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Cancers Feb 2021Cytarabine is a pyrimidine nucleoside analog, commonly used in multiagent chemotherapy regimens for the treatment of leukemia and lymphoma, as well as for neoplastic... (Review)
Review
Cytarabine is a pyrimidine nucleoside analog, commonly used in multiagent chemotherapy regimens for the treatment of leukemia and lymphoma, as well as for neoplastic meningitis. Ara-C-based chemotherapy regimens can induce a suboptimal clinical outcome in a fraction of patients. Several studies suggest that the individual variability in clinical response to Leukemia & Lymphoma treatments among patients, underlying either Ara-C mechanism resistance or toxicity, appears to be associated with the intracellular accumulation and retention of Ara-CTP due to genetic variants related to metabolic enzymes. Herein, we reported (a) the latest Pharmacogenomics biomarkers associated with the response to cytarabine and (b) the new drug formulations with optimized pharmacokinetics. The purpose of this review is to provide readers with detailed and comprehensive information on the effects of Ara-C-based therapies, from biological to clinical practice, maintaining high the interest of both researcher and clinical hematologist. This review could help clinicians in predicting the response to cytarabine-based treatments.
PubMed: 33669053
DOI: 10.3390/cancers13050966 -
Central nervous system manifestations of systemic haematological malignancies and key differentials.Clinical Radiology May 2022Central nervous system (CNS) involvement by haematological malignancies is uncommon, and generally associated with a poor prognosis. Neuroimaging plays a key role in the... (Review)
Review
Central nervous system (CNS) involvement by haematological malignancies is uncommon, and generally associated with a poor prognosis. Neuroimaging plays a key role in the accurate diagnosis, including in the critical differentiation from other processes such as infection and treatment-related toxicity. This review illustrates a variety of manifestations of CNS involvement by haematological malignancies and relevant differential diagnoses. CNS involvement can be seen in lymphoma (both primary and secondary), Waldenström macroglobulinaemia, multiple myeloma, leukaemia, and the malignant histiocytoses. The typical patterns vary between the different disorders, for example, in the most common sites of involvement and the relative frequency of parenchymal and meningeal involvement. Adjacent structures may also be involved. Nevertheless, there is some overlap in the imaging appearances, with common features including pre-contrast hyperdensity on computed tomography (CT), diffusion restriction, and avid post-contrast enhancement. In the post-treatment context, it is also important to distinguish between disease relapse and post-treatment effects. This includes opportunistic infections and the effects of chemotherapy and/or radiotherapy, including toxic effects and radiotherapy-induced neoplasms.
Topics: Central Nervous System; Central Nervous System Neoplasms; Hematologic Neoplasms; Humans; Lymphoma; Neuroimaging; Tomography, X-Ray Computed
PubMed: 35164931
DOI: 10.1016/j.crad.2022.01.043 -
Journal of Integrative Neuroscience May 2023Lesions of the central nervous system (CNS) can present with numerous and overlapping radiographical and clinical features that make diagnosis difficult based... (Review)
Review
Lesions of the central nervous system (CNS) can present with numerous and overlapping radiographical and clinical features that make diagnosis difficult based exclusively on history, physical examination, and traditional imaging modalities. Given that there are significant differences in optimal treatment protocols for these various CNS lesions, rapid and non-invasive diagnosis could lead to improved patient care. Recently, various advanced magnetic resonance imaging (MRI) techniques showed promising methods to differentiate between various tumors and lesions that conventional MRI cannot define by comparing their physiologic characteristics, such as vascularity, permeability, oxygenation, and metabolism. These advanced MRI techniques include dynamic susceptibility contrast MRI (DSC), diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI, Golden-Angle Radial Sparse Parallel imaging (GRASP), Blood oxygen level-dependent functional MRI (BOLD fMRI), and arterial spin labeling (ASL) MRI. In this article, a narrative review is used to discuss the current trends in advanced MRI techniques and potential future applications in identifying difficult-to-distinguish CNS lesions. Advanced MRI techniques were found to be promising non-invasive modalities to differentiate between paraganglioma, schwannoma, and meningioma. They are also considered promising methods to differentiate gliomas from lymphoma, post-radiation changes, pseudoprogression, demyelination, and metastasis. Advanced MRI techniques allow clinicians to take advantage of intrinsic biological differences in CNS lesions to better identify the etiology of these lesions, potentially leading to more effective patient care and a decrease in unnecessary invasive procedures. More clinical studies with larger sample sizes should be encouraged to assess the significance of each advanced MRI technique and the specificity and sensitivity of each radiologic parameter.
