bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Clinical Features and Survival in 42 Cases of Acute Monocytic Leukemia
Authors: Qiu Hongxia , Wu Hanxin , Ju Songwen , Xu Wei , Xu Ji , Lv Xin , Shao Jinzhang , Zhang Ri 
Published: April 2020

Abstract
Background: Acute monocytic leukemia (M5) is a distinct subtype of acute myeloid leukemia (AML) with characteristic biologic and clinical features. This study was designed to analyze the clinical and laboratory features, and management and survival of newly diagnosed patients at with M5.
Methods: The white blood counts, immunophenotype and karyotypes were retrospectively analyzed in 42 patients (pts) with M5. The overall survival(OS)was estimated by Kaplan-Meier analysis, and the different groups were compared using log-rank test.
Results: Of the 42 pts, 7 had M5a and 35 had M5b. The incidence rates of M5 in newly diagnosed patients with acute leukemia and acute myelocytic leukemia were 13.7% and 22%, respectively. 28(66.7%) pts with M5 had a higher white blood counts more than 25×109/L. 36 pts obtained the outcomes of karyotype, 14(39%) pts with an abnormal cytogenetic clone, seven (19.4%) of these patients had trisomy 8 as the sole or accompanied complex cytogenetic aberration, 5(13.8%) had a translocation involving 11q23. An immunophenotype consistent with acute monocytic leukemia (CD14) was seen in 24(57.1%) of 42 pts. 16 pts (38.1%) gave up the chemotherapy at diagnosis and the complete remission rate was 73.1% for 26 pts who received induction chemotherapy. The OS for all M5 pts was 90 days (95%CI, 51.3~128.7) and the median survival for all M5 pts was 137.5 days. The median OS for the 19 CR pts was 273 days (95% CI, 226~320.1) and 85 days (95% CI, 72.2~97.8) for the 16 NR pts (95% CI, 72.2~97.8). For 16 pts who didn’t receive chemotherapy, the median OS was 35 days (95% CI, 33~37)(P&lt;0.0001). M5 presents hyperleukocytosis, 86.1% pts of M5 has a normal clone or trisomy 8 or a translocation involving 11q23. The overall survival of M5 pts with currently available therapy is poor.
Acute Myeloid Leukemia Occurring in Responders to the 9/11 Attack on the World Trade Center: A Single Institution Case Series
Authors: Allen Steven L. , Bayer Ruthee-Lu , Patel Dilip , Kolitz Jonathan E. 
Published: April 2020

Abstract
Responders to the 9/11/01 attack on the World Trade Center (WTC) were exposed to a variety of toxins resulting from the combustion of jet fuels, collapse of the towers, smoldering fires, and diesel exhaust generated by heavy equipment during debris removal. These toxins included polycyclic aromatic hydrocarbons, polychlorinated biphenyls and furans, and dioxins. The potential for subsequent development of secondary malignancies has been of concern. We report a single institution series of 6 cases of acute myeloid leukemia (AML) occurring in responders to the WTC disaster. All spent extended periods of time at Ground Zero.
Case Age WTC Role 9/11 to Dx (months) FAB Karyotype Response Status 1 38 Construction worker 29 M2 46, XY CR Relapse at 33 mos; expired 2 43 Bus driver 57 M4 48, XY, +8, +11 CMMoL Alive s/p allo SCT 3 38 Glass cutter 71 M3 46, XY, t (15;17) CR Alive 4 53 Police 74 M4 46, XY CR Relapse at 8 mos; alive 5 45 Police 79 M1 46, XY CR Alive 6 62 Police 79 M5a 46, XY CR Alive
AML arising in WTC responders after a latency period of at least 29 months raises the possibility of an association. There are no distinctive characteristics apparent in this small single institution series. Case 2 has myelodysplasia at a relatively young age, consistent with a possible toxic etiology. AML patients should be questioned regarding activity at Ground Zero and identified cases should be asked about the duration and types of exposure at the WTC, in addition to other occupational or environmental exposures. Clinicians should report cases of hematologic malignancy in WTC responders to the appropriate state cancer registry to facilitate epidemiologic investigation. Studies of cancer among persons exposed to the 9/11 disaster are ongoing by the New York City Fire Department, the WTC Medical Monitoring and Treatment Program and the WTC Health Registry.
