Papers by Aleksandra Novkovic
Hematology, 2012
The objective of this single-center study was to determine the pretreatment risk factors and infl... more The objective of this single-center study was to determine the pretreatment risk factors and influence of comorbidity on outcome in patients with acute myeloid leukemia (AML). The research involved 145 patients with AML during a 58-month follow-up period. The results suggest that the most significant predictor of poor overall survival (OS) is an adverse karyotype (P = 0.007), while for poor rate of complete remission (CR) it is age ≥55 years, and for early death the most significant predictor is comorbidity, as scored by the Hematopoetic Cell Transplantation Comorbidity Index (HCT-CI), P = 0.001. When we divided the patients into two groups: aged ≥55 years and aged <55 years, these predictors differed. In the group aged ≥55 years the most significant predictor of OS (P = 0.013) and for early death (P = 0.003) was HCT-CI (P = 0.013), while in the younger group it was karyotype (P < 0.001). The most significant predictor of CR in the elderly was increased serum lactate dehydrogenase (LDH) level (P = 0.045). In the younger patients, the most significant predictor of CR was leukocytosis (P = 0.001) and for early death it was infection as the comorbidity (P = 0.007). We point out the importance of comorbidity for OS and early death, as well as the impact of infection in patients with AML.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
The aim of this 10-year retrospective study was to investigate prognostic clinical and laboratory... more The aim of this 10-year retrospective study was to investigate prognostic clinical and laboratory factors significant for the outcome of patients with mucosa associated lymphoid tissue (MALT) lymphoma. The study involved 87 patients diagnosed with MALT lymphoma: 37 (42.5%) with gastrointestinal (GI) and 50 (57.5%) with non-GI localization. The following pretreatment laboratory parameters were analyzed: hemoglobin, serum albumin and lactate dehydrogenase (LDH) level, beta2-microglobulin (bgr;2-M) and bacteriological (H.pylori) status. Estimated clinical features were: stage of disease, ECOG performance status (PS), tumor mass, number of extranodal localizations, presence of B symptomatology, splenomegaly and enlarged lymph nodes. Diagnosis of MALT lymphoma was based on histopathological analysis of tissue samples, obtained by endoscopy or surgery. The median disease-free survival (DFS) was 36 months and the 5-year overall survival (OS) was 64%. OS rate of patients with non-GI localiz...
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
The aim of this 10-year retrospective study was to investigate prognostic clinical and laboratory... more The aim of this 10-year retrospective study was to investigate prognostic clinical and laboratory factors significant for the outcome of patients with mucosa associated lymphoid tissue (MALT) lymphoma. The study involved 87 patients diagnosed with MALT lymphoma: 37 (42.5%) with gastrointestinal (GI) and 50 (57.5%) with non-GI localization. The following pretreatment laboratory parameters were analyzed: hemoglobin, serum albumin and lactate dehydrogenase (LDH) level, beta2-microglobulin (bgr;2-M) and bacteriological (H.pylori) status. Estimated clinical features were: stage of disease, ECOG performance status (PS), tumor mass, number of extranodal localizations, presence of B symptomatology, splenomegaly and enlarged lymph nodes. Diagnosis of MALT lymphoma was based on histopathological analysis of tissue samples, obtained by endoscopy or surgery. The median disease-free survival (DFS) was 36 months and the 5-year overall survival (OS) was 64%. OS rate of patients with non-GI localiz...
Thrombosis Research, 2012
Medical Oncology, 2011
Clinical features of 40 lymphoproliferative neoplasm patients in the setting of systemic autoimmu... more Clinical features of 40 lymphoproliferative neoplasm patients in the setting of systemic autoimmune diseases managed in the Clinic of Hematology during 1994-2006 were analyzed retrospectively. The classification of systemic autoimmune disease patients was as follows: 15 systemic lupus erythematosus-SLE, 11 rheumatoid arthritis-RA, 12 Sjögren's syndrome-SS, 1 scleroderma, and 1 dermatomyositis. Patients comprised 31 women and 9 men of mean age 55 years (range 33-76). Systemic autoimmune diseases preceeded the development of lymphoproliferative neoplasms in 37/40 (92.5%) patients. Mean latency period between the onset of systemic autoimmune diseases and lymphoproliferative neoplasms occurrence was significantly longer in RA (113 months) than in SLE (75 months) and SS patients (65 months)-P \ 0.05. The most frequent lymphoproliferative neoplasms were non-Hodgkin's lymphoma-NHL (35/40; 88%), diffuse large B-cell lymphoma (DBCL)-12 (34%), follicular lymphoma (FC)-7 (20%), small lymphocytic (SL), and marginal zone lymphoma (MZL)-5 (14%) each. The primary site of NHL was extranodal in 18/35 (51.5%) cases. Advanced disease on diagnosis (III ? IV clinical stages), constitutional symptoms, and bulky disease were diagnosed in 27/35 (77%), 26/35 (74%), and 3/35 (8.5%) patients, respectively. The overall survival (OS) was as follows (months): DBCL-12, FC-63, SLL-60, and MZL-48. There was no association between the lymphoproliferative neoplasm histological subtype and the systemic autoimmune diseases type or antirheumatic treatment P [ 0.05. Our findings are in line with earlier reports showing a high proportion of patients with advanced disease, constitutional symptoms, extranodal manifestations, high grade histology, and low OS in the systemic autoimmune diseases setting.
