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1.
J Oncol Pharm Pract ; 28(1): 232-236, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34152210

ABSTRACT

INTRODUCTION: The use of TKIs in CML has dramatically altered the natural course of the disease and improved outcomes for patients. TKIs overall have a very favorable safety profile. Dasatinib, a second generation TKI, is commonly used as a first-line treatment option in CML. CASE REPORT: We describe the first two reported cases of first-line dasatinib induced aplastic anemia in CML. In both patients, pancytopenia occurred within one year of diagnosis/starting dasatinib. Both bone marrow biopsies showed hypocellularity with mild fibrosis and persistent BCR-Abl1 positivity. MANAGEMENT & OUTCOME: Dose reduction was attempted without success in both patients. In one patient, multiple TKIs were trialed, while in the other, growth factor support was attempted; neither regimen was effective. Ultimately, the cytopenias associated with dasatinib were only resolved after immunosuppression in one patient and allogeneic stem cell transplant in the other patient. DISCUSSION: Prior reports have shown that aplasia/aplastic anemia can rarely be associated with imatinib and nilotinib. Here we show that dasatinib can lead to this phenomenon as well. This diagnosis should be considered in patients with CML who unexpectedly develop cytopenias.


Subject(s)
Anemia, Aplastic , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Pancytopenia , Anemia, Aplastic/chemically induced , Dasatinib/adverse effects , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Pancytopenia/chemically induced , Protein Kinase Inhibitors/adverse effects
2.
Case Rep Hematol ; 2018: 7586719, 2018.
Article in English | MEDLINE | ID: mdl-30538872

ABSTRACT

Paroxysmal cold hemoglobinuria (PCH) is a rare form of cold autoimmune hemolytic anemia first discovered in the early 20th century in adults with tertiary syphilis. Today, it is more commonly seen in children as a life-threatening anemia during a viral upper respiratory tract infection (URI). Although respiratory syncytial virus (RSV) has previously been reported to cause PCH in a child, herein we present the first documented case in an adult. The Donath-Landsteiner (DL) test, the diagnostic test for PCH, was positive on two separate occasions. The patient was treated successfully with warming and avoidance of cold temperatures. To facilitate identification of this rare entity by clinicians, we include a discussion about the pathophysiology, diagnosis, and treatment of PCH.

3.
Case Rep Hematol ; 2018: 2414278, 2018.
Article in English | MEDLINE | ID: mdl-29607225

ABSTRACT

We are reporting the case of a 58-year-old woman with history of bilateral silicone breast implants for cosmetic augmentation. At 2-year interval from receiving the breast implants, she presented with swelling of the right breast with associated chest wall mass, effusion around the implant, and axillary lymphadenopathy. Pathology confirmed breast implant-associated anaplastic large cell lymphoma (stage III, T4N2M0, using BIA-ALCL TNM staging and stage IIAE, using Ann-Arbor staging). The patient underwent bilateral capsulectomy and right partial mastectomy with excision of the right breast mass and received adjuvant CHOP chemotherapy and radiation to the right breast and regional nodes. Since completion of multimodality therapy, the patient has sustained remission on both clinical exam and PET/CT scan. We report this case and review of the literature on this rare form of lymphoma.

6.
Leuk Lymphoma ; 56(5): 1266-70, 2015 May.
Article in English | MEDLINE | ID: mdl-25356924

ABSTRACT

The purpose of this study was to evaluate the long-term outcome and patterns of failure in patients treated with primary radiotherapy (RT) for orbital lymphoma (OL). Seventy-nine patients diagnosed with stage IE OL between 1995 and 2012 were included. Fifty-nine patients (75%) had mucosa-associated lymphoid tissue lymphoma and 20 patients (25%) had follicular lymphoma subtype. The median follow-up was 49.7 months. Major tumor sites were conjunctiva (29%), orbit (47%) and lacrimal gland (24%). After treatment to a median dose of 30.6 Gy, there were a total of no local, one contralateral orbital, two regional and two distant recurrences, all outside of the treatment fields. The 10-year local relapse-free, distant metastasis-free and overall survival rates were 100%, 94.2% and 98.2%, respectively. Definitive RT to 30 Gy was shown to be highly effective for indolent OL, and this study represents one of the largest single-institution studies using primary RT for stage IE OL.


