Diagnostics in Waldenström's macroglobulinemia: a consensus statement of the European Consortium for Waldenström's Macroglobulinemia.


Journal

Leukemia
ISSN: 1476-5551
Titre abrégé: Leukemia
Pays: England
ID NLM: 8704895

Informations de publication

Date de publication:
02 2023
Historique:
received: 15 09 2022
accepted: 09 11 2022
revised: 07 11 2022
pubmed: 27 11 2022
medline: 8 2 2023
entrez: 26 11 2022
Statut: ppublish

Résumé

The diagnosis of Waldenström's macroglobulinemia (WM), an IgM-associated lymphoplasmacytic lymphoma, can be challenging due to the different forms of disease presentation. Furthermore, in recent years, WM has witnessed remarkable progress on the diagnostic front, as well as a deeper understanding of the disease biology, which has affected clinical practice. This, together with the increasing variety of tools and techniques available, makes it necessary to have a practical guidance for clinicians to perform the initial evaluation of patients with WM. In this paper, we present the consensus recommendations and laboratory requirements for the diagnosis of WM developed by the European Consortium of Waldenström's Macroglobulinemia (ECWM), for both clinical practice as well as the research/academical setting. We provide the procedures for multiparametric flow cytometry, fluorescence in situ hybridization and molecular tests, and with this offer guidance for a standardized diagnostic work-up and methodological workflow of patients with IgM monoclonal gammopathy of uncertain significance, asymptomatic and symptomatic WM.

Identifiants

pubmed: 36435884
doi: 10.1038/s41375-022-01762-3
pii: 10.1038/s41375-022-01762-3
pmc: PMC9898035
doi:

Substances chimiques

Immunoglobulin M 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

388-395

Informations de copyright

© 2022. The Author(s).

