Hydroxyurea‐related toxicity in 3,411 patients with Ph'‐negative MPN

Antonioli, Elisabetta; Guglielmelli, Paola; Pieri, Lisa; Finazzi, MariaChiara; Rumi, Elisa; Martinelli, Vincenzo; Vianelli, Nicola; Randi, Maria Luigia; Bertozzi, Irene; Stefano, Valerio De; Zà, Tommaso; Rossi, Elena; Ruggeri, Marco; Elli, Elena Maria; Cacciola, Rossella; Cacciola, Emma; Pogliani, Enrico Maria; Rodeghiero, Francesco; Baccarani, Michele; Passamonti, Francesco; Finazzi, Guido; Rambaldi, Alessandro; Bosi, Alberto; Cazzola, Mario; Barbui, Tiziano; Vannucchi, Alessandro M.

doi:10.1002/ajh.23160

Cited by 114 publications

(109 citation statements)

References 15 publications

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“…Overall survival in our patients was 44 months and no mortality was reported in the follow-up. The incidence of second malignancies during hydroxyurea therapy in other studies was significantly higher compared with our study [22][23][24]. One reason for the low incidence of secondary cancer is the study by Lanzkron et al [25].…”

Section: Discussioncontrasting

confidence: 45%

The Clinical Course and Prognosis of Patients With Essential Thrombocythemia Treated With Hydroxyurea and Low-Dose Aspirin in an 11-Year Follow-Up

Aznab¹,

Fathi²,

Ahmadi³

2016

J Hematol

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Section: Discussioncontrasting

confidence: 45%

The Clinical Course and Prognosis of Patients With Essential Thrombocythemia Treated With Hydroxyurea and Low-Dose Aspirin in an 11-Year Follow-Up

Aznab¹,

Fathi²,

Ahmadi³

2016

J Hematol

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“…A recent study of 3,411 patients with Philadelphia chromosome negative myeloproliferative neoplasms treated with hydroxyurea reported 5% incidence of mucocutaneous complications, 80% of which were leg ulcers [72]. Many patients had other predisposing factors.…”

Section: Systemic and Local Therapiesmentioning

confidence: 99%

Critical Reviews: How we treat sickle cell patients with leg ulcers

Minniti

Kato

2015

American J Hematol

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The past five decades have seen an improvement in the mortality and morbidity of sickle cell disease (SCD) because of prophylaxis against infectious complications, improved and expanded red cell transfusions, implementation of hydroxyurea therapy, and advances in supportive care. Now that the majority of patients in the western hemisphere reaches adulthood, end organ diseases are frequent, which include vasculopathic complications such as chronic leg ulcers. The management of patients with leg ulcers requires the hematologist to lead a team of health care professionals, and investigates the presence of associated, but potentially still occult signs of vasculopathy, such as pulmonary hypertension, renal disease, priapism and retinopathy. These complications may be asynchronous, and long term careful screening is indicated, in order to ensure early diagnosis and intervention. It is crucial to address both the immediate consequences of pain, infection and disability, and long term effects on quality of life, employment and stigma associated with chronic ulceration. Recent insights into their pathophysiology may have practical implications. We propose a holistic approach to the management of patients' physical and emotional problems and mechanisms of ulcers formation and delayed healing. An overview of topical and systemic therapies for chronic ulcers is given, with the understanding that wound care therapy is best left to the wound specialists, medical and surgical, with whom the hematologist must keep an open line of communication. In the absence of evidence-based guidelines, our opinion is based on both a critical review of the literature and our personal clinical and research experience. Am. J. Hematol. 91:22-30, 2016. V C 2015 Wiley Periodicals, Inc. Clinical CasesCase 1. A 49 year old African American woman with sickle cell anemia, bilateral hip replacements for avascular necrosis of the femoral head, pulmonary arterial hypertension documented by pulmonary artery catheterization, and history of laser treatment and vitrectomy for proliferative retinopathy and vitreous hemorrhage, presented with a very painful ulcer at the right malleolus. She has had three previous ulcers, on both legs, the first at age 32 years, attributed to excessive standing at her job, no trauma, which had responded to topical care and healed within few months of presentation. At that time she was not taking hydroxyurea, but has been taking it now for longer than 10 years with good fetal hemoglobin response: 17%. This current ulcer developed while she was experiencing high personal stress but no physical trauma. She rarely experiences vaso-occlusive pain crisis and has very infrequent hospitalizations. She was referred to the wound care service and after 7 months of unfruitful therapies, including surgical debridement, MIST ultrasound therapy, antibiotics, and compressions, she was started on monthly transfusions and her ulcer healed 5 months later. She has had consistently elevated serum lactate dehydrogenase (LDH) (>600 IU/L), serum dire...

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“…on May 11, 2018. by guest www.bloodjournal.org From adverse effects 52 ; more importantly, it does not specifically target the mutant clone and is therefore unlikely to modify the natural history of disease. On the contrary, pegylated interferon a-2a has been shown to induce sustained complete molecular response in a subset of patients with JAK2 (V617F)-mutant ET.…”

Section: How We Treat Patients With Et According To Their Individual mentioning

confidence: 99%

How I treat essential thrombocythemia

Rumi

Cazzola

2016

Blood

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Essential thrombocythemia (ET) is an indolent myeloproliferative neoplasm that may be complicated by vascular events, including both thrombosis and bleeding. This disorder may also transform into more aggressive myeloid neoplasms, in particular into myelofibrosis. The identification of somatic mutations of JAK2, CALR, or MPL, found in about 90% of patients, has considerably improved the diagnostic approach to this disorder. Genomic profiling also holds the potential to improve prognostication and, more generally, clinical decision-making because the different driver mutations are associated with distinct clinical features. Prevention of vascular events has been so far the main objective of therapy, and continues to be extremely important in the management of patients with ET. Low-dose aspirin and cytoreductive drugs can be administered to this purpose, with cytoreductive treatment being primarily given to patients at high risk of vascular complications. Currently used cytoreductive drugs include hydroxyurea, mainly used in older patients, and interferon α, primarily given to younger patients. There is a need for disease-modifying drugs that can eradicate clonal hematopoiesis and/or prevent progression to more aggressive myeloid neoplasms, especially in younger patients. In this article, we use a case-based discussion format to illustrate our approach to diagnosis and treatment of ET.

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Hydroxyurea‐related toxicity in 3,411 patients with Ph'‐negative MPN

Cited by 114 publications

References 15 publications

The Clinical Course and Prognosis of Patients With Essential Thrombocythemia Treated With Hydroxyurea and Low-Dose Aspirin in an 11-Year Follow-Up

The Clinical Course and Prognosis of Patients With Essential Thrombocythemia Treated With Hydroxyurea and Low-Dose Aspirin in an 11-Year Follow-Up

Critical Reviews: How we treat sickle cell patients with leg ulcers

How I treat essential thrombocythemia

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