DOCSLIB.ORG

Bone Marrow Failure

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bone Marrow Failure Bone Marrow Failure Robert A. Brodsky, MD Johns Hopkins Family Professor of Medicine and Oncology Director, Division of Hematology Johns Hopkins University Disclosures • Dr. Brodsky serves as a Scientific Advisory Board member to Alexion Pharmaceuticals. • Alexion Pharmaceuticals – grant funding • Apellis: Scientific Advisor • Achillion: Scientific Advisor Aplastic Anemia Diagnosis And Nomenclature • SAA – Bone marrow (< 25% cellular) – Peripheral cytopenias (at least 2 of 3) • ANC < 500 per µl 2 year • Platelets < 20,000 per µl mortality • Absolute retic < 60,000 or corrected retic < 1% > 70% • VSAA: as above, but ANC < 200 • Moderate AA or (NSAA) – Hypocellular marrow but does not meet criteria for SAA APLASTIC ANEMIA Etiology • Acquired AA (most cases idiopathic) – Drugs (5 – 10%) – Infection (hepatitis –usually seronegative) – Toxic (benzene, radiation) • Inherited – Fanconi anemia – Shwachman-Diamond – Dyskeratosis congenita Aplastic Anemia: Differential Dx • Rule out inherited forms – Fanconi: all patients < 40yo (DEB,MMC) – Others: careful history • PNH - flow cytometry • Hypoplastic MDS – morphology, cytogenetics, CD34 count • LGL - flow cytometry 156 patients with marrow failure, 20 of whom have IBMFS. None of the IBMSF patients had (PNH) clones. Aplastic Anemia: Pathophysiology • Autoimmune - mediated bone marrow failure – cytotoxic T cells attack hematopoietic progenitors • CD34 pool is markedly reduced – Usually < 0.05 % , (normal 0.5% to 1.0%) APLASTIC ANEMIA: Pathophysiology High quality HSC Low quality HSC Progenitors T cells SAA Normal CD34 Pool CD34 Pool Autoimmune attack is a set-up for clonal hematopoiesis 6pLOH ~ 10-15%; PIGA mutations ~ 50% NKG2D receptor GPI-AP+ NK HSC Normal cell Cell Strong Cell kill ULBPs GPI-anchored MICA/B NK GPI-AP- Cell HSC PNH cell Weak Cell kill Katagiri T et al. Blood 2011;118:6601-6609 ©2011 by American Society of Hematology Hanaoka et al, Blood 2006 Relationship among bone Marrow Failure Diseases CHIP + PIGA PIGA AA PNH CLASSICAL PNH 6pLOH 10~12% DNMT3A ASLX1 Acquired AA Monosomy 7 MDS PIGA clonal escape AA/PNH Take Home: Autoimmune attack on stem cells Predisposes to clonal escape/malignancy Initial Management - Essentials • CBC, diff & retic, biochem profile • Bone marrow aspirate, bx, FISH and cytogenetics, CD34 Count • Peripheral blood for PNH and Fanconi • Transfuse CMV-neg., Irradiated blood products (avoid family members) • Consider prompt referral to specialized center Severe Aplastic Anemia Definitive management • Allogeneic bone marrow transplantation – HLA-identical – unrelated – mismatched • Immunosuppressive therapy – ATG/CSA • High-dose cyclophosphamide Probability of Survival after Allogeneic Transplants for SAA, Probability of Survival after Allogeneic Transplants for SAA, 2000-2009 - By Donor Type and Age - 2000-2009 100 - By Donor Type and Age - 100 90 ≤ 20y, Sibling Donor (N=1,191) 90 80 80 > 20y, Sibling Donor (N=1,256) 70 70 ≤ 20y, Unrelated Donor (N=574) 60 60 50 50 > 20y, Unrelated Donor (N=550) 40 40 30 30 Probability of Survival, % 20 20 10 10 P < 0.0001 0 0 0 1 2 3 4 5 6 CIBMTR Years Horse ATG is superior to rabbit ATG Response to ATG/CSA is roughly 60% Mortality Decreasing But response fixed Scheinberg et al, NEJM 2011,;365:430-38 ATG/CSA: Late complications Rosenfeld et. al, Jama 2003;289: 1130-35 Risk of relapse > 40% in Risk of clonal evolution responders 25-35% failure-free survival ELTROMBOPAG ADDED TO STANDARD IMMUNOSUPPRESSION AS FIRST TREATMENT IN APLASTIC ANEMIA Hematologic response h-ATG Day 1 to 4 3 mo 6 mo CSA x 6 months Cohort EPAG 150 mg Day 14 to 6 months 5 year follow-up EPAG 150 mg Day 14 to 3 mos EPAG 150 mg Day 1 to 6 months Supplemental methods: The