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Wei W, Zhou F, Zhang Y, Guo L, Shi H, Hou J. A combination of thalidomide and arsenic trioxide is effective and well tolerated in patients with myelodysplastic syndromes. Leuk Res 2012; 36:715-9. [DOI: 10.1016/j.leukres.2011.12.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 12/08/2011] [Accepted: 12/30/2011] [Indexed: 11/25/2022]
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Abel GA, Friese CR, Neville BA, Wilson KM, Hastings BT, Earle CC, Keating NL, Richardson LC. Referrals for suspected hematologic malignancy: a survey of primary care physicians. Am J Hematol 2012; 87:634-6. [PMID: 22473854 DOI: 10.1002/ajh.23172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 02/17/2012] [Accepted: 02/21/2012] [Indexed: 12/31/2022]
Abstract
Little is known about referrals from primary care providers (PCPs) for suspected hematologic malignancies, including their clinical triggers and frequency. A random sample of 190 Massachusetts PCPs were presented with a vignette concerning a patient with a new finding of moderate anemia, asked how they would respond, and then asked what they would do if the patient returned with persistent anemia plus one additional sign or symptom. We also asked about referral behaviors for suspected hematologic malignancies during the prior year. A total of 134 (70.5%) PCPs responded. At first anemia presentation,only 3.8% reported referring to hematology. The development of a second sign or symptom yielded higher referral rates: pancytopenia 588.7%, leukopenia 5 63.9%, thrombocytopenia 5 63.9%, lymphadenopathy 5 42.9%, leukocytosis 5 37.6%, night sweats 5 25.6%, and weight loss 5 23.3%. The median yearly number (interquartile range) of patients PCPs reported suspecting of having hematologic malignancy was 5 (3, 10), and the median formally referred was 5 (3, 10). We conclude that anemia plus signs and symptoms suggestive of myelodysplasia or leukemia (compared with those suggestive of lymphoma) are more likely to prompt hematology referral. In addition, given their rarity,the numbe
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Affiliation(s)
- Gregory A Abel
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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Myelodysplastic syndrome and histone deacetylase inhibitors: "to be or not to be acetylated"? J Biomed Biotechnol 2011; 2011:214143. [PMID: 21629744 PMCID: PMC3100562 DOI: 10.1155/2011/214143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 03/03/2011] [Indexed: 12/31/2022] Open
Abstract
Myelodysplastic syndrome (MDS) represents a heterogeneous group of diseases with clonal proliferation, bone marrow failure and increasing risk of transformation into an acute myeloid leukaemia. Structured guidelines are developed for selective therapy based on prognostic subgroups, age, and performance status. Although many driving forces of disease phenotype and biology are described, the complete and possibly interacting pathogenetic pathways still remain unclear. Epigenetic investigations of cancer and haematologic diseases like MDS give new insights into the pathogenesis of this complex disease. Modifications of DNA or histones via methylation or acetylation lead to gene silencing and altered physiology relevant for MDS. First clinical trials give evidence that patients with MDS could benefit from epigenetic treatment with, for example, DNA methyl transferase inhibitors (DNMTi) or histone deacetylase inhibitors (HDACi). Nevertheless, many issues of HDACi remain incompletely understood and pose clinical and translational challenges. In this paper, major aspects of MDS, MDS-associated epigenetics and the potential use of HDACi are discussed.
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Vigna E, Recchia AG, Madeo A, Gentile M, Bossio S, Mazzone C, Lucia E, Morabito L, Gigliotti V, Stefano LD, Caruso N, Servillo P, Franzese S, Fimognari F, Bisconte MG, Gentile C, Morabito F. Epigenetic regulation in myelodysplastic syndromes: implications for therapy. Expert Opin Investig Drugs 2011; 20:465-93. [DOI: 10.1517/13543784.2011.559164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ernesto Vigna
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Anna Grazia Recchia
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Antonio Madeo
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Massimo Gentile
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Sabrina Bossio
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Carla Mazzone
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Eugenio Lucia
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Lucio Morabito
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Vincenzo Gigliotti
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Laura De Stefano
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Nadia Caruso
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Pasquale Servillo
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Stefania Franzese
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | | | - Maria Grazia Bisconte
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Carlo Gentile
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
| | - Fortunato Morabito
- Unità Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza, Viale della Repubblica, 87100 Cosenza, Italy ;
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Xiao Z, Xu Z, Zhang Y, Qin T, Zhang H, Fang L. Cyclosporin A and thalidomide in patients with myelodysplastic syndromes: Results of a pilot study. Leuk Res 2011; 35:61-5. [DOI: 10.1016/j.leukres.2010.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 05/28/2010] [Accepted: 06/05/2010] [Indexed: 11/16/2022]
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Lindsey M, Beavers J. Myelodysplastic syndromes in older adults. Clin J Oncol Nurs 2010; 14:545-7. [PMID: 20880813 DOI: 10.1188/10.cjon.545-547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Myelodsyplastic syndromes are a collection of disorders that affect the hematopoietic development of myeloid cells in the bone marrow. Although this disorder is curable by way of allogeneic stem cell transplantation, advanced age, limited donor availability, and multiple comorbidities often exclude patients from curative treatment. Developments using the drugs lenalidomide, decitabine, and azacitidine have offered treatment options to patients ineligible for transplantation. Nurses remain instrumental in the administration, patient monitoring, and patient education associated with these new therapies.
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Affiliation(s)
- Melissa Lindsey
- James Cancer Hospital and Solove Research Institute, Ohio State University, Columbus, USA.
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Abstract
The efficacy of azacitidine, a cytosine nucleoside analog, has been demonstrated in two large phase III trials in myelodysplastic syndromes (MDS) patients, primarily in higher-risk patients. In the Cancer and Leukemia Group B (CALGB) study (lower-and higher-risk MDS patients; n = 191) azacitidine significantly prolonged median time-to-progression to acute myeloid leukemia or death (21 vs 13 months for supportive care; p = 0.007). The AZA-001 trial (Intermediate-2-and High-risk MDS patients; n = 358) showed azacitidine significantly prolonged median overall survival compared with conventional care regimens (24.5 vs 15.0 months; p = 0.0001). These results establish azacitidine as a reference first-line treatment in patients with Intermediate-2-and High-risk MDS who are not immediate candidates for allogeneic stem cell transplantation.
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