found with ponatinib (RR 9.21; 95% CI; 2.86-29.66, z=3.72, p=0.0002). Conclusion: Hypertension is a common cardiovascular complication in CML patients treated with second- or third-generation TKI

Systematic Review and Meta-Analysis of Health-Related Quality of Life in Patients with β-Thalassemia Underwent Hematopoietic Stem Cell Transplantation

Abstract: Background: β-Thalassemia major (β-TM) represents one of the most important hemoglobinopathies worldwide. Remarkable improvements have been achieved in supportive therapy based on blood transfusions and iron chelation, and nowadays, this approach is capable of assuring a long life in these patients in industrialized countries. The only curative treatment is represented by hematopoietic stem cell transplantation (HSCT). However, this treatment may be burdened by deterioration in the Health-Related Quality of Life (HRQoL). This paper aimed to evaluate the role of HRQoL in transplanted β-TM patients with a systematic review and meta-analysis. Methods: PubMed database, Web of Science, and Scopus were systematically searched for studies published between January 1st, 2000 to September 2020. The following terms were entered in the database queries: β-thalassemia, HRQoL, and HSCT. The study was carried out according to the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA) statement. Results: We identified a total of 33 potential studies. Among these, 10 were finally considered in the systematic review and 5 in the meta-analysis. Overall, good scores in the principal domains of HRQoL were reported by transplanted patients. These data were confirmed by results of meta-analysis that showed significant difference between transplanted and β-TM patients treated with conventional therapy in the physical and emotional dimension, with a medium effect size [d=0.65, 95% CI (0.29-1.02), z = 3.52, p =0.0004, I2 =75%; and d=0.59, 95% CI (0.43-0.76), z = 6.99, p <0.00001,I 2 =0%, respectively]. Conclusion: HRQoL is generally good in β-TM transplanted patients and may significantly contribute in deciding whether or not to transplant a β-TM patient treated with conventional therapy

Magic extraction: solid-phase extraction and analytical pyrolysis to study polycyclic aromatic hydrocarbon and polychlorinated biphenyls in freshwater

Polycyclic aromatic hydrocarbons and polychlorinated biphenyls are commonly categorized as persistent organic pollutants. In order to analyze these pollutants, customized stationary phases are increasingly being developed and synthesized for solid-phase extraction. In this work, we tested a new solventless solid-phase extraction approach based on the use of a Magic Chemisorber (R) (Frontier Lab) which consists of a bead-covered polydimethylsiloxane stationary phase with a thickness of 500 mu m. These devices are directly immersed into aqueous samples and then introduced into a pyrolysis-gas chromatography-mass spectrometry system equipped with a cryofocusing system for the thermal desorption and analysis of the adsorbed species. Our new method performs better than the most recent solid-phase extraction devices, with limits of detection lower than 2.7 ng/L and limits of quantification lower than 9.0 ng/L. The method was tested on standard compounds and on an environmental sample, showing the potential to characterize other chemical species besides the persistent organic pollutants, such as phthalate plasticizers and antioxidants

Model study of modern oil-based paint media by triacylglycerols profiling in positive and negative ionization modes

Lipid binders have traditionally been determined in paintings by using gas chromatography/mass spectrometry (GC/MS) to identify the characteristic profiles and ratios of fatty acids . However, the presence of mixtures in contemporary and modern oil paints makes the GC/MS determination of fatty acids insufficient to fully characterize the lipid binding media. In this study we prove that triacylglycerol (TAG) profiling by high-performance liquid chromatography with high-resolution tandem mass spectrometry, using ESI in positive and negative ionization modes is highly effective. We exploited this analytical approach to study the curing and degradation processes undergone by six plant oils used in the formulation of media in modern paints, using both natural and artificial ageing experiments. We believe that is the first time that a negative ionization mode has been applied for this purpose and that a survey with HPLC-ESI-Q-ToF has been carried out to study the ageing kinetics of plant oils. TAG profiling enabled us to study the evolution over time of the constituents of modern oils, with respect to curing and ageing. The data analyzed in this study demonstrate that our approach is efficient to study the oxidation of TAGs during ageing. The data also improve current knowledge on the properties of vegetable oils, which could lead to the development of new paint materials and conservation treatments for modern and contemporary works of art

Occurrence of immune thrombocytopenic purpura in a patient with essential thrombocythemia: How the immune system can overcome a neoplastic clone

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