Intervento della Dott.ssa Serena Merante, Haematology Consultant James Cook University Hospital
Middlesbrough, UK al Convegno dell'Associazione Italiana Pazienti Leucemia Mieloide Cronica del 20 Maggio 2017 presso Triuggio (Mb)
Integrative Cancer - New theories and Advances in Treatment From Hippocrates ...Sheldon Stein
Professor Serge Jurasunsas' recent paper on Integrative Cancer, From Hippocrates to the Human Genome - posted on his behalf. Discusses testing, protocols and case discussion.
Integrative Cancer - New theories and Advances in Treatment From Hippocrates ...Sheldon Stein
Professor Serge Jurasunsas' recent paper on Integrative Cancer, From Hippocrates to the Human Genome - posted on his behalf. Discusses testing, protocols and case discussion.
Melanoma epidemiology, etiopathogenesis and prevention - Professor Torello L...VR Foundation
Melanoma incidence has continued to increase significantly during the last half of 20th century wherever available data exist.
The incidence of malignant melanoma appears to be lower and stable in dark-skin individuals (Africans, Native Americans, Asians, and Hispanics).
Decreased incidence reported from some countries is probably partly due to an influx of low risk immigrants.
Potential of Targeting Bone Metastases with Immunotherapies_Crimson PublishersCrimsonpublishersCancer
Cancer-related bone metastases are incurable and cause high mortality in patients. Immunotherapies have been evaluated in large-scale clinical trials with advanced cancer patients, but effects on bone metastases have not been specified. This mini review introduces case reports where patients with bone metastases have been treated with immunotherapies and local effects on tumor growth have been assessed. Potential skeletal-related adverse effects of immunotherapies are also discussed.
Ana Ramírez de Molina-El impacto de las ciencias ómicas en la medicina, la nu...Fundación Ramón Areces
El 29 de marzo de 2016 celebramos un Simposio Internacional sobre el 'Impacto de las ciencias ómicas en la medicina, nutrición y biotecnología'. Organizado por la Fundación Ramón Areces en colaboración con la Real Academia Nacional de Medicina y BioEuroLatina, abordó cómo un mejor conocimiento del genoma humano está permitiendo notables avances hacia una medicina de precisión.
Main goal of this article is to present more exhaustive information about genetic immunity to cancerous disease. The data about the subsistence of the disease in 125 ethnoses around the World have been analyzed. The groups of most immune and most susceptible ethnoses have been revealed. Causative agent of this disease is a specific eukaryotic genomic parasite, spreading amongst humans via its intrusion in the genomes of susceptible organisms. The Intrusion of cancerous genes is performing by contaminated human gametes, either by the sperm or by the egg. The parasite subsistence of human cancerous disease is functioning at the expense of substances and functions derived from the body of its prey. This trait is cruial for the progression of cancerous disease within a human body but intensive nutrition of developed cancerous tissues leads contaminated person to the loss of his body weight. The subsistence is provided with the possession by cancerous subjects of genetic immunity to the victim’s immune defense and cell regulation. These new notions provide framework and landmarks for the detection and discovery of genomic roots of cancerous disease and encourage new proposals for its healing and prevention, as well as for the discovery of the origin and evolution of cancerous disease.
Dr. Michael Morse from Duke University and Fight CRC’s Andi Dwyer discuss the state of the science and clinical care of Immunotherapy (IO); giving a glimpse of the contributions of the Fight CRC IO Workgroup.
Colorectal cancer is one of the leading causes of death in the United States. Recent advances of understandings in anatomical patterns and molecular mechanisms may bring better therapeutical options and treatment plan. This article reviews the different outcomes of colorectal cancer associated with anatomical pattern: left-sided or right-sided; and the recently discoveries of colorectal cancer related miRNA.
Cancer chemotherapy for medical studentstaklo simeneh
Cancer chemotherapy has been presented in detail for medical students. It can be used for other health students by modifying it based on their curriculum and time given.
Melanoma epidemiology, etiopathogenesis and prevention - Professor Torello L...VR Foundation
Melanoma incidence has continued to increase significantly during the last half of 20th century wherever available data exist.
The incidence of malignant melanoma appears to be lower and stable in dark-skin individuals (Africans, Native Americans, Asians, and Hispanics).
Decreased incidence reported from some countries is probably partly due to an influx of low risk immigrants.
Potential of Targeting Bone Metastases with Immunotherapies_Crimson PublishersCrimsonpublishersCancer
Cancer-related bone metastases are incurable and cause high mortality in patients. Immunotherapies have been evaluated in large-scale clinical trials with advanced cancer patients, but effects on bone metastases have not been specified. This mini review introduces case reports where patients with bone metastases have been treated with immunotherapies and local effects on tumor growth have been assessed. Potential skeletal-related adverse effects of immunotherapies are also discussed.