Rasburicase Effectively Lowers Serum Uric Acid Levels in High Risk, Poor Performance Status Patients with Hematologic Malignancies
Authors: Ponce Doris , Liu Delong , Rasul Muhammad , Ahmed Nasir , Dimicco Marie , Seiter Karen 
Published: April 2020

Abstract
Tumor lysis remains a significant cause of morbidity and mortality in patients with highly proliferative hematologic malignancies. Traditionally, intravenous hydration and oral allopurinol have been the mainstays of therapy. However in some patients, hyperuricemia and renal failure still occur. The resultant renal failure precludes the administration of full doses of chemotherapy and results in a poor treatment outcome. Recently we participated in a large phase III randomized trial comparing rasburicase with standard allopurinol therapy. Rasburicase is a recombinant urate oxidase that effectively reduces serum uric acid due to conversion of uric acid into allantoin, a readily excretable and soluble substance. The results of that study are reported in a separate abstract. However while the study was open, we treated 12 extremely high risk, newly diagnosed hematologic malignancy patients who were ineligible for the study with commercially available rasburicase off study. The reasons for study ineligibility were ECOG Performance Status 4 and/or expected survival of less than one month. Other baseline characteristics: Diagnosis: Burkitts ALL: 3, AML: 7, CML-BP: 1, T-ALL: 1; Age: 64 (27–85), Sex: 6M/6F; WBC: 58,000/mm3 (1.6- 245,000); LDH: 2201 U/l (1068- &gt;2500); # of preexisting comorbid medical conditions: 4 (0–7); chemotherapy: hyper-CVAD: 4, standard ara-c based rx: 5, high dose ara-C based rx: 3. Nine patients received one dose of rasburicase (0.2 mg/kg IV), 3 patients required a second dose. The median uric acid levels were: pretreatment : 9.2 mg/dl (2.8–28.6), at 24 hours: &lt;0.2 (0.2–7.5) and at 48 hours: &lt;0.2 (&lt;0.2–4.9). All patients achieved normal serum uric acid level by day 2. The median baseline creatinine was 2.6 mg/dl (0.7 – 5.6); by day seven 10 patients had a serum creatinine less than 2 mg/dl (day 7 median creatinine 0.9, range 0.4–5.5). Four patients achieved CR to chemotherapy, 5 had refractory disease and 3 had induction death. Administration of rasburicase in this extremely high risk group of patients resulted in a rapid decrease in serum uric acid levels. In many patients this allowed for preservation of or improvement in renal function and administration of chemotherapy. Although some patients had a poor outcome due to the aggressive nature of their underlying disease, 4 of 12 patients (33%) attained CR and were able to receive subsequent cycles of intensive chemotherapy without incident.
Assessment of Response to Therapy in Primary Myeloid Sarcoma Using Positron Emission Tomography/Computer Tomography Imaging: A Case Report
Authors: Schöndube Daniel , Dresel Stefan , Ludwig Wolf-Dieter , Hildebrandt Martin 
Published: April 2020

Abstract
Myeloid sarcoma or chloroma, an extramedullary myeloid tumor, is observed in a minority of patients with acute non-lymphocytic leukaemia. Very few cases may present without bone marrow involvement (i.e., primary myeloid sarcoma). Among the various sites of disease manifestation reported, solitary bone lesions may occur. Diagnosis and, even more so, assessment of response to systemic therapy is strikingly more difficult than in systemic disease, i.e. acute leukaemia. We report the case of a patient diagnosed with primary myeloid sarcoma involving thoracic vertebral bones and associated with spinal cord compression. Here, positron emission tomography/computer tomography imaging allowed assessment of the initial extent of the disease as well as the response to a combined radiochemotherapeutic approach.
