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Hematology and Medical Oncology, 2020
La mision del Laboratorio Clinico consiste en generar informacion clinica relevante, en tiempo re... more La mision del Laboratorio Clinico consiste en generar informacion clinica relevante, en tiempo real, que resulte util al clinico para prevenir y diagnosticar la enfermedad, y para ayudarle en la seleccion de la terapeutica mas adecuada en cada caso, asi como en el seguimiento del tratamiento elegido. El Laboratorio Clinico debe ser capaz de ofrecer parametros adaptados a los nuevos requerimientos y necesidades. La Hematologia Analitica ha ido automatizandose progresivamente. La funcion principal de los modernos analizadores de hematimetria es proporcionar los resultados de los parametros necesarios para el diagnostico y seguimiento de los pacientes. Los modernos contadores aplican los principios de la citometria de flujo con laser y permiten el recuento de las tres series celulares (hematies, leucocitos y plaquetas), la cuantificacion de hemoglobina, el recuento leucocitario diferencial y recuento de reticulocitos. El analisis de reticulocitos ha progresado desde el simple recuento ...
BACKGROUND Current treatment choices are based on generalized outcome data from clinical trials, ... more BACKGROUND Current treatment choices are based on generalized outcome data from clinical trials, but not all MM patients respond the same and a considerable percentage of them do not achieve a desirable treatment endpoint. Contradictory results based on the rate of descent of the monoclonal component (M-component) to predict long-term outcome have been published, but no to identify patients with insufficient response to a therapeutic regimen. The ability to identify treatment early on resistance could accelerate the introduction of another (and more effective) line of therapy. AIM Develop and validate a rule based on the rate of descent of the M-component, to predict the probability of disease resistance to reach a complete remission (CR) in MM patients. METHODS Three studies were conducted: exploratory, confirmatory, and clinical validation. A total of 87 patients treated between July 2014 and September 2018, were included for the first two. Patients who were unable to complete the...
La Diabetes Gestacional (DG) es una alteración del metabolismo de los glúcidos que se descubre o ... more La Diabetes Gestacional (DG) es una alteración del metabolismo de los glúcidos que se descubre o inicia por primera vez durante el embarazo. Es la complicación más frecuente del mismo. Su frecuencia es variable, y afecta aproximadamente al 10 % de las gestantes. El diagnóstico y tratamiento precoz reduce el riesgo de complicaciones. Si la primera prueba (O´Sullivan) resulta positiva, se realiza otra sobrecarga oral. Esta segunda prueba tiene variantes y diferentes criterios diagnósticos, así tenemos la del Grupo Español de diabetes y embarazo (GEDE), la de la Asociación americana de Diabetes (ADA), y la última propuesta por esa misma asociación, de consenso 2011 (ADA 2011). Objetivos: Comparar la frecuencia de DG según diferentes criterios recomendados (GEDE, ADA, ADA 2011, y variantes de ésta última). Comparar los valores de corte más significativos para los diferentes criterios diagnósticos. Valorar la variación en frecuencia de DG con respecto a edad de la gestante.
Blood
Background: Assessing MRD has become a standard procedure in clinical trials to evaluate treatmen... more Background: Assessing MRD has become a standard procedure in clinical trials to evaluate treatment efficacy. In accordance with its consistent prognostic value, the International Myeloma Working Group added MRD-negative criteria into response guidelines for its standardized use in clinical trials. That notwithstanding, the expectations for MRD as biomarker are to use it in routine clinical practice to help in treatment decisions, since in most clinical trials the therapeutic approach is defined upfront and does not vary according to patients' depth of response. However, the use of MRD in clinical practice is controversial and it remains unknown if tailoring treatment to achieve MRD-negativity is safe and improves patients' survival. Aim: Compare in clinical practice, outcome and tolerability of a treatment strategy tailored to achieve sustained undetectable MRD by NGF and imaging, as compared to conventional treatment approaches that are not modified according to patients...
Diagnostics
A targeted and timely treatment can be a beneficial tool for patients with hematological emergenc... more A targeted and timely treatment can be a beneficial tool for patients with hematological emergencies (particularly acute leukemias). The key challenges in the early diagnosis of leukemias and related hematological disorders are their symptom-sharing nature and prolonged turnaround time as well as the expertise needed in reporting confirmatory tests. The present study made use of the potential morphological and immature fraction-related parameters (research items or cell population data) generated during complete blood cell count (CBC), through artificial intelligence (AI)/machine learning (ML) predictive modeling for early (at the pre-microscopic level) differentiation of various types of leukemias: acute from chronic as well as myeloid from lymphoid. The routine CBC parameters along with research CBC items from a hematology analyzer in the diagnosis of 1577 study subjects with hematological neoplasms were collected. The statistical and data visualization tools, including heat-map a...
