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  1. Article: Managing acute myeloid leukemia in the elderly.

    Melchert, Magda

    Oncology (Williston Park, N.Y.)

    2006  Volume 20, Issue 13, Page(s) 1674–82; discussion 1683–4, 1687

    Abstract: Acute myeloid leukemia (AML) is a disease of the elderly, with the majority of patients diagnosed in their 6th and 7th decade of life. Older patients with AML are less likely to achieve complete remission after induction chemotherapy, and they suffer ... ...

    Abstract Acute myeloid leukemia (AML) is a disease of the elderly, with the majority of patients diagnosed in their 6th and 7th decade of life. Older patients with AML are less likely to achieve complete remission after induction chemotherapy, and they suffer from higher rates of leukemia relapse compared to younger cohorts. Suboptimal outcomes are the result of adverse biologic characteristics of leukemia in the elderly, as well as the presence of medical comorbidities and patient or physician preferences as to initiating treatment. In addition, there is a distinct lack of randomized, prospective data to guide management decisions for the treatment of AML in the elderly. Patients who are over age 75, with poor performance status, multiple comorbidities, or poor prognostic features, should be considered for a clinical trial or palliative therapy. Elderly patients who are candidates for standard induction chemotherapy and achieve complete remission are unlikely to benefit from intensive postremission therapy and should be referred to a clinical trial when possible. Further prospective trials are needed to identify a tolerable, effective treatment regimen for older patients with AML.
    MeSH term(s) Acute Disease ; Age Factors ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Clinical Trials as Topic ; Humans ; Karyotyping ; Leukemia, Myeloid/drug therapy ; Leukemia, Myeloid/genetics ; Leukemia, Myeloid/pathology ; Prognosis ; Treatment Outcome
    Language English
    Publishing date 2006-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1067950-9
    ISSN 0890-9091
    ISSN 0890-9091
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Targeted therapies in myelodysplastic syndrome.

    Melchert, Magda / List, Alan

    Seminars in hematology

    2008  Volume 45, Issue 1, Page(s) 31–38

    Abstract: Therapeutic alternatives for patients with myelodysplastic syndrome (MDS) have expanded in recent years but remain limited. While agents approved by the US Food and Drug Administration (FDA), including azacitidine, decitabine, and lenalidomide, have ... ...

    Abstract Therapeutic alternatives for patients with myelodysplastic syndrome (MDS) have expanded in recent years but remain limited. While agents approved by the US Food and Drug Administration (FDA), including azacitidine, decitabine, and lenalidomide, have yielded hematologic and cytogenetic responses in a substantial portion of patients, these therapies are not curative. Active investigation of novel targets with biological relevance in myelopoiesis has stimulated the pharmacologic development of a multitude of agents that show promise in the treatment of MDS. Many of these drugs have entered or completed early phase clinical testing in MDS and include immunomodulatory agents, immunosuppressive therapies, survival signal inhibitors, thrombopoiesis-stimulating agents, pharmacologic differentiators, and anti-angiogenic and apoptotic agents. As we continue to collect clinical experience with these agents, the repertoire of available therapeutics for the treatment of MDS will expand and provide a foundation for novel therapeutic combinations.
    MeSH term(s) Angiogenesis Inhibitors/therapeutic use ; Apoptosis/drug effects ; Cytokines/immunology ; Cytokines/metabolism ; Enzyme Inhibitors/therapeutic use ; Farnesyltranstransferase/antagonists & inhibitors ; Growth Inhibitors/therapeutic use ; Humans ; Immunologic Factors/therapeutic use ; Immunosuppressive Agents/therapeutic use ; Myelodysplastic Syndromes/drug therapy ; Myelodysplastic Syndromes/immunology ; Receptors, Thrombopoietin/agonists ; Receptors, Thrombopoietin/metabolism ; Thrombopoiesis/drug effects
    Chemical Substances Angiogenesis Inhibitors ; Cytokines ; Enzyme Inhibitors ; Growth Inhibitors ; Immunologic Factors ; Immunosuppressive Agents ; Receptors, Thrombopoietin ; Farnesyltranstransferase (EC 2.5.1.29)
    Language English
    Publishing date 2008-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 206923-4
    ISSN 1532-8686 ; 0037-1963
    ISSN (online) 1532-8686
    ISSN 0037-1963
    DOI 10.1053/j.seminhematol.2007.10.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Management of RBC-transfusion dependence.