Topics: Humans; Brain Neoplasms; Magnetic Resonance Imaging; Central Nervous System Neoplasms; Glioma; Meningeal Neoplasms
PubMed: 37258452
DOI: 10.31083/j.jin2203073 -
Seminars in Ultrasound, CT, and MR Feb 2022The central nervous system (CNS) tumors constitute the most common type of solid tumors in the pediatric population. The cerebral and cerebellar parenchyma are the most... (Review)
Review
The central nervous system (CNS) tumors constitute the most common type of solid tumors in the pediatric population. The cerebral and cerebellar parenchyma are the most common site of pediatric CNS neoplasms. Imaging plays an important role in detection, characterization, staging and prognostication of brain tumors. The focus of the current article is pediatric brain tumor imaging with emphasis on pearls and pitfalls of conventional and advanced imaging in various pediatric brain tumor subtypes. The article also elucidates changes in brain tumor terms and entities as applicable to pediatric patients, updated as per World Health Organization (WHO) 2016 classification of primary CNS tumors. This classification introduced the genetic and/or molecular information of primary CNS neoplasms as part of comprehensive tumor pathology report in the routine clinical workflow. The concepts from 2016 classification have been further refined based on current research, by the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) group and published in the form of updates. The updates serve as guidelines in the time interval between WHO updates and expect to be broadly adopted in the subsequent WHO classification. The current review covers most pediatric brain tumors except pituitary tumors, meningeal origin tumors, nerve sheath tumors and CNS lymphoma/leukemia.
Topics: Brain Neoplasms; Central Nervous System Neoplasms; Child; Diagnostic Imaging; Humans; World Health Organization
PubMed: 35164908
DOI: 10.1053/j.sult.2021.05.004 -
Brain and Nerve = Shinkei Kenkyu No... Aug 2014Non-Hodgkin lymphoma occurs and recurs in the peripheral nerves or skeletal muscles. Lymphoma cells infiltrate along anatomic structures. They typically do not invade... (Review)
Review
Non-Hodgkin lymphoma occurs and recurs in the peripheral nerves or skeletal muscles. Lymphoma cells infiltrate along anatomic structures. They typically do not invade the central nervous system from the cranial or peripheral nerve roots. Analysis of cerebrospinal fluid often does not lead to the diagnosis of neurolymphomatosis, even when meningeal infiltration is present. The concentration of soluble interleukin 2 (IL2) receptor, together with the findings of magnetic resonance imaging (MRI) and 18 fluoro-2-deoxyglucose positron emission tomography (FDG-PET) may contribute to the diagnosis, but not in early stages of the disease. Investigation of other tissues including bone marrow is sometimes useful. Differential diagnosis includes inflammatory demyelinating neuropathy in the nerve, and focal myositis in the muscle, in addition to other malignancies. Some lymphoma clones appear to have affinity for the peripheral nerves or muscle tissues.
Topics: Biopsy; Diagnosis, Differential; Humans; Lymphoma; Muscle Neoplasms; Neoplasm Invasiveness; Peripheral Nervous System Neoplasms
PubMed: 25082317
DOI: No ID Found -
Cancers Jun 2019The central nervous system (CNS) may be considered as a sanctuary site, protected from systemic chemotherapy by the meninges, the cerebrospinal fluid (CSF) and the... (Review)
Review
The central nervous system (CNS) may be considered as a sanctuary site, protected from systemic chemotherapy by the meninges, the cerebrospinal fluid (CSF) and the blood-brain barrier (BBB). Consequently, parenchymal and CSF exposure of most antineoplastic agents following intravenous (IV) administration is lower than systemic exposure. In this review, we describe the different strategies developed to improve delivery of antineoplastic agents into the brain in primary and metastatic CNS tumors. We observed that several methods, such as BBB disruption (BBBD), intra-arterial (IA) and intracavitary chemotherapy, are not routinely used because of their invasiveness and potentially serious adverse effects. Conversely, intrathecal (IT) chemotherapy has been safely and widely practiced in the treatment of pediatric primary and metastatic tumors, replacing the neurotoxic cranial irradiation for the treatment of childhood lymphoma and acute lymphoblastic leukemia (ALL). IT chemotherapy may be achieved through lumbar puncture (LP) or across the Ommaya intraventricular reservoir, which are both described in this review. Additionally, we overviewed pharmacokinetics and toxic aspects of the main IT antineoplastic drugs employed for primary or metastatic childhood CNS tumors (such as methotrexate, cytosine arabinoside, hydrocortisone), with a concise focus on new and less used IT antineoplastic agents.
PubMed: 31200562
DOI: 10.3390/cancers11060824 -
Expert Opinion on Pharmacotherapy 2015Primary Central Nervous System (CNS) lymphomas are a rare group of malignancies with peculiar clinical and biologic features, aggressive course, and unsatisfactory... (Review)
Review
INTRODUCTION
Primary Central Nervous System (CNS) lymphomas are a rare group of malignancies with peculiar clinical and biologic features, aggressive course, and unsatisfactory outcome in contrast with other aggressive lymphomas. Despite a high chemo- and radiosensitivity, remissions are frequently short lasting, mainly because the blood-brain barrier limits the access of many drugs to the CNS, preventing a homogeneous treatment of all CNS tissues. Moreover, survivor patients are at high risk of developing severe treatment-related toxicity, mainly disabling neurotoxicity for elderly ones, raising the question of whether to intensify therapy to improve the cure rate or to downgrade treatment to reduce side effects. Although prognosis remains poor, it has significantly improved over the past two decades as a result of better treatment strategies with a curative aim.
AREAS COVERED
The purpose of this review is to focus on either the actual pharmaco-therapeutic knowledge or the predictable future developments for the immunocompetent population (the vast majority of patients today). The most important published reports on these fields are presented.
