Hematology/oncology clinics of North America
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Hematol. Oncol. Clin. North Am. · Feb 2015
ReviewA critical look at local-regional management of peritoneal metastasis.
For patients with stage IV colorectal cancer, the presence of peritoneal metastases is a poor prognostic feature. Despite the improvement in systemic therapy, long-term survival remains poor for patients with peritoneal carcinomatosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can be associated with long-term survival in patients who have limited peritoneal disease, particularly those who can have complete cytoreduction. Whether the possible benefit of CRS and HIPEC is from the surgical resection of all disease or the combination of CRS and HIPEC remains unclear.
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Autologous stem cell transplant (ASCT) remains an integral part of the treatment strategy for many myeloma patients. The role of allogeneic stem cell transplant continues to be defined. There is increasing evidence that posttransplant maintenance therapy can significantly improve outcomes. It is predicted that with more routine use of cytogenetic and gene expression profiling in the future, we will be better able to identify those subgroups of patients who are expected to benefit most from early versus late versus no ASCT and those who will benefit from allogeneic stem cell transplant.
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Hematol. Oncol. Clin. North Am. · Oct 2014
ReviewFrontline Therapy for Patients with Multiple Myeloma not Eligible for Stem Cell Transplantation.
Considerable progress has been recently made in the treatment of elderly patients with multiple myeloma (MM). In Europe the combination of thalidomide with melphalan and prednisone and of bortezomib with melphalan and prednisone are 2 standards of care for frontline therapy for elderly patients. In United States the combination of lenalidomide and dexamethasone is the preferred option in this setting. This article focuses on more recent therapeutic approaches in older MM patients, not eligible for high-dose therapy and autologous stem cell transplantation.
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Hematol. Oncol. Clin. North Am. · Oct 2014
ReviewTreatment of transplant-eligible patients with multiple myeloma in 2014.
Induction regimens containing a proteasome inhibitor and/or immunomodulatory agent with dexamethasone result in rapid disease control before autologous stem cell transplantation (ASCT). ASCT followed by consolidation and/or maintenance further improves depth of response following effective induction. ⋯ The optimal timing of ASCT and methods to prevent relapse following ASCT are under active investigation. Different patient populations may benefit differentially from currently available treatments.
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Hematol. Oncol. Clin. North Am. · Aug 2014
ReviewTransfusional iron overload and iron chelation therapy in thalassemia major and sickle cell disease.
Iron overload is an inevitable consequence of blood transfusions and is often accompanied by increased iron absorption from the gut. Chelation therapy is necessary to prevent the consequences of hemosiderosis. Three chelators, deferoxamine, deferiprone, and deferasirox, are presently available and a fourth is undergoing clinical trials. ⋯ Also, many studies have shown the efficacy of the combination of deferoxamine plus deferiprone as an intensive treatment of severe iron overload. Alternating chelators can reduce adverse effects and improve compliance. Adherence to therapy is crucial for good results.