Leucocytes, especially neutrophils featuring pro- and anti-cancerous characteristics, are involve... more Leucocytes, especially neutrophils featuring pro- and anti-cancerous characteristics, are involved in nearly every stage of tumorigenesis. Phenotypic and functional differences among mature and immature neutrophil fractions are well reported, and their correlation with tumor progression and therapy has emerging implications in modern oncology practices. Technological advancements enabled modern hematology analyzers to generate extended information (research parameters) during complete blood cell count (CBC) analysis. We hypothesized that neutrophil and lymphocyte fractions-related extended differential leucocytes count (DLC) parameters hold superior diagnostic utility over routine modalities. The present study was carried out over a four-and-a-half-year period wherein extended neutrophil (immature granulocyte [IG] and mature neutrophil [NEUT#&]), and lymphocyte (activated/high fluorescence lymphocyte count [HFLC] and resting lymphocyte [LYMP#&]) parameters were challenged over routi...
Iron is an essential micronutrient, as it is required for adequate erythropoietic function, oxida... more Iron is an essential micronutrient, as it is required for adequate erythropoietic function, oxidative metabolism and cellular immune responses. Although the absorption of dietary iron (1-2 mg/day) is regulated tightly, it is just balanced with losses. Therefore, internal turnover of iron is essential to meet the requirements for erythropoiesis (20-30 mg/day). Increased iron requirements, limited external supply, and increased blood loss may lead to iron deficiency. Hepcidin, produced primarily by hepatocytes in response to liver iron levels, inflammation, hypoxia and anemia, is the main iron regulatory hormone. Once secreted into the circulation, hepcidin acts on enterocytes and macrophages. Thus, in chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, which results in hypoferremia and iron-restricted erythropoiesis (despite normal iron stores) and anemia of chronic disease. In contrast, low hepcidin expression may lead to iron overload, as in some hemochromatosis types. Laboratory tests provide evidence of iron depletion in the body, or reflect iron-deficient red cell production. The appropriate combination of these laboratory tests help to establish a correct diagnosis of iron status and anemia.
Hematology and Medical Oncology, 2020
La mision del Laboratorio Clinico consiste en generar informacion clinica relevante, en tiempo re... more La mision del Laboratorio Clinico consiste en generar informacion clinica relevante, en tiempo real, que resulte util al clinico para prevenir y diagnosticar la enfermedad, y para ayudarle en la seleccion de la terapeutica mas adecuada en cada caso, asi como en el seguimiento del tratamiento elegido. El Laboratorio Clinico debe ser capaz de ofrecer parametros adaptados a los nuevos requerimientos y necesidades. La Hematologia Analitica ha ido automatizandose progresivamente. La funcion principal de los modernos analizadores de hematimetria es proporcionar los resultados de los parametros necesarios para el diagnostico y seguimiento de los pacientes. Los modernos contadores aplican los principios de la citometria de flujo con laser y permiten el recuento de las tres series celulares (hematies, leucocitos y plaquetas), la cuantificacion de hemoglobina, el recuento leucocitario diferencial y recuento de reticulocitos. El analisis de reticulocitos ha progresado desde el simple recuento ...
BACKGROUND Current treatment choices are based on generalized outcome data from clinical trials, ... more BACKGROUND Current treatment choices are based on generalized outcome data from clinical trials, but not all MM patients respond the same and a considerable percentage of them do not achieve a desirable treatment endpoint. Contradictory results based on the rate of descent of the monoclonal component (M-component) to predict long-term outcome have been published, but no to identify patients with insufficient response to a therapeutic regimen. The ability to identify treatment early on resistance could accelerate the introduction of another (and more effective) line of therapy. AIM Develop and validate a rule based on the rate of descent of the M-component, to predict the probability of disease resistance to reach a complete remission (CR) in MM patients. METHODS Three studies were conducted: exploratory, confirmatory, and clinical validation. A total of 87 patients treated between July 2014 and September 2018, were included for the first two. Patients who were unable to complete the...
