Pub Date : 2018-07-11eCollection Date: 2018-03-01DOI: 10.2217/ijh-2018-0004
John Ashcroft, Davneet Judge, Sujith Dhanasiri, Gavin Taylor-Stokes, Chloe Middleton
Aim: To understand the current treatment patterns, clinical outcomes and healthcare resource utilization-associated costs for multiple myeloma patients, post autologous stem cell transplant (ASCT) across Europe.
Patients & methods: Medical records were used to abstract data for 337 multiple myeloma patients who had received ASCT.
Results: Following ASCT, 7% received maintenance therapy prior to progression. Lenalidomide was the most frequently prescribed maintenance, second- and third-line therapy. Monthly resource use was considerably lower in patients who received maintenance therapy (€638.14 vs €1001.74). Median time to progression was longer for patients who had received maintenance therapy.
Conclusion: The study highlights the diversity in current treatment patterns post-ASCT. Results suggest patients who receive maintenance therapy have a prolonged remission period, and as a result their associated healthcare resource utilization is spread across the treatment pathway.
{"title":"Chart review across EU5 in MM post-ASCT patients.","authors":"John Ashcroft, Davneet Judge, Sujith Dhanasiri, Gavin Taylor-Stokes, Chloe Middleton","doi":"10.2217/ijh-2018-0004","DOIUrl":"https://doi.org/10.2217/ijh-2018-0004","url":null,"abstract":"<p><strong>Aim: </strong>To understand the current treatment patterns, clinical outcomes and healthcare resource utilization-associated costs for multiple myeloma patients, post autologous stem cell transplant (ASCT) across Europe.</p><p><strong>Patients & methods: </strong>Medical records were used to abstract data for 337 multiple myeloma patients who had received ASCT.</p><p><strong>Results: </strong>Following ASCT, 7% received maintenance therapy prior to progression. Lenalidomide was the most frequently prescribed maintenance, second- and third-line therapy. Monthly resource use was considerably lower in patients who received maintenance therapy (€638.14 vs €1001.74). Median time to progression was longer for patients who had received maintenance therapy.</p><p><strong>Conclusion: </strong>The study highlights the diversity in current treatment patterns post-ASCT. Results suggest patients who receive maintenance therapy have a prolonged remission period, and as a result their associated healthcare resource utilization is spread across the treatment pathway.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2018-0004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36569697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-28eCollection Date: 2018-03-01DOI: 10.2217/ijh-2018-0002
Emily Bryer, David Henry
Extensive and significant technological advancements have enhanced the sensitivity and accuracy of the pathologic classification, diagnosis, and therapeutics of lymphoma. These advances have prompted a more comprehensive understanding of neoplastic behavior and have led to improvements in both treatment and prognosis. This paper presents a comprehensive review of lymphoma and features a case report of a unique presentation of peripheral T-cell lymphoma - not otherwise specified that presented with isolated hypoglossal nerve dysfunction.
{"title":"Isolated hypoglossal nerve palsy as a presenting symptom of metastatic peripheral T-cell lymphoma - not otherwise specified (PTCL-NOS): a unique case & a review of the literature.","authors":"Emily Bryer, David Henry","doi":"10.2217/ijh-2018-0002","DOIUrl":"https://doi.org/10.2217/ijh-2018-0002","url":null,"abstract":"<p><p>Extensive and significant technological advancements have enhanced the sensitivity and accuracy of the pathologic classification, diagnosis, and therapeutics of lymphoma. These advances have prompted a more comprehensive understanding of neoplastic behavior and have led to improvements in both treatment and prognosis. This paper presents a comprehensive review of lymphoma and features a case report of a unique presentation of peripheral T-cell lymphoma - not otherwise specified that presented with isolated hypoglossal nerve dysfunction.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2018-0002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36569696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-13eCollection Date: 2018-03-01DOI: 10.2217/ijh-2017-0025
Mahsa Eskian, MirHojjat Khorasanizadeh, Alessandro Isidori, Nima Rezaei
Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy and the sixth cause of death from cancer in the USA. Autologous stem cell transplantation (ASCT) is a potentially curative therapeutic option for many NHL patients. Choosing the most effective conditioning regimen prior to ASCT can lead to longer survival in these patients, and, as in many cases of high risk NHL, the only potentially curative option is stem cell transplantation. Radioimmunotherapy (RIT) is based on using radiolabeled monoclonal antibodies against tumoral antigens. Since lymphoma cells are sensitive to radiation, RIT has become a potential approach in treating NHL. In this review, we have discussed the efficacy and safety of RIT as an alternative conditioning regimen prior to ASCT.
