Gallamini A.,BMT Unit |
Kostakoglu L.,Mount Sinai Medical Center
Blood | Year: 2012
Despite the rewarding results achieved in the treatment of Hodgkin lymphoma (HL), concerns have been raised regarding the long-term complications induced by therapy. Hence, the current challenge is to develop a new therapeutic strategy maintaining excellent patient outcome while reducing potentially life-threatening late adverse effects. Therefore, it would be beneficial to identify chemoresistant or refractory patients early during therapy for appropriate and timely escalation of treatment. Recently, compelling data have emerged on the prognostic role of interim [18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) performed early during the course of treatment to predict ultimate outcome, even proving superior to conventional prognostic factors. Several ongoing prospective trials are exploring the feasibility of treatment de-escalation strategies in patients with a negative interim PET, as well as therapy escalation in advanced-stage HL patients who have a positive interim PET result. In this article, the published reports on the contribution of interim PET to the design of ongoing response-adapted clinical trials are reviewed. Moreover, some of the unresolved issues revolving around the suboptimal positive predictive value of interim PET are addressed with an emphasis on the interpretation criteria.Afinal remark on the appropriate use of interim PET is also provided. © 2012 by The American Society of Hematology.
Frucht S.J.,Mount Sinai Medical Center
Movement Disorders | Year: 2013
The definition of dystonia has been a subject of much debate and controversy for the last century. In this paper, a practical definition of dystonia for the movement disorders expert is presented, based on a new algorithm. © 2013 Movement Disorder Society.
Corti R.,University of Zurich |
Fuster V.,Mount Sinai Medical Center
European Heart Journal | Year: 2011
Atherosclerosis and its thrombotic complications are the major cause of morbidity and mortality in the industrialized countries. Despite advances in our understanding of the pathophysiology, pathogenesis, and new treatment modalities, the absence of an adequate non-invasive imaging tool for early detection limits both the prevention and treatment of patients with various degrees and anatomical localizations of atherothrombotic disease. An ideal clinical imaging modality for atherosclerotic vascular disease should be safe, inexpensive, non-invasive or minimally invasive, accurate, and reproducible, and the results should correlate with the extent of atherosclerotic disease and have high predictive values for future clinical events. High-resolution magnetic resonance imaging (MRI) has emerged as the most promising technique for studying atherothrombotic disease in humans in vivo. Most importantly, MRI allows for the characterization of plaque composition, i.e. the discrimination of lipid core, fibrosis, calcification, and intraplaque haemorrhage deposits. Magnetic resonance imaging also allows for the detection of arterial thrombi and in defining thrombus age. Magnetic resonance imaging has been used to monitor plaque progression and regression in several animal models of atherosclerosis and in humans. Emerging MRI techniques capable of imaging biological processes, including inflammation, neovascularization, and mechanical forces, may aid in advancing our understanding of the atherothrombotic disease. Advances in diagnosis do prosper provided they march hand-in-hand with advances in treatment. We stand at the threshold of accurate non-invasive assessment of atherosclerosis. Thus, MRI opens new strategies ranging from screening of high-risk patients for early detection and treatment as well as monitoring of the target lesions for pharmacological intervention. Identification of subclinical atherosclerosis and early treatment initiation has the potential to surpass conventional risk factor assessment and management in terms of overall impact on cardiovascular morbidity and mortality. Such strategy is currently under clinical investigation. © 2011 The Author.
Kostakoglu L.,Mount Sinai Medical Center
Seminars in Nuclear Medicine | Year: 2013
Preoperative systemic therapy with cytotoxic or biologic anticancer regimens has gained significant popularity in the management of breast cancer. Moreover, there is a worldwide paradigm shift toward an individualized approach to identify predictive surrogate markers for stratifying patients into distinct subgroups to improve outcome after neoadjuvant or adjuvant therapy. Although achievement of pathologic complete response constitutes the gold standard for assessing therapeutic efficacy only a minority of patients achieve a pathologic complete response. Imaging has evolved to play a crucial role in monitoring treatment effectiveness, particularly, early during therapy. There is mounting evidence that (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a more superior metabolic imaging modality than anatomic modalities for assessment of the response during or at completion of treatment. Ultimately, the prediction of therapeutic effectiveness or survival or both by FDG-PET imaging could successfully tailor treatment and avoid unnecessary toxicities. This paper provides an overview of current use and the main indications of FDG-PET and integrated PET/computed tomography in response assessment of breast cancer as well as the future directions for the management using non-FDG-based tracers developed against specific targets. © 2013 Elsevier Inc.
Tomer Y.,Mount Sinai Medical Center |
Tomer Y.,James ters Va Medical Center
Annual Review of Pathology: Mechanisms of Disease | Year: 2014
Recent advances in our understanding of genetic-epigenetic interactions have unraveled new mechanisms underlying the etiology of complex autoimmune diseases. Autoimmune thyroid diseases (AITDs) are highly prevalent, affecting 1% to 5% of the population. The major AITDs include Graves disease (GD) and Hashimoto's thyroiditis (HT); although these diseases contrast clinically, their pathogenesis involves shared immunogenetic mechanisms. Genetic data point to the involvement of both shared and unique genes. Among the shared susceptibility genes, HLA-DRβ1-Arg74 (human leukocyte antigen DR containing an arginine at position β74) confers the strongest risk. Recent genome-wide analyses have revealed new putative candidate genes. Epigenetic modulation is emerging as a major mechanism by which environmental factors interact with AITD susceptibility genes. Dissecting the genetic-epigenetic interactions underlying the pathogenesis of AITD is essential to uncover new therapeutic targets. © 2014 by Annual Reviews. All rights reserved.