A male, 60 years old patient presented with pain in the flanks extending to the left leg. MRI imaging revealed an intraspinal mass in close proximity to the eleventh thoracic vertebral bone. Surgical resection of the mass including biopsy of the vertebral bone allowed the histopathological diagnosis of a myeloid sarcoma. Upon presentation, the assessment of bone marrow and meningeal involvement yielded negative results. MRI imaging revealed changes suggestive of residual manifestations albeit remaining inconclusive with regard to an enhancement secondary to the surgical intervention.
PET/CT imaging revealed a distinct signal located to the eleventh vertebral bone as a result of enhanced metabolic turnover (SUV 8.8) that was interpreted as active myelosarcoma tissue. Induction chemotherapy was initiated consisting of high-dose Ara C and Mitoxantrone (HAM). Following induction therapy, PET/CT assessment showed no change in metabolic activity. Extended field radiation therapy was performed, involving the two adjacent upper and lower vertebral bones, with a total dose of 30 Gy. This time, response assessment via PET/CT showed only a slight enhancement in metabolic turnover, suggestive of remission. As a consolidation, high dose Ara C therapy was initiated. Until now the patient is fine and shows no sign of residual myeloid sarcoma.
PET/CT in this case was the only method which reliably allowed the assessment of tumor location, extent and activity in a previously operated vertebral bone and, as a tool for the assessment of response, was guiding therapeutic decisions. In our opinion, the exposure to substantial radiation exposure due to PET/CT imaging is outweighed by the obvious diagnostic benefit.
Successful Treatment of Acute Myelocytic Leukemia in Pregnancy Complicated with Lung Abscess
Authors: Lan Jianping , Wang Xiaogang , Peng Ye , Qian Meihua , Wang Lianmin , Huang He 
Published: April 2020

Abstract
Acute leukemia in pregnancy is a rare event and the cytotoxic treatment during pregnancy remains controversial due to the concerns on significant teratogenicity led by chemotherapeutic agents. We here reported a woman who was diagnosed as acute myelocytic leukemia and lung abscess underwent a standard chemotherapy of DA regimen at her early third trimester of gestation and delivered a healthy baby without any abnormalities by Caesarean section. A 24-year-old woman at her 29th weeks of pregnancy was admitted because she experienced shortness of breath for one month and fever and cough with expectoration for three days. At admission, she had a moderate fever and looked severely anemic with no lymphadenopathy and hepatosplenomegaly. The whole blood counts showed her hemoglobin was 31 g/L, WBC 8.5 × 109/L with 42% blasts and platelet 13 × 109/L. The morphologic, immunophenotyping and cytogenetic findings of the bone marrow samples met the criteria of acute myelocytic leukemia (AML-M2a) diagnosis. Computerized tomography of chest indicated pneumonia with the formation of right lung abscess. Ultrasound examination revealed a normal-appearing fetus and an anterior placenta. Since the patient insisted maintaining the pregnancy, a standard induction regimen of daunorubicin and cytarabine was initiated and broad-spectrum antibiotics were simultaneously prescribed to control the pulmonary infection. During profound myelosuppression, granulocyte stimulating factor and anti-fungal agents were also administrated. After 4 weeks of induction, the patient’s symptoms all disappeared and her peripheral blood counts completely recovered. A repeat bone marrow aspirate confirmed complete leukemia remission. A living baby boy weighed 2200g was delivered by Caesarean section 2 weeks later (at the 35th week of gestation). Physical examinations and laboratory tests showed a healthy baby without any abnormalities. The mother is still in good condition and receives scheduled consolidation and maintenance therapy. The growth and development of the baby is also normal at the time of writing (8 months after birth). Our experience suggested chemotherapy of acute leukemia at the third trimester may not require termination of pregnancy since a remission of leukemia and delivery of a healthy baby can be obtained.