{"title":"Radioimmunotherapy-based conditioning regimen prior to autologous stem cell transplantation in non-Hodgkin lymphoma.","authors":"Mahsa Eskian, MirHojjat Khorasanizadeh, Alessandro Isidori, Nima Rezaei","doi":"10.2217/ijh-2017-0025","DOIUrl":"https://doi.org/10.2217/ijh-2017-0025","url":null,"abstract":"<p><p>Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy and the sixth cause of death from cancer in the USA. Autologous stem cell transplantation (ASCT) is a potentially curative therapeutic option for many NHL patients. Choosing the most effective conditioning regimen prior to ASCT can lead to longer survival in these patients, and, as in many cases of high risk NHL, the only potentially curative option is stem cell transplantation. Radioimmunotherapy (RIT) is based on using radiolabeled monoclonal antibodies against tumoral antigens. Since lymphoma cells are sensitive to radiation, RIT has become a potential approach in treating NHL. In this review, we have discussed the efficacy and safety of RIT as an alternative conditioning regimen prior to ASCT.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2017-0025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36569751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-10eCollection Date: 2018-03-01DOI: 10.2217/ijh-2017-0023
Yazeed Sawalha, Anjali S Advani
The management of acute lymphoblastic leukemia (ALL) in older patients is challenging. Older patients often have multiple comorbidities and poor performance status, and disease factors associated with poor prognosis are more common in this age group. Patient and disease-related factors should be taken into account to determine whether intensive therapy is appropriate. The use of comorbidity indices and comprehensive geriatric assessment tools can be valuable in this setting. Fit patients should be considered for aggressive therapies including allogeneic hematopoietic stem cell transplantation, whereas low intensity options may be more suitable for the frail. The Philadelphia (Ph) chromosome is present in up to half of the cases of ALL in older patients. The incorporation of TK inhibitors into the treatment plans of older patients with Ph-positive ALL has improved the outcomes significantly. For less fit patients with Ph-positive ALL, the use of TK inhibitors with reduced-intensity chemotherapy or steroids alone results in high rates of remission, but, without further consolidation, relapses are inevitable. Many novel targeted and immunotherapeutic agents are being developed, offering more effective and tolerable treatment options.
{"title":"Management of older adults with acute lymphoblastic leukemia: challenges & current approaches.","authors":"Yazeed Sawalha, Anjali S Advani","doi":"10.2217/ijh-2017-0023","DOIUrl":"https://doi.org/10.2217/ijh-2017-0023","url":null,"abstract":"<p><p>The management of acute lymphoblastic leukemia (ALL) in older patients is challenging. Older patients often have multiple comorbidities and poor performance status, and disease factors associated with poor prognosis are more common in this age group. Patient and disease-related factors should be taken into account to determine whether intensive therapy is appropriate. The use of comorbidity indices and comprehensive geriatric assessment tools can be valuable in this setting. Fit patients should be considered for aggressive therapies including allogeneic hematopoietic stem cell transplantation, whereas low intensity options may be more suitable for the frail. The Philadelphia (Ph) chromosome is present in up to half of the cases of ALL in older patients. The incorporation of TK inhibitors into the treatment plans of older patients with Ph-positive ALL has improved the outcomes significantly. For less fit patients with Ph-positive ALL, the use of TK inhibitors with reduced-intensity chemotherapy or steroids alone results in high rates of remission, but, without further consolidation, relapses are inevitable. Many novel targeted and immunotherapeutic agents are being developed, offering more effective and tolerable treatment options.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2017-0023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36569752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-12-21DOI: 10.2217/ijh-2017-0024
Claire Harrison
Professor Claire Harrison speaks to Roshaine Wijayatunga, managing commissioning editor: Professor Claire Harrison became a consultant at Guy's and St Thomas' hospital in 2001. She is also deputy clinical director of cancer and hematology. She has influenced major advances in her field, including the description of key mutations and designing/leading global clinical trials, for example, the first JAK inhibitor trial in Europe. She is the chief investigator for several other international and national clinical trials. She has strong international collaborations and authors many papers in peer-reviewed journals such as the New England Journal of Medicine and Blood. She has worked with enthusiastic patients to create a patient charity, MPN Voice. She is an internationally regarded expert in her field as a patient advocate.