Références

Owen RG, Treon SP, Al-Katib A, Fonseca R, Greipp PR, McMaster ML, et al. Clinicopathological definition of Waldenström’s macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom’s Macroglobulinemia. Semin Oncol. 2003;30:110–5.
doi: 10.1053/sonc.2003.50082
Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127:2375–90.
doi: 10.1182/blood-2016-01-643569
Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IB, de O, et al. The 5th edition of the World Health Organization Classification of haematolymphoid tumours: lymphoid neoplasms. Leukemia. 2022;36:1720–48.
doi: 10.1038/s41375-022-01620-2
Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, et al. The International Consensus Classification of mature lymphoid neoplasms: a report from the Clinical Advisory Committee. Blood. 2022;140:1229–53.
Castillo JJ, Garcia-Sanz R, Hatjiharissi E, Kyle RA, Leleu X, McMaster M, et al. Recommendations for the diagnosis and initial evaluation of patients with Waldenström Macroglobulinaemia: a Task Force from the 8th International Workshop on Waldenström Macroglobulinaemia. Br J Haematol. 2016;175:77–86.
doi: 10.1111/bjh.14196
Pratt G, El-Sharkawi D, Kothari J, D’Sa S, Auer R, McCarthy H, et al. Guidelines on the diagnosis and management of Waldenström macroglobulinaemia—a British Society for Haematology guideline. Br J Haematol. 2022;197:171–87.
doi: 10.1111/bjh.18036
Morice WG, Chen D, Kurtin PJ, Hanson CA, McPhail ED. Novel immunophenotypic features of marrow lymphoplasmacytic lymphoma and correlation with Waldenström’s macroglobulinemia. Mod Pathol. 2009;22:807–16.
doi: 10.1038/modpathol.2009.34
Paiva B, Montes MC, García-Sanz R, Ocio EM, Alonso J, de las Heras N, et al. Multiparameter flow cytometry for the identification of the Waldenström’s clone in IgM-MGUS and Waldenström’s Macroglobulinemia: new criteria for differential diagnosis and risk stratification. Leukemia. 2014;28:166–73.
doi: 10.1038/leu.2013.124
García-Sanz R, Jimenez C, Puig N, Paiva B, Gutierrez NC, Rodríguez-Otero P, et al. Origin of Waldenstrom’s macroglobulinaemia. Best Pr Res Clin Haematol. 2016;29:136–47.
doi: 10.1016/j.beha.2016.08.024
Treon SP, Xu L, Yang G, Zhou Y, Liu X, Cao Y, et al. MYD88 L265P somatic mutation in Waldenström’s macroglobulinemia. N Engl J Med. 2012;367:826–33.
doi: 10.1056/NEJMoa1200710
Xu L, Hunter ZR, Yang G, Zhou Y, Cao Y, Liu X, et al. MYD88 L265P in Waldenstrom’s macroglobulinemia, IgM monoclonal gammopathy, and other B-cell lymphoproliferative disorders using conventional and quantitative allele-specific PCR. Blood. 2013;121:2051–8.
doi: 10.1182/blood-2012-09-454355
Varettoni M, Arcaini L, Zibellini S, Boveri E, Rattotti S, Riboni R, et al. Prevalence and clinical significance of the MYD88 (L265P) somatic mutation in Waldenström’s macroglobulinemia and related lymphoid neoplasms. Blood. 2013;88:2522–8.
doi: 10.1182/blood-2012-09-457101
Jiménez C, Sebastián E, Chillón MC, Giraldo P, Mariano Hernández J, Escalante F, et al. MYD88 L265P is a marker highly characteristic of, but not restricted to, waldenström’s macroglobulinemia. Leukemia. 2013;27:1722–8.
doi: 10.1038/leu.2013.62
Poulain S, Roumier C, Decambron A, Renneville A, Herbaux C, Bertrand E, et al. MYD88 L265P mutation in Waldenstrom macroglobulinemia. Blood. 2013;121:4504–11.
doi: 10.1182/blood-2012-06-436329
Willenbacher W, Willenbacher E, Brunner A, Manzl C. Improved accuracy of discrimination between IgM multiple myeloma and Waldenström macroglobulinaemia by testing for MYD88 L265P mutations. Br J Haematol. 2013;161:902–4.
doi: 10.1111/bjh.12313
Martínez-Trillos A, Pinyol M, Navarro A, Aymerich M, Jares P, Juan M, et al. Mutations in TLR/MYD88 pathway identify a subset of young chronic lymphocytic leukemia patients with favorable outcome. Blood. 2014;123:3790–6.
doi: 10.1182/blood-2013-12-543306
Gachard N, Parrens M, Soubeyran I, Petit B, Marfak A, Rizzo D, et al. IGHV gene features and MYD88 L265P mutation separate the three marginal zone lymphoma entities and Waldenström macroglobulinemia/lymphoplasmacytic lymphomas. Leukemia. 2013;27:183–9.
doi: 10.1038/leu.2012.257
Hunter ZR, Xu L, Yang G, Zhou Y, Liu X, Cao Y, et al. The genomic landscape of Waldenström macroglobulinemia is characterized by highly recurring MYD88 and WHIM-like CXCR4 mutations, and small somatic deletions associated with B-cell lymphomagenesis. Blood. 2014;123:1637–46.
doi: 10.1182/blood-2013-09-525808
Jiménez C, Prieto-Conde MI, García-Álvarez M, Alcoceba M, Escalante F, Chillón MDC, et al. Unraveling the heterogeneity of IgM monoclonal gammopathies: a gene mutational and gene expression study. Ann Hematol. 2018;97:475–84.
doi: 10.1007/s00277-017-3207-3
Roccaro AM, Sacco A, Jimenez C, Maiso P, Moschetta M, Mishima Y, et al. C1013G/CXCR4 acts as a driver mutation of tumor progression and modulator of drug resistance in lymphoplasmacytic lymphoma. Blood. 2014;123:4120–31.