protocol was amended starting with subject # 46 on cohort 2, so that cyclosporine was continued at a 6 fixed daily dose, 2mg/kg/day, for an additional 18 months in order to prevent relapse. Townsley, DM et al, NEJM 2017; 376:1540-50. Supplemental Figure 4 Median follow-up 23 months Refractory SAA • Repeat IST – low response rate • Supportive care • Eltrombopag (Olnes et al, NEJM 2012) • BMT – usually from a MUD or alternative donor Post Transplant High Dose Cy • Mitigates GVHD • Allows for greater use of alternative donors (haplo BMT) – No difference for engraftment or GVHD btw matched sibs and HLA-haplo identical donors • Average person in US has 4.5 HLA haplo- identical donors Conditioning for HLA Haplo- identical BMT Flu Flu Flu Flu Flu GVHD Prophylaxis: Tacrolimus, MMF, & Cy Cy Post-HSCT Cy rATG rATG rATG TBI Cy Cy -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 Flu = Fludarabine 30 mg/m2 IV daily Cy = Cyclophosphamide 14.5 mg/kg IV daily TBI = 200 cGy Cy = Cyclophosphamide 50 mg/kg IV daily rATG = Thymoglobulin 0.5 mg/kg (day-9) & 2 mg/kg (day -8,-7) 20 Mini Haplo BMT with PTCy for Refractory SAA • 21 patients with refractory SAA (median f/u 24 mos (range 3-72) − Median age: 29 years (range 5-69) − 15/21 had evidence of clonality (PNH and/or cytogenetic abnormality) − 18 haplo 1 mm URD(9/10) 2 URD (10/10) • Rapid and consistent engraftment − Day 60 chimerism 100% in 20/21 patients • One primary graft failure (engrafted with 2nd BMT from different donor) − ANC 15 days Reds 25 days Platelets 28 days • Excellent Disease Free Survival − All 21 alive, transfusion-independent, without clonality (KPS 100) − Acute GVHD grade II-IV 2/21 (9.5%) − Extensive chronic GVHD 0/21 − All off IST – median f/u 30 months Dezern et al, Biol Blood Marrow Transplant 2017, 23:498-504 Conclusions • SAA: IST vs BMT – Exciting clinical trials of IST and BMT – BMT advancing faster; solves problem of relapse and clonality – Upfront mini-haplo BMT: requires increased TBI to 400: 6/6 engrafted. • Clonality underlies most of acquired SAA • Post-transplant Cy is safely expanding the donor pool in SAA – Adopted by BMT-CTN – Standard of care for refractory SAA – Haplo BMT front-line? Paroxysmal Nocturnal Hemoglobinuria Biology • Acquired Clonal Hematopoietic Stem Cell Disease • PIG-A mutation – X(p22.1) • PIG-A gene product necessary for 1st step in the biosynthesis of GPI anchors • PNH cells have deficiency or absence of all GPI anchored proteins GPI-AP Biosynthesis: Involves >10 steps and > 25 genes plasma membrane raft N N N PIG-A PI GlcNAc-PI endoplasmic reticulum PNH Pathogenesis of hemolytic anemia • CD59 – Membrane inhibitor of reactive lysis – Prevents incorporation of C9 into C5b-8; thus, MAC does not form • CD55 – Decay accelerating factor – Block C3 convertase • Protect cells from complement-mediated destruction Effects of Terminal Complement on RBCs and Clinical Consequences in PNH esophageal spasm, abdominal pain, male ED Complement Activation Free hemoglobin is a nitric oxide scavenger Fatigue Intact RBC Thrombosis ? Free hemoglobinAnemia in the blood from destroyed PNH RBC Renal Failure Anemia/Transfusions Flow Cytometric Diagnosis of PNH PNH Aplastic anemia Brodsky RA, Blood 2009; 113(26):6522-7. PNH: Therapy • Eculizumab: – FDA approved monoclonal antibody for PNH • Allogeneic BMT - only curative therapy – Indications: severe cytopenias, poor response to eculizumab – Non-myeloablative conditioning acceptable. • Supportive care – Fe, folic acid, transfusions Brodsky RA, Blood 2009, 113:6522-7 Lectin Pathway Classical Pathway Alternate Pathway MBL, MASP, C1q, C1r, C1s C3 C4 + C2 C4 + C2 Factor B + D C3 convertases CD55 C4b2a, C3bBb C3b C5 convertases C4b2a3b, C3bBb3b C5a C 5 CD59 C6,C7,C8,C9 Eculizumab C5b Membrane attack complex (MAC) Dosing schedule: Intravenous infusion over 30 min – Induction period • 600 mg every 7±2 days for 4 doses – Maintenance period • 900 mg 1 week later, followed by… • 900 mg every 14±2 days for a total of 26 weeks Hillmen et al, NEJM 2006, 355:1233-43 Brodsky et al, Blood 2008, 111:1840-7 Effect of Eculizumab on Hemolysis – lactate dehydrogenase (LDH) 3000 Placebo 2500 2000 1500 P < 0.00000000001 1000 Eculizumab 500 Normal Lactate Dehydrogenase (IU/L) 0 Screening-4 -2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 Study Week Response to Eculizumab Hematocrit Retic count LDH Pre eculizumab 19.2 7.6 1650 post eculizumab 33.2 5.5 301 Patients continue to have compensated extravascular hemolysis Intravascular and Extravascular Hemolysis in PNH Absence of CD55 & CD59 MAC forms intravascular hemolysis PNHpatient = C3dg MAC Absence of CD55 & CD59 Extravascular hemolysis PNH patienton eculizumab Long‐term safety and efficacy of sustained eculizumab treatment in patients with paroxysmal nocturnal haemoglobinuria British Journal of Haematology Volume 162, Issue 1, pages 62-73, 25 APR 2013 DOI: 10.1111/bjh.12347 Lessons from Eculizumab Trials (TRIUMPH, SHEPHERD, EXTENSION) • Safe – Mild side-effects – 1000-2000 fold increased risk for Neisserial infections (~0.5% per year) – Strongly consider microbial prophylaxis – PCN – Macrolide if Pen allergic • Effective – Decreases intravascular hemolysis – Decreases (>90%) or eliminates (>75%) need for PRBC – Improves quality of life – Reduces the risk for thrombosis by >90% Lessons from Eculizumab Trials – cont. (TRIUMPH, SHEPHERD, EXTENSION) • Drawbacks – Lifelong therapy intravenous therapy – Cost (> 350K a year) – Some patients have a lot of extravascular hemolysis • Indications – Severe anemia – thrombosis – Disabling fatigue or other severe symptoms – Labs: large clone, high retic, LDH > 2x ULN – Bone marrow: normal to hypercellular • Not as effective in patients with AA/PNH – Does not treat bone marrow failure How to monitor PNH pt of eculizumab • CBC with retic, LDH, comp once a month – Draw labs before giving drug • PNH clone every 12 months
Load more

Recommended publications
  • Paroxysmal Nocturnal Haemoglobinuria: a Case Series from Oman Arwa Z
    Paroxysmal Nocturnal Haemoglobinuria: A Case Series from Oman Arwa Z. Al-Riyami1*, Yahya Al-Kindi2, Jamal Al-Qassabi1, Sahimah Al-Mamari1, Naglaa Fawaz1, Murtadha Al-Khabori1 , Mohammed Al-Huneini1 and Salam AlKindi3 1Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman 2College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman 3Department of Hematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman Received: 17 August 2020 Accepted: 23 December 2020 *Corresponding author: [email protected] DOI 10.5001/omj.2022.13 Abstract Introduction Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired stem cell disorder that manifests by hemolytic anemia, thrombosis and cytopenia. There are no data on PNH among Omani patients. Methods We performed a retrospective review of all patients tested for PNH by flow cytometry at the Sultan Qaboos University Hospital between 2012 and 2019. Manifestations, treatment modalities and outcomes were assessed. Results Total of 10 patients were diagnosed or were on follow up for PNH (median age 22.5 years). Clinical manifestations included fatigue (80%) and anemia (70%). There were six patients who had classical PNH with evidence of hemolysis, three patient had PNH in the context of aplastic anemia, and one patient with subclinical PNH. The median reported total type II+III clone size was 95.5 (range 1.54-97) in neutrophils (FLAER/CD24) and 91.6 (range 0.036-99) in monocytes (FLAER/CD14). There were four patients who were found to have a clone size > 50% at time of diagnosis. The median follow up of the patients were 62 months (range: 8-204).