{"title":"A discussion of blood cancers and the MPN landmark survey.","authors":"Claire Harrison","doi":"10.2217/ijh-2017-0024","DOIUrl":"https://doi.org/10.2217/ijh-2017-0024","url":null,"abstract":"<p><p><b>Professor Claire Harrison speaks to Roshaine Wijayatunga, managing commissioning editor:</b> Professor Claire Harrison became a consultant at Guy's and St Thomas' hospital in 2001. She is also deputy clinical director of cancer and hematology. She has influenced major advances in her field, including the description of key mutations and designing/leading global clinical trials, for example, the first JAK inhibitor trial in Europe. She is the chief investigator for several other international and national clinical trials. She has strong international collaborations and authors many papers in peer-reviewed journals such as the <i>New England Journal of Medicine</i> and <i>Blood</i>. She has worked with enthusiastic patients to create a patient charity, MPN Voice. She is an internationally regarded expert in her field as a patient advocate.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2017-0024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36569748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2018-02-22DOI: 10.2217/ijh-2017-0022
Philip McCarthy
Philip McCarthy speaks to Roshaine Wijayatunga, Senior Editor: Oncology Philip McCarthy completed his MD at Tufts University School of Medicine, Boston, MA, USA and his Internal Medicine Residency at Yale, New Haven Hospital, New Haven, CT, USA. His Fellowship was completed at Brigham and Women's Hospital and the Dana Farber Cancer Insitute, Harvard University, Boston, MA, USA. His research interests are devoted to developing novel intensive and reduced intensity allogeneic (allo) and autologous (auto) hematopoietic stem cell transplant (HSCT) approaches for the treatment of hematologic disorders, leading to improved patient outcomes and decreased toxicity. He has over 20 years of experience treating HSCT patients and directing clinical and translational HSCT research studies. He has served as chair or co-chair of several clinical trials including CALGB 100104, a Phase III clinical trial evaluating lenalidomide maintenance after auto-HSCT for multiple myeloma (MM). This study demonstrated an improved progression-free and overall survival for MM patients receiving lenalidomide maintenance therapy after auto-HSCT. The Roswell Park Comprehensive Cancer Center Blood and Marrow Transplant team has developed a systematic approach to the evaluation and treatment of HSCT patients with a specific focus on predicting and minimizing treatment-related mortality. The team participates with a core group of basic science and clinical researchers who are committed to the investigation of the complications of auto- and allo-HSCT and to the developing novel approaches to improve outcomes.