doi: 10.1182/blood-2014-03-564583
Cao Y, Hunter ZR, Liu X, Xu L, Yang G, Chen J, et al. The WHIM-like CXCR4 S338X somatic mutation activates AKT and ERK, and promotes resistance to ibrutinib and other agents used in the treatment of Waldenstrom’s macroglobulinemia. Leukemia. 2015;29:169–76.
doi: 10.1038/leu.2014.187
Castillo JJ, Sarosiek SR, Gustine JN, Flynn CA, Leventoff CR, White TP, et al. Response and survival predictors in a cohort of 319 patients with Waldenström macroglobulinemia treated with ibrutinib monotherapy. Blood Adv. 2022;6:1015–24.
doi: 10.1182/bloodadvances.2021006106
Treon SP, Gustine J, Xu L, Manning RJ, Tsakmaklis N, Demos M, et al. MYD88 wild-type Waldenstrom macroglobulinaemia: differential diagnosis, risk of histological transformation, and overall survival. Br J Haematol. 2018;180:374–80.
doi: 10.1111/bjh.15049
Braggio E, Keats JJ, Leleu X, Van Wier S, Jimenez-Zepeda VH, Valdez R, et al. Identification of copy number abnormalities and inactivating mutations in two negative regulators of nuclear factor-kB signaling pathways in Waldenström’s macroglobulinemia. Cancer Res. 2009;69:3579–88.
doi: 10.1158/0008-5472.CAN-08-3701
Schop RFJ, Kuehl WM, Van Wier SA, Ahmann GJ, Price-Troska T, Bailey RJ, et al. Waldenström macroglobulinemia neoplastic cells lack immunoglobulin heavy chain locus translocations but have frequent 6q deletions. Blood. 2002;100:2996–3001.
doi: 10.1182/blood.V100.8.2996
García-Sanz R, Dogliotti I, Zaccaria GM, Ocio EM, Rubio A, Murillo I, et al. 6q deletion in Waldenström macroglobulinaemia negatively affects time to transformation and survival. Br J Haematol. 2021;192:843–52.
doi: 10.1111/bjh.17028
Krzisch D, Guedes N, Boccon-Gibod C, Baron M, Bravetti C, Davi F, et al. Cytogenetic and molecular abnormalities in Waldenström’s macroglobulinemia patients: correlations and prognostic impact. Am J Hematol. 2021;96:1569–79.
doi: 10.1002/ajh.26339
Gustine JN, Tsakmaklis N, Demos MG, Kofides A, Chen JG, Liu X, et al. TP53 mutations are associated with mutated MYD88 and CXCR4, and confer an adverse outcome in Waldenström macroglobulinaemia. Br J Haematol. 2019;184:242–5.
doi: 10.1111/bjh.15560
Poulain S, Roumier C, Bertrand E, Renneville A, Caillault-Venet A, Doye E, et al. TP53 mutation and its prognostic significance in Waldenstrom’s macroglobulinemia. Clin Cancer Res. 2017;23:6325–36.
doi: 10.1158/1078-0432.CCR-17-0007
Varettoni M, Zibellini S, Defrancesco I, Ferretti VV, Rizzo E, Malcovati L, et al. Pattern of somatic mutations in patients with Waldenström macroglobulinemia or IgM monoclonal gammopathy of undetermined significance. Haematologica. 2017;102:2077–85.
doi: 10.3324/haematol.2017.172718
Kyle RA, Larson DR, Therneau TM, Dispenzieri A, Kumar S, Cerhan JR, et al. Long-term follow-up of monoclonal gammopathy of undetermined significance. N Engl J Med. 2018;378:241–9.
doi: 10.1056/NEJMoa1709974
Khwaja J, D’Sa S, Minnema MC, Kersten MJ, Wechalekar A, Vos JM. IgM monoclonal gammopathies of clinical significance: diagnosis and management. Haematologica. 2022;107:2037–50.
doi: 10.3324/haematol.2022.280953
Puig N, Ocio EM, Jiménez C, Paiva B, Miguel JFS, García-Sanz R. Waldenström’s macroglobulinemia immunophenotype. In: Leblond V, Treon S, Dimoploulos M, editors. Waldenström’s Macroglobulinemia. Springer, Cham; 2017. p. 21–34.
Varettoni M, Arcaini L, Rattotti S, Ferretti V, Cazzola M. Bone marrow assessment in asymptomatic immunoglobulin M monoclonal gammopathies. Br J Haematol. 2015;168:301–2.
doi: 10.1111/bjh.13091
Maqbool MG, Tam CS, Morison IM, Simpson D, Mollee P, Schneider H, et al. A practical guide to laboratory investigations at diagnosis and follow up in Waldenström macroglobulinaemia: recommendations from the Medical and Scientific Advisory Group, Myeloma Australia, the Pathology Sub-committee of the Lymphoma and Related Disease. Pathology. 2020;52:167–78.
doi: 10.1016/j.pathol.2019.11.002
Kalina T, Flores-Montero J, Van Der Velden VHJ, Martin-Ayuso M, Böttcher S, Ritgen M, et al. EuroFlow standardization of flow cytometer instrument settings and immunophenotyping protocols. Leukemia. 2012;26:1986–2010.
doi: 10.1038/leu.2012.122
Amaador K, Vos JMI, Pals ST, Kraan W, Dobber JA, Minnema MC, et al. Discriminating between Waldenström macroglobulinemia and marginal zone lymphoma using logistic LASSO regression. Leuk Lymphoma. 2022;63:1070–9.
doi: 10.1080/10428194.2021.2018584
Schmidt J, Federmann B, Schindler N, Steinhilber J, Bonzheim I, Fend F, et al. MYD88 L265P and CXCR4 mutations in lymphoplasmacytic lymphoma identify cases with high disease activity. Br J Haematol. 2015;169:795–803.
doi: 10.1111/bjh.13361
Zanwar S, Abeykoon JP, Ansell SM, Gertz MA, Dispenzieri A, Muchtar E, et al. Primary systemic amyloidosis in patients with Waldenström macroglobulinemia. Leukemia. 2019;33:790–4.
doi: 10.1038/s41375-018-0286-7
