Refractory anemia with ring sideroblasts associated with marked thrombocytosis (RARS-T) is a hematologic malignancy that often results in transfusion dependency and a hypercoagulable state. This rare ...disease currently lacks formal guidelines for treatment; however, various case reports have demonstrated efficacy in the use of lenalidomide. This immunomodulatory drug has shown promise in patients with 5q deletions, with reports of achieving transfusion independence and normalization of platelet counts. Herein we present the case of a 68-year-old African American woman with RARS-T who tested negative for 5q deletion and
V617F and
W515K/L mutations. Her treatment with lenalidomide therapy resulted in a five-year durable complete clinical response.
Acute myeloid leukemia (AML) is a hematological malignancy of myeloid progenitor cells that disrupt normal hematopoiesis. Current chemotherapy regimens result in complete remission in many cases; ...however, there exists no standard efficacious therapy for refractory acute myeloid leukemia. The hypomethylating agent, azacitidine, is effective in a limited number of such cases. We present a 57-year-old Filipino male with acute myeloid leukemia who was refractory to two induction chemotherapy regimens; however, he achieved complete remission after palliative therapy with azacitidine. We report this case to demonstrate the efficacy of azacitidine in refractory acute myeloid leukemia. Although the effectiveness of azacitidine in improving overall survival has been shown, this case demonstrates the effect on remission induction in high risk AML. Further studies are needed to delineate subsets of acute myeloid leukemia in which azacitidine will serve as effective therapy and to identify other targeted agents that may potentiate its effects.
The Salton Sea is the largest lake in California, and its most abundant macroinvertebrate is the pileworm (Neanthes succinea: Polychaeta). This is a major dietary item for three of the four most ...abundant fish species in the lake, and for at least one waterbird, the eared grebe (Podiceps nigricollis). Pileworm abundance in April 2004 was monitored at depths of 2, 6 and 10 m on seven transects distributed around the perimeter of the lake. Temperature and oxygen showed marked stratification with depth. Densities were compared to those observed in April 1999. Abundances at 2 m stations were similar to those in 1999; however, densities were greatly reduced at 6 and 10 m stations compared to 1999. The development of hypoxic or anoxic bottom conditions apparently occurred earlier in the spring in 2004 than in 1999. This was the most likely cause for the low densities at 6 and 10 m. Worm densities were higher at sites with coarser sediments (sand and/or barnacle shell debris), and lowest at 2 m sites near or downstream of freshwater inflows and at 10 m where near anoxic conditions prevailed. In March 2005, a sampling of 74 stations at depths ranging from 1 m to 10 m all around the perimeter of the lake found only a single pileworm. It was evident that the lake had just turned over and that sulfide levels were very high and had probably killed off most pileworms and many other organisms as well.
I have reported a rare case of hypercalcemia associated with small cell carcinoma of the lung. Our patient initially had small cell carcinoma of the right bronchial orifice, with metastases to the ...mediastinum and the lumbar vertebrae. Complete remission was achieved with chemotherapy over the next 3 years, but then three metastatic foci were found in the brain. Subsequently, recurrent small cell carcinoma was identified in the lung, and chemotherapy was resumed. The patient's condition deteriorated over the following 2 months. When intravenous saline failed to control hypercalcemia, octreotide acetate was given. The serum calcium level returned to normal and remained stable, without any other intervention, until the day after octreotide therapy was discontinued. I have discussed hypercalcemia due to bronchogenic carcinoma in terms of incidence in relation to histologic type, mechanisms of pathogenesis, and current treatment methods.
Type B lactic acidosis is rare among patients with malignant diseases. To date only one case report has documented lactic acidosis occurring in a patient with multiple myeloma (MM). Our patient, a ...55-year-old black man, was diagnosed with stage IIIA immunoglobulin G-kappa (IgG- κ ) MM in September 1995. He was found to have severe lactic acidosis at the time of second relapse. During the terminal phase of his disease, he required multiple hospitalizations for management of lactic acidosis and other complications of his MM. No other cause of his elevated lactate levels was identified. Although type B lactic acidosis may more commonly occur in patients with leukemia or lymphoma, it may rarely present in patients with rapidly progressive and refractory MM.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Both paclitaxel (P) and carboplatin (C) have a significant activity in non-small cell lung cancer (NSCLC). Weekly administration of P is active, is dose intense, and has a favorable toxicity profile. ...To evaluate the efficacy and toxicity of weekly P and C in advanced-stage NSCLC, we initiated this phase II study in patients with advanced NSCLC (III B with pleural effusion and stage IV).
Eligible patients were treated with paclitaxel 100 mg/m2 intravenously (iv) over 1 h followed by carboplatin AUC 2 iv over 30 min. This treatment was administered weekly for 3 of every 4 wk until disease progression or intolerable toxicities.
Of the 30 patients enrolled in the study, one patient did not meet the eligibility criteria. Of the remaining 29 patients, 6 did not complete at least two cycles of treatment and hence were not assessable for response. The overall response rate was 43.5% (10/23) (all partial responses). An additional 43.5% had stable disease. The median time to progression was 162 d and the median duration of response was 169 d. Overall survival at 1 yr on intent-to-treat analyses was 44% and median survival was 10.8 mo. We observed the following grade 3/4 toxicities: hypersensitivity to paclitaxel (13%), hypersensitivity to carboplatin (3%), neutropenia (31%), thrombocytopenia (7%); 31% experienced grade 1 neuropathy and 17% experienced grade 2 neuropathy.
We conclude that weekly paclitaxel and carboplatin is active and very well tolerated in patients with advanced NSCLC.
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