Philip McCarthy在美国马萨诸塞州波士顿的塔夫茨大学医学院完成了医学博士学位,并在美国康涅狄格州纽黑文的耶鲁大学纽黑文医院完成了内科住院医师。他的研究在美国马萨诸塞州波士顿的哈佛大学布里格姆妇女医院和达纳法伯癌症研究所完成。他的研究兴趣是致力于开发新的强化和降低强度的同种异体(allo)和自体(auto)造血干细胞移植(HSCT)治疗血液系统疾病的方法,从而改善患者的预后并降低毒性。他有超过20年的治疗HSCT患者和指导临床和转化HSCT研究的经验。他曾担任多项临床试验的主席或联合主席,包括CALGB 100104,这是一项评估多发性骨髓瘤(MM)自体造血干细胞移植后来那度胺维持的III期临床试验。这项研究表明,自体造血干细胞移植后接受来那度胺维持治疗的MM患者的无进展和总生存率有所改善。Roswell Park综合癌症中心的血液和骨髓移植团队已经开发出一种系统的方法来评估和治疗HSCT患者,并特别关注预测和最小化治疗相关的死亡率。该团队与基础科学和临床研究人员组成的核心小组一起参与,他们致力于研究自体和同种异体造血干细胞移植的并发症,并开发新的方法来改善结果。
{"title":"Interview with Dr Philip McCarthy.","authors":"Philip McCarthy","doi":"10.2217/ijh-2017-0022","DOIUrl":"https://doi.org/10.2217/ijh-2017-0022","url":null,"abstract":"<p><p><b>Philip McCarthy speaks to Roshaine Wijayatunga, Senior Editor:</b> Oncology Philip McCarthy completed his MD at Tufts University School of Medicine, Boston, MA, USA and his Internal Medicine Residency at Yale, New Haven Hospital, New Haven, CT, USA. His Fellowship was completed at Brigham and Women's Hospital and the Dana Farber Cancer Insitute, Harvard University, Boston, MA, USA. His research interests are devoted to developing novel intensive and reduced intensity allogeneic (allo) and autologous (auto) hematopoietic stem cell transplant (HSCT) approaches for the treatment of hematologic disorders, leading to improved patient outcomes and decreased toxicity. He has over 20 years of experience treating HSCT patients and directing clinical and translational HSCT research studies. He has served as chair or co-chair of several clinical trials including CALGB 100104, a Phase III clinical trial evaluating lenalidomide maintenance after auto-HSCT for multiple myeloma (MM). This study demonstrated an improved progression-free and overall survival for MM patients receiving lenalidomide maintenance therapy after auto-HSCT. The Roswell Park Comprehensive Cancer Center Blood and Marrow Transplant team has developed a systematic approach to the evaluation and treatment of HSCT patients with a specific focus on predicting and minimizing treatment-related mortality. The team participates with a core group of basic science and clinical researchers who are committed to the investigation of the complications of auto- and allo-HSCT and to the developing novel approaches to improve outcomes.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2017-0022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36569747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2018-01-26DOI: 10.2217/ijh-2017-0020
Sarah J Nagle, Nirav N Shah, Alex Ganetsky, Daniel J Landsburg, Sunita D Nasta, Anthony Mato, Stephen J Schuster, Ran Reshef, Donald E Tsai, Jakub Svoboda
Aim: To describe the long-term outcomes of patients with lymphoma in the CNS treated with rituximab, temozolomide and high-dose methotrexate without consolidation therapy.
Patients & methods: A retrospective cohort study of 46 consecutive patients with primary CNS lymphoma (PCNSL, 27 patients) or secondary CNS involvement of diffuse large B-cell lymphoma (DLBCL, 19 patients) who were treated with rituximab on day 1 in combination with high-dose methotrexate (days 1 and 15) and temozolomide (days 1-5) in 28-day cycles without further consolidation.
Results: Median follow-up was 21.2 months. Patients received a median of five cycles (range 1-15). Median overall survival (OS) was 26 months and median progression-free survival was 8.6 months. At 3 years, 37% of patients were alive and without evidence of disease. The patients with PCNSL had a significantly higher response rates (ORR 81 vs 47%; p = 0.015) and longer median OS (55.3 vs 4.8 months; p < 0.01) than those with secondary CNS DLBCL. Toxicities were mild and manageable.
Conclusion: The rituximab, temozolomide and methotrexate regimen is an effective therapy for patients with PCNSL without the toxicities typically associated with consolidation therapy.
