Single-Fraction Radiotherapy for Palliation of Myelofibrosis-Related Extremity Pain Syndrome

Cox, John A.; Sevak, Parag; Grumbles, Loretta L.; Swanson, Todd A.; Hatch, Sandra S.

doi:10.1016/j.jpainsymman.2013.09.008

Cited by 2 publications

(1 citation statement)

References 32 publications

(12 reference statements)

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“…There is a report of cytarabine syndrome during continuous injection of low-dose cytarabine (20 mg/m 2 /day), but bone pain was not observed [18]. Primary and secondary myelofibrosis accompanies progressive bone pain in extremities due to extramedullary hematopoiesis [19]. In our case, bone pain occurred on day 18 of induction therapy with ATRA, on days 7–10 of the first consolidation therapy, and days 4–12 of the second consolidation therapy with a relatively small amount of cytarabine by continuous injection.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia

Inagawa

Komeno

Saitô

et al. 2019

Case Reports in Hematology

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A 34-year-old woman was diagnosed with acute promyelocytic leukemia. Chemotherapy was administered following the JALSG APL204 protocol. Induction therapy with all-trans retinoic acid resulted in complete remission on day 49. She developed coccygeal pain from day 18, which spread to the spine and cheekbones and lasted 5 weeks. She had similar bone pain on days 7–10 of the first consolidation therapy and on days 4–12 of the second consolidation therapy. Oral loxoprofen was prescribed for pain relief. On day 33 of the third consolidation, white blood cell and neutrophil counts were 320/μL and 20/μL, respectively. After she developed epigastralgia and hematemesis, she developed septic shock. Gastroendoscopy revealed markedly thickened folds and diffusely damaged mucosa with blood oozing. Computed tomography revealed thickened walls of the antrum and the pylorus. Despite emergency treatments, she died. Bacterial culture of the gastric fluid yielded Enterobacter cloacae and enterococci growth. Collectively, she was diagnosed with phlegmonous gastritis. Retrospective examination of serial bone marrow biopsy specimens demonstrated progressive bone marrow fibrosis, which may have caused prolonged myelosuppression. Thus, evaluation of bone marrow fibrosis by bone marrow biopsy after each treatment cycle might serve as a predictor of persistent myelosuppression induced by chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia

Inagawa

Komeno

Saitô

et al. 2019

Case Reports in Hematology

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Reducing symptom burden in patients with myeloproliferative neoplasms in the era of Janus kinase inhibitors

Mesa

Scherber

Geyer

2015

Leukemia & Lymphoma

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Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) are clonal stem cell-derived malignancies that include primary myelofibrosis, polycythemia vera and essential thrombocythemia and are characterized by dysregulated Janus kinase-signal transducers and activators of transcription (JAK-STAT) signaling. Clinical manifestations include splenomegaly, cytopenias and/or systemic inflammation. Patients have a heterogeneous symptom profile that includes fatigue, loss of appetite, pruritus and night sweats, which significantly impact quality of life (QoL) and lead to poor survival outcomes. With the introduction of JAK inhibitors, improvement in disease-related symptoms has emerged as a realistic expectation of therapy and an integral measure of clinical efficacy. The JAK1/JAK2 inhibitor ruxolitinib is approved for the treatment of myelofibrosis and is currently under clinical development for polycythemia vera. Ruxolitinib has demonstrated significant reductions in symptom burden, with consequent improvements in QoL measures. With the potential to improve QoL, recognition of the impact and burden of symptoms on patients with MPNs is critical.

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Single-Fraction Radiotherapy for Palliation of Myelofibrosis-Related Extremity Pain Syndrome

Cited by 2 publications

References 32 publications

Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia

Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia

Reducing symptom burden in patients with myeloproliferative neoplasms in the era of Janus kinase inhibitors

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