Subject(s)
Lymphoma/radiotherapy , Orbital Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Female , Humans , Lymphoma/mortality , Lymphoma/pathology , Lymphoma, B-Cell, Marginal Zone/mortality , Lymphoma, B-Cell, Marginal Zone/pathology , Lymphoma, B-Cell, Marginal Zone/radiotherapy , Male , Middle Aged , Neoplasm Staging , Orbital Neoplasms/mortality , Orbital Neoplasms/pathology , Time Factors , Treatment Failure , Treatment Outcome , Young Adult
7.
Int J Gynecol Cancer ; 23(9): 1577-82, 2013 Nov.
Article in English | MEDLINE | ID: mdl-24172094

ABSTRACT

BACKGROUND: Phase 2 trials suggest that prolonged intravenous (IV) infusion of the topoisomerase 1 inhibitor topotecan may be less toxic than when given by standard IV bolus 5-day administration. Oxaliplatin exhibits efficacy in platinum-pretreated disease and shows preclinical synergy with topoisomerase 1 inhibitors. We sought to determine the efficacy and safety of oxaliplatin plus infusion topotecan in recurrent platinum-pretreated ovarian cancer. METHODS: Patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancers previously treated with 1 to 2 prior regimens including platinum and taxane received oxaliplatin (85 mg/m(2) day 1 and day 15) and topotecan (0.4 mg/m(2) per day) by continuous IV infusion over 14 days every 4 weeks. The primary objective of the trial was to estimate the objective response rate in platinum-resistant disease (stratum 1) and in platinum-sensitive disease (stratum 2). Toxicities were assessed in all patients. RESULTS: Thirty-eight patients received 144 cycles of therapy (median, 4; range, 1-6). The most common grade 3 and grade 4 toxicities included thrombocytopenia (grade 3, 37%; and grade 4, 19%), neutropenia (grade 3, 37%; grade 4, 11%), and anemia (grade 3, 15%). Response occurred in 4 of 19 patients in stratum I (21%; 95% confidence intervals, 6%-46%) and 9 of 19 patients in stratum 2 (47%; 95% CI, 24%-71%). Three in each stratum had lengthy complete responses. CONCLUSIONS: Biweekly oxaliplatin plus a 14-day continuous IV infusion of topotecan, given monthly, is an active regimen in platinum-pretreated ovarian cancer and merits additional evaluation.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Neoplasms, Glandular and Epithelial/drug therapy , Organoplatinum Compounds/administration & dosage , Ovarian Neoplasms/drug therapy , Topotecan/administration & dosage , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carcinoma, Ovarian Epithelial , Chemotherapy, Adjuvant , Female , Humans , Infusion Pumps , Middle Aged , Neoplasms, Glandular and Epithelial/mortality , Organoplatinum Compounds/adverse effects , Ovarian Neoplasms/mortality , Oxaliplatin , Survival Analysis , Topotecan/adverse effects
8.
Clin Lymphoma Myeloma Leuk ; 13(4): 360-9, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23876844

ABSTRACT

Peripheral T-cell lymphomas are a heterogeneous group of lymphoid malignancies. Among these, hepatosplenic γδ T-cell lymphoma (HTCL) represents an aggressive and treatment-resistant subgroup for which new avenues of treatment are critically needed. HTCL is characterized by primary extranodal distribution of the malignant cells with typical intrasinusoidal infiltration of the liver, spleen, and bone marrow, which results in hepatosplenomegaly and peripheral blood cytopenias. Another characteristic feature is the expression of γδ T-cell receptors. HTCL exhibits a rapid progressive course and an extremely poor response to currently known therapeutic strategies, with a 5-year overall survival rate of only 7%. In this review, we discuss the clinical, pathologic, and molecular characteristics of this disease, along with the challenges that are associated with its diagnosis and treatment.