    Melchert, Magda / List, Alan F

    Hematology. American Society of Hematology. Education Program

    2007  , Page(s) 398–404

    Abstract: Strategies for the management of anemia in patients with myelodysplastic syndrome (MDS) have evolved following the U.S. Food and Drug Administration (FDA) approval of three new therapeutics from one of symptom amelioration with red blood cell (RBC) ... ...

    Abstract Strategies for the management of anemia in patients with myelodysplastic syndrome (MDS) have evolved following the U.S. Food and Drug Administration (FDA) approval of three new therapeutics from one of symptom amelioration with red blood cell (RBC) transfusions to one of active treatment. Most patients develop transfusion-dependent anemia over the course of their disease, however, and its adverse consequence on the natural history of disease has only recently been appreciated. Although severe anemia contributes to symptoms of fatigue and reduced quality of life, transfusion dependence increases the risk of organ complications from iron overload coupled with an increased risk of leukemia transformation. Among World Health Organization categories without elevation in bone marrow myeloblasts, an incremental rise in RBC transfusion burden is associated with a proportionate reduction in both overall survival and leukemia-free survival, implying that anemia severity is an important variable limiting the otherwise favorable natural history of patients with lower risk disease. Moreover, therapeutic strategies that successfully restore effective erythropoiesis, such as erythropoetic stimulating agents, immunomodulatory agents, immunosuppressive therapies, or hypomethylating agents, may favorably affect the natural history of this disease, creating perhaps a new urgency for the initiation of erythropoietic promoters that have durable clinical benefit. Selection of primary therapy for the management of anemia should consider four response determinants: age, RBC transfusion burden and duration, endogenous erythropoietin production, and karyotype.
    MeSH term(s) Anemia/etiology ; Anemia/therapy ; Erythrocyte Transfusion ; Humans ; Myelodysplastic Syndromes/complications ; Prognosis ; United States ; United States Food and Drug Administration
    Language English
    Publishing date 2007
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 1520-4391
    ISSN 1520-4391
    DOI 10.1182/asheducation-2007.1.398
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: The thalidomide saga.

    Melchert, Magda / List, Alan

    The international journal of biochemistry & cell biology

    2007  Volume 39, Issue 7-8, Page(s) 1489–1499

    Abstract: Over the past 50 years, thalidomide has been a target of active investigation in both malignant and inflammatory conditions. Although initially developed for its sedative properties, decades of investigation have identified a multitude of biological ... ...

