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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...
September 12, 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...
September 6, 2018: Expert Review of Hematology
Mayur Narkhede, Maryam S 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...
September 5, 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...
September 1, 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...
August 27, 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.
August 20, 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...
August 16, 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...
August 16, 2018: Expert Review of Hematology
Martin Griesshammer, Parvis Sadjadian, Kai Wille
The management of pregnancy during the course of BCR-ABL1-negative myeloproliferative neoplasms (MPN) is an increasingly relevant problem. This is mostly due to earlier and better diagnosis of MPN together with the trend in modern society toward delaying pregnancy until later life. Areas Covered: The present review aims to provide an overview of the available literature data concerning outcome of pregnancy in MPN. Possible therapeutic modalities are discussed and a management algorithm is suggested. Expert Commentary: Most data are available for women with essential thrombocythemia and we present 793 published pregnancies...
September 2018: Expert Review of Hematology
Mahmoud Rezk Abdelwahed Hussein
Non-Hodgkin lymphomas of the oral and maxillofacial regions are uncommon malignancies. They usually have progressive course and dismal outcome. Areas covered: This review provides an update about the clinicopathologic, immunophenotypic, and molecular features of these lymphomas. Some relevant case reports are presented. Expert commentary: The lymphomas of the oral and maxillofacial regions involve the tongue, gingiva, hard palate, maxilla, mandible, Waldeyer's ring, palatine, and lingual tonsils. They include diffuse large B-cell lymphoma (DLBCL), T-cell lymphoma, Burkitt lymphoma (BL), natural killer/T-cell lymphoma (NKTCL), marginal zone lymphoma, plasmablastic lymphoma (PBL), mantle cell lymphoma, and lymphoblastic lymphoma...
September 2018: Expert Review of Hematology
Simon Rule, Robert W Chen
Despite recent prognostic improvements, mantle cell lymphoma (MCL) remains incurable. Bruton tyrosine kinase (BTK) is a key receptor in B-cell tumorigenesis, and the benefits of the first BTK inhibitor, ibrutinib, are becoming clear in MCL. However, off-target activities, which contribute to ibrutinib-related adverse events, suggest potential for further improvement of this drug class. Areas covered: The authors systematically interrogated for trials containing keywords for BTK and MCL. Published literature for new and emerging BTK inhibitors being investigated in MCL was then identified (PubMed and Embase), summarized, and placed in the context of treatment guidelines...
September 2018: Expert Review of Hematology
Rory M Shallis, Nora Chokr, Maximilian Stahl, Alexander B Pine, Amer M Zeidan
Myelodysplastic syndromes (MDS) encompass a heterogenous collection of clonal hematopoietic stem cell disorders defined by dysregulated hematopoiesis, peripheral cytopenias, and a risk of leukemic progression. Increasing data support the role of innate and adaptive immune pathways in the pathogenesis and disease course of MDS. The role of immunosuppressive therapy has an established role in the treatment of other hematologic diseases, such as aplastic anemia whose pathogenesis is postulated to reflect that of MDS with regards to many aspects of immune activation...
September 2018: Expert Review of Hematology
Fadi G Mirza, Rezan Abdul-Kadir, Christian Breymann, Ian S Fraser, Ali Taher
Iron deficiency and iron deficiency anemia are highly prevalent among women throughout their lives. Some females are particularly vulnerable to iron deficiency/iron deficiency anemia, including those with heavy menstrual bleeding (HMB) and pregnant/postpartum women. Despite the high prevalence of iron deficiency/iron deficiency anemia in women, the condition is still underdiagnosed and therefore undertreated, with serious clinical consequences. Areas covered: The following review examines the impact of iron deficiency and iron deficiency anemia on clinical outcomes and quality of life in women from adolescence to post-menopause, paying particular attention to guidelines and current recommendations for diagnostic tests and management...
September 2018: Expert Review of Hematology
Gudula Boon, L F Van Dam, F A Klok, M V Huisman
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most frequent cardiovascular disease besides myocardial infarction and stroke. Because DVT may cause life-threatening conditions, treatment should be started as soon as possible. This comprises certain challenges in special populations. Areas covered: In cancer-associated VTE, current treatment is different from non-cancer VTE due to disease-related interventions and higher bleeding risks. In the treatment of patients with extensive DVT, the role of catheter-directed thrombolysis has been investigated in two randomized trials, but results do not yield a recommendation for standard thrombolysis...
September 2018: Expert Review of Hematology
Douglas Tremblay, John Mascarenhas
Treatment with ruxolitinib, a selective JAK1/2 inhibitor, has significantly improved the lives of patients with myelofibrosis. Unfortunately, this treatment is frequently limited by cytopenias, precluding a high-risk group characterized by baseline thrombocytopenia. Additionally, there are no approved treatments for patients who have progressed while receiving ruxolitinib. Pacritinib is a novel JAK2/FLT3 inhibitor associated with less treatment-related myelosuppression that has the potential to fill these unmet treatment needs...
September 2018: Expert Review of Hematology
Marlise R Luskin
No abstract text is available yet for this article.
August 2018: Expert Review of Hematology
Marcel Levi, Suthesh Sivapalaratnam
Activation of the hemostatic system can occur in many clinical conditions. However, a systemic and strong activation of coagulation complicating clinical settings such as sepsis, trauma or malignant disease may result in the occurrence disseminated intravascular coagulation (DIC). Areas covered: This article reviews the clinical manifestation and relevance of DIC, the various conditions that may precipitate DIC and the pathogenetic pathways underlying the derangement of the hemostatic system, based on clinical and experimental studies...
August 2018: Expert Review of Hematology
Shaoying Li, Pei Lin, L Jeffrey Medeiros
The designation high-grade B-cell lymphoma (HGBL) has been incorporated into the 2016 Revision of the WHO classification of lymphoid neoplasms and includes two types: (1) HGBL, not otherwise specified; and (2) HGBL with MYC and BCL2 and/or BCL6 rearrangements, also known as double or triple hit lymphoma (DHL/THL). These categories of lymphomas represent 1-2% of non-Hodgkin lymphomas and a considerable portion of DLBCL patients who are primary refractory to R-CHOP therapy. It corresponds to the designation 'B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma' in the 2008 WHO classification...
August 2018: Expert Review of Hematology
Francesca R Mauro, Maria D Caputo, Serena Rosati, Sara Pepe, Daniela De Benedittis, Maria L De Luca, Robin Foà
In recent years, innovative mechanism-based drugs have enriched the therapeutic armamentarium for patients with chronic lymphocytic leukemia (CLL) and are widely used in the clinical practice. These small molecules targeting the B-cell receptor signaling pathway and the BCL-2 anti-apoptotic protein offer new chemo-free options to both unfit patients and high-risk patients who show a poor response to chemoimmunotherapy. Nonetheless, treatment with ibrutinib, idelalisib and venetoclax is associated with unique side effects...
August 2018: Expert Review of Hematology
Martina Crysandt, Kira Brings, Fabian Beier, Christian Thiede, Tim H Brümmendorf, Edgar Jost
Germ line predisposition to myeloid neoplasms has been incorporated in the WHO 2016 classification of myeloid neoplasms and acute leukemia. The new category of disease is named hereditary myeloid disorder (HMD). Although most myeloid neoplasms are sporadic, germ line mutations and familial predisposition can contribute to development of chronic myeloid diseases and acute myeloid leukemia. This finding and upcoming frequent use of genome wide detection of molecular aberrations will lead to a higher detection rate of a genetic predisposition and influence treatment decisions...
August 2018: Expert Review of Hematology
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