bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Examination of Educational Gaps in the Diagnosis and Treatment of Myelodysplastic Syndromes
Authors: Shammo Jamile M. , Foran James M. , Houk Alice , Epstein James , Narang Mohit , Rubinstein Pesha , Dennison Betsy , Latsko Joan M. , Naganna Gourishankar , York John M. 
Published: August 2017

Background Myelodysplastic syndromes (MDS) comprise a heterogeneous group of hematologic malignancies, with an incidence rate of 3.4 cases per 100,000 in the United States. MDS affects patients predominantly over 60 years of age. As these syndromes are not well understood by many medical practitioner, patients with MDS may be underrecognized or underdiagnosed. The availability of new MDS treatment options further establishes the need to more closely assess gaps in clinical practice and underscores the necessity to develop educational activities to address those gaps. Methods A multidisciplinary panel was convened to examine current educational needs and gaps. A group consensus approach incorporating a modified nominal group technique was utilized to prioritize and review needs identified in the pre-meeting survey and to evaluate data provided by panelists prior to the meeting. Results The panel identified and prioritized seven educational areas of need: (1) MDS disease awareness, (2) diagnosis, (3) classification and risk stratification, (4) treatment issues, (5) referral to stem cell transplantation or new treatment protocols, (6) clinical monitoring and toxicity management, and (7) translation of new data into patient care. Conclusions In-depth knowledge is critical to the timely diagnosis and optimal care of MDS patients. A number of key educational needs exist. Educational programs should be practical in orientation to integrate data into practice, and they should be tailored for the intended audience. In addition, an effective educational program must be easily applied by participants.
Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation in Adults with Acute Myeloid Leukemia
Authors: Hamadani Mehdi , Mohty Mohamad , Kharfan-Dabaja Mohamed A. 
Published: August 2017

Background Acute myeloid leukemia (AML), whether de novo or arising from antecedent hematologic disorders in elderly patients, is less likely to be curable with standard chemotherapy regimens used for younger patients. Allogeneic hematopoietic cell transplantation (alloHCT) is currently the most efficient anti-leukemia treatment for AML and has shown a survival advantage in younger patients with intermediate- or poor-risk cytogenetics. Methods The authors review their experience as well as the published data regarding the role of reduced-intensity conditioning (RIC) alloHCT in adults with AML. MEDLINE/PubMed and EMBASE/Ovid were searched, as well as reference lists of relevant articles, conference proceedings, and ongoing trial databases. Results Elderly patients with AML have a poor survival for all cytogenetics subgroups (except for acute promyelocytic leukemia) and higher rates of transplant-related mortality with myeloablative alloHCT. RIC regimens have been shown to decrease procedure-related toxicity and have emerged as an attractive treatment modality in AML patients not suitable for myeloablative conditioning regimens. While prospective data comparing outcomes of AML patients undergoing RIC alloHCT vs conventional chemotherapy alone are not yet available, RIC alloHCT is a reasonable option for high-risk older patients and for younger AML patients with medical comorbidities who achieve a first or subsequent remission. The application of RIC for patients with refractory disease or untreated relapse as well as the use of alternative donors should be considered within the context of clinical trials. Conclusions RIC alloHCT is a safe and effective treatment modality in high-risk elderly AML patients and in younger AML patients with medical comorbidities.
Hematopoietic Cell Transplantation for Lymphomas
Authors: Ayala Ernesto , Tomblyn Marcie 
Published: August 2017

Background The heterogeneity of lymphomas results in numerous treatment options, including both autologous and allogeneic hematopoietic cell transplantation. However, the type of transplantation, the timing the procedure, and the selection of suitable patients for transplant continue to evolve. Methods We reviewed the current medical literature to provide a succinct synthesis for the most common types of lymphoma and the indications for transplantation. Results This review discusses the outcomes of autologous and allogeneic transplantation for patients with diffuse large B-cell lymphoma, follicular lymphoma, HIV-associated lymphomas, mantle cell lymphoma, T-cell lymphoma, and Hodgkin lymphoma. Conclusions Each of these histologies differs in the indications and timing for transplantation. However, ongoing clinical trials support the continuing role of both autologous and allogeneic transplantation for lymphoma management.
Advances in the Autologous and Allogeneic Transplantation Strategies for Multiple Myeloma
Authors: Nishihori Taiga , Alsina Melissa 
Published: August 2017

