Somedeb Ball

Thrombosis in Philadelphia negative classical myeloproliferative neoplasms: a narrative review on epidemiology, risk assessment, and pathophysiologic mechanisms

Thrombosis is common in cancer patients and is associated with increased morbidity and mortality. Myeloproliferative neoplasms (MPN) are common malignancies in elderly individuals and are known for a high incidence of thrombotic complications. Different risk factors have been identified in studies, and risk models have been developed to identify patients with MPN at higher risk for thrombosis. Several pathophysiological mechanisms help explain the increased likelihood of thrombosis in these patients. Factors, such as leukocyte and platelet activation leading to the formation of leukocyte–platelet aggregates, activation of the coagulation cascade by microparticles, high levels of inflammatory cytokines, and endothelial dysfunction have a crucial role in thrombosis in MPN patients. Recent studies have demonstrated a significant association between the allele burden of specific genetic mutations (mainly JAK2V617F) associated with MPN and the incidence of thrombotic events, thus suggesting a possible role for these mutations in thrombogenesis.

Canakinumab: Promises and Future in Cardiometabolic Diseases and Malignancy

Inflammation has proven in multiple studies to be responsible for the progression of cardiometabolic diseases and malignancies. The interleukin family has been critically associated with progression of atherosclerosis, insulin resistance, and various malignancies. Given the advent of pharmacologic interleukin-1 (IL-1) inhibition, this pathway can potentially be targeted to improve outcomes. In the recently concluded Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) trial, investigators looked at the potential role of IL-1 (especially IL-1β) inhibition in halting the progression of atherosclerosis. In the subset analysis of the data from this trial, IL-1β inhibition with canakinumab was found to have beneficial effects in other cardiometabolic diseases characterized by inflammation, like diabetes, stroke, and chronic kidney disease, and also in patients with lung cancer. In this article, we will try to review the current literature on the role of canakinumab in the treatment of cardiometabolic diseases and malignancies.

Infection with ibrutinib in patients with chronic lymphocytic leukemia: How strong is the association?

We read the recent review by Tillman etxa0al. [1] with great interest and wanted to revisit the association of ibrutinib with increased risk of infection. Based on our clinical experience and the results of ibrutinib trials, we agree with the authors regarding the possibility of increased risk of infections with ibrutinib. [2,3] However, chronic lymphocytic leukemia (CLL) and other B-cell malignancies by themselves confer increased risk of infections owing to acquired defects of the innate and adaptive immunity secondary to the disease process, hypogammaglobulinemia, and T-cell and complement dysfunction, among others. This article is protected by copyright. All rights reserved.

Risk of Infection with Ibrutinib in Patients with Chronic Lymphocytic Leukemia: A Systematic Review and Meta-analysis of Phase III Randomized Controlled Trials

patients (86.7%) have died (survival range 0.3-113.2 months, mean 21.7, median 8.3). Cause of death included infection (n1⁄45), GVHD (n1⁄43), multi-organ failure (n1⁄42), CLL (n1⁄41), secondary malignancy (n1⁄41), unknown (n1⁄41). 4 patients (30.8%) received repeat transplant or DLI due to relapse, (2 died), 1 DLI, 1 new PBSC (survival 4.7 and 9.4 years, respectively). 2 remain alive, 1 new PBSC, 1 DLI (survival-to-date 5.6 and 11.7 years, respectively). Conclusions: AlloHSCT for CLL patients with treatment failure to multiple regimens, especially fludarabine, is a feasible treatment modality leading to improved OS in a significant proportion of patients. Repeat transplant is also viable demonstrating the highest overall survival. The utility of alloHSCT should not be dismissed. Future studies need to include data with use of novel therapeutic agents.

Bruns nystagmus: an important clinical clue for cerebellopontine angle tumours

A 24-year-old woman presented with gradual-onset left-sided hearing loss, progressive diminution of vision, headache and unsteadiness of gait. Comprehensive clinical evaluation revealed a left-sided lower motor neuron type of facial nerve palsy (figure 1), bilateral papilloedema, sensory loss in the distribution of ophthalmic branch of the left trigeminal nerve and cerebellar ataxia. Sensorineural hearing loss and absent corneal reflex were also observed on the left side. A coarse, left-beating nystagmus with leftward gaze and a fine primary-position right-beating nystagmus which increased on rightward gaze, consistent with Bruns nystagmus (video 1), were appreciated. In view of the clinical findings, a diagnosis of a space-occupying lesion involving the left cerebellopontine angle was considered. MRI of the brain documented a space-occupying lesion (4×3.5u2009cm) in the left cerebellopontine angle, most likely a vestibular schwannoma (figures 2 and 3). The condition was explained to the patient and …

Solicitation for article submission by electronic journals

Abstract The business model, editorial policies, and content quality vary significantly in online medical journals. Some online journals have been labeled as predatory journals because their main effort involves collecting article processing charges with little interest in content, peer review, or manuscript presentation. Some of these journals send frequent email solicitations for submissions. One author affiliated with a department of internal medicine collected all email requests for submissions to online journals over a 6-month period. These emails included 210 unique journal names that covered over 40 medical fields and requested 15 different article types. Most of these journals were not listed in PubMed or the Directory of Open Access Journals. One hundred and eighty two were on Beall’s list of predatory journals. The median article processing charge was

Microparticles in Hematological Malignancies – their Role in Coagulopathy and Tumor Pathogenesis

1035. Faculty and trainees at medical schools receive multiple requests for submissions, but it is difficult to determine the quality of the journal sending these requests. At a minimum, a journal should be listed in the Directory of Open Access Journals and have very clear editorial and publication policies.

Mega Journals, Scientifically Sound Peer Review and Medical Organizations

ABSTRACT Microparticles (MP) are submicron vesicles released from various cells in response to activation, injury or apoptosis. They contain different structural and functional proteins and RNAs, which contribute to physiological intercellular “crosstalk” and to the pathogenesis of various diseases including cancer. In hematological malignancies, these MPs participate in the initiation and propagation of thrombosis through different pathways. They have a role in the angiogenesis, malignant cell survival and metastasis. MPs act as a mediator of resistance of leukemic cells to chemotherapy. The number of MPs is one of the prognostic factors following stem cell transplant, and studies have also found they contribute to the pathogenesis of graft versus host disease. MPs are being tested as therapeutic options in leukemias and graft versus host disease. Future studies should help us understand the interactions between MPs and cancer cells better, thereby opening new approaches for treatment of hematological malignancies.