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How I Treat (Compiled from Blood Journal)

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96 papers 100 to 500 followers
https://www.readbyqxmd.com/read/25258344/how-i-treat-burkitt-lymphoma-in-adults
#1
Caron Jacobson, Ann LaCasce
Burkitt lymphoma (BL) is an aggressive B-cell non-Hodgkin lymphoma that is almost uniformly associated with translocations involving the gene for MYC on chromosome 8. The 3 subtypes of BL, endemic, sporadic, and immunodeficiency-associated, differ from epidemiologic and clinical perspectives but may be genetically similar. Prompt administration of multiagent immunochemotherapy regimens is associated with favorable outcomes for the majority of patients. Survival is inferior in older patients, likely reflecting increased therapy-related toxicity, possibly resulting in decreased treatment intensity...
November 6, 2014: Blood
https://www.readbyqxmd.com/read/25293771/how-i-treat-patients-with-massive-hemorrhage
#2
Pär I Johansson, Jakob Stensballe, Roberto Oliveri, Charles E Wade, Sisse R Ostrowski, John B Holcomb
Massive hemorrhage is associated with coagulopathy and high mortality. The transfusion guidelines up to 2006 recommended that resuscitation of massive hemorrhage should occur in successive steps using crystalloids, colloids, and red blood cells (RBCs) in the early phase and plasma and platelets in the late phase. With the introduction of the cell-based model of hemostasis in the mid-1990s, our understanding of the hemostatic process and of coagulopathy has improved. This has contributed to a change in resuscitation strategy and transfusion therapy of massive hemorrhage along with an acceptance of the adequacy of whole blood hemostatic tests to monitor these patients...
November 13, 2014: Blood
https://www.readbyqxmd.com/read/19474451/how-i-treat-von-willebrand-disease
#3
REVIEW
Francesco Rodeghiero, Giancarlo Castaman, Alberto Tosetto
Recent multicenter studies have clarified the molecular basis underlying the different von Willebrand disease (VWD) types, all of which are caused by the deficiency and/or abnormality of von Willebrand factor (VWF). These studies have suggested a unifying pathophysiologic concept. The diagnosis of VWD, remains difficult because its clinical and laboratory phenotype is very heterogeneous and may overlap with normal subjects. Stringent criteria are therefore required for a clinically useful diagnosis. In this paper, we delineate a practical approach to the diagnosis and treatment of VWD...
August 6, 2009: Blood
https://www.readbyqxmd.com/read/16204307/how-i-treat-refractory-cll
#4
REVIEW
Emili Montserrat, Carol Moreno, Jordi Esteve, Alvaro Urbano-Ispizua, Eva Giné, Francesc Bosch
Therapy for patients with chronic lymphocytic leukemia (CLL) has greatly changed over the past few years. After years of stagnation, with treatment revolving around the use of rather ineffective drugs such as alkylators, many patients are now being treated with more effective agents such as purine analogs either alone or combined with other drugs and/or monoclonal antibodies. Treatment of patients refractory to these treatments is particularly challenging and should be decided only upon a careful evaluation of the disease, patient characteristics, and prognostic factors...
February 15, 2006: Blood
https://www.readbyqxmd.com/read/17311989/how-i-treat-indolent-lymphoma
#5
John G Gribben
Despite advances in treatment, there was little evidence until recently that this led to improvement in the survival of patients with indolent lymphoma, with patients continuing to have an unremitting course of relapse of disease. There appears to have been a change in the natural history of these diseases with the introduction of chemoimmunotherapy that may finally result in improvements in survival. With so many agents available for the treatment of indolent lymphomas, questions that have to be addressed include the following: is there still a role for a "watch-and-wait" approach in asymptomatic patients or should they be treated at diagnosis, what are the optimal first-line and salvage treatments, what is the role of maintenance therapy, and is there any role for stem cell transplantation in these diseases? No established treatment of choice has yet emerged, and many of these questions remain unresolved...
June 1, 2007: Blood
https://www.readbyqxmd.com/read/18606874/how-i-treat-cobalamin-vitamin-b12-deficiency
#6
Ralph Carmel
The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor-driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key management principle is the importance of follow-up, which also requires knowing how the deficiency arose...
September 15, 2008: Blood
https://www.readbyqxmd.com/read/17626839/how-i-treat-chronic-myeloid-leukemia-in-the-imatinib-era
#7
REVIEW
John M Goldman
Although it is now generally accepted that imatinib is the best initial treatment for patients newly diagnosed with chronic myeloid leukemia (CML) in chronic phase, a number of questions remain unanswered. For example, (1) Is imatinib the best initial treatment for every chronic-phase patient? (2) At what dose should imatinib be started? (3) How should response to treatment be monitored? (4) For how long should the drug be continued in patients who have achieved and maintain a complete molecular response? (5) How does one handle a patient who achieves a 2-log but not a 3-log reduction in BCR-ABL transcripts? (6) How should response or failure be defined? (7) For the patient deemed to have failed imatinib, should one offer dasatinib or nilotinib? (8) For the patient who has failed imatinib but has a possible allogeneic transplant donor, should one offer dasatinib or nilotinib before recommending a transplantation? (9) Should the transplantation be myeloablative or reduced intensity conditioning? (10) How should one treat the patient who relapses after allografting? This paper will address these issues, many of which cannot yet be answered definitively...