Background Multiple myeloma is largely an incurable malignant plasma cell neoplasm; however, the landscape of its treatment is rapidly changing. Methods The recent literature on both autologous and allogeneic transplant approaches for multiple myeloma was reviewed. Results High-dose chemotherapy followed by autologous hematopoietic cell transplantation (HCT) remains an integral component of upfront treatment strategy, and the incorporation of novel immunomodulators and proteasome inhibitor to induction regimens improves response rates and increases overall survivals. Bortezomib-and lenalidomide-based combination chemotherapy regimens have become the standard induction myeloma therapy. When myeloma patients proceed to transplant after novel combination regimens, their response rates are further improved. Despite these recent major improvements, myeloma remains incurable and long-term survival appears elusive. Due in part to a potential graft-vs-myeloma effect, allogeneic HCT is a potentially curative transplant option. However, initial attempts have been hampered by the high transplant-related mortality. With a reduction of toxicity, allogeneic transplant approaches with reduced-intensity conditioning have been utilized, although they are subject to continued disease progression and relapse following transplantation. Recent research efforts have shifted to the use of a tandem autologous-allogeneic HCT approach. The long-term follow-up of this new strategy is awaited. Conclusions Recent advances in HCT have improved outcomes of patients with multiple myeloma. Ongoing research activity focuses on the strategies to improve outcomes of HCT by incorporation of tandem autologous-allogeneic transplantation schema, novel conditioning regimens, and the use of consolidation and maintenance therapy.
Biology of Bone Metastases
Authors: Theriault Rachel L. , Theriault Richard L. 
Published: August 2017

Background Bone metastases cause morbidity and mortality in multiple malignancies. In addition to portending a dire prognosis, bone metastases cause bone pain, fractures, hypercalcemia, spinal cord compression, and other nerve compression syndromes. Improved understanding of the mechanisms that predispose tumor metastases to bone is needed to improve patients’ therapeutic options, maintain their quality of life, and improve their survival. Methods This review discusses selected preclinical and clinical data regarding bone metastasis development and cytokine/molecular interactions predisposing to bone metastases formation. Potential interventions for reducing bone metastases are also described. Results Biologic mechanisms resulting in metastases of tumor cells to bone are being studied. Among these are the RANKL pathway, osteoclast activation via cytokines (produced by tumor cell and cells in the bone microenvironment), interactions with transient and stromal cells in the bone microenvironment, and molecules such as PTHrP and endothelin-1. These molecules offer important opportunities for targeted interventions to decrease bone metastases-associated morbidity. Conclusions Knowledge of the pathophysiology of bone and cancer is developing rapidly. Relationships among cancer cells, bone-derived cells, and cytokines provide opportunities for the development of new interventions. Therapy targeting osteoclast/osteoblast interactions has proven benefit for patients with bone metastases.
The Management of Pain in Metastatic Bone Disease
Authors: Buga Sorin , Sarria Jose E. 
Published: August 2017

Background Metastatic bone disease is a common cause of pain in cancer patients. A multidisciplinary approach to treatment is often necessary because simplified analgesic regimens may fail in the face of complex pain generators, especially those involved in the genesis of neuropathic pain. From the origins of formalized guidelines by the World Health Organization (WHO) to recent developments in implantable therapies, great strides have been made to meet the needs of these patients. Methods The authors review the existing literature on the pathophysiology and treatment options for pain generated by metastatic bone disease and summarize classic and new approaches. Results Relatively recent animal models of malignant bone disease have allowed a better understanding of the intimate mechanisms involved in the genesis of pain, resulting in a mechanistic approach to its treatment. Analgesic strategies can be developed with specific targets in mind to complement the classic, opioid-centered WHO analgesic ladder obtaining improved outcomes and quality of life. Unfortunately, high-quality evidence is difficult to produce in pain medicine, and these concepts are evolving slowly. Conclusions Treatment options are expanding for the challenging clinical problem of painful metastatic bone disease. Efforts are concentrated on developing alternative nonopioid approaches that appear to increase the success rate and improve patients’ quality of life.
Lessons Learned from the Bevacizumab Experience
Authors: Mortimer Joanne , Zonder Helene B. , Pal Sumanta K. 
Published: August 2017

Background Bevacizumab is an important agent in the oncologic armamentarium, with activity in a broad spectrum of solid tumors. It has been approved in the management of metastatic colorectal cancer, non-small cell lung cancer, renal cancers, and recurrent glioblastoma multiforme. Methods We reviewed the published literature and briefing documents of the US Food and Drug Administration that provided the data leading to approval or change in approval status. Results Bevacizumab initially received accelerated approval for the treatment of advanced breast cancer. However, lack of confirmatory data from additional clinical trials resulted in the loss of that indication. Both the expected and unexpected toxicities reported from clinical trials using bevacizumab have helped us to understand the drug's mechanism of action and to identify who are most likely to benefit from this important agent. Conclusions The side effects of treatment may provide important information about drug mechanism and efficacy. Bevacizumab is clearly an important agent in oncology and is likely to become more significant once a clinical or pathological marker to predict its efficacy has been identified.
Sequencing Systemic Therapies in Metastatic Castration-Resistant Prostate Cancer
Authors: Liu Jane Jijun , Zhang Jingsong 
Published: August 2017