    [Show full text]
  • Increased Red Cell Distribution Width in Fanconi Anemia: a Novel Marker Of
    Sousa et al. Orphanet Journal of Rare Diseases (2016) 11:102 DOI 10.1186/s13023-016-0485-0 RESEARCH Open Access Increased red cell distribution width in Fanconi anemia: a novel marker of stress erythropoiesis Rosa Sousa1, Cristina Gonçalves2, Isabel Couto Guerra3, Emília Costa3, Ana Fernandes4, Maria do Bom Sucesso4, Joana Azevedo5, Alfredo Rodriguez6, Rocio Rius6, Carlos Seabra7, Fátima Ferreira8, Letícia Ribeiro5, Anabela Ferrão9, Sérgio Castedo10, Esmeralda Cleto3, Jorge Coutinho2, Félix Carvalho11, José Barbot3 and Beatriz Porto1* Abstract Background: Red cell distribution width (RDW), a classical parameter used in the differential diagnosis of anemia, has recently been recognized as a marker of chronic inflammation and high levels of oxidative stress (OS). Fanconi anemia (FA) is a genetic disorder associated to redox imbalance and dysfunctional response to OS. Clinically, it is characterized by progressive bone marrow failure, which remains the primary cause of morbidity and mortality. Macrocytosis and increased fetal hemoglobin, two indicators of bone marrow stress erythropoiesis, are generally the first hematological manifestations to appear in FA. However, the significance of RDW and its possible relation to stress erythropoiesis have never been explored in FA. In the present study we analyzed routine complete blood counts from 34 FA patients and evaluated RDW, correlating with the hematological parameters most consistently associated with the FA phenotype. Results: We showed, for the first time, that RDW is significantly increased in FA. We also showed that increased RDW is correlated with thrombocytopenia, neutropenia and, most importantly, highly correlated with anemia. Analyzing sequential hemograms from 3 FA patients with different clinical outcomes, during 10 years follow-up, we confirmed a consistent association between increased RDW and decreased hemoglobin, which supports the postulated importance of RDW in the evaluation of hematological disease progression.
    [Show full text]
  • Phenotypic Correction of Fanconi Anemia in Human Hematopoietic Cells with a Recombinant Adeno-Associated Virus Vector
    Phenotypic correction of Fanconi anemia in human hematopoietic cells with a recombinant adeno-associated virus vector. C E Walsh, … , N S Young, J M Liu J Clin Invest. 1994;94(4):1440-1448. https://doi.org/10.1172/JCI117481. Research Article Find the latest version: https://jci.me/117481/pdf Phenotypic Correction of Fanconi Anemia in Human Hematopoietic Cells with a Recombinant Adeno-associated Virus Vector Christopher E. Walsh,* Arthur W. Nienhuis, Richard Jude Samulski,5 Michael G. Brown,11 Jeffery L. Miller,* Neal S. Young,* and Johnson M. Liu* *Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892; tSt. Jude Children's Research Hospital, Memphis, Tennessee 38112; §Department of Pharmacology, University of North Carolina, Chapel Hill, North Carolina 27599; and 11Oregon Health Sciences University, Portland, Oregon 97201 Abstract ity to malignancy (1). Most patients are diagnosed in the first decade of life and die as young adults, usually from complica- Fanconi anemia (FA) is a recessive inherited disease charac- tions of severe bone marrow failure or, more rarely, from the terized by defective DNA repair. FA cells are hypersensitive development of acute leukemia or solid tumors. Therapy is to DNA cross-linking agents that cause chromosomal insta- currently limited to allogeneic bone marrow transplantation bility and cell death. FA is manifested clinically by progres- from a histocompatible sibling, but most patients do not have sive pancytopenia, variable physical anomalies, and predis- an appropriate marrow donor (2). position to malignancy. Four complementation groups have Although the biochemical defect in FA has not been deline- been identified, termed A, B, C, and D.
