483 research outputs found
Choosing treatment options for patients with relapsed/refractory multiple myeloma
No full textMultiple myeloma (MM) is a clonal plasma cell disorder that is still incurable using conventional treatments. Over the last decade, advances in front-line therapy have led to an increase in survival, but there are still some doubts in the case of relapsed/refractory disease. We searched the PubMed database for articles on treatment options for patients with relapsed/refractory MM published between 1996 and 2013. These treatments included hematopoietic cell transplantation (HCT), rechallenges using previous chemotherapy regimens, and trials of new regimens. The introduction of new agents such as the immunomodulatory drugs (IMIDs) thalidomide and lenalidomide, and the first-in-its-class proteasome inhibitor bortezomib, has greatly improved clinical outcomes in patients with relapsed/refractory MM, but not all patients respond and those that do may eventually relapse or become refractory to treatment. The challenge is therefore to select the optimal treatment for each patient by balancing efficacy and toxicity. To do this, it is necessary to consider disease-related factors, such as the quality and duration of responses to previous therapies, and the aggressiveness of the relapse, and patient-related factors such as age, comorbidities, performance status, pre-existing toxicities and cytogenetic patterns. The message from the trials reviewed in this article is that the new agents may be used to re-treat relapsed/refractory disease, and that the sequencing of their administration should be modulated on the basis of the various disease and patient-related factors. Moreover, our understanding of the pharmacology and molecular action of the new drugs will contribute to the possibility of developing tailored treatment
The infrared optical constants of limestone particles and implications for the search of carbonates on Mars
No full textTheoretical studies and numerical models of the atmosphere and surface of Mars need the knowledge of the optical constants of candidate materials for Martian dust, Limestone, as a carbonate bearing material, is also sommonly considered a likely component particularly important for its links with the climate evolution and water resources on Mars. In this work we present the complex indices of refraction of submicron particles of limestone, derived from laboratory transmission spectra in the wavelength range 3,5-20 Î1⁄4m by means of dispersion theory. The results are discussed and compared with the bulk optical constants of the same material already available in the literature. Since a comparison between the infrared spectrum of our dust sample of limestone (composed of more than 98% of calcium carbonate) and that of pure calcite particles shows no differences, we can consider the optical properties presented in this paper valid also for a collection of randomly oriented submicron calcite grains. The extinction and scattering efficiencies of limestone grains, calculated using our particulate optical constants, have been used as input parameters in a simple model of radiative transfer to compute synthetic spectra of the surface and the aerosol of Mars. The results clearly show that, for quantitative anlyses concerning the abundance and composition of the different solid materials present on the surface and atmosphere, the physical status of the various dust components has to be taken into account. This means that any extrapolation in the use of the bulk optical constants to describe the optical behavior of small particles and vice versa has to be checked a priori. © 1998 Elsevier Science Ltd. All rights reserved
Sustenibilidade e novos olhares sobre a soberaneia do consumidor
No full textThe chapter looks at the political investment of the consumer, critically considering the deployment of market choice, exit and voice for ethical, political and environmental reasons. The dialectic of globalization is at the heart of contemporary forms of political consumerism: as we know, global capitalism has tended to raise local hackles, provoking resistance in many different forms, including fundamentalist ones. As globalization proceeds, it is especially large multinationals that have become the targets of growing critical attention within environmentalist organizations and the alter-global movement. In introducing innovations which alter the routines of consumption, in expanding the relevant human community, in promoting the dis-embedment of economic from socio-cultural processes, globalization creates a space to address both commodities as vectors of social relations and the re-embedment of economic process. The paper closes with a discussion of the scope for transforming conventional consumer capitalist market relations through ethically charged consumer initiatives
Current and Emerging Treatment Options for Patients with Relapsed Myeloma
No full textMultiple myeloma (MM) is a neoplastic disorder. It results from proliferation of clonal plasma cells in bone marrow with production of monoclonal proteins, which are detectable in serum or urine. MM is clinically characterized by destructive bone lesions, anemia, hypercalcemia and renal insufficiency. Its prognosis is severe, with a median survival after diagnosis of approximately 3 years due to frequent relapses. Treatments for patients with relapsed/refractory MM include hematopoietic cell transplantation, a rechallenge using a previous chemotherapy regimen or a trial of a new regimen. The introduction of new drugs such as thalidomide, lenalidomide and bortezomib has markedly improved MM outcomes. When relapse occurs, the clinician's challenge is to select the optimal treatment for each patient while balancing efficacy and toxicity. Patients with indolent relapse can be first treated with a 2-drug or a 3-drug combination. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. Autologous stem cell transplantation should be considered as salvage therapy at first relapse for patients who have cryopreserved stem cells early in the disease course. The aim of this review is to provide an overview on the pharmacological and molecular action of treatments used for patients with relapsed/refractory multiple myeloma
