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Antineoplastic Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Busulfan (Myleran) is an FDA-approved alkylating agent for the palliative treatment of chronic myelogenous leukemia. It is a primary treatment for acute non-lymphocytic leukemia. A summary of 16 different reports of 22 infants born to busulfan-exposed patients found two infants with major congenital anomalies (2/22, 9.1 percent) (Doll et al., 1989). Six (14 percent) of 44 infants exposed to alkylating agent (30 different reports) had major congenital anomalies. In a more recent analysis, 6/31 (19.4 percent) infants exposed to busulfan was found (Nicholson et al., 1968; Lee et al., 1962; Diamond et al., 1960; Abarmovici et al., 1978; Gililland et al., 1983; Ozumba et al., 1992; Boros et al., 1977; Dugdale and Fort, 1967; Zuazu et al., 1991). The frequency of birth defects in animals whose mothers were given busulfan during organogenesis was increased in rodents.
Papulosquamous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Melek Aslan Kayıran, Jordan V. Wang, Ayşe Serap Karadağ
The most common cause of erythroderma is psoriasis. Other cutaneous diseases, such as atopic dermatitis, seborrheic dermatitis, contact dermatitis, PRP, LP, acquired ichthyosis, subacute lupus erythematosus, bullous pemphigoid, pemphigus foliaceus, actinic dermatoses, sarcoidosis, dermatomyositis, and graft versus host, are among other causes. Infections include staphylococcal scalded skin syndrome, toxic shock syndrome, crusted scabies, dermatophytosis, and congenital cutaneous candidiasis. In 1% of patients, there is an underlying malignancy. This can include mycosis fungoides, cutaneous T-cell lymphoma, diffuse cutaneous mastocytosis, B-cell chronic lymphocytic leukemia, and solid organ cancers. In newborns, ichthyosiform diseases may result from primary immune deficiencies and metabolic diseases. It is accepted to be idiopathic when the cause cannot be determined.
Radiation Hormesis in Cancer
Published in T. D. Luckey, Radiation Hormesis, 2020
The concepts of Bross and associates regarding the dangers from diagnostic X-rays to patients were not supported by statistically significant data and were severely criticized by Boice and Land.103 The latter group had previously found no excess leukemia in 100 cases of fluoroscopic chest examinations.85 No excess leukemia was found in women exposed to 5 to 10 Gy for cancer of the cervix.979 Although 42 to 85 new leukemias were predicted for this cohort (BEIR III), only nine were found.56 Although it is readily induced by high doses of ionizing radiation, low doses do not cause leukemia.352,480 Using carefully selected controls, Linos et al. indicated that the incidence of acute and lymphocytic leukemia is lowered by therapeutic use of 1 to 50 cGy radiation in routine medical care.488 This suggests hormesis with medical exposures. Sakamoto et al. suggested that exposure of the spleen to about 10 cGy twice weekly was the key to current methods of tumor therapy.786
What role for AHR activation in IL4I1-mediated immunosuppression ?
Published in OncoImmunology, 2021
Flavia Castellano, Armelle Prevost-Blondel, José L. Cohen, Valérie Molinier-Frenkel
The role of IL4I1 has been characterized in mouse models of transplanted and spontaneous melanoma, both in WT and IL4I1 deficient backgrounds, clearly showing that it facilitates tumor growth by inhibiting the antitumor cytotoxic T-cell response and remodeling the tumor immune microenvironment.9,10 These observations have been recently extended to a model of chronic lymphocytic leukemia.11 In line with this, clinical correlations have been reported between IL4I1 expression by stromal cells and invasion of the sentinel lymph nodes, a higher melanoma stage, and rapid relapse in human primary cutaneous melanomas, in which IL4I1 expression was analyzed by immunohistochemistry.12 Most interestingly, zones in which IL4I1 expression was concentrated were depleted of cytotoxic CD8+ T cells and enriched with regulatory FoxP3+ T cells. Moreover, IL4I1 was overexpressed in melanoma patients with progressive disease under treatment with the anti-PD-1 antibody nivolumab, suggesting a relation between IL4I1 expression and resistance to immune-checkpoint blockade.11
Case Series and Review of Hematological and Non-Hematological Malignancies in Aging Patients with Sickle Cell Disease in the Hydroxyurea Era
Published in Hemoglobin, 2020
Sanaa Rizk, David J. Axelrod, Rasaq Olaosebikan, Samir K. Ballas
A more recent analysis released by Brunson et al. [14] in 2017, compared cancer incidences in sickle cell disease patients to the general population. Six thousand, four hundred and twenty-three sickle cell disease patients were identified using the California database from the Office of Statewide Health Planning and Development. Compared to the California population, sickle cell disease patients had a 72.0% increased risk of hematological malignancies and 38.0% reduced risk of solid tumors. There was a 2-fold increased risk of leukemia, specifically acute myeloid leukemia and chronic lymphocytic leukemia. This risk was increased by 4-fold in more severe sickle cell disease. There was a 38.0% reduced risk of solid tumors, specifically, there was a lower risk of breast cancer and male genital cancers. The cancer incidence was different from the English study [13], most likely due to different recruitment practices (hospital coding) rather than using the highly validated registry data in the California study [14]. Brunson et al. [14] also commented on the effect of HU on cancer incidence and mentioned no difference in cancer incidence before and after HU in 1998.
Managing patients with hematological malignancies during COVID-19 pandemic
Published in Expert Review of Hematology, 2020
Certain specific characteristics are specified in the case of Chronic lymphocytic leukemia (CLL). First, it is usually a disease of old individuals with a median age at diagnosis ranging from 65–70 years [24]. Secondly, it is a B cell disorder and the associated hypogammaglobulinemia predisposes for increased risk of recurrent infections. CLL is the most common form of leukemia in the western world, and with the old age and other associated comorbidities, this population is likely to perform worse, however, this needs confirmation. Based on the International Workshop on Chronic Lymphocytic Leukemia (iwCLL), for those CLL patients in whom treatment is indicated, it is advisable to avoid intense regimens like fludarabine, cyclophosphamide, and rituximab (FCR) due to risk of severe myelosuppression [25]. Similarly, the monoclonal antibodies, such as rituximab and obinutuzumab, may lead to B-cell depletion, reduce the humoral immunity further, and hence are recommended to avoid. Several oral target agents are now available, such as ibrutinib (BTK inhibitor), acalabrutinib (a second-generation BTK inhibitor), and venetoclax for use in CLL which can be used either alone or in combination depending upon various patient or disease-related risk factors.