    [Show full text]
  • Aplastic Anemia: Diagnosis and Treatment Gabrielle Meyers, MD, and Curtis Lachowiez, MD
    Clinical Review Aplastic Anemia: Diagnosis and Treatment Gabrielle Meyers, MD, and Curtis Lachowiez, MD year. 2,3 A recent Scandinavian study reported that the in- ABSTRACT cidence of aplastic anemia among the Swedish popula- Objective: To describe the current approach to diagnosis tion is 2.3 cases per million individuals per year, with a and treatment of aplastic anemia. median age at diagnosis of 60 years and a slight female 2 Methods: Review of the literature. predominance (52% versus 48%, respectively). This data is congruent with prior observations made in Barcelona, Results: Aplastic anemia can be acquired or associated with an inherited marrow failure syndrome (IMFS), where the incidence was 2.34 cases per million individu- and the treatment and prognosis vary dramatically als per year, albeit with a slightly higher incidence in males between these 2 etiologies. Patients may present along compared to females (2.54 versus 2.16, respectively).4 The a spectrum, ranging from being asymptomatic with incidence of aplastic anemia varies globally, with a dispro- incidental findings on peripheral blood testing to life- portionate increase in incidence seen among Asian pop- threatening neutropenic infections or bleeding. Workup ulations, with rates as high as 8.8 per million individuals and diagnosis involves investigating IMFSs and ruling per year.3-5 This variation in incidence in Asia versus other out malignant or infectious etiologies for pancytopenia. countries has not been well explained. There appears to Conclusion: Treatment outcomes are excellent with modern be a bimodal distribution, with incidence peaks seen in supportive care and the current approach to allogeneic young adults and in older adults.2,3,6 transplantation, and therefore referral to a bone marrow transplant program to evaluate for early transplantation is Pathophysiology the new standard of care for aplastic anemia.
    [Show full text]
  • Prevelance, Incidence and Risk of Leukemic Transformation in IBMFS • Incidence: ~ 60 Per Million Live Births – Fanconi Anemia > DBA > Schwachman‐Diamond > DC
    Prevelance, Incidence and Risk of Leukemic Transformation in IBMFS • Incidence: ~ 60 per million live births – Fanconi anemia > DBA > Schwachman‐Diamond > DC • Prevalence: – DBA > FA > Schwachman‐Diamond > DC • Risk of leukemia – FA and DC > DBA or Schwachman‐Diamond Clinical presentation: Fanconi Anemia • Usually presents with physical anomalies early in life or with hemtaologic manifestations within the first decade. • Cytopenias (usually thrombocytopenia followed by progressive pancytopenia; affect 90% of patients by age 40). • Incidence: less than 1/100,000 Physical Findings in Fanconi Anemia • Café‐au‐lait spots & other pigmentation changes (65%) • Short stature (60%) • Upper limb abnormalities (hypoplastic or bifid/supernumerary thumbs most common, 50%) • “Fanconi facies” Hematology: Basic Principles and Practice Hoffman ed. Copyright © 2005 Elsevier Inc. (USA) Laboratory Assays in Fanconi Anemia Reflect Defect in DNA Repair DEB or MMC DEB = dihypoxybutane MMC = mitomycin C Howlett laboratory website, Univ. of Michigan Medical School Leukemic Transformation • Fanconi anemia patients –predisposed to malignancies – avg. age 16 as opposed to 68 for the general population – head/neck and esophageal Ca more common solid tumors • 120 of 754 registered FA patients have developed hematologic malignancies (60 AML, 53 MDS, and 5 ALL) Ref: 'Cancer in Fanconi Anemia, 1927‐2001.' Cancer 97:425‐440, 2003. Bone Marrow Transplant in Fanconi Anemia • BMT is the main therapeutic approach for marrow failure in Fanconi anemia • Ideally the donor is
