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Gale R.P.,Imperial College London | Wiernik P.H.,Cancer Research Foundation of New York | Lazarus H.M.,Case Western Reserve University
Leukemia | Year: 2014

Despite more than 40 years of extensive study, it remains uncertain which individuals, if any, with acute myelogenous leukemia (AML) in first remission should receive a blood cell or bone marrow transplant versus post-remission chemotherapy (or both). Nevertheless, there is a recent trend toward recommending more transplants in this setting. We consider four myths underlying this recommendation: (1) only individuals achieving second remission benefit from a transplant; (2) there is no effective therapy for relapse other than an allotransplant; (3) we can accurately predict which individuals with AML in first remission need a transplant; and (4) detection of minimal residual disease in first remission will resolve this controversy. We discuss these misconceptions and suggest approaches to resolve this issue. © 2014 Macmillan Publishers Limited. All rights reserved.

Wiernik P.H.,Cancer Research Foundation of New York
Current Treatment Options in Oncology | Year: 2014

Although it is absolutely clear that postremission therapy is currently necessary to obtain disease-free long-term survivorship for patients with acute myeloid leukemia (AML) in first complete remission (CR), it is not entirely clear what form that treatment should take. High-dose cytarabine is clearly effective and there definitely is a dose-response relationship for cytarabine and remission duration. High-dose cytarabine is effective for younger patients but not elderly patients. It is effective for patients with favorable cytogenetics but it is not clear whether it is effective for patients with intermediate or unfavorable cytogenetics. Furthermore, it is not clear what the most effective and least toxic dose and schedule of high-dose cytarabine is. © 2014 Springer Science+Business Media.

Wiernik P.H.,Cancer Research Foundation of New York
Medical Oncology | Year: 2014

Despite some claims to the contrary, I believe substantial progress has been made in the last half century toward cure of acute myeloid leukemia in children and adults. The tried and true mechanism for this progress has been clinical trial and error. This method has been supplemented with an ever-increasing amount of work at the clinical laboratory interface that is beginning to allow us to develop specific therapy for afflicted individuals. This review details where we stand today and how we got here. © Springer Science+Business Media 2014.

Dutcher J.P.,Cancer Research Foundation of New York | Wiernik P.H.,Cancer Research Foundation of New York
Clinical Advances in Hematology and Oncology | Year: 2015

A little-appreciated association between renal cell carcinoma (RCC) and hematologic malignancies (HMs) has been reported for at least 20 years. The HM characteristically occurs first in patients with both neoplasms, and the large majority (94%) of these HMs are of B-cell origin. Furthermore, the majority of patients with RCC and an HM are male. Recently, we have noted an increased incidence of HMs in families of patients with RCC and are exploring this observation further. Here, we summarize our reports on the association between these neoplasms in individual patients and review the relevant literature. © 2015, Millennium Medical Publishing, Inc. All rights reserved.

Dutcher J.P.,New York Medical College | Dutcher J.P.,Cancer Research Foundation of New York | Wiernik P.H.,New York Medical College | Wiernik P.H.,Cancer Research Foundation of New York | And 4 more authors.
Familial Cancer | Year: 2016

The relationship between renal cell cancer (RCC) and hematologic malignancy (HM) in the same individual has been reported for more than 20 years, and is noted in SEER database studies. Family histories suggest a familial association as well. This study evaluates the occurrence of renal cell cancer and hematologic malignancies in individual patients and families, and the occurrence of age-of-onset anticipation among generations. Family history data from our familial patient registry, including more than 700 pedigrees of familial hematologic malignancies, and 700 patients with renal cell cancer, were reviewed. Twenty-six patients with a personal history of both RCC and HM are reported. Seventy four patients with RCC are noted to have 95 family members with HM. Consistent with past reports, there was male predominance among the patients with both diseases (71 %), and among the RCC patients’ relatives with HM (57 %). Also consistent was a predominance of lymphoid malignancies in those with both diseases (92 %) and in the HMs among family members of RCC patients (79 %). The majority (95 %) of HM relatives were first or second degree relatives of the patient with RCC. Thirty of 34 parent/child pairs demonstrated age of onset anticipation in which the child developed either disease at a younger age than the parent. The co-occurrence of RCC and HM in the same patient has been shown to be significantly greater than expected. Families also appear to have an increased association. The appearance of anticipation suggests that genetic factors may be significant in this association of RCC and HM. © 2016 Springer Science+Business Media Dordrecht

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