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By Ronald Lands Benign hematologist
B Lipe, R Vukas, J Mikhael
Multiple myeloma is the second most common type of blood cancer and remains incurable despite advances in therapy. Current therapy for multiple myeloma includes a phased-approach, often consisting of initial induction therapy, consolidation and maintenance therapy. With an ever-growing landscape of treatment options, the approach to optimal therapy has become increasingly complex. Specifically, controversy surrounds the optimal use and duration of maintenance therapy. We conducted a comprehensive literature search to analyze the most current literature and to provide recommendations for maintenance therapy in multiple myeloma...
October 21, 2016: Blood Cancer Journal
Clive S Zent
No abstract text is available yet for this article.
October 13, 2016: Blood
Matthew T Drake
Monoclonal gammopathy of undetermined significance (MGUS) is a common finding in clinical practice, affecting greater than 3% of adults aged 50 years and older. As originally described, the term MGUS reflected the inherent clinical uncertainty of distinguishing patients with a benign stable monoclonal plasma cell disorder from subjects destined to progress to malignancy. There is now clear epidemiologic evidence, however, that patients with MGUS suffer from a significantly increased fracture risk and that the prevalence of MGUS is increased in patients with osteoporosis...
December 2014: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Neha Korde, Sigurdur Y Kristinsson, Ola Landgren
Monoclonal gammopathy of unknown significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic plasma cell dyscrasias, with a propensity to progress to symptomatic MM. In recent years there have been improvements in risk stratification models (involving molecular markers) of both disorders, which have led to better understanding of the biology and probability of progression of MGUS and SMM. In the context of numerous molecular events and heterogeneous risk of progression, developing individualized risk profiles for patients with MGUS and SMM represents an ongoing challenge that has to be addressed by prospective clinical monitoring and extensive correlative science...
May 26, 2011: Blood
Rong Li, Juan Du, Jian Hou
BACKGROUNDS: Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell disorder. The etiology of MGUS progression remains unclear and is a current topic of investigation. METHODS: This review summarizes the essential features of MGUS and the potential risk factors for MGUS of progression. RESULTS: Many clinical studies have been conducted to identify the critical risk markers that play important roles in progression...
January 2015: Hematology (Amsterdam, Netherlands)
Ingemar Turesson, Stephanie A Kovalchik, Ruth M Pfeiffer, Sigurdur Y Kristinsson, Lynn R Goldin, Mark T Drayson, Ola Landgren
In 728 Swedish cases of monoclonal gammopathy of undetermined significance (MGUS), followed up to 30 years (median, 10 years), we estimated the cumulative risk of hematologic disorders originating from lymphoid and myeloid lineages. Using Cox regression models, we examined associations of demographic and laboratory factors with progression and determined the discriminatory power of 3 prediction models for progression. Eighty-four MGUS cases developed a lymphoid disorder, representing a cumulative risk of 15...
January 16, 2014: Blood
Raymond L Comenzo
No abstract text is available yet for this article.
September 1, 2014: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Roger E G Schutgens, Jeroen F van der Heijden, Eveline P Mauser-Bunschoten, Pier M Mannucci
No abstract text is available yet for this article.
September 26, 2016: Blood
Stuart J Connolly, Truman J Milling, John W Eikelboom, C Michael Gibson, John T Curnutte, Alex Gold, Michele D Bronson, Genmin Lu, Pamela B Conley, Peter Verhamme, Jeannot Schmidt, Saskia Middeldorp, Alexander T Cohen, Jan Beyer-Westendorf, Pierre Albaladejo, Jose Lopez-Sendon, Shelly Goodman, Janet Leeds, Brian L Wiens, Deborah M Siegal, Elena Zotova, Brandi Meeks, Juliet Nakamya, W Ting Lim, Mark Crowther
Background Andexanet alfa (andexanet) is a recombinant modified human factor Xa decoy protein that has been shown to reverse the inhibition of factor Xa in healthy volunteers. Methods In this multicenter, prospective, open-label, single-group study, we evaluated 67 patients who had acute major bleeding within 18 hours after the administration of a factor Xa inhibitor. The patients all received a bolus of andexanet followed by a 2-hour infusion of the drug. Patients were evaluated for changes in measures of anti-factor Xa activity and were assessed for clinical hemostatic efficacy during a 12-hour period...
September 22, 2016: New England Journal of Medicine
Bethany T Samuelson, Adam Cuker
Direct oral anticoagulants (DOACs) offer noninferior efficacy and improved safety compared to vitamin K antagonists (VKAs) for the prevention and treatment of venous thromboembolism and for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Unlike VKAs, DOACs do not require routine laboratory monitoring of anticoagulant effect and dose adjustment. In certain situations, however, laboratory assessment of anticoagulant effect may be desirable. Here we review the utility of currently available assays for assessment of DOAC effect and recommend an optimal assessment strategy for each drug, including calibrated dilute thrombin time or ecarin-based assays for dabigatran and calibrated anti-Xa activity assays for the factor Xa inhibitors...
September 2, 2016: Blood Reviews
V Koenig-Oberhuber, M Filipovic
In our daily anaesthetic practice, we are confronted with an increasing number of patients treated with either antiplatelet or anticoagulant agents. During the last decade, changes have occurred that make the handling of antithrombotic medication a challenging part of anaesthetic perioperative management. In this review, the authors discuss the most important antiplatelet and anticoagulant drugs, the perioperative management, the handling of bleeding complications, and the interpretation of some laboratory analyses related to these agents...