目的:描述无巩固治疗的利妥昔单抗、替莫唑胺和大剂量甲氨蝶呤治疗中枢神经系统淋巴瘤患者的长期预后。患者和方法:一项回顾性队列研究,连续46例原发性中枢神经系统淋巴瘤(PCNSL, 27例)或继发性弥漫性大b细胞淋巴瘤(DLBCL, 19例)患者,在第1天接受利妥昔单抗联合高剂量甲氨蝶呤(第1天和第15天)和替莫唑胺(第1天至第5天)治疗,28天周期,无进一步巩固。结果:中位随访时间为21.2个月。患者平均接受5个周期(范围1-15)。中位总生存期(OS)为26个月,中位无进展生存期为8.6个月。3年时,37%的患者存活且无疾病迹象。PCNSL患者的缓解率明显更高(ORR为81比47%;p = 0.015)和更长的中位OS (55.3 vs 4.8个月;结论:利妥昔单抗、替莫唑胺和甲氨蝶呤联合治疗PCNSL是一种有效的治疗方案,且无巩固治疗的毒副作用。
{"title":"Long-term outcomes of rituximab, temozolomide and high-dose methotrexate without consolidation therapy for lymphoma involving the CNS.","authors":"Sarah J Nagle, Nirav N Shah, Alex Ganetsky, Daniel J Landsburg, Sunita D Nasta, Anthony Mato, Stephen J Schuster, Ran Reshef, Donald E Tsai, Jakub Svoboda","doi":"10.2217/ijh-2017-0020","DOIUrl":"https://doi.org/10.2217/ijh-2017-0020","url":null,"abstract":"<p><strong>Aim: </strong>To describe the long-term outcomes of patients with lymphoma in the CNS treated with rituximab, temozolomide and high-dose methotrexate without consolidation therapy.</p><p><strong>Patients & methods: </strong>A retrospective cohort study of 46 consecutive patients with primary CNS lymphoma (PCNSL, 27 patients) or secondary CNS involvement of diffuse large B-cell lymphoma (DLBCL, 19 patients) who were treated with rituximab on day 1 in combination with high-dose methotrexate (days 1 and 15) and temozolomide (days 1-5) in 28-day cycles without further consolidation.</p><p><strong>Results: </strong>Median follow-up was 21.2 months. Patients received a median of five cycles (range 1-15). Median overall survival (OS) was 26 months and median progression-free survival was 8.6 months. At 3 years, 37% of patients were alive and without evidence of disease. The patients with PCNSL had a significantly higher response rates (ORR 81 vs 47%; p = 0.015) and longer median OS (55.3 vs 4.8 months; p < 0.01) than those with secondary CNS DLBCL. Toxicities were mild and manageable.</p><p><strong>Conclusion: </strong>The rituximab, temozolomide and methotrexate regimen is an effective therapy for patients with PCNSL without the toxicities typically associated with consolidation therapy.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2017-0020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36569750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-01Epub Date: 2017-12-21DOI: 10.2217/ijh-2017-0019
Elie El Rassy, Alain Chebly, Rima Korban, Warde Semaan, Ziad Bakouny, Tarek Assi, Hampig Raphael Kourie, Fadi El Karak, Eliane Chouery, Joseph Kattan
Aim: We aimed to understand the biology of chronic lymphocytic leukemia (CLL) patients in Lebanon.
Materials & methods: We applied conventional cytogenetic and FISH studies on Lebanese patients diagnosed with CLL and undergoing a watch and wait approach.
Results: Our study disclosed 53.6% of patients with aberrant karyotypes among which 26.7% were complex karyotypes. Genetic aberrations included del(13q14) 46.4%, 14q32 translocation in 25%, trisomy 12 in 14.3%, del(17p13) and del(11q22) in 7.1% each. The deletion of 6q21/6q23 was not found in any of our patients.
Conclusion: The higher prevalence of del(13q14) as a sole abnormality could be the primary event in inducing CLL. The del(17p13) and del(11q22) followed as potential drivers for progression in CLL patients with a watch and wait approach.
