Critical reviews in oncology/hematology
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Crit. Rev. Oncol. Hematol. · Aug 2010
ReviewAbnormal immunity and stem/progenitor cells in acquired aplastic anemia.
Acquired aplastic anemia (AA) is considered as an immune-mediated bone marrow failure syndrome, characterized by hypoplasia and pancytopenia with fatty bone marrow. Abnormal immunity is the major factor mediating the pathogenesis of acquired AA. Activated DCs might promote the polarization to Th1 cells, and activate CD8(+) T cells. ⋯ Inversely, deficient MSCs, CD4(+)CD25(+) T cells, NK cells, NKT cells and early hematopoietic growth factors diminish the capacity of immune regulation and the support of hematopoiesis. As a result, stem/progenitor cells are significantly impaired to be disabled cells with markedly deficient proliferation, differentiation, induced apoptosis and dysfunctional response to growth factor stimuli, together with rare normal ones. Although some patients can be ameliorated by stem-cell transplantation or immunosuppressive therapy, more effective and convenient therapies such as patient-specific pluripotent iPS cells based on definite pathogenesis are expected.
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Crit. Rev. Oncol. Hematol. · Aug 2010
ReviewBrain metastases in HER2-positive breast cancer: the evolving role of lapatinib.
Due to improvements in diagnosis and systemic therapy, brain metastases are an increasingly common cause of morbidity and mortality for patients with advanced breast cancer. The incidence of symptomatic brain metastases among women with metastatic breast cancer ranges from 10% to 16%. ⋯ Surgery and radiation therapy are the primary approaches to the treatment of brain metastases but new chemotherapy and biological agents promise to play an important role in the future management of central nervous system disease. This article reviews the epidemiology, current treatment options and recent advances in the field, with a focus on HER2-positive disease and the emerging role of lapatinib for the treatment and prevention of brain metastases.
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Spirituality is more about constant questioning than about providing fixed or final answers. Cancer patients do not expect spiritual solutions from oncology team members, but they wish to feel comfortable enough to raise spiritual issues and not be met with fear, judgmental attitudes, or dismissive comments. Spiritual needs may not be explicit in all illness phases, yet spirituality is not only confined to the areas of palliative or end-of-life care. ⋯ In addition, formal education and training in communication about cancer patients' spiritual issues and in how to assess and address them in the clinical context is being increasingly provided. Spirituality can be a major resource for both patients and physicians, yet it can never be imposed but only shared. Those oncology professionals who are familiar with their own spirituality will be better at recognizing, understanding and attending to their patients' spiritual needs and concerns.
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Most human cancer cells are characterized by changes in the amount or organization of DNA resulting in chromosome instability and aneuploidy. Several mitotic kinases, Aurora kinases amongst others, regulate the progression of the cell through mitosis. ⋯ In this review we provide a brief insight into the mechanism of action as far as currently available. We review the available pre-clinical data, discuss the clinical phase I data and try to give a direction for future headings.
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Crit. Rev. Oncol. Hematol. · Feb 2010
ReviewThe perioperative management of patients with gynaecological cancer undergoing major surgery: A debated clinical challenge.
Major extensive surgery still represents a cornstone of therapy of gynaecological cancer, and the adoption of implemented clinical guidelines for perioperative management can significantly decrease patient morbidity and mortality and reduce hospital stay. The overall risk of deep venous thrombosis in patients undergoing gynaecological surgery ranges from 7% to 45%, and fatal pulmonary embolism occurs in approximately 1% of these women. A meta-analyses of randomised trials showed a significant decrease in deep venous thrombosis in women receiving unfractioned heparin [UFH] compared with controls, and revealed no significant difference in deep venous thrombosis and pulmonary embolism between patients who received UFH and those who received low-molecular weight heparin [LMWH]. ⋯ After major abdominal gynaecological surgery, early oral feeding (within the first 24h regardless of the resolution of postoperative ileus) appears to be associated with increased nausea, shorter time to the presence of bowel sound, shorter time to first solid diet, and a trend toward shorter hospital stay when compared with delayed feeding. Since early oral feeding is safe but associated with increased nausea, the decision whether to adopt this postoperative regimen should be individualised. Decision making processes about thromboprophylaxis, antibiotic prophylaxis, bowel preparation for surgery that may involve colon-rectum, and timing of postoperative oral feeding will become more and more relevant for improved safety and quality of life of women with gynaecological cancer.