Xu L, Hunter ZR, Yang G, Cao Y, Liu X, Manning R, et al. Detection of MYD88 L265P in peripheral blood of patients with Waldenström’s macroglobulinemia and IgM monoclonal gammopathy of undetermined significance. Leukemia. 2014;28:1698–704.
doi: 10.1038/leu.2014.65
Minnema MC, Kimby E, D’Sa S, Fornecker LM, Poulain S, Snijders TJ, et al. Guideline for the diagnosis, treatment and response criteria for Bing-Neel syndrome. Haematologica. 2017;102:43–51.
doi: 10.3324/haematol.2016.147728
Poulain S, Boyle EM, Roumier C, Demarquette H, Wemeau M, Geffroy S, et al. MYD88 L265P mutation contributes to the diagnosis of Bing Neel syndrome. Br J Haematol. 2014;167:506–13.
doi: 10.1111/bjh.13078
Muñiz C, Martín-Martín L, López A, Sánchez-González B, Salar A, Almeida J, et al. Contribution of cerebrospinal fluid sCD19 levels to the detection of CNS lymphoma and its impact on disease outcome. Blood. 2014;123:1864–9.
doi: 10.1182/blood-2013-11-537993
Drandi D, Genuardi E, Dogliotti I, Ferrante M, Jiménez C, Guerrini F, et al. Highly sensitive MYD88L265P mutation detection by droplet digital polymerase chain reaction in Waldenström macroglobulinemia. Haematologica. 2018;103:1029–37.
doi: 10.3324/haematol.2017.186528
Hiemcke-Jiwa LS, Minnema MC, Radersma-van Loon JH, Jiwa NM, de Boer M, Leguit RJ, et al. The use of droplet digital PCR in liquid biopsies: a highly sensitive technique for MYD88 p.(L265P) detection in cerebrospinal fluid. Hematol Oncol. 2018;36:429–35.
doi: 10.1002/hon.2489
Paiva B, Corchete LA, Vidriales M-B, Garcia-Sanz R, Perez JJ, Aires-Mejia I, et al. The cellular origin and malignant transformation of Waldenstrom macroglobulinemia. Blood. 2015;125:2370–80.
doi: 10.1182/blood-2014-09-602565
Loken MR, Chu SC, Fritschle W, Kalnoski M, Wells DA. Normalization of bone marrow aspirates for hemodilution in flow cytometric analyses. Cytom Part B Clin Cytom. 2009;76:27–36.
doi: 10.1002/cyto.b.20429
D’Angelo G, Hotz AM, Monti M. Lymphoplasmacytic non-Hodgkin lymphoma/Waldenström’s macroglobulinemia with CD5+, CD23+, and CD10-. Blood Res. 2013;48:300–3.
doi: 10.5045/br.2013.48.4.300
El-Ayoubi A, Wang JQ, Hein N, Talaulikar D. Role of plasma cells in Waldenström macroglobulinaemia. Pathology. 2017;49:337–45.
doi: 10.1016/j.pathol.2017.02.004
Wang CZ, Lin J, Qian J, Shao R, Xue D, Qian W, et al. Development of high-resolution melting analysis for the detection of the MYD88 L265P mutation. Clin Biochem. 2013;46:385–7.
doi: 10.1016/j.clinbiochem.2012.11.007
Jiménez C, Chillón MC, Balanzategui A, Puig N, Sebastián E, Alcoceba M, et al. Detection of MYD88 L265P mutation by real-time allele-specific oligonucleotide polymerase chain reaction. Appl Immunohistochem Mol Morphol. 2014;22:768–73.
doi: 10.1097/PAI.0000000000000020
Poulain S, Roumier C, Galiègue-Zouitina S, Daudignon A, Herbaux C, Aiijou R, et al. Genome wide SNP array identified multiple mechanisms of genetic changes in Waldenstrom macroglobulinemia. Am J Hematol. 2013;88:948–54.
doi: 10.1002/ajh.23545
Bagratuni T, Ntanasis-Stathopoulos I, Gavriatopoulou M, Mavrianou-Koutsoukou N, Liacos C, Patseas D, et al. Detection of MYD88 and CXCR4 mutations in cell-free DNA of patients with IgM monoclonal gammopathies. Leukemia. 2018;32:2617–25.
doi: 10.1038/s41375-018-0197-7
Willenbacher E, Willenbacher W, Wolf DG, Zelger B, Peschel I, Manzl C, et al. Digital PCR in bone marrow trephine biopsies is highly sensitive for MYD88 L265P detection in lymphomas with plasmacytic/plasmacytoid differentiation. Br J Haematol. 2019;186:189–91.
doi: 10.1111/bjh.15792
Treon SP, Xu L, Hunter Z. MYD88 mutations and response to ibrutinib in Waldenström’s macroglobulinemia. N Engl J Med. 2015;373:584–6.
doi: 10.1056/NEJMc1506192
Malecka A, Trøen G, Tierens A, Østlie I, Malecki J, Randen U, et al. Immunoglobulin heavy and light chain gene features are correlated with primary cold agglutinin disease onset and activity. Haematologica. 2016;101:e361–4.
doi: 10.3324/haematol.2016.146126
Poulain S, Roumier C, Venet-Caillault A, Figeac M, Herbaux C, Marot G, et al. Genomic landscape of CXCR4 mutations in Waldenström macroglobulinemia. Clin Cancer Res. 2016;22:1480–8.
doi: 10.1158/1078-0432.CCR-15-0646
Dogliotti I, Drandi D, Genuardi E, Ferrero S. New molecular technologies for minimal residual disease evaluation in B-cell lymphoid malignancies. J Clin Med. 2018;7:288.
doi: 10.3390/jcm7090288
Ferrante M, Furlan D, Zibellini S, Borriero M, Candido C, Sahnane N, et al. MYD88 L265P detection in IgM monoclonal gammopathies: methodological considerations for routine implementation. Diagnostics. 2021;11:779.
doi: 10.3390/diagnostics11050779
Bagratuni T, Markou A, Patseas D, Mavrianou-Koutsoukou N, Aktypi F, Liacos CI, et al. Determination of MYD88L265P mutation fraction in IgM monoclonal gammopathies. Blood Adv. 2022;6:189–99.
doi: 10.1182/bloodadvances.2021005354