Trousseau’s Syndrome Revisited: Should We Screen Extensively for Malignancy in Patients with Venous Thromboembolism? a Systematic Review and Meta-Analysis
Authors: Carrier Marc , Le Gal Gregoire , Wells Philip , Fergusson Dean , Ramsay Tim , Rodger Marc A 
Published: April 2020

Abstract
Background: Identifying previously undiagnosed malignancy in patients with newly diagnosed venous thromboembolism (VTE) is important. Malignancy screening can potentially diagnose more cancers and at earlier stage, thereby preventing malignancy associated morbidity and perhaps mortality.
Purpose: To summarize the period prevalence of previously undiagnosed malignancy at baseline (within 1 month of VTE diagnosis), 6 and 12 months following VTE. To quantify the additional value of an “extensive” malignancy screening strategy at baseline compared to a more “limited” screen (history, physical exam and simple widely available tests) at baseline.
Data Source: A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews.
Study Selection: We selected 36 studies that reported the prevalence of undiagnosed malignancies at baseline, at 6 and 12 months. Fourteen articles and one abstract also met inclusion criteria for the assessment of “extensive” versus “limited” malignancy screening.
Data extraction: Two reviewers independently extracted data onto standardized forms.
Data Synthesis: The period prevalence of previously undiagnosed malignancy in patients with unprovoked VTE is 6.1% (95% confidence intervals (CI): 5.0 to 7.1) at baseline and 10.0% (95% CI: 8.6 to 11.3) from baseline to 12 months. An “extensive” malignancy screening strategy using computed tomography of the abdomen/pelvis significantly increases the proportion of previously undiagnosed malignancy detected from 49.4% (95% CI: 40.2 to 58.5) (limited screening alone) to 69.7% (95% CI: 61.1 to 77.8) in patients with unprovoked VTE.
Limitations: Unable to determine complication rates, cost-effectiveness and difference in morbidity and mortality associated with “extensive” screening strategies.
Conclusion: Previously undiagnosed malignancies are frequent in patients with unprovoked VTE. Malignancy screening using an “extensive” screening strategy detects more malignancies compared to a limited screening strategy. Computed tomography of the abdomen/pelvis should be considered in the diagnostic work up of previously undiagnosed malignancy in patients with unprovoked VTE.
A Murine AML Model for the Development of Resistance to NRAS(G12V) Oncogene Repression and/or Ara-C Treatment in Vivo
Authors: Kim Won-IL , Rathe Susan K , Diers Miechaleen D , Largaespada David A 
Published: April 2020

Abstract
We previously reported the development of a model of AML in mice induced by the combined expression of a conditionally expressed NRASG12V oncogene and the MLL fusion oncogene MLL-AF9. This mouse model combines a Vav promoter-Tet transactivator (Vav-tTA) transgene, a doxycycline (DOX)-repressible tet-regulated element promoter-NRASG12V (TRE-NRASG12V) transgene, and Mll-AF9 “knock-in” transgene. When we transplanted triple transgenic Vav-tTA; TRE-NRASG12V; Mll-AF9 AML into SCID mice we found that doxycycline (DOX) treatment via the drinking water could prevent AML engraftment or eliminate AML cells after growth to full-blown leukemia. However, these mice eventually develop DOX-resistant AML, which does not re-express the NRASG12V transgene. In more recent data, we find that the Vav-tTA; TRE-NRASG12V; Mll-AF9 AML cells are also Ara-C sensitive as we can repeatedly induce temporary remission in transplant recipients of these cells by 5 day courses of 50 mg/kg Ara-C given once per day intra-peritoneally. Although Ara-C is the backbone of human Ara-C treatment, many patients develop Ara-C resistant AML over time. In our model, fully Ara-C resistant AML develops after 4 to 5 courses of treatment. Nevertheless, a combination of Ara-C treatment and NRASG12V transgene suppression using DOX can extend remission and survival compared to treatment with either approach alone suggesting that some benefit could be obtained by combining RAS pathway inhibitors with conventional chemotherapy. However, even in this case, AML that is resistant to both Ara-C and NRASG12V transgene suppression eventually develops in all mice. Primary AML samples that have been selected in vivo for resistance to Ara-C, NRASG12V oncogene suppression, or both, have been collected and are being analyzed by mRNA microarray for changes in gene expression that might be responsible for the acquisition of resistance.