EXPERT OPINION
Actual front-line therapy consists of high-dose-methotrexate-based polichemotherapy, mostly in combination with high-dose cytarabine and/or alkylating agents. The use of high-dose chemotherapy supported by autologous stem-cell transplantation is increased; with some pros and cons, this strategy appears in controlling microscopic disease. Management of intraocular and meningeal lymphomas is controversial considering their peculiar characteristics that need to be specifically addressed. Finally, management of elderly patients and of relapsed disease is addressed.
Topics: Antineoplastic Combined Chemotherapy Protocols; Central Nervous System Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Lymphoma; Prognosis; Salvage Therapy
PubMed: 26371872
DOI: 10.1517/14656566.2015.1088828 -
FP Essentials Apr 2016Care of patients with HIV infection starts with diagnosis as soon as possible, preferably at or near the time of acute infection. Opportunistic infections, malignancies,... (Review)
Review
Care of patients with HIV infection starts with diagnosis as soon as possible, preferably at or near the time of acute infection. Opportunistic infections, malignancies, and other conditions develop progressively over time, particularly in untreated patients. The AIDS-defining opportunistic infections most common in the United States include Pneumocystis jirovecii pneumonia, Candida esophagitis, toxoplasmic encephalitis, tuberculosis, disseminated Mycobacterium avium complex, cryptococcal meningitis, and cytomegalovirus retinitis. Specific prophylaxis regimens exist for several opportunistic infections, and effective antiretroviral therapy reduces the risk of most others. Other AIDS-defining conditions include wasting syndrome and HIV encephalopathy. AIDS-defining malignancies include Kaposi sarcoma, systemic non-Hodgkin lymphoma, primary central nervous system lymphoma, and invasive cervical cancer. Although not an AIDS-defining condition, anal cancer is common in patients with HIV infection. Other HIV-related conditions include thrombocytopenia, recurrent bacterial respiratory infections, HIV-associated nephropathy, and HIV-associated neurocognitive disorder.
Topics: AIDS Dementia Complex; AIDS-Associated Nephropathy; AIDS-Related Opportunistic Infections; Anus Neoplasms; Candidiasis; Central Nervous System Neoplasms; Comorbidity; Cytomegalovirus Retinitis; Esophageal Diseases; Female; HIV Infections; Humans; Lymphoma; Lymphoma, Non-Hodgkin; Male; Mycobacterium avium-intracellulare Infection; Neoplasms; Pneumonia, Pneumocystis; Sarcoma, Kaposi; Thrombocytopenia; Toxoplasmosis, Cerebral; Tuberculosis; United States; Uterine Cervical Neoplasms
PubMed: 27092563
DOI: No ID Found -
Seminars in Ultrasound, CT, and MR Jun 2023Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin's lymphoma that accounts for 1%-5% of all central nervous system tumors.... (Review)
Review
Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin's lymphoma that accounts for 1%-5% of all central nervous system tumors. Contrast-enhanced MR is the imaging technique of choice. PCNLs have a predilection for the periventricular and superficial regions, often abutting the ventricular or meningeal surfaces. Although PCNLs may have characteristic imaging features on conventional MRI, none of these will unequivocally differentiate PCNSLs from other brain lesions. Diffusion restriction, relative hypoperfusion, increased choline/creatinine, decrease of N-acetyl aspartate (NAA) peak as well as the presence of lactate and lipid peaks are consistent advanced imaging findings in CNS lymphoma that may help in the differentiation of Primary central nervous system lymphomas (PCNSLs) from other malignancies. Furthermore, advanced imaging techniques will presumably play an important role in the planning of new targeted therapies, for prognostication, and for the monitoring of treatment response in the future.
Topics: Humans; Brain Neoplasms; Magnetic Resonance Imaging; Lactic Acid; Lymphoma
PubMed: 37245879
DOI: 10.1053/j.sult.2023.02.003 -
Cureus May 2023Kikuchi-Fujimoto disease (KFD) is an autoimmune condition that is more common in females and occurs in the third decade of life. The condition is usually benign and...
Kikuchi-Fujimoto disease (KFD) is an autoimmune condition that is more common in females and occurs in the third decade of life. The condition is usually benign and self-resolving and is characterized by fever, cervical lymphadenopathy, night sweats, myalgia, and rashes. The disease can be misdiagnosed as reactive follicular hyperplasia, tuberculous lymphadenitis, systemic lupus erythematosus, and malignant lymphoma. The diagnosis of KFD involves the excision of the affected lymph node. Although there is no specific treatment for the disease, usually symptomatic and supportive measures are effective; however, steroids and immunosuppressive therapies are considered in more severe cases. The disease lasts for around one to four months. The neurological complications include cerebellar ataxia, meningoencephalitis, and aseptic meningitis. Here, we describe the case of a 36-year-old male who presented with complaints of fever, malaise chills, anorexia, and fatigue associated with a tender right axillary lymph node. The patient underwent a biopsy which confirmed KFD and responded well to supportive therapy.
PubMed: 37332401
DOI: 10.7759/cureus.39098