October 15, 2007: Blood
https://www.readbyqxmd.com/read/20009037/how-i-treat-influenza-in-patients-with-hematologic-malignancies
#8
REVIEW
Corey Casper, Janet Englund, Michael Boeckh
The 2009 H1N1 influenza pandemic has heightened the interest of clinicians for options in the prevention and management of influenza virus infection in immunocompromised patients. Even before the emergence of the novel 2009 H1N1 strain, influenza disease was a serious complication in patients with hematologic malignancies receiving chemotherapy or undergoing hematopoietic cell transplantation. Here we review the clinical manifestations of seasonal and 2009 H1N1 influenza and discuss current diagnosis, antiviral treatment, and prophylaxis options...
February 18, 2010: Blood
https://www.readbyqxmd.com/read/20837781/how-i-treat-adenovirus-in-hematopoietic-stem-cell-transplant-recipients
#9
REVIEW
Caroline A Lindemans, Ann M Leen, Jaap Jan Boelens
Adenovirus (AdV) infections are very common in the general pediatric population. The delayed clearance in young persons imposes a threat to immunocompromised patients after hematopoietic stem cell transplantation (HSCT), who can reactivate the virus, resulting in life-threatening disseminated disease. Although a definitive cure requires adequate immune reconstitution, 2 approaches appear to be feasible and effective to improve the outcomes of AdV infections. Strict monitoring with AdV quantitative polymerase chain reaction followed by preemptive treatment with low-dose (1 mg/kg) cidofovir 3 times a week, is effective in most cases to bridge the severely immunocompromised period shortly after HSCT, with acceptable toxicity rates...
December 16, 2010: Blood
https://www.readbyqxmd.com/read/21832280/how-i-treat-patients-who-mobilize-hematopoietic-stem-cells-poorly
#10
REVIEW
L Bik To, Jean-Pierre Levesque, Kirsten E Herbert
Transplantation with 2-5 × 10(6) mobilized CD34(+)cells/kg body weight lowers transplantation costs and mortality. Mobilization is most commonly performed with recombinant human G-CSF with or without chemotherapy, but a proportion of patients/donors fail to mobilize sufficient cells. BM disease, prior treatment, and age are factors influencing mobilization, but genetics also contributes. Mobilization may fail because of the changes affecting the HSC/progenitor cell/BM niche integrity and chemotaxis. Poor mobilization affects patient outcome and increases resource use...
October 27, 2011: Blood
https://www.readbyqxmd.com/read/23149846/how-i-treat-thrombocytopenia-in-pregnancy
#11
REVIEW
Terry Gernsheimer, Andra H James, Roberto Stasi
A mild thrombocytopenia is relatively frequent during pregnancy and has generally no consequences for either the mother or the fetus. Although representing no threat in the majority of patients, thrombocytopenia may result from a range of pathologic conditions requiring closer monitoring and possible therapy. Two clinical scenarios are particularly relevant for their prevalence and the issues relating to their management. The first is the presence of isolated thrombocytopenia and the differential diagnosis between primary immune thrombocytopenia and gestational thrombocytopenia...
January 3, 2013: Blood
https://www.readbyqxmd.com/read/23426950/how-i-treat-patients-with-indolent-and-smoldering-mastocytosis-rare-conditions-but-difficult-to-manage
#12
Animesh Pardanani
Indolent systemic mastocytosis (SM) patients have a varied clinical presentation, ranging from predominantly cutaneous symptoms to recurrent systemic symptoms (eg, flushing, palpitations, dyspepsia, diarrhea, bone pain) that can be severe and potentially life threatening (anaphylaxis). Mastocytosis patients without skin involvement pose a diagnostic challenge; a high index of suspicion is needed in those with mast cell-degranulation symptoms, including anaphylaxis following Hymenoptera stings or other triggers...
April 18, 2013: Blood
https://www.readbyqxmd.com/read/24269956/how-i-treat-leukemia-during-pregnancy
#13
Dragana Milojkovic, Jane F Apperley
Leukemia in pregnancy remains a challenging therapeutic prospect. The prevalence is low at ∼1 in 10 000 pregnancies, and as a result data are limited to small retrospective series and case reports, rendering evidence-based recommendations for management strategies difficult. The management of the leukemias in pregnancy requires close collaboration with obstetric and neonatology colleagues as both the maternal and fetal outcomes must be taken into consideration. The decision to introduce or delay chemotherapy must be balanced against the impact on maternal and fetal survival and morbidity...
