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Expert Review of Hematology

Fabio Efficace, Francesco Cottone
No abstract text is available yet for this article.
November 9, 2018: Expert Review of Hematology
Mattia Algeri, Francesca Del Bufalo, Federica Galaverna, Franco Locatelli
The clinical application of immunotherapy has resulted into a significant improvement in the outcome of children with relapsed/refractory B-cell precursor acute lymphoblastic leukemia (r/r BCP-ALL). In this setting, the use of bispecific T-cell-engager antibodies (BiTEs), such as blinatumomab, which harness the cytotoxic activity of T cells against CD19-positive lymphoblasts, has emerged as a most promising and impactful strategy. Areas covered: This review discusses the main structural and functional features of BiTEs, as well as the current status of their clinical application in childhood ALL...
October 25, 2018: Expert Review of Hematology
Agne Paner, Tochukwu M Okwuosa, Kristin J Richardson, Edward N Libby
Multiple three drug combination regimens have been approved for the treatment of multiple myeloma in the last few years. Triplets have become the new standard of care for transplant eligible and ineligible patients with newly diagnosed as well as relapsed multiple myeloma. Novel agents have a unique profile of side effects. The management of toxicities is important to maintain quality of life and maximize treatment duration and benefit. Areas covered: This article reviews efficacy data, incidence of key adverse events and provide recommendations and expert opinion regarding how to manage common toxicities in triplet therapies...
October 19, 2018: Expert Review of Hematology
Catherine Tang, John Kuruvilla
No abstract text is available yet for this article.
October 19, 2018: Expert Review of Hematology
Ramy Rahmé, Lionel Adès
Myelodysplastic syndromes (MDS) are clonal stem cell disorders mostly affecting the elderly. They are classified into lower and higher risk MDS according to prognostic scoring systems. In higher-risk patients, treatments should aim to modify the disease course by avoiding progression to acute myeloid leukemia, and therefore to improve survival. Areas covered: Stem cell transplantation remains the only curative treatment when feasible, but this concerns a small minority of patients. Treatment is principally based on hypomethylating agents (HMAs)...
October 18, 2018: Expert Review of Hematology
Dimitrios C Ziogas, Meletios A Dimopoulos, Efstathios Kastritis
Multiple myeloma (MM) is characterized by notable inter-patient and intra-clonal heterogeneity that is gradually decoded over the last decade. Despite the deeper and better understanding of its biology and the development of novel therapeutic strategies that have prolonged overall survival, MM still retains a poor prognosis in patient subgroups with certain high-risk features. Areas covered: This article summarizes currently identified features that stratified patients in high-risk myeloma with impaired prognosis and discusses available therapeutic options that may partially overcome the impact of these adverse factors in patients' outcome...
November 2018: Expert Review of Hematology
Eran Zimran, Alla Keyzner, Camelia Iancu-Rubin, Ronald Hoffman, Marina Kremyanskaya
Despite the dramatic progress made in the treatment of patients with myelofibrosis since the introduction of the JAK1/2 inhibitor ruxolitinib, a therapeutic option that can modify the natural history of the disease and prevent evolution to blast-phase is still lacking. Recent investigational treatments including immunomodulatory drugs and histone deacetylase inhibitors benefit some patients but these effects have proven modest at best. Several novel agents do show promising activity in preclinical studies and early-phase clinical trials...
November 2018: Expert Review of Hematology
Andrea Cervi, Mark Crowther
While associated life-threatening and fatal bleeding events are less frequent with the direct factor Xa inhibitors compared to vitamin K antagonists, significant concern surrounding management of major bleeds and urgent periprocedural interruption of these agents exists among clinicians. Andexanet alfa is a recombinant human factor Xa decoy protein developed in response to this clinical gap in the care of patients receiving anticoagulation with factor Xa inhibitors. Areas covered: This paper reviews results from preclinical and healthy-volunteer studies demonstrating the ability of andexanet to rapidly and reliably normalize coagulation indices in patients treated with both direct and indirect factor Xa inhibitors...
November 2018: Expert Review of Hematology
Johannes Oldenburg, Guy Young, Elena Santagostino, Carmen Escuriola Ettingshausen
Inhibitors against factor VIII (FVIII), which develop in around 20-30% of patients with severe hemophilia A, represent a significant complication of on-demand or prophylactic FVIII therapy. Currently, the main treatment option for inhibitor patients is eradication using immune tolerance induction (ITI) therapy. Areas covered: This article reviews inhibitor eradication in clinically complicated hemophilia A patients. The benefits and disadvantages of ITI therapy are discussed, with reference to the new nonfactor replacement agents such as emicizumab, which are becoming available...
November 2018: Expert Review of Hematology
Nikolaos Kanellias, Maria Gavriatopoulou, Evangelos Terpos, Meletios Athanasios Dimopoulos
Bone disease (BD) is one of the most common features of multiple myeloma. Seventy to eighty percent of patients at diagnosis present with lytic lesions which may lead to skeletal-related events. Areas covered: The aim of this review is to present the possible adverse profile of bisphosphonates (BPs) on renal function, the underlying mechanisms by which BPs may affect renal function and the novel therapeutic approaches on myeloma bone disease management. Expert commentary: BPs remain the cornerstone in the management of myeloma-related BD...
November 2018: Expert Review of Hematology
Guy Young, Michael Callaghan, Amy Dunn, Rebecca Kruse-Jarres, Steven Pipe
Hemophilia is a serious bleeding disorder characterized by repeated bleeding episodes into joints and muscles which can lead to permanent disabilities. Treatment with factor replacement therapy has proven to be effective at preventing these complications; however, it can lead to formation of neutralizing antibodies termed inhibitors which significantly complicate the management of the disorder. These inhibitor patients suffer from increased morbidity and mortality and there has been a major unmet need for novel therapeutic approaches...
November 2018: Expert Review of Hematology
Gualtiero Palareti, Daniela Poli
Venous thromboembolism (VTE) is frequent in the elderly, with an unclear recurrence risk. After the initial and early maintenance anticoagulant treatment, the decision about its extension versus recurrences is difficult because of the high risk of bleeding in this population. Areas covered: This paper analyzes recent literature on VTE recurrence and risk of bleeding associated with extended anticoagulation in elderly patients with VTE, focusing on available data regarding efficacy and safety of old anticoagulant or recent direct oral anticoagulant (DOACs)...
November 2018: Expert Review of Hematology
Michael Auerbach, Glenn M Chertow, Mitchell Rosner
Ferumoxytol is a superparamagnetic molecule originally developed as a contrast agent for magnetic resonance imaging. Elemental iron is contained within the carbohydrate core and is released slowly after infusion allowing a large dose of iron to be administered in a short period of time. Ferumoxytol, originally approved for iron deficiency in chronic kidney disease, received a broad label for any cause of iron deficiency after oral iron intolerance or in those circumstances when oral iron is ineffective or harmful...
October 2018: Expert Review of Hematology
Saurabh Zanwar, Jithma Prasad Abeykoon, Prashant Kapoor
Proteasome inhibitors (PIs) have been an integral part of treatment for multiple myeloma (MM) over the past decade. Many newer PIs are being evaluated in pre-clinical and clinical setting, with an aim to improve the safety, efficacy and resistance profile of this class of drugs. Ixazomib is the first oral PI with a robust efficacy and favorable safety profile in MM. Areas covered: This review provides an overview of the (i) pharmacology and dosing of ixazomib, (ii) the efficacy and safety data from clinical studies, (iii) highlight the various novel combinations that have been reported, and (iv) give an overview of the ongoing studies with ixazomib...
October 2018: Expert Review of Hematology
Georgia J B McCaughan, Emmanuel J Favaloro, Leonardo Pasalic, Jennifer Curnow
The landscape of therapeutic anticoagulation has changed dramatically over the past decade, with availability of direct oral anticoagulants (DOACs), which inhibit factor Xa or thrombin. However, the optimal anticoagulant agent and dosing strategy for patients at both extremes of body weight has not been established for any anticoagulant, including DOACs, vitamin K antagonists (VKA), and the various heparin options. Areas covered: This paper reviews available evidence to assist clinicians in prescribing of anticoagulation therapy at the extremes of body weight...
October 2018: Expert Review of Hematology
Daniele Caracciolo, Martina Montesano, Emanuela Altomare, Francesca Scionti, Maria Teresa Di Martino, Pierosandro Tagliaferri, Pierfrancesco Tassone
MicroRNAs (miRNAs) are short non-coding RNAs that are crucial players as post-transcriptional regulators of messenger RNAs (mRNAs). miRNA deregulation has been associated to the pathogenesis of several human malignancies, since they might potentially regulate relevant pathways involved in cancer onset and progression. Therefore, targeting the miRNA network could represent a promising therapeutic strategy for human cancer. Area covered: This review summarizes recent findings on miRNAs as therapeutics or therapeutic targets against multiple myeloma (MM) and its microenvironment, including the challenges to overcome in the next future for the clinical application of this innovative therapeutic approach...
October 2018: Expert Review of Hematology
Mayur Narkhede, Maryam Sarraf Yazdy, Bruce Cheson
Hodgkin's lymphoma (HL) accounts for about 10% of all lymphomas in the U.S.A. Exceptional progress has been made in the treatment of HL with complete response (CR) rates up to 94% in limited stage and 88% in advanced stage disease with regimens such as adriamycin, bleomycin, vinblastine, and dacarbazine in the frontline setting. Nevertheless, up to 10% of patients with limited stage disease and 20-30% of those with advanced stage HL relapse. In the last decade, newer agents such as brentuximab vedotin (BV) and checkpoint inhibitors have been approved by the FDA for treatment of patients with relapsed or refractory HL...
October 2018: Expert Review of Hematology
Øystein Bruserud, Guro K Melve, Tobias Gedde-Dahl, Tor Henrik Anderson Tvedt
No abstract text is available yet for this article.
October 2018: Expert Review of Hematology
Verena Wais, Donald Bunjes, Florian Kuchenbauer, Mohamed L Sorror
Allogeneic hematopoietic cell transplantation (HCT) provides potential cure to a large number of malignant and nonmalignant hematological disorders. With the development of non-myeloablative and reduced-intensity conditioning regimens, allogeneic HCT can nowadays be offered to a number of older or medically unfit patients. Up until the twenty-first century, chronological age was considered a hypothetical barrier. Recent reports, however, have shown that comorbidities, function, and other patient-related factors influence HCT outcomes at a higher magnitude than age alone...
October 2018: Expert Review of Hematology
Netanel A Horowitz, Doaa Akasha, Jacob M Rowe
Acute lymphoblastic leukemia (ALL) is a clonal disease of the hematopoietic system characterized by unique genetic characteristics. The significance of these genetic features has evolved over the past three decades. In the 1980s and 1990s, the primary interest was in excluding the Philadelphia chromosome; a finding more common in older adults which uniformly predicted for a rapidly fatal outcome. Areas covered: Over the past 15 years, much has evolved. Tyrosine kinase inhibitors completely changed the prognosis of Ph-positive ALL...
October 2018: Expert Review of Hematology
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