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Haifa, Israel

Amit A.,Gynecologic Oncology Unit | Person O.,Oncology Institution | Keidar Z.,Rambam Healthcare Campus
Current Opinion in Obstetrics and Gynecology | Year: 2013

Purpose of Review: To evaluate the role of fluorodeoxyglucose (FDG) PET/CT as cancer response testing in gynecological malignancies. Recent Findings: The application of FDG PET/CT in patients with endometrial and ovarian cancer to evaluate treatment response was found to have no clinical benefits.Patients with cervical cancer seem to benefit from the use of PET/CT in estimation of treatment response. The influence of different treatments on FDG uptake, timing, frequency of examination, and survival advantage are evaluated and discussed. Summary: Growing evidence supports an important role for functional imaging FDG PET/CT as a monitoring tool in patients with uterine-cervix carcinoma. Further studies are needed to establish the clinical benefits of this modality in this population. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Michaelson-Cohen R.,Hebrew University of Jerusalem | Gershoni-Baruch R.,Rambam Healthcare Campus | Sharoni R.,Genetic Institute | Shochat M.,Raphael Recanati Genetic Institute | And 2 more authors.
Fetal Diagnosis and Therapy | Year: 2014

Non-invasive prenatal testing (NIPT) of cell-free fetal DNA in maternal plasma is a novel approach, designed for detecting common aneuploidies in the fetus. The Israeli Society of Medical Geneticists (ISMG) supports its use according to the guidelines stated herein. The clinical data collected thus far indicate that NIPT is highly sensitive in detecting trisomies 21 and 18, and fairly sensitive in detecting trisomy 13 and sex chromosome aneuploidies. Because false-positive results may occur, an abnormal result must be validated by invasive prenatal testing. At this juncture, NIPT does not replace existing prenatal screening tests for Down syndrome, as these are relatively inexpensive and cost-effective. Nonetheless, NIPT may be offered to women considered to be at high risk for fetal chromosomal abnormalities as early as 10 weeks of gestation. The ISMG states that NIPT should be an informed patient choice, and that pretest counseling regarding the limitations of NIPT is warranted. Women at high risk for genetic disorders not detected by NIPT should be referred for genetic counseling. A normal test result may be conveyed by a relevant healthcare provider, while an abnormal result should be discussed during a formal genetic consultation session. © 2014 S. Karger AG, Basel.

Blumenfeld Z.,Rambam Healthcare Campus
Expert Review of Obstetrics and Gynecology | Year: 2011

Premature ovarian failure (POF) is defined as ovarian failure and early menopause before the age of 40 years. This POF occurs in 1% of women younger than 40 and up to 0.1% women younger than 30, and may have different etiologic causes, such as genetic, autoimmune, iatrogenic, toxic, enzymatic, infectious and metabolic. The etiologic cause can be diagnosed in less than half of the cases. Signs of intermittent ovarian function in karyotypically normal women have been described, but predicting the probability of spontaneous remission in a specific woman is impossible. The possible beneficial effect of treatments such as immunosuppressive therapies, gonadotropin-releasing hormone (GnRH) agonists, exogenous high-dose gonadotropins and estrogen replacement, published in numerous anecdotal case reports, is unclear, and the cause-effect relationship has not been proven by prospective randomized studies. Therefore, in order to find effective treatments, basic pathophysiologic mechanisms must be better understood. For those women who want to conceive, it seems reasonable to attempt a corrective therapy based on defined etiology, before falling back on a donor oocyte program. Iatrogenic POF after chemotherapy has gained worldwide interest owing to significantly improved survival in the last three decades, and owing to the ability to preserve future fertility and ovarian function in many young female survivors of young-age malignancy. The attempts of IVF-assisted reproductive technologies and embryos or unfertilized oocytes cryopreservation, combined with ovarian tissue cryopreservation and coadministration of GnRH agonists in parallel to chemotherapy, may maximize future fertility and minimize long-term POF in these women. © 2011 Expert Reviews Ltd.

Agur A.,Hebrew University of Jerusalem | Amir G.,Hebrew University of Jerusalem | Paltiel O.,Hebrew University of Jerusalem | Klein M.,Hebrew University of Jerusalem | And 3 more authors.
Leukemia and Lymphoma | Year: 2015

The prognostic role of CD68 tumor-associated macrophages in classic Hodgkin lymphoma (cHL) remains controversial. We stained diagnostic biopsies and scored for CD68 using the PGM1 antibody among 98 consecutive patients with cHL from our center followed over a median of 45 months for progression-free survival (PFS). Among 79 patients we assessed interim and post-treatment positron emission tomography-computed tomography (PET-CT). Residual mass (RM) size was based on the greatest diameter of the largest mass seen in post-treatment imaging, and percent reduction was calculated by comparing RM size with its greatest pretreatment diameter. We found a significant association between CD68 positivity and absolute size of initial disease mass (p = 0.014) and residual mass at the end of therapy (p = 0.006) but no association was observed with interim PET-CT results or PFS. Our findings suggest that macrophages may influence tumor size by altering the microenvironment. This study does not support a prognostic role of CD68 positivity in predicting survival. © 2014 Informa UK, Ltd.

Ofran Y.,Rambam Healthcare Campus | Ofran Y.,Technion - Israel Institute of Technology | Rowe J.M.,Rambam Healthcare Campus | Rowe J.M.,Shaare Zedek Medical Center | Rowe J.M.,Technion - Israel Institute of Technology
Current Opinion in Hematology | Year: 2015

PURPOSE OF REVIEW: Acute myeloid leukemia (AML) is a heterogeneous disease. Detection of minimal residual disease (MRD) has the potential to improve risk stratification, and its routine monitoring may allow timely therapeutic actions such as allogeneic hematopoietic stem cell transplantation. The current review will discuss challenges and available evidence for clinical application of MRD detection in AML management. RECENT FINDINGS: The heterogeneous nature of AML, variations in genetic aberrations and immunophenotypes among patients and between malignant subclones coexisting within a single patient, is a challenge for the development of a reliable MRD test in AML. MRD value was demonstrated in subtypes of AML in which reliable leukemia-specific genetic marker is present (e.g., core-binding leukemia, AML positive for NPM1 mutation). Multicolor flow cytometry and quantitative PCR monitoring for Wilms tumor 1 gene transcript have also been shown to correlate with disease progression. MRD results should always be interpreted within patient-specific clinical context considering other risk factors and timing of MRD eradication. SUMMARY: Introduction of MRD testing into routine clinical practice is a challenge in AML. An improvement in laboratory techniques along with identification of additional leukemia-specific markers is required. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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