Seminars in hematology
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Seminars in hematology · Jan 1999
Plasmapheresis in the management of heparin-induced thrombocytopenia.
This study investigated the role of plasmapheresis in the treatment of severe heparin-induced thrombocytopenia (HIT). Patients diagnosed with HIT were divided into three experimental groups. Sixteen patients did not receive plasmapheresis (control). ⋯ Thus, plasmapheresis within 4 days of the onset of thrombocytopenia reduced mortality in HIT patients, whereas plasmapheresis after 4 days was not beneficial. There were no adverse events related to plasmapheresis. These findings suggest that plasmapheresis may be useful in the treatment of HIT when initiated within 4 days of onset of thrombocytopenia.
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The standard treatment of multiple myeloma is systemic chemotherapy. Despite 30 years of drug development in myeloma, there are no new drug regimens significantly superior to melphalan and prednisone. ⋯ Recent evaluation of the topo I inhibitor topotecan demonstrated activity in advanced myeloma, suggesting a possible role for these drugs in the treatment of this disease. Further evaluation of the mechanisms of resistance to topo I inhibitors, study of combination therapy with topotecan, and evaluation of other topo I poisons in multiple myeloma is proposed.
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The camptothecins are a new class of antitumor agents that target topoisomerase I. Irinotecan and topotecan are the most widely used camptothecin analogs in clinical practice, with documented clinical activity in colorectal and ovarian cancer. ⋯ Newer camptothecin analogs in clinical development, such as 9-aminocamptothecin, 9-nitrocamptothecin, GI1147211, and DX-8951f, are also being studied to determine if they have improved toxicity and efficacy profiles compared with existing analogs. The successful development of the camptothecins as antitumor agents demonstrates the importance of topoisomerase 1 as a target for cancer chemotherapy.
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Seminars in hematology · Jul 1997
Review Randomized Controlled Trial Clinical TrialPerioperative epoetin alfa increases red blood cell mass and reduces exposure to transfusions: results of randomized clinical trials.
To avoid the inherent risk of complications associated with perioperative allogeneic transfusion, preoperative autologous blood donation (PAD) is frequently employed by patients undergoing major elective surgical procedures. However, many patients are unable to donate a sufficient quantity of blood prior to surgery. Recent studies have shown that epoetin alfa (Procrit; Ortho-Biotech, Raritan, NJ) effectively increases red blood cell (RBC) mass when administered preoperatively and decreases the requirement for allogeneic transfusion. ⋯ Our study demonstrated that epoetin alfa is safe and effective in increasing RBC mass; however, iron stores considered sufficient for basal erythropoiesis may not optimally support the accelerated RBC production associated with epoetin alfa therapy. In a subsequent randomized multicenter trial, we compared weekly epoetin alfa dosing to daily dosing in patients undergoing elective major orthopedic surgery. The results of this study indicated that administering epoetin alfa on a weekly schedule for several weeks prior to surgery may be at least as effective and more convenient than perioperative daily epoetin alfa dosing.