Background Men with prostate cancer will not die of the disease until it progresses to the metastatic castration-resistant stage. At that stage, the median survival is 9 to 30 months. Methods Recently approved and emerging treatments for metastatic castration-resistant prostate cancer (mCRPC) were reviewed based on their mechanisms of action, as well as sequencing and combining these treatments with existing options. Results Advances in androgen deprivation therapy, immunotherapy, bone-targeted therapy, and chemotherapy have led to approvals of abiraterone acetate, sipuleucel-T, denosumab, and cabazitaxel for the treatment of mCRPC. Despite improvements in patient survival and quality of life, mCRPC remains incurable. Conclusions With the emerging new therapies, this is an unprecedented time in treating mCRPC. A better understanding of their mechanisms of action, the genetic makeup of each mCRPC, and the development of new prognostic and predictive biomarkers will help determine sequencing or different combination treatments for each individual patient.
Controversial Issues in Kyphoplasty and Vertebroplasty in Malignant Vertebral Fractures
Authors: Papanastassiou Ioannis D. , Filis Andreas K. , Gerochristou Maria A. , Vrionis Frank D. 
Published: August 2017

BackgroundKyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures.MethodsA critical review of the medical literature was performed and controversial issues were analyzed. Results: Evidence supports KP as the treatment of choice to control fracture pain and the possible restoration of sagittal balance, provided that no overt instability or myelopathy is present, the fracture is painful and other pain generators have been excluded, and positive radiological findings are present. Unilateral procedures yield similar results to bilateral ones and should be pursued whenever feasible. Biopsy should be routinely performed and 3 to 4 levels may be augmented in a single operation. Higher cement filling appears to yield better results. Radiotherapy is complementary with KP and VP but must be individualized.ConclusionsIn cases of painful cancer fractures, if overt instability or myelopathy is not present, unilateral KP should be pursued, whenever feasible, followed by radiotherapy. The technological advances in hardware and biomaterials, as well as combining KP with other modalities, will help ensure a safe and more effective procedure.
Practical Applications of Digital Pathology
Authors: Saeed-Vafa Daryoush , Magliocco Anthony M. 
Published: August 2017

Background Virtual microscopy and advances in machine learning have paved the way for the ever-expanding field of digital pathology. Multiple image-based computing environments capable of performing automated quantitative and morphological analyses are the foundation on which digital pathology is built. Methods The applications for digital pathology in the clinical setting are numerous and are explored along with the digital software environments themselves, as well as the different analytical modalities specific to digital pathology. Prospective studies, case-control analyses, meta-analyses, and detailed descriptions of software environments were explored that pertained to digital pathology and its use in the clinical setting. Results Many different software environments have advanced platforms capable of improving digital pathology and potentially influencing clinical decisions. Conclusions The potential of digital pathology is vast, particularly with the introduction of numerous software environments available for use. With all the digital pathology tools available as well as those in development, the field will continue to advance, particularly in the era of personalized medicine, providing health care professionals with more precise prognostic information as well as helping them guide treatment decisions.
Advances in EGFR as a Predictive Marker in Lung Adenocarcinoma
Authors: Khalil Farah K. , Altiok Soner 
Published: August 2017

Background Worldwide, lung cancer is the most common cause of mortality. Toxins from tobacco smoke are known to increase the risk of lung cancer; however, up to 15% of lung cancer–related deaths in men and up to 50% of lung cancer–related deaths in women occur in people who do not smoke. Despite the fact that chemotherapy generally provides a survival benefit for non–small-cell lung cancer, not every patient will respond to therapy and many experience therapy-related adverse events. Thus, predictive markers are used to determine which patients are more likely to respond to a given regimen. Methods We reviewed the current medical literature in English relating to predictive markers that may be positive, such as the presence of an activating EGFR mutation. Results The advances in using EGFR as a molecular predictive marker were summarized. This biomarker influences therapeutic response in patients with lung adenocarcinoma. Clinical evidence supporting its value is also reviewed. Conclusions The use of EGFR as a predictive factor in lung adenocarcinoma may help target therapy to individual tumors to achieve the best likelihood for long-term survival and to avoid adverse events from medications unlikely to be effective.
Developments in Intralesional Therapy for Metastatic Melanoma
Authors: Sloot Sarah , Rashid Omar M. , Sarnaik Amod A. , Zager Jonathan S. 
Published: August 2017