Ana Ramírez de Molina-El impacto de las ciencias ómicas en la medicina, la nu...Fundación Ramón Areces
El 29 de marzo de 2016 celebramos un Simposio Internacional sobre el 'Impacto de las ciencias ómicas en la medicina, nutrición y biotecnología'. Organizado por la Fundación Ramón Areces en colaboración con la Real Academia Nacional de Medicina y BioEuroLatina, abordó cómo un mejor conocimiento del genoma humano está permitiendo notables avances hacia una medicina de precisión.
Main goal of this article is to present more exhaustive information about genetic immunity to cancerous disease. The data about the subsistence of the disease in 125 ethnoses around the World have been analyzed. The groups of most immune and most susceptible ethnoses have been revealed. Causative agent of this disease is a specific eukaryotic genomic parasite, spreading amongst humans via its intrusion in the genomes of susceptible organisms. The Intrusion of cancerous genes is performing by contaminated human gametes, either by the sperm or by the egg. The parasite subsistence of human cancerous disease is functioning at the expense of substances and functions derived from the body of its prey. This trait is cruial for the progression of cancerous disease within a human body but intensive nutrition of developed cancerous tissues leads contaminated person to the loss of his body weight. The subsistence is provided with the possession by cancerous subjects of genetic immunity to the victim’s immune defense and cell regulation. These new notions provide framework and landmarks for the detection and discovery of genomic roots of cancerous disease and encourage new proposals for its healing and prevention, as well as for the discovery of the origin and evolution of cancerous disease.
Dr. Michael Morse from Duke University and Fight CRC’s Andi Dwyer discuss the state of the science and clinical care of Immunotherapy (IO); giving a glimpse of the contributions of the Fight CRC IO Workgroup.
Colorectal cancer is one of the leading causes of death in the United States. Recent advances of understandings in anatomical patterns and molecular mechanisms may bring better therapeutical options and treatment plan. This article reviews the different outcomes of colorectal cancer associated with anatomical pattern: left-sided or right-sided; and the recently discoveries of colorectal cancer related miRNA.
Cancer chemotherapy for medical studentstaklo simeneh
Cancer chemotherapy has been presented in detail for medical students. It can be used for other health students by modifying it based on their curriculum and time given.
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...AnonIshanvi
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...daranisaha
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...JohnJulie1
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...NainaAnon
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
The simultaneous occurrence of two lymphatic malignancies in
one patient is extremely rare with an incidence rate of 1.4–6.5
cases/1,000,000 individuals [8]. Co-existence of MM and other
lymphoid malignancies like Chronic Lymphocytic Leukemia (CLL)
[9], MM and Hodgkin’s Disease (HD) [10], MM and Lympho
Plasmacytic Lymphoma (LPL) [11] has been reported. However,
there are less than 5 reported cases in PubMed of simultaneous
presentation of DLBCL and MM
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...EditorSara
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...semualkaira
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...semualkaira
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
E’ arrivata l’estate, come nutrirsi?
Ce lo racconta Federica Pessina, nostra dietista, mentre Chiara Zanotti ci accompagnerà nella preparazione di gustose ricette, facili da preparare, fresche e nutrienti.
Potete sbizzarrivi con leggere le slide di Federica e preparare le ricette autonomamente oppure seguire Chiara passo dopo passo nella preparazione delle ricette.
La prevenzione inizia dalla tavola e in estate la parola d’ordine è: Idratazione!
Buona estate
Link: colazione con Chiara Zanotti www.aipleucemiamieloidecronica.it/cooking-academy-con-chiara-focaccia-proteica-al-quark-e-frutti-di-bosco/
Link: piatto unico ideale per il pranzo o la cena con Chiara Zanotti www.aipleucemiamieloidecronica.it/cooking-academy-con-chiara-riso-venere-con-seppie-e-gamberi-di-mazara-del-vallo/
“Sospensione della terapia: sempre sicura?”
Carlo Gambacorti Passerini
Professore di Ematologia (Uni Milano Bicocca)
Direttore Ematologia, Ospedale San Gerardo,
Monza
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. • 2005 Jul;90(7):979-81.
Outcome of four patients with chronic
myeloid leukemia after
imatinib mesylate discontinuation.
Merante S, Orlandi E, Bernasconi P, Calatroni S, Boni M, Lazzarino M
3. Rischio di secondi tumori e LMC
• Il rischio è legato alla mia malattia
(LMC)?
