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  • Chronic immunosuppression has been reported to

    2019-06-29

    Chronic immunosuppression has been reported to be linked with PEL [11]. Several patients with concomitant PEL and HIV infection were reported. Thus, a small portion of the elderly with immunosuppressive conditions may have a tendency to develop MALT lymphoma. Our elderly patient had no HIV infection, no medical history of recurrent infections, and no immunosuppressive condition, and thus some mechanism of localized NU 7026 including that with HP may be associated with the pathogenesis of esophageal MALT lymphoma.
    Conflict of interest
    Introduction Acute Myeloid Leukemia (AML) is a clinically, morphologically and genetically heterogeneous disease characterized by clonal expansion of myeloid blasts in peripheral bone marrow (BM), blood or other tissues [1]. The incidence of AML increases with age, particularly after 65 years old, and the median age at diagnosis is around 70 years [2]. Age in itself is one of the most powerful prognostic factors NU 7026 for survival in AML [3–5]. Elderly patients not only present more comorbidities and worse performance status [6] but also have more adverse molecular features compared to younger patients [7–9]. Due to the presence of comorbidities and poor performance status, intensive chemotherapy (IC) or allogeneic stem cell transplant is often unsuitable for a large proportion of elderly patients with AML, resulting in early mortality and prolonged hospitalization [5,10]. However, when feasible, treatment is associated with better survival when compared to best supportive care only but the median overall survival achieved with IC in the elderly is only 5–13 months [11,12]. Therefore, there is an increasing need for new treatment options for elderly patients with AML. The AZA-001 phase III trial has demonstrated effectiveness of azacitidine (AZA) in a dose of 75mg/m2 daily for 7 consecutive days in patients with high-risk myelodysplastic syndromes [13]. A subset analysis of the AZA-001 trial restricted to patients with 20–30% BM blasts [14], demonstrated superior efficacy of AZA when compared with conventional care regimens, leading to AZA international approval for the treatment of low BM blast count (20–30%) WHO-defined AML. These results raise the question of the potential use of AZA in AML irrespectively of the BM blast count. This is supported by the identification of somatic mutations of genes involved in epigenetic regulation in approximately 30% of AML patients [15]. Consequently several groups have assessed and reported the efficacy of AZA in patients with AML [16–19]. More recently a randomized phase III trial comparing first-line AZA to conventional therapies, including intensive chemotherapy, in elderly patients with AML revealed that AZA achieved clinically meaningful survival benefit compared to conventional treatments [20].
    Methods Responses were defined according to IWG criteria [21]. OS and PFS were estimated using the Kaplan-Meier method. Survival curves of the different treatment groups were compared using the log-rank test (univariate analysis). All tests were two-tailed and P-values less than 0.05 were considered to be statistically significant. All analyses were performed using R1[22].
    Results Table 1 shows the demographic and diagnostic data for the AZA and ICT treated cohorts. It is noteworthy that almost half the population treated with AZA had secondary AML and that one fifth had high risk cytogenetics. Of the patients treated with AZA in ≥2nd line, 4 had <5% blasts at the time of AZA start and were deemed unfit for consolidation chemotherapy. A further five had 5–20% blasts with dysplastic features after induction. Treatment details are shown in Table 2. All patients received the standard AZA regimen (75mg/m2 1–7) except for 35 patients treated at IPOFGL, who received 100mg/m2 1–5 [23]. AZA was used as first line therapy in 51 (66%) of patients. All those who were treated in second line had received IC as first line treatment and had refractory or relapsed disease. All patients were treated with AZA until progression or death with no limit to. the number of cycles.