Background Locoregional advanced melanoma poses a complex clinical challenge that requires a multidisciplinary, patient-centered approach. Numerous agents have been studied for their suitability as intralesional therapy in the past decades, but few have successfully completed phase 3 clinical trial testing. Methods The relevant medical literature was searched for articles regarding use of intralesional therapies in metastatic melanoma. Therapies with data from phase 2 or higher studies were selected for review. This review also summarizes the mechanisms of action, adverse-event profiles, and clinical data for these agents. Results Intralesional therapies demonstrate promising effects in select patients with advanced melanoma. The optimal approach should be individually tailored and consist of a combination of intralesional therapies, regional perfusions, systemic immunotherapies, targeted therapies, and surgery, if necessary. Conclusions Due to its relatively good local response rates and tolerable adverse-event profile, intralesional therapy may be a treatment option for select patients with unresectable, locally advanced or metastatic melanoma.
Association of microRNA 21 with Biological Features and Prognosis of Neuroblastoma
Authors: Zhou Yaodong , Sheng Bo 
Published: August 2017

Background The aim of this study was to assess the differences in microRNA 21 expression among neuroblastoma (NB), embryonic tissue, and normal adrenal tissue and to identify correlations between microRNA 21 expression, the biological features of the tumor, and prognosis. Methods A total of 70 patients with NB were selected from December 2005 and December 2007. Real-time polymerase chain reaction was used to assess microRNA 21 expression. All patients were followed-up for 5 years. Results Significant differences in microRNA 21 expression were found between the 3 groups, with the highest expression in the NB samples (P < .001). The expression of microRNA 21 was highest in the high-risk group compared with the moderate- and low-risk groups (P < .001). The microRNA 21 expression in the MYCN amplification group was higher than in the group without amplification (P = .001). The 5-year overall survival rate of patients with NB was 71.4%. Conclusions The higher expression of microRNA 21 in NB samples compared with embryonic and normal tissue samples predicted a close correlation between microRNA 21 expression and the biological features of NB. In patients with NB, higher microRNA 21 expression correlated with lower rates of overall survival. Therefore, microRNA 21 expression may represent a novel risk factor for determining the prognosis of patients with NB.
Clinical Benefits of Proton Beam Therapy for Tumors of the Skull Base
Authors: Ahmed Kamran A. , Demetriou Stephanie K. , Mcdonald Mark , Johnstone Peter A.S. 
Published: August 2017

Background The unique radiobiological properties of protons have been understood for many years. In addition, many of the clinical benefits of radiotherapy were first noted in tumors involving the skull base. More public attention has been given to proton beam therapy due to the increasing number of centers now in operation or in the planning stages for offering this treatment option. Methods We reviewed the physical properties of protons and the clinical studies performed to justify their use in the management of skull-base tumors and determine the benefits of proton beam therapy. Results Published reports suggest a benefit to proton beam therapy for use in tumors of the skull base, including craniopharyngiomas, chordomas, skull-base sarcomas, and unresectable meningiomas. Conclusions Use of proton beam therapy may be beneficial in select patients. Surgical and medical oncologists should have a general understanding of such cases to facilitate their appropriate referral.
Primary Gangrenous Cutaneous Mold Infections in a Patient with Cancer and Neutropenia
Authors: Yacoub Abraham , Soni Kiran K. , Mojica Lysenia , Mai Jane , Morano Jamie , Cruse C. Wayne , Sandin Ramon L. , Nanjappa Sowmya , Bohra Chandrashekar , Gajanan Ganesh , Greene John N. 
Published: August 2017

BackgroundOpportunistic fungal infections caused by Aspergillus and Candida followed by infections with Fusarium, Rhizopus, Mucor, and Alternaria species are an important cause of morbidity and mortality in patients with hematological malignancies. Cutaneous mucormycosis infections are rare, and the incidence, outcomes, and factors associated with survival in the setting of hematological malignancies are not clear.MethodsA literature search was conducted for all cases of primary cutaneous mold infections in patients with hematological malignancy, of which 50 cases were found. Our case of a patient with a hematological malignancy who sustained a cat bite that in turn caused a primary cutaneous mold infection is also included.ResultsIn the 51 cases identified, 66.7% were neutropenic upon presentation, and 54.9% were male with an average age of 32 years. Aspergillus species (33.3%) was the most cited followed by Rhizopus species (19.6%). Overall mortality rate was 29.4% and was observed more frequently in patients with neutropenia (60.0%) and without surgical intervention (73.3%). Survival rate was higher (35.3%) for cases utilizing both antifungal and surgical intervention. The antifungal agent with the highest survival rate was amphotericin B and its formulations (58.8%).ConclusionsNeutropenia within hematological malignancies demonstrate a risk for developing severe cutaneous fungal infections, of which primary cutaneous mucormycosis can carry significant mortality. Combination antifungal therapy and surgical debridement appears to be associated with higher survival outcomes and warrants further investigation.