    [Show full text]
  • Blueprint Genetics Anemia Panel
    Anemia Panel Test code: HE0401 Is a 88 gene panel that includes assessment of non-coding variants. Is ideal for patients suspected to have hereditary anemia who have had HBA1 and HBA2 variants excluded as the cause of their anemia or patients suspected to have hereditary anemia who are not suspected to have HBA1 or HBA2 variants as the cause of their anemia. The genes on this panel are included in the Comprehensive Hematology Panel. Is not recommended for patients suspected to have anemia due to alpha-thalassemia (HBA1 or HBA2). These genes are highly homologous reducing mutation detection rate due to challenges in variant call and difficult to detect mutation profile (deletions and gene-fusions within the homologous genes tandem in the human genome). Is not recommended for patients with a suspicion of severe Hemophilia A if the common inversions are not excluded by previous testing. An intron 22 inversion of the F8 gene is identified in 43%-45% individuals with severe hemophilia A and intron 1 inversion in 2%-5% (GeneReviews NBK1404; PMID:8275087, 8490618, 29296726, 27292088, 22282501, 11756167). This test does not detect reliably these inversions. About Anemia Anemia is defined as a decrease in the amount of red blood cells or hemoglobin in the blood. The symptoms of anemia include fatigue, weakness, pale skin, and shortness of breath. Other more serious symptoms may occur depending on the underlying cause. The causes of anemia may be classified as impaired red blood cell (RBC) production or increased RBC destruction (hemolytic anemias). Hereditary anemia may be clinically highly variable, including mild, moderate, or severe forms.
    [Show full text]
  • Bone Marrow Failure Syndromes, Overlapping Diseases with a Common Cytokine Signature
    International Journal of Molecular Sciences Review Bone Marrow Failure Syndromes, Overlapping Diseases with a Common Cytokine Signature Valentina Giudice 1,2,3 , Chiara Cardamone 1,4 , Massimo Triggiani 1,4,* and Carmine Selleri 1,3 1 Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; [email protected] (V.G.); [email protected] (C.C.); [email protected] (C.S.) 2 Clinical Pharmacology, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy 3 Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy 4 Internal Medicine and Clinical Immunology, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy * Correspondence: [email protected]; Tel.: +39-089-672810 Abstract: Bone marrow failure (BMF) syndromes are a heterogenous group of non-malignant hemato- logic diseases characterized by single- or multi-lineage cytopenia(s) with either inherited or acquired pathogenesis. Aberrant T or B cells or innate immune responses are variously involved in the pathophysiology of BMF, and hematological improvement after standard immunosuppressive or anti-complement therapies is the main indirect evidence of the central role of the immune system in BMF development. As part of this immune derangement, pro-inflammatory cytokines play an important role in shaping the immune responses and in sustaining inflammation during marrow failure. In this review, we summarize current knowledge of cytokine signatures in BMF syndromes. Keywords: cytokines; bone marrow failure syndromes; aplastic anemia; myelodysplastic syndromes Citation: Giudice, V.; Cardamone, C.; Triggiani, M.; Selleri, C. Bone Marrow 1.