• Il rischio è aumentato dalla terapia che sto
facendo?
• Il rischio è uguale a tutte le età?
• Si può PREVENIRE un secondo tumore?
• Si può curare un secondo tumore?
• Posso continuare a curarmi per la LMC e
anche per un secondo tumore?
4. Chronic myelogenous leukemia and exposure to ionizing
radiation--a retrospective study of 443 patients.
Corso A, Lazzarino M, Morra E, Merante S, Astori C, Bernasconi P, Boni M, Bernasconi C. .
Annals of hematology Volume: 70 Issue 2 (1995)
• We performed a retrospective study of 443 consecutive CML
patients, looking for a history of significant exposure to Rx,
and evaluated the clinical and hematological characteristics in
order to find any difference between radiation-related CML
patients and those with de novo CML
• In conclusion, this study of a large cohort of CML patients
indicates that the subgroup of patients with a history of
significant exposure to ionizing radiation has particular
clinical and hematological features at onset (lower tumor
burden, higher frequency of anemia) and a better survival.
5. Messaggio
Un sottogruppo di pazienti con una
storia di significativa esposizione a
radiazioni ionizzanti ha particolari
caratteristiche:
• Bassa “massa tumorale”
• Anemia
• Migliore sopravvivenza
6. American Journal of Epidemiology
ª Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public
Health. September 22, 2010
Are Chronic Myeloid Leukemia Patients More at Risk for Second Malignancies?
A Population-based Study
Paola Rebora, Kamila Czene, Laura Antolini, Carlo Gambacorti Passerini, Marie Reilly, and MariaGrazia
Valsecchi*
• To assess the incidence rate of second primary cancers among chronic
myeloid leukemia (CML) patients and the long-term survival of CML patients
before the introduction of tyrosine kinase inhibitors.
• Swedish Cancer Registry, 2,753 adult CML patients diagnosed between 1970
and 1995 who were followed through December 2007. Standardized incidence
ratios (SIRs) and relative survival ratios were computed.
• With a total of 145 subsequent primary malignancies, an increased incidence
rate of second malignancy was found for stomach cancer (SIR ¼ 2.76, 95%
confidence interval (CI): 1.33,5.08), skin cancer (SIR ¼ 5.36, 95% CI: 3.18, 8.47),
urogenital tract cancer (SIR ¼ 1.61, 95% CI: 1.15, 2.21), and lymphoid leukemia
(SIR ¼ 5.53, 95% CI: 1.79, 12.89).
• Long-term relative survival figures showed that CML was related, in the era
prior to the introduction of imatinib, to a very steep decline in survival (2 years
from diagnosis,relative survival ¼ 51%, 95% CI: 49, 53). This was in spite of a
marginal improvement after 1985, possibly related to the introduction of
interferon-a for treatment.
• Relevant reference for future studies and a benchmark for comparisons with
prognosis in CML patients after chronic use of tyrosine kinase inhibitors.
7. Prima dell’introduzione della terapia con
inibitori delle tirosinchinasi
• Una maggiore incidenza di secondi
tumori
• Una caduta della curva della
sopravvivenza (a 2 anni dalla diagnosi)
• Studio base per studi futuri di
confronto fra “prima” e “dopo” TKIs
9. Chronic myeloid leukemia and risk of second malignancy
in two eras of treatment
Brady L. Stein Leukemia & Lymphoma 2012
” …the evidence is stronger for this association in the “pre-
imatinib era”
Clearly, the issue of secondary cancer in CML is complex, various factors:
- cumulative treatment, possibly when radiation,
hydroxyurea or busulfan are utilized
- immunodefciency,
- lifestyle choices, particularly smoking,
- aging,
- genetic predisposition
10. Rischio di seconde neoplasie nelle due ere di
trattamento
• Il rischio è più significativo nella “pre-imatinib era”
• L’argomento è complesso e deve tenere conto di vari
fattori
• Il trattamento cumulativo spesso venivano utlizzate
associazioni (radiazioni, idrossiurea,busulfano, altra
chemioterapia)
• Alterazioni del sistema immunitario
• Stile di vita (fumo, alcool, dieta)
• Età
• Predisposizione genetica
11. Second malignancies following treatment of chronic
myeloid leukaemia in the tyrosine kinase inhibitor era
British Journal of Haematology, 2015, 169, 683–688
• Founded on a population-based material, our
results indicate that CML patients treated in
the TKI era are at an increased risk of
developing a second malignancy, with
indications that this risk may more likely be
linked to CML itself rather than to the TKI
treatment.
