RESUMO
BACKGROUND: The ABO blood group may influence the development and progression of cancer. In particular, the prognosis of patients with blood type O is better for pancreatic adenocarcinoma, although this has not been extensively explored in pancreatic neuroendocrine tumors (PanNET). OBJECTIVE: To assess the influence of the ABO and Rhesus blood types on the risk of recurrence in patients who underwent curative intent PanNET surgical resection. METHODS: All consecutive patients operated on for well-differentiated panNET in an expert center from 2003 to 2018 were retrospectively included. Blood group, Rhesus system, demographic and clinical data were collected. The primary endpoint was recurrence free survival (RFS). Factors associated with RFS were explored using Cox proportional hazard models. RESULTS: Overall, 300 patients (male 43%) were included, median age 54 years old (IQR 45-64). The ABO blood group distribution was similar to that of the French population. There was no association between blood group and tumor features. The median postoperative follow-up was 43.9 months (17.0-77.8). The 5- and 10-year RFS rates were 85 ± 4% and 71 ± 13% in O RhD + patients, versus 72 ± 4% and 63 ± 6% otherwise, respectively (p = 0.035). The O RhD + blood group was associated with a decreased risk of recurrence (HR 0.34, 95% CI [0.15-0.75]), p = 0.007 in multivariable analysis adjusted for age, ki67, functioning syndrome, resection margins, tumor size, lymph node status, oncogenetic syndrome. CONCLUSIONS: After curative-intent surgical resection for PanNET, patients with a non-O RhD + blood group may have an increased risk of recurrence and could benefit from closer follow-up.
Assuntos
Tipagem e Reações Cruzadas Sanguíneas , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Humanos , Margens de Excisão , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/diagnóstico , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico , Prognóstico , Estudos RetrospectivosRESUMO
We report on our experiences since 2010 with pregnant women with rare blood types. The lack of compatible blood is a challenge for the anaesthetist whose priority is to prevent and treat anaemia in late pregnancy in order to avoid immunisation after transfusion of incompatible blood. In our hospital, the blood type is checked during the first obstetric consult, which is variable, starting from the fourth month of pregnancy. Rare blood types are most often diagnosed in an advanced stage of pregnancy (30 weeks of gestation: WG) due to the late inscription for obstetrics consult, resulting in even later anaesthetic visit. In our 13 patients, the most common blood systems are Duffy, MNS, and RH. 61.5% of the patients have associated antibodies (anti-MNS5). The majority of patients received iron with significant increase of ferritin (17.24 ± 12.95 µg/L versus 262.2 ± 404.4 µg/L, p = .033). Six of the patients had 2-3 injections of EPO between 29 - 36 + 1 WG. There were no transfers for paediatric management of haemolytic disease in the newborn following the birth. Overall, this treatment of patients with a rare blood group has also changed our practices for the follow-up of other pregnant women, and ferritin is more regularly prescribed.Impact statementWhat is already known on this subject? For rare blood groups, the frequency in the general population is less than 1/4000. The most common antibodies at risk of haemolytic disease and 'hydrops fetalis' are anti-D, anti-E, anti-C, and anti-K. The survey of pregnant women with a rare blood type takes into account the maternal risk of 'transfusion deadlock' and haemolytic disease of the newborn.What do the results of this study add? Rare blood types are most often diagnosed in an advanced stage of pregnancy (30 WG) due to the late inscription for obstetrics consults at Maternity. The most common blood systems are Duffy, MNS, RH, and 61.5% of the patients have associated antibodies (anti-MNS5). The most efficient treatment of prenatal anaemia was iron perfusions who allowed significant increase of ferritin and a maternal haemoglobin concentration of 12.1±1.46 g/dL in the ninth month of pregnancy.What are the implications of these findings for clinical practice and/or further research? A pregnant woman with a rare blood group is a situation that requires a technical platform specialised in haemorrhagic risk and a multidisciplinary team, including a blood bank as well as anaesthetic and obstetrical teams, with excellent interdisciplinary coordination.
Assuntos
Anemia , Incompatibilidade de Grupos Sanguíneos/prevenção & controle , Tipagem e Reações Cruzadas Sanguíneas/métodos , Transfusão de Sangue/métodos , Complicações Hematológicas na Gravidez , Reação Transfusional , Adulto , Anemia/sangue , Anemia/epidemiologia , Anemia/terapia , Sistema do Grupo Sanguíneo Duffy , Diagnóstico Precoce , Feminino , França/epidemiologia , Humanos , Recém-Nascido , Ferro/uso terapêutico , Sistema do Grupo Sanguíneo MNSs , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/epidemiologia , Complicações Hematológicas na Gravidez/terapia , Resultado da Gravidez , Sistema do Grupo Sanguíneo Rh-Hr , Risco Ajustado/métodos , Oligoelementos/uso terapêutico , Reação Transfusional/etiologia , Reação Transfusional/prevenção & controleRESUMO
The emergence of SARS-CoV-2 Omicron variant has led to a complete reconfiguration of the therapeutic landscape, with all monoclonal antibodies having lost any neutralization activity. We report here a case series of 75 immunocompromised patients infected by the Omicron variant who benefited from COVID-19 convalescent plasma (CCP). At Day 28, the overall survival was 76% (95% CI 67-86) with no significant difference in the clinical outcome between patients with hematological malignancies, solid organ transplantation or autoimmune diseases. No safety concern was reported during the course of the study. These results showed that CCP is well tolerated and represents a treatment option for immunocompromised patients who remain highly impacted by the COVID19 epidemic.
Assuntos
COVID-19 , Humanos , COVID-19/terapia , Soroterapia para COVID-19 , SARS-CoV-2 , Imunização Passiva , Hospedeiro Imunocomprometido , Anticorpos Antivirais/uso terapêutico , Anticorpos NeutralizantesRESUMO
Patients with hematological malignancy and COVID-19 display a high mortality rate. In such patients, immunosuppression due to underlying disease and previous specific treatments impair humoral response, limiting viral clearance. Thus, COVID-19 convalescent plasma (CCP) therapy appears as a promising approach through the transfer of neutralizing antibodies specific to SARS-CoV-2. We report the effect of CCP in a cohort of 112 patients with hematological malignancy and COVID-19 and a propensity score analysis on subgroups of patients with B-cell lymphoid disease treated (n = 81) or not (n = 120) with CCP between May 1, 2020 and April 1, 2021. The overall survival of the whole cohort was 65% (95% CI = 56-74.9) and 77.5% (95% CI = 68.5-87.7) for patients with B-cell neoplasm. Prior anti-CD20 monoclonal antibody therapy was associated with better overall survival, whereas age, high blood pressure, and COVID-19 severity were associated with a poor outcome. After an inverse probability of treatment weighting approach, we observed in anti-CD20-exposed patients with B-cell lymphoid disease a decreased mortality of 63% (95% CI = 31-80) in the CCP-treated group compared to the CCP-untreated subgroup, confirmed in the other sensitivity analyses. Convalescent plasma may be beneficial in COVID-19 patients with B-cell neoplasm who are unable to mount a humoral immune response.