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Bockorny B.,University of Connecticut | Codreanu I.,University of Arizona | Dasanu C.A.,St Francis Hospital and Medical Center
British Journal of Haematology | Year: 2012

Richter transformation in chronic lymphocytic leukaemia (CLL) represents an entity of considerable genetic, molecular, immunological and clinical heterogeneity. A rare occurrence, Hodgkin variant of Richter syndrome, has not been comprehensively characterized or systematized to date. We conducted a retrospective analysis of the existing cases of Hodgkin lymphoma as Richter syndrome reported in the medical literature in the previous three and a half decades. Our search identified 86 such patients; this entity affects predominantly older men and the most common histological subtype is mixed cellularity. Interval between the diagnosis of CLL and subsequent development of Hodgkin lymphoma is circa 4·3years. The overall survival of patients was approximately 1·7years in our analysed cohort. However, our pooled data showed that patients in whom CLL had been treated with fludarabine had a shorter survival after transformation compared to the ones not treated with this agent. The role of immunosuppression and Epstein-Barr virus infection in the aetiopathogenesis of this entity remains to be clarified. © 2011 Blackwell Publishing Ltd. Source

Dasanu C.A.,St Francis Hospital and Medical Center
Journal of Oncology Pharmacy Practice | Year: 2011

Over the last decade, bortezomib moved in a stepwise fashion from a benchside promise into a bedside reality and is currently an important tool in the treatment of plasma cell disorders. This review focuses on the relationship between bortezomib and hemolytic anemia. In animal models with lupus-like disease, this agent was shown to deplete the auto-reactive plasma cells and serum autoantibody levels. In humans, two isolated reports advocate the efficacy of bortezomib in autoimmune hemolytic anemia, but important concerns remain with data interpretation and length bias. Conversely, bortezomib may be causative of hemolytic anemia, as reported in a cohort of patients with chronic lymphocytic anemia. Concerted efforts of both basic and clinical researchers are necessary to further explore the safety and efficacy of this agent in nonmalignant disorders, including autoimmune disorders and anemias. © The Author(s) 2010. Source

Dasanu C.A.,St Francis Hospital and Medical Center
Expert Opinion on Pharmacotherapy | Year: 2011

Introduction: Adult T-cell leukemia/lymphoma (ATL) is a rare disease with a unique geographic distribution. Conducting controlled randomized trials to assess the effective therapeutic strategies has therefore been a significant challenge to date. Areas covered: This review explores the natural history and diagnostic evaluation of ATL, followed by a focused review of existing studies on the most potent individual pharmaceutical agents and combinations used in the therapy of this malignancy. Readers will acquire considerable insights about the clinical subsets, diagnosis and the most effective therapies used in various ATL types. Expert opinion: International, multicenter, randomized clinical trials are essential to design optimal therapeutic strategies for various ATL subsets. It appears that patients with acute ATL type benefit considerably from the first-line combined antiviral therapy with zidovudine and interferon alpha, whereas patients with ATL of the lymphoma type may experience a better outcome with intensive chemotherapy. The role of therapy in smoldering and chronic disease types remains to be clarified. In addition, the results of allogeneic stem-cell transplantation in ATL appear promising, as up to 40% of patients who achieve remission and have suitable donors can now become long-term survivors. Prospective evaluation of novel effective agents and their incorporation into various therapeutic algorithms is stringently needed. © 2011 Informa UK, Ltd. Source

Laslett L.J.,University of California at Davis | Alagona Jr. P.,Penn State Heart and Vascular Institute | Clark III B.A.,St Francis Hospital and Medical Center | Drozda Jr. J.P.,Mercy Health | And 4 more authors.
Journal of the American College of Cardiology | Year: 2012

The environment in which the field of cardiology finds itself has been rapidly changing. This supplement, an expansion of a report created for the Board of Trustees, is intended to provide a timely snapshot of the socio-economic, political, and scientific aspects of this environment as it applies to practice both in the United States and internationally. This publication should assist healthcare professionals looking for the most recent statistics on cardiovascular disease and the risk factors that contribute to it, drug and device trends affecting the industry, and how the practice of cardiology is changing in the United States. © 2012 American College of Cardiology Foundation. Source

Dasanu C.A.,St Francis Hospital and Medical Center
Journal of Oncology Pharmacy Practice | Year: 2012

A recent large randomized clinical trial showed a survival advantage with 36 vs 12 months of adjuvant imatinib in patients with resected gastrointestinal stromal tumors (GISTs). However, there was a higher therapy discontinuation rate with the longer duration of treatment. Preferences of individual GIST patients and the imatinib risk/benefit ratio should always be sought before employing this agent in adjuvant setting for longer than 12 months. A shorter duration of therapy may be preferred in patients with a limited life expectancy, serious cardiovascular co-morbidities, diminished compliance or poor adherence to oral therapy. Further study of underlying economic, psychosocial, and physical barriers of longer vs shorter duration of adjuvant therapy in this patient population is probably warranted. © 2012 The Author(s) Reprints and permissions. Source

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