{"title":"Untreated chronic lymphocytic leukemia in Lebanese patients: an observational study using standard karyotyping and FISH.","authors":"Elie El Rassy, Alain Chebly, Rima Korban, Warde Semaan, Ziad Bakouny, Tarek Assi, Hampig Raphael Kourie, Fadi El Karak, Eliane Chouery, Joseph Kattan","doi":"10.2217/ijh-2017-0019","DOIUrl":"10.2217/ijh-2017-0019","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to understand the biology of chronic lymphocytic leukemia (CLL) patients in Lebanon.</p><p><strong>Materials & methods: </strong>We applied conventional cytogenetic and FISH studies on Lebanese patients diagnosed with CLL and undergoing a watch and wait approach.</p><p><strong>Results: </strong>Our study disclosed 53.6% of patients with aberrant karyotypes among which 26.7% were complex karyotypes. Genetic aberrations included del(13q14) 46.4%, 14q32 translocation in 25%, trisomy 12 in 14.3%, del(17p13) and del(11q22) in 7.1% each. The deletion of 6q21/6q23 was not found in any of our patients.</p><p><strong>Conclusion: </strong>The higher prevalence of del(13q14) as a sole abnormality could be the primary event in inducing CLL. The del(17p13) and del(11q22) followed as potential drivers for progression in CLL patients with a watch and wait approach.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172003/pdf/ijh-06-105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36569749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01Epub Date: 2017-11-20DOI: 10.2217/ijh-2017-0013
Manisha Pant, Vijaya Raj Bhatt
Acute myeloid leukemia (AML) is a disease of older adults [1] and has a median age of 68 years at the time of diagnosis. The management of AML in older patients (>60 years) is far from optimal and often associated with poor outcomes. Over half of the older patients do not receive initial chemotherapy [1,2], remission rate is lower than in younger patients and lasts shorter duration, and long term survival is dismal. For example, 5-year survival is over 50% for patients aged 15–24 years that drops steadily to 13% for patients between 60 and 69 years of age and 3% for those aged 70–79 years [3]. Functional status varies widely even in older patients with similar biological age and affects outcome. For instance, data from the Southwest Oncology Group trials demonstrated that the early mortality at 1 month for patients older than 75 years is 14% with Eastern Cooperative Oncology Group performance score of 0 versus 82% for a score of 3 [4]. Higher incidence of comorbidities negatively affects outcomes [1]. This is reflected by a higher 8-week mortality (30 vs 19%) in patients with a higher modified Charlson Comorbidity Index of >1 versus ≤ 1, respectively [5]. Comorbidities may lead to poor tolerance of chemotherapy, enhanced toxicity, particularly following intensive chemotherapy and a lower rate of complete response. Malnutrition, decreased immunity with increased susceptibility to infection, cognitive decline and social isolation pose increased risk of toxicity from chemotherapy. Older adults have higher rates of multidrug resistance compared with the younger patients (57 vs 33%) [4]. The proportion with unfavorable cytogenetics increases with age, whereas translocation associated with favorable response drops. AML in younger patients may result from a limited number of mutational events restricting diversity of leukemic subclones and leaving many cell functions intact including mechanism of apoptosis. AML in the older patients, however, may arise due to string of mutational events producing multiple leukemic subclones giving rise to chemoresistance. Patients with pre-existing myelodysplastic or myeloproliferative disorders (i.e., secondary AML) have higher probability of harboring poor cytogenetics, which translates to poor survival. Also, the presence of secondary AML type mutations, commonly observed in older patients, is associated with poor chances of achieving remission and long-term disease control [6]. Overall care of older patients with AML may improve with refined risk-stratification and personalized therapy based on the principles of geriatric medicine. For example, careful assessment of comorbid conditions is vital in older patients. Comprehensive geriatric assessment is also valuable in determining tolerance to various intensities of chemotherapy. Geriatric assessment evaluates multiple health domains including comorbidities, polypharmacy, cognitive, nutritional, psychological, functional and social status, and can predict tolerance of