Auteurs

Irene Dogliotti (I)

Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy.

Cristina Jiménez (C)

Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain. jscris@usal.es.

Marzia Varettoni (M)

Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Dipti Talaulikar (D)

Canberra Health Services, College of Medicine, Biology and Environment Australian National University, Canberra ACT, Australia.

Tina Bagratuni (T)

Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Martina Ferrante (M)

Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy.

José Pérez (J)

Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain.

Daniela Drandi (D)

Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy.

Noemí Puig (N)

Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain.

Milena Gilestro (M)

Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy.

María García-Álvarez (M)

Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain.

Roger Owen (R)

The Leeds Teaching Hospitals National Health Service Trust, Leeds, UK.

Wojciech Jurczak (W)

Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland.

Alessandra Tedeschi (A)

ASST Grande Ospedale Metropolitano Niguarda Hospital, Milan, Italy.

Veronique Leblond (V)

Département d'Hématologie Hôpital Pitié-Salpêtrière APHP, UPMC Université Paris, Paris, France.

Efstathios Kastritis (E)

Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Marie José Kersten (MJ)

Department of Hematology, Amsterdam UMC, Location University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands.

Shirley D'Sa (S)

Centre for Waldenströms Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London, UK.

Michal Kaščák (M)

Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.

Wolfgang Willenbacher (W)

Department of Haematology and Oncology, Internal Medicine V, Innsbruck University Hospital & Syndena GmbH, Connect to Cure, Innsbruck, Austria.

Aldo M Roccaro (AM)

Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, Brescia, Italy.

Stephanie Poulain (S)

Laboratory of Hematology, Biology and Pathology Center, CHU of Lille, INSERM UMR-S 1277, Team 4, Oncolille, Lille, France.

Pierre Morel (P)

Service d'Hematologie Clinique et Therapie Cellulaire, Centre Hospitalier Universitaire d'Amiens-Picardie, Amiens, France.

Charalampia Kyriakou (C)

Centre for Waldenströms Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London, UK.

Falko Fend (F)

Institute of Pathology and Comprehensive Cancer Centre, Eberhard-Karls-University, University Hospital Tübingen, Tübingen, Germany.

Josephine M I Vos (JMI)

Department of Hematology, Amsterdam UMC, Location University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands.

Meletios A Dimopoulos (MA)

Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Christian Buske (C)

Institute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany.

Simone Ferrero (S)

Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy.
Hematology Division 1U, "AOU Città della Salute e della Scienza di Torino", Torino, Italy.

Ramón García-Sanz (R)

Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH