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woensdag 1 maart 2017

The Lancet: [News] Optimising haemopoietic cell transplantation

[News] Optimising haemopoietic cell transplantation
High-intensity (myeloablative) haemopoietic cell transplantation (HCT) should continue as standard treatment for patients younger than 65 years with acute myeloid leukaemia (AML) or myelodysplastic syndromes, according to findings from a phase 3 trial.
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[Comment] Mercaptopurine in childhood acute lymphoblastic leukaemia
Unlike other cancers, acute lymphoblastic leukaemia requires prolonged therapy, consisting of induction (about 1 month), post-induction intensification (about 6 months), and maintenance or continuation therapy (18–30 months). Two decades ago, findings from a large meta-analysis1 showed a small, but significant, advantage of a third year of maintenance therapy despite more deaths from pneumocystis, varicella, and measles, which are rarely seen today, compared with shorter treatment groups. In the Tokyo Children's Cancer Study Group L92-13 study,2 maintenance therapy was terminated at 1 year from diagnosis and resulted in an event-free survival of 57% at 12 years.
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[Articles] DNA-thioguanine nucleotide concentration and relapse-free survival during maintenance therapy of childhood acute lymphoblastic leukaemia (NOPHO ALL2008): a prospective substudy of a phase 3 trial
Our results suggest the need for intervention trials to identify clinically applicable strategies for individualised drug dosing to increase DNA-TGN concentration, and randomised studies to investigate whether such strategies improve cure rates compared with current dose adjustments based on white blood cell counts.
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[Comment] Targeted therapy of pancreatic cancer: biomarkers are needed
Pancreatic cancer remains one of the most challenging malignancies to treat, and is predicted to be the second leading cause of cancer-associated mortality within the next 5–10 years,1 partly because only incremental progress has been made in the palliative treatment of this disease.2
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[Comment] Refining megatherapy, improving outcome in neuroblastoma
Neuroblastoma is a major cause of paediatric cancer mortality and is clinically and biologically heterogeneous. Over 30 years ago, amplification of the MYCN oncogene was shown to be associated with aggressive disease.1 Currently, disease risk is assessed and treatment selected based on MYCN amplification and other biological features. In parallel with the refinement in risk assignment, treatment has substantially improved by use of multimodality approaches. Over the past 20 years, 5-year overall survival for children with high-risk neuroblastoma has increased from 29% to 50%.
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