Myelodysplastic syndromes (MDS) are clonal hematologic neoplasms that can result in cytopenias and increase the risk of leukemic transformation. The disease is characterized by several recurrent cytogenetic defects, which can affect diagnosis, prognosis, and treatment. Metaphase cytogenetics (MC) is the gold standard in karyotypic analysis in hematology. Progress in molecular analysis, including additional karyotypic tools exemplified by fluorescence in situ hybridization, comparative genomic hybridization, and more importantly, single nucleotide polymorphism array (SNP-A) analysis, has led to increased detection of chromosomal abnormalities in myeloid malignancies and improved prognostic risk stratification. SNP-A, together with MC, has also been instrumental in the discovery of genes that have improved our understanding of the biology of MDS. Newly elucidated molecular abnormalities in MDS include mutations in CBL, TET2, ASXL1, IDH1/IDH2, EZH2, DNMT3A, and UTX. This review provides an update on the changing landscape of molecular and cytogenetic characterization in MDS and its significance in disease biology and clinical practice.

in a cohort of pre-treated intermediate to poor-prognosis patients with metastatic RCC, weekly i.v. temsirolimus is associated with predictable, but manageable toxicity, and a TTP approaching 4 months.

Relapsed small cell lung cancer (SCLC) carries a poor prognosis. Toposiomerase I and II inhibitors and DNA damaging agents are considered amongst the most active agents against SCLC. Rebeccamaycin analogue (RA, Becatacarin) is an anti-tumor antibiotic with inhibitory activity against both topoisomerase I and II as well as DNA intercalating properties. We performed a phase II trial of RA in relapsed, sensitive SCLC with the primary endpoint of response rate. Patients with previously treated SCLC who relapsed more than 60 days after completion of first-line chemotherapy were treated with RA administered i.v. at a dose of 140 mg/m2 on days 1–5 of 21 day cycles for a maximum of 6 cycles. Eligibility included ECOG PS 0–2 and adequate organ function. A 2-stage design was employed. Twenty evaluable patients were enrolled. Median age was 61 years. Two (10%) patients had a partial response and six had stable disease. The clinical benefit rate (CBR) was 40% (95% CI 23–64%). The median progression free survival was 2 months (95% CI 1.2–5.2 mo). The median survival was 6.7 months (95% CI: 3.3–8.0 months). No treatment-related deaths occurred. Grade 4 neutropenia and thrombocytopenia occurred in 23% and 14% of patients respectively. In conclusion, RA has single-agent activity in relapsed, sensitive SCLC with manageable toxicities but is unlikely to provide any superiority compared to existing agents for this disease.