Medical Oncology, 2011
This single-center study estimated the significance of pretreatment factors, including comorbidit... more This single-center study estimated the significance of pretreatment factors, including comorbidities, which may predict outcome in elderly patients with acute myeloid leukemia and determined how poor risk factors may be used as decision criteria for intensity of chemotherapy in this group of patients. Seventy-seven patients aged ≥ 55 years treated under four different regimens were followed up 36 month. Our results suggest that the
Thrombosis Research, 2013
P<0.001), and maximum rest ≥2 days before delivery OR = 5 (95% CI: 2-11 P<0.001). A balance... more P<0.001), and maximum rest ≥2 days before delivery OR = 5 (95% CI: 2-11 P<0.001). A balanced diet plus ≥12-hour fast before delivery decreased the risk, OR = 0.2 (95% CI: 0.08-0.4, P<0.001). Excessive carbohydrate intake plus maximum rest conferred an OR = 329 (95% CI: 32-3362, P<0.001) compared to no risk factors. Excessive carbohydrate intake throughout pregnancy stimulates fetal beta cells to synthesize an excess of insulin, resulting in macrosomia. Excessive carbohydrate intake combined to lack of physical activity stimulates mater- nal beta cells to synthesize insulin. Abnormal response results in gestational diabetes. Adequate response (hyperinsulinemia) stimulates plasminogen activator inhibitor 1 synthesis. Resultant hypofibrinolysis impairs placen- tal remodeling and intrauterine growth restriction "corrects" macrosomia. In this setting, prematurity and small-for-gestational-age infants are a consequence of maternal risk factors that increase the risk for neonatal hyperinsulinemia and hypoglycemia.
Medical Oncology, 2012
Using various risk factor scores, we aimed to identify a subset of elderly patients with acute my... more Using various risk factor scores, we aimed to identify a subset of elderly patients with acute myeloid leukaemia (AML) for whom it was possible to assess the prognosis. We also aimed to develop a novel prognostic score system. This single centre study involved 102 patients of C60 years of age with non-promyelocytic AML. The adverse cytogenetic risk group appeared as the most significant independent prognostic factor for overall survival (OS). Our prognostic scoring system was developed after analysing prognostic risk factors and was applied for patients with favourable and intermediate (I and II) cytogenetic risk groups: age \65 years of age, normal lactate dehydrogenase (LDH) and a comorbidity score obtained applying the haematopoietic cell transplantationspecific comorbidity index (HCT-CI) \ 3 = 0 points, in which age C65 years = 1 point and an elevated LDH score and HCT-CI C3 = 2 points. According to this prognostic model, patients without adverse cytogenetics were classified into three risk groups: favourable = 0-2 points, intermediate = 3-4 points and poor = [ 4 points. The OS between these groups was highly significant (p \ 0.001). The prognostic model developed in this study may refine the prognosis procedure of elderly AML patients without an adverse karyotype regarding OS, thereby guiding the treatment approach.
Medical Oncology, 2011
Background and Objectives. CD56 antigen expression has been reported in several hematologic malig... more Background and Objectives. CD56 antigen expression has been reported in several hematologic malignancies. In acute myeloid leukemia (AML)M2 with t(8;21) and acute promyelocytic leukemia (APL) it has been found to be consistently associated with an unfavorable prognosis, whereas in other AML subtypes its role remains uncertain. We investigated CD56 expression in a cohort of AML patients in order to assess its frequency and prognostic relevance. Design and Methods. Immunophenotypic analysis including that of CD56 antigen was available for 171 consecutive AML patients (139 with AML and 32 with APL), enrolled between December 1995 and December 1999 at a single institution. A sample of fresh bone marrow cells taken at diagnosis was recorded as positive when at least 20% of the cells double-stained with specific monoclonal antibodies against CD56 and CD33 antigens. Results. CD56 positivity was demonstrated in 37 cases (21.6%). Its frequency was lower in M4 (6%) and higher in M5 (37%). The median percentage for CD56 + blasts was 56% (range 21-99%). CD56 positivity did not correlate with age, sex, blast count, favorable or unfavorable cytogenetics at diagnosis, nor did it influence the outcome in terms of complete remission (CR) duration (606 vs. 417 days, p=n.s.) or overall survival (OS) (210 vs. 277 days, p= n.s.). In the APL subgroup a significant difference in relapse rate was found at 3 years (71.4% in the CD56 positive group vs. 12% in the CD56 negative group, p=0.005). Interpretation and Conclusions. Our data confirm that CD56 positivity in APL patients at diagnosis is associated with a worse prognosis, suggesting that close molecular monitoring is necessary in CD56 positive APL patients. In contrast, the prognostic role of CD56 remains uncertain in the other AML subtypes.
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Papers by Aleksandra Novkovic