Oral Anticoagulation in Atrial Fibrillation. Comparison Between Patients Younger and Older Than 75 Years
Authors: Colorio Cecilia Claudia , Puente Dolores P , Rossi Andrea , Tabares Maria , Pombo Gonzalo , Forastiero Ricardo 
Published: April 2020

Abstract
Atrial fibrillation (AF) is the most common cardiac rhythm disorder. The prevalence is nearly 10 % in patients (pts) older than 75 years (yrs). Some authors are reluctant to give oral anticoagulant therapy for older pts based on their higher incidence of bleeding
Objective : to compare characteristics, incidence of thrombosis and bleeding in 2 groups of pts with AF, under OA for at least 3 months.
Methods: we retrospectively analyzed 184 pts below 75 yrs (Group A) and 133 pts with 75 yrs and older (Group B), between Jan 2002 and Aug 2007.
Results: the mean follow-up was 514 pts/year for the A group and 382 pts/year for group B. The features of each group are listed in the table below:
Group A Group B p Age (mean- range) 64,9 (33/74) 79,8 (75/91) Gender (M/F) 116/68 (1,7/1) 55/78 (0,7/1) Rheumatic AF 89/184 61/114 Non valvular AF 80/184 53/114 Previous thrombosis 21/184 (11.4%) 29/133 (21.8%) 0,01 Diabetes mellitus 28/184 (15.2%) 10/133 (7.5%) 0,05 Arterial Hypertension 78/184 (42.3 %) 53/133 (39.8%) Hyperthyroidism 29/184 (15.7%) 18/133 (13.5%) Left Mega Atrium 43/174 (24.7%) 32/110 (29%) Coronary Artery Disease 38/184 (20.6%) 31/133 (23.3%) Cardiomegaly 53/170 (31.1%) 41/122 (33.6%) Ejection Fraction ≤30% 26/175 (14,8%) 20/112 (17.8%) Creatinin ≥ 2 mg/dl 8/184 (4.3%) 8/133 (6.1%) Thromboses 4/184 (2.1%) 3/133 (2.2%) Bleeding minor 59/184 (32%} 49/133 (36.8%) major 5/184 (2.7%) 2/133 (1.5%) fatal 0 2/2 (100%) Controls with INR 2-3 61 % 60,5 %
Conclusion: There was no difference in the incidence of major and minor bleeding/thrombotic complications between the groups.
Group B disclosed a higher number of thromboses previous to OA therapy, and fewer pts with diabetes. In our experience, OA seemed to be equally safe and effective when we compared both populations. There was no difference in the incidence of major and minor bleeding/thrombotic complications between the groups.
The Evaluation of a Prothrombotic Risk in a Human Fibrinogen Concentrate
Authors: Dickneite Gerhard , Joch Christine , Bergman Garrett E. 