Subject(s)
Liver Neoplasms/pathology , Lymphoma, T-Cell/pathology , Receptors, Antigen, T-Cell, gamma-delta/immunology , Splenic Neoplasms/pathology , Humans , Immunophenotyping , Liver Neoplasms/immunology , Lymphoma, T-Cell/immunology , Splenic Neoplasms/immunology , Transplantation, Autologous , Transplantation, Homologous
9.
Leuk Res ; 36(11): 1376-9, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22917767

ABSTRACT

We report eight patients of myelodysplastic syndrome (MDS) with HIV infection. Compared to a historical cohort of HIV-uninfected MDS patients, HIV/MDS were younger (p=0.019), had more complex cytogenetics (p=0.015), and more often had 7q deletion or monosomy 7 (p=0.011). In five patients, HIV/MDS transformed to acute myeloid leukemia, with a median time to transformation of 7 months. Also, the median overall survival was shorter in the HIV/MDS than in their HIV-uninfected counterparts (8 vs. 22 months; p=0.003). These results suggest that HIV/MDS is a high-risk MDS necessitating thorough cytogenetic analysis and follow-up.


Subject(s)
HIV Infections/complications , HIV Infections/genetics , Myelodysplastic Syndromes/complications , Myelodysplastic Syndromes/genetics , Adult , Aged , Cell Transformation, Neoplastic/genetics , Female , HIV Infections/mortality , Humans , In Situ Hybridization, Fluorescence , Kaplan-Meier Estimate , Leukemia, Myeloid, Acute/etiology , Male , Middle Aged , Myelodysplastic Syndromes/mortality , Prognosis
11.
Oncology (Williston Park) ; 23(8): 718-21, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19711588

ABSTRACT

Extraskeletal myxoid chondrosarcomas usually arise deep in the proximal extremities and limb girdles. Patients with this type of sarcoma have high rates of local recurrence and metastases, but do not typically have paraneoplastic syndromes. We report an unusual case of a 49-year-old man with anti-Hu syndrome in the setting of an extraskeletal myxoid chondrosarcoma. This case shows the importance of searching for antineural antibodies in oncologic patients with new neurologic deficits, and of having a judicious workup for occult malignancies in patients with known antineural antibodies.


Subject(s)
Autoantibodies/blood , Bone Neoplasms/pathology , Chondrosarcoma/pathology , ELAV Proteins/immunology , Paraneoplastic Polyneuropathy/pathology , Bone Neoplasms/immunology , Chondrosarcoma/immunology , Clavicle/pathology , Combined Modality Therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Paraneoplastic Polyneuropathy/immunology , Radiotherapy
13.
Am J Ophthalmol ; 138(4): 659-62, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15488802

ABSTRACT

PURPOSE: Present a case of bilateral foveal acute myelogenous leukemic tumors that responded to radiation therapy. DESIGN: Case report. METHODS: A patient was diagnosed with bilateral subfoveal infiltration of known systemic acute myelogenous leukemia. He received a standard induction chemotherapy, followed by consolidation therapy for his systemic leukemia. However, despite a complete marrow response, the intraocular tumors did not regress. Therefore, he was given low dose (1950-cGy) ocular external beam radiation therapy. RESULTS: One course of systemic cytarabine chemotherapy failed to control the subfoveal tumors, leaving the patient at risk for permanent vision loss. In contrast, external beam radiation therapy improved his vision from 20/60 in his right eye to 20/20 and from 20/70 in his left eye to 20/25. CONCLUSION: Although systemic chemotherapy can be used to treat intraocular metastasis, external beam radiation may provide more prompt resolution of vision-threatening tumors.


Subject(s)
Leukemia, Myeloid, Acute/radiotherapy , Recovery of Function/physiology , Retinal Neoplasms/radiotherapy , Visual Acuity/physiology , Adult , Fluorescein Angiography , Humans , Leukemia, Myeloid, Acute/physiopathology , Male , Retinal Neoplasms/physiopathology
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