CHevrevska, Lidija

Preferred name
CHevrevska, Lidija
Official Name
CHevrevska, Lidija
Main Affiliation
Email
lidija.chevrevska@medf.ukim.edu.mk

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    Correlation of Somatic Mutations and Clinical Characteristics at Presentation in Patients with Essential Thrombocytemia
    (American Society of Hematology, 2014-12-06)
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    Popova-Simjanovska, Marija
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    Ivanovski, Martin
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    <jats:title>Abstract</jats:title> <jats:p>Background</jats:p> <jats:p>Most patients with essential thromocythemia (ET) have somatic mutations in janus kinase 2 (JAK2), calreticulin (CALR) and thrombopoietin receptor (MPL) genes. The clinical correlates at the presentation of patients with different mutations has not been established as yet.</jats:p> <jats:p>Materials and methods</jats:p> <jats:p>We evaluated the clinical, laboratory, and molecular features of 150 consecutive patients (93 females/57 males; average age 59,0+/- 14,2 years) with ET who were diagnosed at the University Clinic for Hematology in Skopje based on the revised WHO criteria. DNA from all patients was isolated from peripheral blood obtained at diagnosis using Qiagene DNA exctraction kit. The presence of JAK2V617F mutation was evaluated with fluorescent allele specific PCR/capillary electrophoresis. The CALR exon 9 insertions or deletions were initially detected with a fluorescent PCR/capillary electrophoresis and characterized with Sanger sequencing. The presence of mutations in exon 10 of the MPL gene was analyzed with direct sequencing of PCR amplified fragments. Informant consent was obtained from all participants. Statistical analysis was performed by Wilcoxon rank- sum test.</jats:p> <jats:p>Results</jats:p> <jats:p>The basic hematological parameters at diagnosis for all patients were as follows; Plt = 962.1x109 ±351,2 x109/L; Hb = 126,8 ±39,2 g/L; Le = 10,2x103 ±4,2 x103/µL. No correlation was found between any of these parameters and age at diagnosis or sex of the patients. JAK2V617F, CALR and MPL mutations were found in 89 (59.3%), 42 (28%) and 2 (1.3%) patients, respectively, while 17 (11.4%) patients did not have a mutation in the 3 evaluated genes (triple negative). Twelve different mutations were found in CALR gene, the most common being 52-bp deletion (c.1092_1143del) and 5-bp insertions (c.1154_1155insTTGTC) which were present in 11 (26,2%) and 20 (47,6%) patients, respectively. Ten different mutations, including 6 insertions (c.1088insTTGTC; c.1088delinsTTTGTC; c.1113_1123delinsTTGT; c.1154delinsTATGTC; c.1126_1131delinsTGCGT; c.1154_1155insGTGTC) and 4 deletions (c.1092_1137del; c.1096_1129del; c.1089_1141del; c.1100_1145del), were detected in the other 11 patients with CALR mutation. The JAK2V617F mutation and triple negative status were more prevalent in female patients (67% and 68% respectively), while no sex preference was detected in patients with the CALR mutation. The average age of patients with JAK2V617F, CALR insertions, CALR deletions and triple negative status were 60,7±13,9, 54,5±12,9, 59,0±15,1 and 58,8+/-14,8 years, respectively. Patients with CALR mutation had a higher platelet count at the time of diagnosis (1134x109 ±372,9 x 109 /L) compared to both patients with mutated JAK2 (952 x109 ±335,6 x109/L) (P=0.047) and to triple negative patients (mean 886 x109/L±303,2 x109/L) (P=0.024). Patients who carried CALR insertions had higher platelet counts (1222,9 ±396,8 x109/L) than patients with CALR deletions (mean 956,8 ±287,8 x109/L ) (P=0.0405). White blood cells counts were the highest in patients with JAK2V617F mutation (mean 11.1±4,5x103/µL) compared to both CALR positive (mean 8,8±2,7x103/µL) and triple negative patients (mean 7,9±2,2x103/µL) (P=0.0049). No difference in Hb levels were present between patients with various mutations.</jats:p> <jats:p>Conclussion</jats:p> <jats:p>ET patients with CALR insertions present with higher platelet counts and at an earlier age than patients with JAK2V617F, CALR deletions or triple negative patients, which might translate to differences in prognosis in these groups of patients. Higher incidence of JAK2V617F mutation and triple negative status in female patients point to a common mechanism for predisposition to these conditions.</jats:p> <jats:sec> <jats:title>Disclosures</jats:title> <jats:p>No relevant conflicts of interest to declare.</jats:p> </jats:sec>
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    Cryopreservation of autologous peripheral blood stem cells - presence and future directions
    (Macedonian Association of Anatomists and Morphologists, 2015)
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    Diversities of Calreticulin Gene Mutations in Macedonian Patients With Essential Thrombocythemia
    (Elsevier BV, 2016-08)
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    Ivanovski, Martin
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    Acquired calreticulin (CALR) gene mutations are one of the molecular hallmarks of essential thrombocythemia (ET). It has been suggested that patients with ET with CALR mutations are associated with a distinct clinical phenotype.