February 13, 2014: Blood
https://www.readbyqxmd.com/read/22566607/how-i-treat-pediatric-acute-myeloid-leukemia
#14
REVIEW
Jeffrey E Rubnitz
Acute myeloid leukemia is a heterogeneous disease that accounts for approximately 20% of acute leukemias in children and adolescents. Despite the lack of targeted therapy for most subtypes and a dearth of new agents, survival rates have reached approximately 60% for children treated on clinical trials in developed countries. Most of the advances have been accomplished by better risk classification, the implementation of excellent supportive care measures, adaptation of therapy on the basis of each patient's response to therapy, and improvements in allogeneic hematopoietic stem cell transplantation...
June 21, 2012: Blood
https://www.readbyqxmd.com/read/22896001/how-i-treat-relapsed-childhood-acute-lymphoblastic-leukemia
#15
Franco Locatelli, Martin Schrappe, Maria Ester Bernardo, Sergio Rutella
The most common cause of treatment failure in childhood acute lymphoblastic leukemia (ALL) remains relapse, occurring in ~ 15%-20% of patients. Survival of relapsed patients can be predicted by site of relapse, length of first complete remission, and immunophenotype of relapsed ALL. BM and early relapse (< 30 months from diagnosis), as well as T-ALL, are associated with worse prognosis than isolated extramedullary or late relapse (> 30 months from diagnosis). In addition, persistence of minimal residual disease (MRD) at the end of induction or consolidation therapy predicts poor outcome because children with detectable MRD are more likely to relapse than those in molecular remission, even after allogeneic hematopoietic stem cell transplantation...
October 4, 2012: Blood
https://www.readbyqxmd.com/read/24764565/how-i-treat-renal-complications-in-sickle-cell-disease
#16
Claire C Sharpe, Swee Lay Thein
Renal disease is one of the most frequent and severe complications experienced by patients with sickle cell disease; its prevalence is likely to increase as the patient population ages. We recommend regular monitoring for early signs of renal involvement and a low threshold for the use of hydroxyurea as preventative measures for end-stage renal disease. Once renal complications are detected, a careful assessment of the patient is required to rule out other causes of renal disease. Proteinuria and hypertension should be managed aggressively and the patient referred to a specialist nephrology center when progressive decline in renal function is noted...
June 12, 2014: Blood
https://www.readbyqxmd.com/read/24833355/how-i-treat-sinusoidal-obstruction-syndrome
#17
Nelson Chao
Sinusoidal obstruction syndrome (SOS), previously called veno-occlusive disease (VOD) can be a difficult problem after hematopoietic cell transplantation (HCT). The overall incidence has changed since the early days of allogeneic HCT. Prophylaxis and treatment remain important components of supportive care. As the indication and the comorbidities for HCT continue to change, especially with older and more infirm patients, SOS remains an important area for clinicians. I discuss how SOS could be addressed, from prophylaxis to diagnosis and potential therapy...
June 26, 2014: Blood
https://www.readbyqxmd.com/read/24615779/how-i-treat-the-peripheral-t-cell-lymphomas
#18
REVIEW
Alison J Moskowitz, Matthew A Lunning, Steven M Horwitz
The peripheral T-cell lymphomas (PTCLs) encompass a heterogeneous group of diseases that have generally been associated with poor prognosis. The most common PTCLs, peripheral T-cell lymphoma, not otherwise specified, angioimmunoblastic T-cell lymphoma, and anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALK-negative), despite their unique presentations and histologies, are currently treated similarly. Here we discuss our general approach to the treatment of the most common PTCLs. Based on the best data currently available, which include retrospective analyses and phase 2 prospective studies, our approach has involved cyclophosphamide, doxorubicin, vincristine, prednisone-based therapy followed by consolidation in first remission with autologous stem cell transplant...
April 24, 2014: Blood
https://www.readbyqxmd.com/read/24599547/how-i-treat-the-clinical-differentiation-and-initial-treatment-of-adult-patients-with-atypical-hemolytic-uremic-syndrome
#19
Spero R Cataland, Haifeng M Wu
Published data demonstrating the efficacy of complement inhibition therapy in patients with atypical hemolytic uremic syndrome (aHUS) are remarkable in contrast to the historically poor long-term prognosis for aHUS patients treated with plasma-based therapy. Although both aHUS and acquired thrombotic thrombocytopenic purpura (TTP) remain clinical diagnoses, an increased understanding of both conditions has improved our ability to differentiate aHUS from acquired TTP. These same data have also demonstrated the importance of a more rapid identification and diagnosis of aHUS as the recovery of end-organ injury present appears to be related to the time to initiate therapy with eculizumab...
April 17, 2014: Blood
https://www.readbyqxmd.com/read/24472834/how-i-treat-isolated-distal-deep-vein-thrombosis-iddvt
#20
REVIEW
Gualtiero Palareti
Thromboses limited to infrapopliteal leg deep veins (isolated distal deep vein thrombosis [IDDVT]) are frequently diagnosed in subjects with suspected pulmonary embolism or DVT and account for one-fourth to one-half of all diagnosed leg DVTs. Despite their frequency, the natural history of IDDVTs and their real risk of thromboembolic complications are still uncertain because of the scarcity of prospective, blind, nonintervention studies. Therefore it is still debated whether they warrant diagnosis and treatment...
March 20, 2014: Blood
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