Ruxolitinib for Glucocorticoid-Refractory Acute Graft-versus-Host Disease

BACKGROUND: Acute graft-versus-host disease (GVHD) remains a major limitation of allogeneic stem-cell transplantation; not all patients have a response to standard glucocorticoid treatment. In a phase 2 trial, ruxolitinib, a selective Janus kinase (JAK1 and JAK2) inhibitor, showed potential efficacy in patients with glucocorticoid-refractory acute GVHD. METHODS: We conducted a multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitinib (10 mg twice daily) with the investigator's choice of therapy from a list of nine commonly used options (control) in patients 12 years of age or older who had glucocorticoid-refractory acute GVHD after allogeneic stem-cell transplantation. The primary end point was overall response (complete response or partial response) at day 28. The key secondary end point was durable overall response at day 56. RESULTS: A total of 309 patients underwent randomization; 154 patients were assigned to the ruxolitinib group and 155 to the control group. Overall response at day 28 was higher in the ruxolitinib group than in the control group (62% [96 patients] vs. 39% [61]; odds ratio, 2.64; 95% confidence interval [CI], 1.65 to 4.22; P<0.001). Durable overall response at day 56 was higher in the ruxolitinib group than in the control group (40% [61 patients] vs. 22% [34]; odds ratio, 2.38; 95% CI, 1.43 to 3.94; P<0.001). The estimated cumulative incidence of loss of response at 6 months was 10% in the ruxolitinib group and 39% in the control group. The median failure-free survival was considerably longer with ruxolitinib than with control (5.0 months vs. 1.0 month; hazard ratio for relapse or progression of hematologic disease, non-relapse-related death, or addition of new systemic therapy for acute GVHD, 0.46; 95% CI, 0.35 to 0.60). The median overall survival was 11.1 months in the ruxolitinib group and 6.5 months in the control group (hazard ratio for death, 0.83; 95% CI, 0.60 to 1.15). The most common adverse events up to day 28 were thrombocytopenia (in 50 of 152 patients [33%] in the ruxolitinib group and 27 of 150 [18%] in the control group), anemia (in 46 [30%] and 42 [28%], respectively), and cytomegalovirus infection (in 39 [26%] and 31 [21%]). CONCLUSIONS: Ruxolitinib therapy led to significant improvements in efficacy outcomes, with a higher incidence of thrombocytopenia, the most frequent toxic effect, than that observed with control therapy

Retrospective evaluation of patients with hairy cell leukemia: Single center experience

Objective: Hairy cell leukemia (HCL) is a rare chronic lymphoproliferative disease which is characterized by circulating B lymphocytes with prominent cytoplasmic projections. Treatment of patients with HCL has changed rapidly during the last 40 years by the introduction of the purine analogs into clinical setting. Splenectomy was the first effective treatment modality increasing the survival. Recently, given the effectiveness of the purine analogs, as well as the ease of administration, other therapies have been abandoned. The aim of this study is to retrospectively evaluate the patients with HCL treated and followed-up in our Center. Method: We retrospectively evaluated 15 patients (14 male, 1 female)who were diagnosed, treated and followed-up in our centerbetween 1992 and 2004. Median age was 50 (28-79) years and median symptom duration was 11.5 months (2-48). Median follow up duration was 48 months (9-148). The most prominent symptoms were as follows; weakness (60%), fever (20%), night sweatening (20%), fatigue (20%). Splenomegaly was found in 14 (93%) of the patients while hepatomegaly was seen only in 3 patients. Pancytopenia was determined in all patients. Peripheral blood smear, bone marrow aspiration and biopsy were applied to all patients. TRAP test was evaluated in 10 patients and was positive in 9 of them. Results: Four patients were treated with interferon alpha only, 1 patient was treated with splenectomy, 3 patients were treated with interferon alpha+cladribine and 6 patients were treated with only cladribine. Splenic radiotherapy was given to only 1 patient. Pancytopenia disappeared after treatment in 13 patients. Relapse was detected in 3 patients after interferon use and all these patients were treated with cladribine. Spleen size reduced to normal size in 13 patients after therapy. All patients are still alive under regular follow up. Conclusion: Cladribine was found to be effective treatment modality in HCL patients either in first line setting or in relapsed patients. It also provides long term survival for our patients. © Hellenic Society of Haematology

ASSESSMENT OF HEMATOLOGY PATIENTS WITH CONFIRMED H1N1 POSITIVITY

15th Annual Meeting of the European-Hematology-Association -- JUN 10-13, 2010 -- Barcelona, SPAINWOS: 000279051301189European Hematol Asso

Castleman's disease in a renal allograft recipient

WOS: A1997XK64700017PubMed ID: 922623

Activated protein C resistance in Behcet's disease

We investigated activated protein C resistance (aPCR) using modified activated partial thromboplastin time (aPTT) in 32 patients with Behcet's disease (BD) and 9 healthy controls. None of the healthy controls were found to have aPCR. However, 11 out of 32 Behcet's patients (34.3%) were found to have aPCR. The frequency of aPCR was increased to 44.4% among 18 Behcet's patients having a history of venous thrombosis. In the subgroup of 14 patients without venous thrombosis, aPCR frequency was %22.2. Our findings show that, besides other factors, aPCR may also predispose patients to venous thrombosis in BD. The detection of aPCR, using modified aPTT may serve as a routine screening test to determine the necessity of prophylactic anticoagulation treatment in patients with BD

Investigation of veterinary drug residues in sea water, sediment, and wild fishes captured around fish farms in the Aegean Sea: Sulfonamides (Sulfamerazine, SMR; Sulfadimidine, SMT; Sulfamethoxazole, SMXZ; Sulfadimethoxine, SDMX)

ALTINTAS, Levent/0000-0002-5148-723X; BAYDAN, Emine/0000-0001-5459-8616WOS: 000358385100184

Primary cutaneous B-cell lymphoma: Report of eight cases and review of the literature

PubMed ID: 18613872[No abstract available