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    Prognostic Model for Aggressive Non-Hodgkin Lymphoma
    (American Society of Hematology, 2005-11-16)
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    Ivkovski, Ljube G.
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    Zografski, Gorgi D.
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    <jats:title>Abstract</jats:title> <jats:p>There are two subgroups of the untreated lymphomas according to the outcome of the disease: indolent and aggressive. Unlike the indolent lymphoma, aggressive lymphomas are fatal in several weeks or months if untreated. However, the therapy available nowadays makes this group of patients with aggressive Non-Hodgkin’s lymphoma curable. Autologous stem cell transplantation used as first-line therapy can improve overall survival in selected group of patients with aggressive Non-Hodgkin lymphoma. To make the right and optimal therapeutic approach we need to stratify those patients in subgroups of patients with "high" and "low" risk, which was achieved with this study. This study comprises 211 patients with histopathology diagnosis of aggressive Non-Hodgkin’s lymphoma treated at the Department of Hematology in the period 1989–2002, which gave us the observation period of 6 to 183 months. There were 88 male patients, median age 53 years and 60 female, median age 52 years. Most of the patients were in the advanced clinical stage at the disease on the initial presentation of the disease, 24% of the patients in the third stage and 43% in the fourth stage. Bone marrow infiltration was found in 29%. Bcl-2 positively was confirmed in 26 cases by imunohistochemistry and there was proliferative index Ki-67 above 60% in 32 patients. Imunophenotipisation suggested that 80% of the cases are B-cell lymphoma. The patients were treated with antracicilin included regiments, most of them being CHOP regiment. After initial chemotherapy complete remission was achieved in 60%, partial response in 4% and there was no response in 32% with early deaths in 4%. At the end of the study 32% of the patients were alive and well, 32% were deceased and the reminder had unknown status. There was relapse of the disease in 50 patients with previous complete remission. According to the univariante analysis the following parameters had significantly influence the overall survival in the patients with aggressive Non-Hodgkin’s lymphoma: initial anemia, initial LDH, the stage of the disease, ECOG score, bone marrow infiltration, number of sites of extranodal infiltration, lymphoma subgroup according to various classification systems, morphology of the lymphoma cell, imunophenotype profile, percent of Ki-67 positively, bcl-2 positively, time to complete remission. The multiply progression analysis produce mathematical model through which we can anticipate the expected survival in each patients individually based on the statistically most influential prognostic markers, those achieving stratification of the patients in risk groups. In our study 32% of the patients with "high" risk are alive and "low risk patients have 70% 5-years overall survival. With the use of this prognostic model for aggressive Non-Hodgkin’s lymphoma we achieved risk based stratification of the patients even in the fourth stage of the disease with statistical significance. This prognostic model for aggressive Non-Hodgkin’s lymphoma enables the clinical hematologist to create the optimal individual therapeutic approach for each patient with aggressive Non-Hodgkin’s lymphoma. The patients with "high" risk are group of patients where beside the standard chemotherapy, use of aggressive chemotherapy and haematopoetic stem cell transplantation as well as the new therapeutic approaches would improve therapeutic results and overall survival.</jats:p>
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