    [Show full text]
  • Darbepoetin Alfa for the Treatment of Anaemia in Alpha Or Beta
    Correspondence Keywords: Fanconi anaemia, Sweet syndrome. First published online 19 April 2011 doi: 10.1111/j.1365-2141.2011.08604.x References Chatham-Stephens, K., Devere, T., Guzman-Cottrill, with Fanconi anemia. Journal of Pediatric J. & Kurre, P. (2008) Metachronous manifesta- Hematology/oncology, 23, 59–62. Alter, B.P. (2003) Cancer in Fanconi anemia, 1927– tions of Sweet’s syndrome in a neutropenic Vardiman, J.W., Thiele, J., Arber, D.A., Brunning, 2001. Cancer, 97, 425–440. patient with Fanconi anemia. Pediatric Blood & R.D., Borowitz, M.J., Porwit, A., Harris, N.L., Le Baron, F., Sybert, V.P. & Andrews, R.G. (1989) Cancer, 51, 128–130. Beau, M.M., Hellstro¨m-Lindberg, E., Tefferi, A. & Cutaneous and extracutaneous neutrophilic Guhl, G. & Garcia-Diez, A. (2008) Subcutaneous Bloomfield, C.D. (2009) The 2008 revision of the infiltrates (Sweet syndrome) in three patients sweet syndrome. Dermatologic Clinics, 26, World Health Organization (WHO) classification with Fanconi anemia. Journal of Pediatrics, 115, 541–551. viii–ix. of myeloid neoplasms and acute leukemia: 726–729. Hospach, T., von den Driesch, P. & Dannecker, G.E. rationale and important changes. Blood, 114, Briot, D., Mace-Aime, G., Subra, F. & Rosselli, F. (2009) Acute febrile neutrophilic dermatosis 937–951. (2008) Aberrant activation of stress-response (Sweet’s syndrome) in childhood and adoles- Vignon-Pennamen, M.D., Juillard, C., Rybojad, M., pathways leads to TNF-alpha oversecretion in cence: two new patients and review of the liter- Wallach, D., Daniel, M.T., Morel, P., Verola, O. Fanconi anemia. Blood, 111, 1913–1923. ature on associated diseases. European Journal of & Janin, A.
    [Show full text]
  • Genetic Screening for Heritable Traits Contents
    Chapter 7 Genetic Screening for Heritable Traits Contents Red Blood Cell Traits . 89 Glucose-6-Phosphate Dehydrogenase Deficiency and Hemolytic Anemia . 90 Sickle-Cell Trait and Sickle-Cell Anemia . 91 The Thalassemias and Erythroblastic Anemia . 91 NADH Dehydrogenase Deficiency and Methemoglobinemia. .. .. .. .. ... ... ......O 92 Traits Correlated With Lung Disease . 93 Serum Alpha1 Antitrypsin Deficiency and Susceptibility to Emphysema . 93 Aryl Hydrocarbon Hydroxylase Inducibility and Susceptibility to Lung Cancer . 94 Other Characterized Genetic Traits . 95 Acetylation and Susceptibility to Arylamine-Induced Bladder Cancer . 95 HLA and Disease Associations . 96 Carbon Oxidation . 96 Diseases of DNA Repair. 96 Less Well-Characterized Genetic Traits . 97 Superoxide Dismutase . 97 Immunoglobuhn A Deficiency . 97 Paraoxanase Polymorphism . .. ., . .., ... ... ...,. 97 Pseudocholinesterase Variants . 98 Erythrocyte Catalase Deficiency . 98 Dermatological Susceptibility . 98 Conclusions . 98 Priorities for Future Research .......,.. 100 Red Blood Cell Traits . 100 Differential Metabolism of Industrial/Pharmacological Compounds . 100 SAT Deficiency . 101 Chapter preferences . 101 Figure Figure No. Page 8.Distribution of Red Cell Phosphatase Activities in the English Population . 99 Chapter 7 Genetic Screening for Heritable Traits Individuals differ widely in their susceptibility each genetic trait, the following questions were to environmentally induced diseases. Differential asked: susceptibility is known to be affected by devel- What is its prevalence in the population? opmental and aging processes, genetic character- Is it compatible with a normal lifestyle? istics, nutritional status, and the presence of With what diseases does the trait correlate? preexisting diseases (11,12). This chapter assesses In what industrial settings might the traits the way in which genetic factors contribute to cause a person to be at increased risk? the occurrence of differential susceptibility to tox- Is there an increased risk for homozygous ic substances.
    [Show full text]
  • Fanconi's Anemia
    Fanconi’s anemia Author: Doctor Ethel Moustacchi1 Creation Date: September 2002 Update: October 2003 Scientific Editor: Professor Nicole Casadevall 1CNRS UMR 218 Section de recherche, Institut Curie, 26 Rue d'Ulm, 75248 Paris Cedex 5, France. [email protected] Abstract Key-words Name of the disease Definition Differential diagnosis Frequency Clinical description Treatment Etiology Genetic counselling Prenatal diagnosis Unresolved questions References Abstract An autosomal recessive disease associated with chromosomal instability, Fanconi's anemia (FA) is remarkable by its phenotypic heterogeneity, which includes bone-marrow failure, a variety of congenital malformations, a propensity to develop acute myeloid leukemia (AML) and cellular hypersensitivity to DNA cross-linking agents. This property has allowed the study of the mechanisms underlying the disease and also contributes to making the clinical diagnosis. FA has been found in all ethnic groups. Its frequency has been estimated to be 1/350,000 births. FA is characterized clinically by pancytopenia, progressive aplastic anemia, diverse congenital malformations and, above all, a marked predisposition to develop AML. The congenital anomalies include skeletal malformations, hyperpigmentation, urogenital, renal and cardiac anomalies. The hematological disorders resulting from bone marrow dysfunction (thrombocytopenia, progressive pancytopenia) usually appear around a mean age of 7 years, but they can arise very early, at birth, or, even more rarely, very late around 40 years of age. Bone-marrow or umbilical cord-blood transplantations are the main treatment, relatively effective, of the hematological failure typical of FA. Even if it is not yet effective, it seems that cellular therapy with isolated and characterized stem cells is a promising approach for FA patients.
    [Show full text]
  • Your Guide to Anemia
    IN BRIEF: Your Guide to Anemia Anemia is a blood disorder. Blood is a vital liquid that In some types of anemia, such as aplastic anemia, your your heart constantly pumps through your veins and body also doesn’t have enough of other types of blood arteries and all throughout your body. When some- cells, such as white blood cells (WBCs) and platelets. thing goes wrong in your blood, it can affect your WBCs help your body’s immune system fight infec- health and quality of life. tions. Platelets help your blood clot, which helps stop bleeding. Many types of anemia exist, such as iron-deficiency anemia, pernicious anemia, aplastic anemia, and hemo- Many diseases, conditions, and other factors can lytic anemia. The different types of anemia are linked cause anemia. For example, anemia may occur dur- to various diseases and conditions. ing pregnancy if the body can’t meet its increased need for RBCs. Certain autoimmune disorders and other Anemia can affect people of all ages, races, and ethnici- conditions may cause your body to make proteins that ties. Some types of anemia are very common, and some destroy your RBCs, which can lead to anemia. Heavy are very rare. Some are very mild, and others are severe internal or external bleeding—from injuries, for or even life-threatening if not treated aggressively. The example—may cause anemia because your body loses good news is that anemia often can be successfully too many RBCs. treated and even prevented. The causes of anemia can be acquired or inherited. What Causes Anemia? “Acquired” means you aren’t born with the condition, Anemia occurs if your body makes too few red blood but you develop it.
    [Show full text]
  • Fanconi Anemia Testing Details
    Fanconi Anemia Fanconi anemia (FA) is a rare, inherited chromosome instability syndrome, estimated to occur in 1 in 100,000 live births. Patients with FA have varied clinical manifestations. Most patients experience bone marrow failure at a median age of five years. Progressive pancytopenia and congenital malformations, including short stature, radial aplasia, urinary tract abnormalities, hyperpigmentation, and developmental delay are common symptoms. FA is associated with a predisposition to cancer, particularly acute myeloid leukemia and an increased risk of developing solid tumors. The symptoms of FA are highly variable; treatment depends on the symptoms experienced by the individual patient. Indications: Testing for Fanconi anemia is indicated in young patients with aplastic anemia, arm and/or thumb, cardiac, central nervous system, genitourinary, kidney, and/or skeletal system anomalies, hyper-pigmentation, small size, and/or bleeding disorders. For more information call 513-636-4474 or visit www.cincinnatichildrens.org/FanconiTesting We also offer testing for other chromosome breakage disorders including Sister Chromatid Exchange (SCE) analysis for Bloom syndrome. Please see our website for additional information. Recommended Testing Algorithm Negative Breakage Study: Patient does not have FA, or possible mosaicism Test 1: Chromosome Breakage Positive Breakage Study: Confirms diagnosis of FA Test 2: Two mutations identified in same AR Fanconi Anemia Panel gene or 1 mutation in FANCB: (22 genes) by Next Genetic diagnosis of FA Generation Sequencing No mutations identified or 1 mutation identified in AR gene, or variant(s) of uncertain significance *Complementation Testing (available for research/ investigational purposes only) Deletion/Duplication testing This is the suggested testing algorithm. Please note that any test can be requested in any order.
    [Show full text]