La Diabetes Gestacional (DG) es una alteración del metabolismo de los glúcidos que se descubre o ... more La Diabetes Gestacional (DG) es una alteración del metabolismo de los glúcidos que se descubre o inicia por primera vez durante el embarazo. Es la complicación más frecuente del mismo. Su frecuencia es variable, y afecta aproximadamente al 10 % de las gestantes. El diagnóstico y tratamiento precoz reduce el riesgo de complicaciones. Si la primera prueba (O´Sullivan) resulta positiva, se realiza otra sobrecarga oral. Esta segunda prueba tiene variantes y diferentes criterios diagnósticos, así tenemos la del Grupo Español de diabetes y embarazo (GEDE), la de la Asociación americana de Diabetes (ADA), y la última propuesta por esa misma asociación, de consenso 2011 (ADA 2011). Objetivos: Comparar la frecuencia de DG según diferentes criterios recomendados (GEDE, ADA, ADA 2011, y variantes de ésta última). Comparar los valores de corte más significativos para los diferentes criterios diagnósticos. Valorar la variación en frecuencia de DG con respecto a edad de la gestante.
Blood
Background: Assessing MRD has become a standard procedure in clinical trials to evaluate treatmen... more Background: Assessing MRD has become a standard procedure in clinical trials to evaluate treatment efficacy. In accordance with its consistent prognostic value, the International Myeloma Working Group added MRD-negative criteria into response guidelines for its standardized use in clinical trials. That notwithstanding, the expectations for MRD as biomarker are to use it in routine clinical practice to help in treatment decisions, since in most clinical trials the therapeutic approach is defined upfront and does not vary according to patients' depth of response. However, the use of MRD in clinical practice is controversial and it remains unknown if tailoring treatment to achieve MRD-negativity is safe and improves patients' survival. Aim: Compare in clinical practice, outcome and tolerability of a treatment strategy tailored to achieve sustained undetectable MRD by NGF and imaging, as compared to conventional treatment approaches that are not modified according to patients...
Diagnostics
A targeted and timely treatment can be a beneficial tool for patients with hematological emergenc... more A targeted and timely treatment can be a beneficial tool for patients with hematological emergencies (particularly acute leukemias). The key challenges in the early diagnosis of leukemias and related hematological disorders are their symptom-sharing nature and prolonged turnaround time as well as the expertise needed in reporting confirmatory tests. The present study made use of the potential morphological and immature fraction-related parameters (research items or cell population data) generated during complete blood cell count (CBC), through artificial intelligence (AI)/machine learning (ML) predictive modeling for early (at the pre-microscopic level) differentiation of various types of leukemias: acute from chronic as well as myeloid from lymphoid. The routine CBC parameters along with research CBC items from a hematology analyzer in the diagnosis of 1577 study subjects with hematological neoplasms were collected. The statistical and data visualization tools, including heat-map a...
Leucocytes, especially neutrophils featuring pro- and anti-cancerous characteristics, are involve... more Leucocytes, especially neutrophils featuring pro- and anti-cancerous characteristics, are involved in nearly every stage of tumorigenesis. Phenotypic and functional differences among mature and immature neutrophil fractions are well reported, and their correlation with tumor progression and therapy has emerging implications in modern oncology practices. Technological advancements enabled modern hematology analyzers to generate extended information (research parameters) during complete blood cell count (CBC) analysis. We hypothesized that neutrophil and lymphocyte fractions-related extended differential leucocytes count (DLC) parameters hold superior diagnostic utility over routine modalities. The present study was carried out over a four-and-a-half-year period wherein extended neutrophil (immature granulocyte [IG] and mature neutrophil [NEUT#&]), and lymphocyte (activated/high fluorescence lymphocyte count [HFLC] and resting lymphocyte [LYMP#&]) parameters were challenged over routi...
Iron is an essential micronutrient, as it is required for adequate erythropoietic function, oxida... more Iron is an essential micronutrient, as it is required for adequate erythropoietic function, oxidative metabolism and cellular immune responses. Although the absorption of dietary iron (1-2 mg/day) is regulated tightly, it is just balanced with losses. Therefore, internal turnover of iron is essential to meet the requirements for erythropoiesis (20-30 mg/day). Increased iron requirements, limited external supply, and increased blood loss may lead to iron deficiency. Hepcidin, produced primarily by hepatocytes in response to liver iron levels, inflammation, hypoxia and anemia, is the main iron regulatory hormone. Once secreted into the circulation, hepcidin acts on enterocytes and macrophages. Thus, in chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, which results in hypoferremia and iron-restricted erythropoiesis (despite normal iron stores) and anemia of chronic disease. In contrast, low hepcidin expression may lead to iron overload, as in some hemochromatosis types. Laboratory tests provide evidence of iron depletion in the body, or reflect iron-deficient red cell production. The appropriate combination of these laboratory tests help to establish a correct diagnosis of iron status and anemia.