Published: April 2020

Abstract
Fibrinogen is a circulating coagulant protein which is converted to polymerizable fibrin by thrombin. The human fibrinogen concentrate (FC) (CSL Behring) has been used for the treatment of bleeding in fibrinogen deficiency. In this investigation we investigated the prothrombotic potential of FC using the in-vivo, Wessler venous stasis assay in rabbits Thrombogenicity in clinical use was assessed in a postmarketing drug surveillance review. Forty-five rabbits were randomized to receive either placebo or 40 mg/kg of one of four different lots of FC, injected into a marginal ear vein. Thirty seconds thereafter, a segment of the right jugular vein (1.5 – 2.0 cm) was ligated. After 15 minutes the segment was removed and evaluated for thrombus formation according to a score system from 0 –3. Thrombogenic materials, such as activated prothrombin complexes, have consistently shown high scores of thrombus formation in this assay. The mean score in the FC treated rabbits (0.85 ± 1.04) was not different from that in the placebo-treated rabbits (0.8 ± 0.84). Postmarketing data was comprised of spontaneous reports to a postmarketing surveillance system for Adverse Drug Reports (ADR). The number of ADR reports was expressed relative to the number of estimated single standard doses. The estimated dose per patient was adjusted to the degree of bleeding (between one to eight gram). Between January 01, 1986 and April 30, 2008 in total 983,195 g of Haemocomplettan® P had been distributed. Very few reports (n=9) of thromboembolic events have been reported throughout postmarketing surveillance, corresponding to one case report for every 13,655 treatments of 8 grams FC. The reported thromboembolic events occurred in patients with congenital afibrinogenemia or acquired hypofibrinogenemia. In most cases, patients had additional risk factors (e.g. concomitant administration of blood products prothrombin complex concentrate, platelet concentrates, activated factor VII, etc.). Although a causal relationship to administration of FC could not be definitely excluded, the occurrence of thromboembolic events is very rare. From congruent results of both a classical preclinical model of thrombogenicity and analysis of postmarketing data, FC appears to have a very low risk of thrombogenicity.
Bloodless Cancer Treatment Results of Patients Who Do Not Want Blood Transfusion: Single Center Experience of 77 Cases
Authors: Kim Sung Hyun , Oh Sung Yong , Kwon Hyuk-Chan , Lee Suee , Lee Dong Mee , Kim Kyeong Hee , Han Jin-Yeong , Park Joo- In , Lee Jong-Hwan , Lee Kyu-Yeol , Kim Hyo-Jin 
Published: April 2020

Abstract
Background: Patients may be unwilling to accept blood products for religious reasons – Jehovah’s Witnesses (JW). Because of its minority, as well as JW patients, physicians have a lot of difficulty and anxiety to treatment. Furthermore, sometimes cancer patients are needed transfusion during operation or chemotherapy. So, we analyze the clinical outcomes of JW cancer patients who had treated for identifying the risk of treatment and transfusion need.
Methods: We analyzed 77 cases of histological confirmed cancer patients (JW) from Jan. 2001 to Apr. 2008.
Results: Male to female ratio was 1:1.48. Median age of patients was 59 years (range, 8 –83 years). The most common primary site was stomach (20.8%) followed by breast (14.3%), colorectal (11.7%), liver (7.8%), lung (6.5%), and hematologic malignancy (5.2%). At diagnosis, 53 patients (68.8%) were operable early cancer patients. Operation was done in 47 patients (89%). three patients refused operation itself. Change of CBC profile after operation was observed in hemoglobin (Mean ± SD; 12.7 ± 2.1 g/dL to 10.6 ± 2.3 g/dL, P&lt;0.001). WBC and platelet were not affected by operation (P=0.818, P=0.179). Twenty-eight patients received adjuvant chemotherapy. Of them, 21 patients (78%) had completed their planed schedule. There is no treatment related transfusion need or death during adjuvant chemotherapy. Initially, 20 patients had been presented with advanced stage and 8 patients relapsed after curative treatment. 127 cycles of palliative intravenous chemotherapy was administrated in 19 patients. G-CSF and erythropoietin was used in 45 and 20 cycles of treatment, respectively. Grade I/II anemia (38.6%) and leucopenia (42.5%) were common hematologic toxicities. Grade ≥III thrombocytopenia and anemia were observed in 3.9% and 2.4%. Only 1 patient had stopped chemotherapy due to thrombocytopenia. Reduced dose chemotherapy was administrated at 23 cycles (18.1%). The median overall survival for all the patients has not yet been determined. 3 year and 5 year survival rate was 80% and 70%, respectively. Major cause of death was disease progression, not bleeding
Conclusion: Bloodless cancer treatment was not accompanied with serious complication. A few cases of palliative chemotherapy were needed transfusion, but adequate physician’s assist - dose modification and use of G-CSF and erythropoietin - could make keep the patient’s hope and quality of life.