{"title":"Early mortality and survival in older adults with acute myeloid leukemia.","authors":"Manisha Pant, Vijaya Raj Bhatt","doi":"10.2217/ijh-2017-0013","DOIUrl":"https://doi.org/10.2217/ijh-2017-0013","url":null,"abstract":"Acute myeloid leukemia (AML) is a disease of older adults [1] and has a median age of 68 years at the time of diagnosis. The management of AML in older patients (>60 years) is far from optimal and often associated with poor outcomes. Over half of the older patients do not receive initial chemotherapy [1,2], remission rate is lower than in younger patients and lasts shorter duration, and long term survival is dismal. For example, 5-year survival is over 50% for patients aged 15–24 years that drops steadily to 13% for patients between 60 and 69 years of age and 3% for those aged 70–79 years [3]. Functional status varies widely even in older patients with similar biological age and affects outcome. For instance, data from the Southwest Oncology Group trials demonstrated that the early mortality at 1 month for patients older than 75 years is 14% with Eastern Cooperative Oncology Group performance score of 0 versus 82% for a score of 3 [4]. Higher incidence of comorbidities negatively affects outcomes [1]. This is reflected by a higher 8-week mortality (30 vs 19%) in patients with a higher modified Charlson Comorbidity Index of >1 versus ≤ 1, respectively [5]. Comorbidities may lead to poor tolerance of chemotherapy, enhanced toxicity, particularly following intensive chemotherapy and a lower rate of complete response. Malnutrition, decreased immunity with increased susceptibility to infection, cognitive decline and social isolation pose increased risk of toxicity from chemotherapy. Older adults have higher rates of multidrug resistance compared with the younger patients (57 vs 33%) [4]. The proportion with unfavorable cytogenetics increases with age, whereas translocation associated with favorable response drops. AML in younger patients may result from a limited number of mutational events restricting diversity of leukemic subclones and leaving many cell functions intact including mechanism of apoptosis. AML in the older patients, however, may arise due to string of mutational events producing multiple leukemic subclones giving rise to chemoresistance. Patients with pre-existing myelodysplastic or myeloproliferative disorders (i.e., secondary AML) have higher probability of harboring poor cytogenetics, which translates to poor survival. Also, the presence of secondary AML type mutations, commonly observed in older patients, is associated with poor chances of achieving remission and long-term disease control [6]. Overall care of older patients with AML may improve with refined risk-stratification and personalized therapy based on the principles of geriatric medicine. For example, careful assessment of comorbid conditions is vital in older patients. Comprehensive geriatric assessment is also valuable in determining tolerance to various intensities of chemotherapy. Geriatric assessment evaluates multiple health domains including comorbidities, polypharmacy, cognitive, nutritional, psychological, functional and social status, and can predict tolerance of","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2017-0013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36568755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01Epub Date: 2017-08-11DOI: 10.2217/ijh-2017-0015
Paul G Richardson, Stephan A Grupp, Antonio Pagliuca, Amrita Krishnan, Vincent T Ho, Selim Corbacioglu
Hepatic veno-occlusive disease, also called sinusoidal obstruction syndrome (VOD/SOS), is a potentially life-threatening and unpredictable complication of hematopoietic stem cell transplantation (HSCT). Characterized by a prothrombotic-hypofibrinolytic state, VOD/SOS typically presents with hyperbilirubinemia, ascites, weight gain and painful hepatomegaly; VOD/SOS with multiorgan failure may be associated with >80% mortality. Treatment has been mainly supportive. However, defibrotide is now approved in the USA for treatment of hepatic VOD/SOS with renal or pulmonary dysfunction following HSCT and in the European Union for treatment of severe hepatic VOD/SOS post-HSCT. In vitro evidence suggests defibrotide may restore thrombotic-fibrinolytic balance at the endothelial level and protect endothelial cells. Defibrotide has demonstrated significant reduction in VOD/SOS-related mortality and resolved VOD/SOS-related symptoms, with a manageable safety profile.
{"title":"Defibrotide for the treatment of hepatic veno-occlusive disease/sinusoidal obstruction syndrome with multiorgan failure.","authors":"Paul G Richardson, Stephan A Grupp, Antonio Pagliuca, Amrita Krishnan, Vincent T Ho, Selim Corbacioglu","doi":"10.2217/ijh-2017-0015","DOIUrl":"10.2217/ijh-2017-0015","url":null,"abstract":"<p><p>Hepatic veno-occlusive disease, also called sinusoidal obstruction syndrome (VOD/SOS), is a potentially life-threatening and unpredictable complication of hematopoietic stem cell transplantation (HSCT). Characterized by a prothrombotic-hypofibrinolytic state, VOD/SOS typically presents with hyperbilirubinemia, ascites, weight gain and painful hepatomegaly; VOD/SOS with multiorgan failure may be associated with >80% mortality. Treatment has been mainly supportive. However, defibrotide is now approved in the USA for treatment of hepatic VOD/SOS with renal or pulmonary dysfunction following HSCT and in the European Union for treatment of severe hepatic VOD/SOS post-HSCT. <i>In vitro</i> evidence suggests defibrotide may restore thrombotic-fibrinolytic balance at the endothelial level and protect endothelial cells. Defibrotide has demonstrated significant reduction in VOD/SOS-related mortality and resolved VOD/SOS-related symptoms, with a manageable safety profile.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh-2017-0015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36609876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}