The evolving landscape in the therapy of acute myeloid leukemia

Acute myeloid leukemia (AML) is a heterogeneous clonal disorder of myeloid precursors arrested in their maturation, creating a diverse disease entity with a wide range of responses to historically standard treatment approaches. While significant progress has been made in characterizing and individualizing the disease at diagnosis to optimally inform those affected, progress in treatment to reduce relapse and induce remission has been limited thus far. In addition to a brief summary of the factors that shape prognostication at diagnosis, this review attempts to expand on the current therapies under investigation that have shown promise in treating AML, including hypomethylating agents, gemtuzumab ozogamicin, FLT3 tyrosine kinase inhibitors, antisense oligonucleotides, and other novel therapies, including aurora kinases, mTOR and PI3 kinase inhibitors, PIM kinase inhibitors, HDAC inhibitors, and IDH targeted therapies. With these, and undoubtedly many others in the future, it is the hope that by combining more accurate prognostication with more effective therapies, patients will begin to have a different, and more complete, outlook on their disease that allows for safer and more successful treatment strategies.

Colorectal neoplasms in symptomatic patients without evidence of bleeding: a prospective study in an Iranian population.

BACKGROUND: Colorectal cancer (CRC) is a preventable disease with a high mortality and morbidity. Data on its prevalence are lacking in Iran, as well as for adenomatous polyps. This study was conducted to estimate prevalence of CRC in patients with long lasting colonic symptoms (except for known risk factors for cancer and those with rectal bleeding) who underwent total colonoscopy. METHODS: This prospective study was carried out in Imam Hospital, Tabriz University of Medical Sciences, Iran. The recruitment procedure involved 228 individuals aged more than 30 who visited a gastroenterologist because of lower gastrointestinal tract symptoms and had criteria for a colonoscopy. The endoscopist visualized the caecum in all, documented by a photo of caecum and/or specimen of the terminal ileum. The Chi square test and multiple logistic regression analysis were used to determine the significance of associations between different symptoms and colonoscopic findings. RESULTS: Thirty four subjects (14.9%) were found to have colorectal neoplasia and 112 (49.1%) had a completely normal colon. Adenomatous polyps were detected in 27 patients, which included 15.6% of men and 7.0% of women. Most of them were tubular (58.3%) and severe dysplasia was reported in only 3 cases (11.1%). Mean age of patients with a polyp (51.1+/-12.5 years) was not significantly different compared to others (p=0.381) nor mean duration of symptoms (21.1 months, p=0.435). Cancer was detected in 7 (3.1%) of our study population, the mean age of 65.7+/-6.0 years in this case being significantly elevated (p<0.0005). None of the symptoms were predictors of cancer or polyps. This result was the same by a multivariate analysis including age, gender and duration of the symptoms. CONCLUSION: The low prevalence of colorectal neoplasms as well as the less advanced pattern of adenomas in Iran are compatible with other data from Asia and the Middle East, contrasting with western countries.

Mast cell profile in prostatic lesions.

Mast cell profile in common prostatic lesions was analysed in this study. 17B consecutive prostatic biopsy specimens specimens were categorised broadly into nodular hyperplasia without prostatitis (101), nodular heperplasia with prostatitis (50, prostatic intraepithelial neoplasia (2) and adenocarcinoma (25). Toluidine blue stain (0.1%) was used to demonstrate the mast cells and their count was expressed per square millimeter. Mast cell count was significantly higher in the fibromuscular stroma when compared to the glandular areas in nodular hyperplasia (p < .05). The mast cell counts were very significantly lower in inflammatory lesions (p < 0.0001) probably due to degranulation. Absence or a low count was the most significant finding in adenocarcinoma irrespective of the grade of the tumour with concentration of mast cells around the tumour. This study shows the variations in mast cell distribution in commonly encountered prostatic lesions. There is paucity of such studies in the literature and the possible utility of mast cell count to differentiate malignant from benign and atypical conditions needs further evaluation.