Introduzione
No full textL'introduzione chiarisce i fondamenti scientifici del volume e ne descrive i contenuti, ricollegandosi alle principali tematiche di ricerca in materia e ricollegandole alla vocazione scientifica dei gruppi di ricerca di Cassino
Sustentabilidate e novos olhares sobra a soverania do consumidor
No full textIl capitolo discute i diversi significati della nozione di consumo, il modo in cui possiamo apprezzare le caratteristiche fondamentali di quella che va sotto il nome di cultura di consumo, e le possibilità di una trasformazione del nostro sguardo sul consumo in relazione alle questioni ambientali e sociali di sostenibilità. Introdurre il tema della sostenibilità apre all'opportunità di modificare la nozione individualista, presentista e de-contestualizzata di scelta
Multifactorial neutropenia in a patient with acute promyelocytic leukemia and associated large granular lymphocyte expansion: A case report
No full textNeutropenia in the setting of acute hematological malignancies may impact disease prognosis, thus affecting therapy dose intensity. This is often due to chemotherapy‐induced aplasia as well as to the disease itself. However, chronic neutropenia deserves further investigation, as the management of reversible concomitant causes may avoid treatment delay. The present study describes a case of an acute promyelocytic leukemia patient with chronic severe neutropenia of multifactorial origin, including acute leukemia itself, chemotherapy, autoimmune activation with anti‐platelets and anti‐neutrophil antibodies positivity, and the rare association of large granular lymphocyte (LGL) expansion. As neutropenia may challenge the diagnosis and treatment of acute malignancies, clinicians and hematopathologists must discuss the differential diagnosis in order to avoid misdiagnosing and undertreating concomitant diseases. In particular, LGL chronic expansion and autoimmunity should be considered
Spectral Alteration of Meteorite Epinal Induced by Ion Irradiation: a Simulation of Space Weathering Effects on Near Earth Asteroids
No full textWe present results obtained for Epinal (H5), an ordinary chondrite meteorite, irradiated with 60 keV Ar++ ions, simulating solar wind
heavy particle irradiation. Bidirectional reflectance spectra (0.3–2.67 μm) measured after irradiating Epinal samples with different ion fluencies exhibit a progressive reddening that is similar to the spread of spectra observed for S-type near-Earth asteroids. The timescales for inducing the same effects in space as those obtained in laboratory are estimated to be 104–106 yr. These results suggest irradiation by heavy ions may be a very efficient weathering process in near-Earth space
Secondary malignancies in chronic lymphocytic leukemia: a single centre retrospective analysis
No full textBackground: Chronic lymphocytic leukemia (CLL) is characterized by progressive immunodeficiency with high prevalence of infections, autoimmune phenomena and secondary malignancies. The immune deregulation may be due to the disease itself or it may be a consequence of the treatment performed. Aims: To evaluate the occurrence of second cancers in CLL patients and their relationship with clinical and laboratory features as well as with therapy lines. Methods: Clinical history of 514 CLL patients diagnosed and followed from 1983 until 2014 at our Institution were retrospectively evaluated and the diagnosis of a second cancer was collected. History of neoplasia preceding CLL diagnosis was also registered. Student t test for continuous variables, chisquare test for categorical ones and Log rank test for survival analysis were performed. Results: Clinical, hematological and biological characteristics are listed in Table 1. Secondary cancers were categorized according originating organ/tissue;
skin cancers were divided into melanoma and non-melanoma. During the follow up 88 patients (17%) developed secondary cancers, with a mean time from diagnosis to secondary neoplasia of 9 years. Considering tumor histology, we observed 9 blood, 9 lung, 5 breast, 19 uro-genital tract (5 kidney, 10 prostate, 4 bladder, 2 uterus, and 2 ovarian), 15 gastro-enteric tract (12 colon, 2 gastric and 1 tongue), 4 pancreas, 3 melanoma and 15 skin cancers other than melanoma. No significant differences were observed according to age, gender, Rai/Binet stage and hematologic parameters in patients with or without secondary tumors (Table 1). Considering CLL prognostic features, the development of second cancers was associated with higher age (p<0.001) at diagnosis, increased beta2microglobuline levels (p=0.03) and un-mutated VHIG status (p<0.005; Figure 1). At variance, no association was found with 13q, 11q or 17p deletion, chromosome 12 trisomy, nor with ZAP-70 and CD-38 positivity (Table1). Past history was positive for malignancies in 70 patients (13%): 2 blood, 3 airways (2 lower and 1 upper), 3 breast, 6 uro-genital tract (3 bladder, 3 prostate, 2 uterus and 1 ovarian), 3 gastro-enteric tract, 3 skin cancers other than melanoma, and 3 melanoma. On the whole, 46/88 (52.3%) and 219/426 (51.4%) patients with or without secondary cancers, underwent at least one therapy line. More specifically, therapy line. More specifically, 86 patients were treated with fludarabine containing regimens, of whom 11 developed a secondary cancer; 180 with chlorambucil, of whom 34 developed a secondary tumor and 65 with alemtuzumab, of whom 10 were later diagnosed with a second cancer. During the follow up, 121 patients died, of whom 8 directly from secondary malignancies, 41 from CLL progression, 2 from thrombotic events, and 11 from infectionsSummary/Conclusions: Secondary malignancies are not infrequent in patients with CLL and patients with un-mutated VHIG status are at higher risk of developing a second cancer. As secondary neoplasia are not clearly related to biologic markers or to the treatment performed, a careful clinical follow up, encompassing sex and age adjusted tumors screening is advised
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