12. Second malignancies following treatment of chronic myeloid
leukaemia in the tyrosine kinase inhibitor era
British Journal of Haematology, 2015, 169, 683–688
• Le persone trattate con TKIs hanno un
aumentato rischio di seconde
neoplasie
• Il rischio tuttavia è più verosimilmente
legato alla LMC “per se”piuttosto che
al trattamento con TKIs.
13. Clin Lymphoma Myeloma Leuk. 2016 Oct;16(10):577-581. doi: 10.1016/j.clml.2016.06.010.
Incidence of Second Malignancies of Chronic Myeloid Leukemia During
Treatment With Tyrosine Kinase Inhibitors.
Yin XF1, Wang JH2, Li X1, Yu MX1, Ma ZX1, Jin J3.
• BACKGROUND: Tyrosine kinase inhibitors (TKIs) have revolutionized the
treatment of chronic myeloid leukemia (CML) by providing patients with
long-term survival. Although most patients who receive TKI treatment have
shown satisfactory tolerance, second malignancies (SMs) should not be
ignored because of lifetime treatment. We designed a retrospective study to
evaluate the incidence and possible risk factors of SMs in CML patients
treated with TKIs.
• PATIENTS AND METHODS: Records of 223 patients with Philadelphia chromosome-positive CML treated
with imatinib were reviewed to investigate frequencies and characteristics of SMs. The data of SMs were
compared with the number expected from the National Central Cancer Registry. The possible risk factors
of SM in CML patients treated with TKIs were also evaluated using Poisson regression in this study.
• RESULTS:After a median follow-up of 64 months (range, 4-253 months) from CML diagnosis,
7 patients (3.14%) developed 6 different SMs including colon, stomach, breast, kidney,
cervical, and lymphonodus tissue. The risk of second cancer was higher than expected
(observed-to-expected ratio, 2.45; 95% confidence interval, 1.17-5.14; P = .018). No
associated elements were found in terms of influencing the incidence of SM in CML patients
treated with TKIs.
• CONCLUSION: We found patients with CML treated with TKIs had a higher
relative incidence of SM compared with the expected incidence among the
general Chinese population. However, the correlations between second
cancer and the potential risk factors including the length of exposure and
cumulative dose of TKIs were not found in this study.
14. Clin Lymphoma Myeloma Leuk. 2016 Oct;16(10):577-581. doi:
10.1016/j.clml.2016.06.010. Incidence of Second Malignancies of Chronic
Myeloid Leukemia During Treatment With Tyrosine Kinase Inhibitors.
Yin XF1, Wang JH2, Li X1, Yu MX1, Ma ZX1, Jin J3.
• Poiché il trattamento dura tutta la vita il
rischio di seconde neoplasie non può
essere ignorato
• Tuttavia le correlazioni tra seconde
neoplasie ed il potenziale rischio di
fattori come la durata del trattamento
con TKIs e la dose cumulativa non è
risultata statisticamente significativa.
15. Warnings…
• Because of improving survival and
longevity, age-appropriate cancer
screening should play a signifcant role in
the care of the patient with CML, but the
current literature cannot implicate imatinib
as a culprit in second cancer risk.
16. Chi è il colpevole?
• Allungamento della vita media-longevità
• Fattori genetici
• Stile di vita (FUMO,ALCOOL, OBESITA’,
DIETA).
• Polluzione atmosferica (radiazioni, smog…)
• La letteratura attuale non dimostra che la
terapia con Imatinib aumenta il rischio di
secondi tumori
17. Messaggi da portare a casa
• La LMC è “per se” un fattore predisponente a
secondi tumori (instabilità genetica?!).
• La lunga sopravvivenza (aging) ottenuta con gli
TKIs espone all’insorgenza di secondi tumori.
• Necessità di un’accurata registrazione dei
secondi tumori (età, fattori predisponenti,durata
LMC)
• PREVENZIONE accurata e regolare: non
dimentichiamo che noi siamo medici e non solo
esperti di LMC!
18. GRAZIE
• Grazie ai pazienti che affidano alle nostre
mani non solo la loro malattia ma anche le
loro vite vissute.
• Grazie a chi sostiene in modo trasparente
la ricerca.
• Grazie alle Associazioni, alle Onlus
• E grazie per le domande che vorrete fare!
Editor's Notes
Figure 1. Estimated cumulative relative survival of chronic myeloid leukemia (CML) patients by period of diagnosis (1970–1984 vs. 1985–1995), Sweden, 1970–1995. Fifteen-year survival figures were 2.4% (95% confidence interval: 1.6, 3.4) and 15.6% (95% confidence interval: 13.1, 18.4), respectively. Dashed lines, 95% confidence interval.