September 2016: British Journal of Anaesthesia
Alessandra Larocca, Antonio Palumbo
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice...
September 6, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Christian Gerecke, Stephan Fuhrmann, Susanne Strifler, Martin Schmidt-Hieber, Hermann Einsele, Stefan Knop
BACKGROUND: Multiple myeloma is a malignant disease of plasma cells with a worldwide incidence of 6-7 cases per 100 000 persons per year. It is among the 20 most common types of cancer in Germany. METHODS: This review is based on pertinent publications up to December 2015 that were retrieved by a selective search of PubMed employing the terms "multiple myeloma" AND "therapy" OR "diagnostic." Systematic reviews, meta-analyses, randomized controlled trials, and treatment recommendations from Germany and abroad were considered...
July 11, 2016: Deutsches Ärzteblatt International
Theodore E Warkentin, Julia A M Anderson
Heparin-induced thrombocytopenia (HIT) is a relatively common prothrombotic adverse drug reaction of unusual pathogenesis that features platelet-activating immunoglobulin G antibodies. The HIT immune response is remarkably transient, with heparin-dependent antibodies no longer detectable 40 to 100 days (median) after an episode of HIT, depending on the assay performed. Moreover, the minimum interval from an immunizing heparin exposure to the development of HIT is 5 days irrespective of the patient's previous heparin exposure status or history of HIT...
July 21, 2016: Blood
Steven M Weisman, David Y Graham
BACKGROUND: In spite of the clear evidence of benefit of aspirin in the secondary prevention of cerebrovascular and cardiovascular thrombotic events, its use in patients at high risk due to a previous event remains suboptimal. A possible explanation for this underuse is concern regarding the relative benefit in relation to the potential risk for serious gastrointestinal events. OBJECTIVE: To compare the benefit and gastrointestinal risk of aspirin use for the secondary prevention of thromboembolic events...
October 28, 2002: Archives of Internal Medicine
Nadine Shehab, Laurence S Sperling, Scott R Kegler, Daniel S Budnitz
BACKGROUND: Dual antiplatelet therapy (DAT) with clopidogrel plus aspirin is a well-established antithrombotic strategy, with hemorrhage being the chief adverse event (AE) of concern. Outside of clinical trials, few published data describe the magnitude and nature of hemorrhage-related AEs from DAT. METHODS: To estimate the numbers and rates of emergency department (ED) visits for hemorrhage-related AEs (hemorrhage or evaluation for potential hemorrhage) from DAT in the United States and put them in the context of those from warfarin, we analyzed AEs from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project, 2006-2008, and outpatient prescribing from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, 2006-2007...
November 22, 2010: Archives of Internal Medicine
Neena S Abraham, Sonal Singh, G Caleb Alexander, Herbert Heien, Lindsey R Haas, William Crown, Nilay D Shah
OBJECTIVE: To determine the real world risk of gastrointestinal bleeding associated with the use of the novel oral anticoagulants dabigatran and rivaroxaban compared with warfarin. DESIGN: Retrospective, propensity matched cohort study. SETTING: Optum Labs Data Warehouse, a large database including administrative claims data on privately insured and Medicare Advantage enrollees. PARTICIPANTS: New users of dabigatran, rivaroxaban, and warfarin from 1 November 2010 to 30 September 2013...
April 24, 2015: BMJ: British Medical Journal
Fatima Khan, Yvonne H Datta
The risk of recurrent venous thromboembolism (VTE) must be weighed against the risk of bleeding in deciding to keep patients on extended anticoagulation with vitamin K antagonists (VKAs). Most of the studies of risk of bleeding on VKAs are randomized controlled trials of highly selected patients followed for less than 1 year. We sought to determine the rate of bleeding in 'real world' patients on long-term anticoagulation with VKAs for VTE. We conducted a retrospective cohort study of patients monitored at our anticoagulation clinic who were treated with prolonged anticoagulation (>1 year) for secondary VTE prevention to assess the incidence of significant bleeding in this population...
January 2015: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Cengiz Gemici, Ozlem Yetmen, Gokhan Yaprak, Sevgi Ozden, Huseyin Tepetam, Hazan Ozyurt, Alpaslan Mayadagli
BACKGROUND: Anemia is a major cause of morbidity in patients with cancer resulting in poor physical performance, prognosis and therapy outcome. The aim of this study is to assess the efficacy of intravenous (iv) iron administration for the correction of anemia, for the prevention of exacerbation of anemia, for decreasing blood transfusion rates, and for the survival of cancer patients. METHODS: Patients with different solid tumor diagnosis who received iv iron during their cancer treatment were evaluated retrospectively...
August 20, 2016: BMC Cancer
Maria Egede Johansen, Jens-Ulrik Jensen, Morten Heiberg Bestle, Lars Hein, Anne Øberg Lauritsen, Hamid Tousi, Kim Michael Larsen, Jesper Løken, Thomas Mohr, Katrin Thormar, Pär I Johansson, Alessandro Cozzi-Lepri, Jens D Lundgren
BACKGROUND: Antimicrobial-induced thrombocytopenia is frequently described in the literature among critically ill patients. Several antimicrobials have been implicated, although experimental evidence to demonstrate causality is limited. We report, using a randomized trial, the potential of antimicrobials to induce thrombocytopenia. METHODS: Randomized trial allocated patients to antimicrobial treatment according to standard- of-care (SOC group) or drug-escalation in case of procalcitonin increases (high-exposure group)...
2013: PloS One
2016-08-24 23:36:33
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