Mojtaba Akhtari, MD

Chemotherapy-induced thrombocytopenia causes nearly two-thirds of cases of thrombocytopenia in the cancer setting. In patients receiving chemotherapy, thrombocytopenia leads to dose reductions in 15% of treatment cycles and chemotherapy delays in 6% of cycles.

Cancer treatment is undergoing significant developments and entering the new golden era of genomics which has true potentials for the promise of personalized medicine. Large-scale sequencing is changing our understanding of malignant disorders particularly acute myeloid leukemia.

Two recent reports show that the prognosis of MDS patients after secondary failure of hypomethylating drugs is poor, and switching from one failing hypomethylating drug to another cannot induce clinically significant responses.

ATG is associated with reduced risk of acute and chronic graft-versus-host disease without increasing the risk of relapse in myeloablative donor transplants. However, there has been an ongoing debate about the role of ATG in reduced intensity conditioning (RIC) HSCT, and there are still bone marrow transplant centers that use ATG in the RIC setting, and their main argument is that ATG could help with engraftment and reducing the risk of GVHD. Different types and doses of ATG have been used in the RIC setting.

A recent case report in the New England Journal of Medicine highlights the promising potentials of adoptive T-cell immunotherapy by redirecting them, through chimeric antigen receptors, as a novel and effective therapeutic modality for cancer.

Equine ATG has been used for the treatment of severe aplastic anemia since the 1980s. Rabbit ATG is used in many parts of the world including South America, Japan, and European countries. The results of a randomized study of equine versus rabbit ATG showed that rabbit ATG was inferior to equine ATG.

Is it time to revisit the therapeutic role of interferon alfa2 (IFN-α-2) in early myelofibrosis (MF) since new data show promising results? Silver et al from Weil-Cornell Medical College in New York has recently published the results of a prospective study, which used IFN-α-2 in the treatment of 17 patients with low and intermediate-1 risk categories, and >80% of patients showed either response or had stable disease with 2 patients achieving complete remission (CR), and seven partial remission (PR).

The current dogma considers cytomegalovirus (CMV) seropositivity being associated with inferior outcomes post hematopoietic stem cell transplant (HSCT). However, there has been a notion of “virus-versus-leukemia” effect since the 1980s; and recently, there have been some interesting reports which may turn this to a hot topic.

Myelodysplastic syndromes, also referred to collectively as MDS, have significant biological and clinical heterogeneity, a highly variable natural history, and a complex pathobiology that is not clearly understood.