Novel Strategies to Treat Children with Refractory or Relapsed Acute Myeloid Leukemia
Luca Lo NigroEmanuela CannataPiera SamperiSilvana MundaDaria BottinoElena MirabileAndrea Di CataldoGiovanna Russo
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Imatinib Mesylate
Complete blood count
Minimal Residual Disease
Salvage therapy
Cytopenia
Imatinib mesylate induces major or complete cytogenetic responses in the majority of patients with chronic myeloid leukemia (CML) in chronic phase. However, 15-40% of patients develop neutropenia and/or thrombocytopenia that makes it necessary to reduce the dosage or to interrupt treatment. Patients with recurrent cytopenias may be less likely to obtain cytogenetic responses. We speculated that low doses of granulocyte colony-stimulating factor (G-CSF) in conjunction with imatinib might offer clinical benefit. Eleven patients with CML in chronic (n=9) or accelerated (n=2) phase who could not tolerate 300 mg/day and had no cytogenetic response after 6 months of imatinib treatment received G-CSF in combination with imatinib. Ten of the 11 patients could then tolerate doses of imatinib equal to or greater than 300 mg/day and 7 patients achieved major (n=6) or complete (n=1) cytogenetic responses. We conclude that G-CSF reverses the hematologic toxicity of imatinib and may thereby increase the proportion of cytogenetic responses.
Imatinib Mesylate
Cytopenia
Leukopenia
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Salvage therapy
Refractory (planetary science)
Complete response
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Summary The diagnosis of myelodysplastic syndromes ( MDS ) is often challenging, time‐ and resource‐consuming. A thorough analysis of complete blood count ( CBC ) parameters could, however, help to screen for MDS among other causes of cytopenia. To test this hypothesis, 109 newly‐diagnosed MDS patients and 399 cytopenic patients older than 50 years with confirmed absence of MDS were enrolled in a prospective study. Multiparametric analysis highlighted three CBC parameters that were significantly different between the two cohorts: mean corpuscular volume, absolute neutrophil count and median neutrophil complexity and width of dispersion of the events measured (Ne‐ WX ), which were used to define an MDS ‐ CBC score. This score enables the prediction of MDS with 86% sensitivity and 88% specificity. The MDS ‐ CBC score excluded MDS in 89% of cytopenic controls. Moreover, high score values at MDS diagnosis significantly correlated with decreased event‐free ( P = 0·02) and overall survival ( P = 0·01). The power of this score was confirmed in an independent validation cohort ( MDS n = 34, cytopenic controls n = 28). The MDS ‐ CBC score is an easy and fast tool to exclude or suspect MDS in unselected patients with cytopenia of unknown reasons at the time of analysis, by prompting blood smear examination. It may thus improve allocation of further MDS ‐specific work‐up in patients with cytopenia at the time of CBC assessment.
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Objective:To explore the causes of cytopenia.Methods:The retrospective analysis was made of the clinical data of 125 patients admitted into and treated in our hospital from 1999 to 2003.Results:The causes of cytopenia were not only blood systemic diseases but also other systemic diseases.Conclusion:Clinicians should attach great importance to cytopenia caused by non-blood systemic diseases.
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Prolonged cytopenia after CAR-T cell therapy is an acknowledged problem. At present, the causes and implications of prolonged cytopenia are unclear. The paper by Kitamura et al identified that prolonged cytopenia is associated with alterations in the bone marrow niche identified before CAR-T therapy, indicating a potential predictor of this serious side-effect of treatment. Commentary on: Kitamura et al. Bone marrow microenvironment disruption and sustained inflammation with prolonged haematologic toxicity after CAR T-cell therapy? Br J Haematol 2023;202:294-307.
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Abstract Traditionally, cytopenias are classified as deficiency mediated, immune mediated, BM failure induced, renal, or idiopathic, with the latter including the so-called idiopathic cytopenias of undetermined significance (ICUS). Clinical findings, symptoms, blood counts, BM findings, and other laboratory parameters are usually sufficient to reveal the type and cause of a marked cytopenia. However, in patients with chronic mild cytopenia, it may be a challenge for the physician to establish a correct diagnosis. In such patients, laboratory features and findings often reflect a diagnostic interface, so that criteria that are otherwise robust may hardly be applicable or are not helpful. Even if the BM is examined, the diagnosis often remains uncertain in these patients. In addition, more than one potential cause of cytopenia may be present, especially in the elderly. A myelodysplastic syndrome (MDS) or another BM disorder, but also an overt autoimmune or other inflammatory disease, may develop during follow-up in these patients. A key problem is that in an early phase of MDS, most laboratory and clinical signs are “nonspecific.” One of the very few reliable peripheral blood parameters distinguishing between an early or “pre-phase” of MDS and most other causes of a mild cytopenia are the numbers of circulating colony-forming progenitor cells. In addition, flow cytometric and molecular investigations may sometimes assist in the delineation between clonal and reactive conditions underlying mild cytopenias. This review provides an overview of diagnostic approaches and algorithms for patients with mild unexplained cytopenia(s).
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The patient(woman, approximately 46 years old)began pazopanib (PAZ) treatment (800 mg/day)f ollowing the recurrence of retroperitoneal leiomyosarcoma. Prior to treatment, the patient's platelet count was 18.6×10(4)/µl and her neutrophil count was 1.61×10(3)/µl . The platelet count decreased to 9.2×10(4)/µl on day 7 and to 5.4×10(4)/µl on day 21 after commencement of treatment. The neutrophil count was 0.97×10(3)/µl on day 28 and 0.68×10(3)/µl on day 35 after commencement of treatment. Thus, PAZ treatment was stopped on day 35. The blood sampling results on day 42 after commencement of treatment showed that the platelet count was 13.0×10(4)/µl and that the neutrophil count had recovered to 1.28×10(3)/µl . At that time, PAZ treatment was resumed at a reduced dose of 600 mg/day. By day 84 after commencement of treatment, the platelet count had increased from 12.7 to 13.8×10(4)/µl and the neutrophil count had increased from 1.02 to 1.34×10(3)/µl ; treatment was subsequently continued. The main adverse effects that have been reported for PAZ are hypertension and frequent liver dysfunction; these reports also indicate that the incidence of severe cytopenia(thrombocytopenia, neutropenia)is quite low. However, our patient exhibited cytopenia after commencement of PAZ treatment and her blood cell counts recovered once treatment was ceased, independent of other possible medications. Our findings suggest that cytopenia should be considered as an adverse effect of PAZ.
Cytopenia
Absolute neutrophil count
Complete blood count
Blood count
Pazopanib
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Objective
To investigate the causes of peripheral cytopenia in patients with posthepatitic cirrhosis and portal hypertensive splenomegaly.
Methods
The clinical data of 183 patients with hepatitic cirrhosis and portal hypertensive splenomegaly complicated by peripheral cytopenia who were operated in our hospital in the past 17 years were retrospectively studied.
Results
All these patients underwent splenectomy. Before operation, all these patients had one or more types of peripheral cytopenia (cumulative cytopenia: 390 patient-times). After splenectomy, blood counts in 79.2% returned to normal; in 15.9% increased but failed to reach normal levels; and in 4.9% became lower than before operation. 5 patients died soon after operation.
Conclusion
Hypersplenism is the main cause for the peripheral cytopenia most cirrhotic portal hypertension patients. Splenectormy is an effective method to treat hypersplenism.
Key words:
Hypertension, portal; Cytopenia; Hypersplenism
Cytopenia
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