    Abstract Over the past 50 years, thalidomide has been a target of active investigation in both malignant and inflammatory conditions. Although initially developed for its sedative properties, decades of investigation have identified a multitude of biological effects that led to its classification as an immunomodulatory drug (IMiD). In addition to suppression of tumor necrosis factor-alpha (TNF-alpha), thalidomide effects the generation and elaboration of a cascade of pro-inflammatory cytokines that activate cytotoxic T-cells even in the absence of co-stimulatory signals. Furthermore, vascular endothelial growth factor (VEGF) and beta fibroblast growth factor (bFGF) secretion and cellular response are suppressed by thalidomide, thus antagonizing neoangiogenesis and altering the bone marrow stromal microenvironment in hematologic malignancies. The thalidomide analogs, lenalidomide (CC-5013; Revlimid) and CC-4047 (Actimid), have enhanced potency as inhibitors of TNF-alpha and other inflammatory cytokines, as well as greater capacity to promote T-cell activation and suppress angiogenesis. Both thalidomide and lenalidomide are effective in the treatment of multiple myeloma and myelodysplastic syndromes for which the Food and Drug Administration granted recent approval. Nonetheless, each of these IMiDs remains the subject of active investigation in solid tumors, hematologic malignancies, and other inflammatory conditions. This review will explore the pharmacokinetic and biologic effects of thalidomide and its progeny compounds.
    MeSH term(s) Antineoplastic Agents/pharmacology ; Antineoplastic Agents/therapeutic use ; Cytokines/secretion ; Fibroblast Growth Factor 2/metabolism ; Humans ; Immunosuppressive Agents/pharmacology ; Immunosuppressive Agents/therapeutic use ; Lymphocyte Activation/drug effects ; Multiple Myeloma/drug therapy ; Myelodysplastic Syndromes/drug therapy ; Neovascularization, Pathologic/drug therapy ; Neovascularization, Pathologic/metabolism ; T-Lymphocytes/drug effects ; T-Lymphocytes/physiology ; Thalidomide/analogs & derivatives ; Thalidomide/pharmacology ; Thalidomide/therapeutic use ; Tumor Necrosis Factor-alpha/metabolism ; Vascular Endothelial Growth Factor A/metabolism
    Chemical Substances Antineoplastic Agents ; Cytokines ; Immunosuppressive Agents ; Tumor Necrosis Factor-alpha ; Vascular Endothelial Growth Factor A ; Fibroblast Growth Factor 2 (103107-01-3) ; Thalidomide (4Z8R6ORS6L)
    Language English
    Publishing date 2007
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 1228429-4
    ISSN 1878-5875 ; 1357-2725
    ISSN (online) 1878-5875
    ISSN 1357-2725
    DOI 10.1016/j.biocel.2007.01.022
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: A multicenter, phase II study of maintenance azacitidine in older patients with acute myeloid leukemia in complete remission after induction chemotherapy.

    Griffin, Patrick T / Komrokji, Rami S / De Castro, Carlos M / Rizzieri, David A / Melchert, Magda / List, Alan F / Lancet, Jeffrey E

    American journal of hematology

    2015  Volume 90, Issue 9, Page(s) 796–799

    Abstract: Older patients with acute myeloid leukemia (AML) have poor outcomes, with median durations of complete remission lasting less than 1 year. Increased toxicity in older patients limits the delivery of standard consolidation therapies, such as allogeneic ... ...

    Abstract Older patients with acute myeloid leukemia (AML) have poor outcomes, with median durations of complete remission lasting less than 1 year. Increased toxicity in older patients limits the delivery of standard consolidation therapies, such as allogeneic stem cell transplant or high-dose cytarabine. Azacitidine, a nucleoside analog/DNA methyltransferase inhibitor, has demonstrated significant activity and favorable tolerability in patients unable to tolerate intensive induction chemotherapy; however, the role of azacitidine in the maintenance setting has not been fully evaluated. We undertook a pilot study of low-dose subcutaneous azacitidine [50 mg/(m(2) day)] for 5 days every 4 weeks) in AML patients ≥60 years of age in first remission following standard induction therapy. The primary objective was to determine the 1-year disease-free survival (DFS); secondary objectives were to determine safety and tolerability. We enrolled 24 patients (median age 68, range 62-81 years), the majority of whom received anthracycline-cytarabine induction regimens. From the time of first complete remission, the estimated 1-year DFS was 50% and the median overall survival was 20.4 months. Thrombocytopenia and neutropenia were the most common grade 3/4 toxicities (50 and 58%, respectively). In our study population, maintenance therapy with subcutaneous azacitidine was safe and well tolerated.
    MeSH term(s) Aged ; Aged, 80 and over ; Anthracyclines/therapeutic use ; Antimetabolites, Antineoplastic/administration & dosage ; Antimetabolites, Antineoplastic/adverse effects ; Azacitidine/administration & dosage ; Azacitidine/adverse effects ; Cytarabine/therapeutic use ; Female ; Humans ; Induction Chemotherapy/methods ; Injections, Subcutaneous ; Leukemia, Myeloid, Acute/drug therapy ; Leukemia, Myeloid, Acute/mortality ; Leukemia, Myeloid, Acute/pathology ; Male ; Middle Aged ; Neutropenia/chemically induced ; Neutropenia/pathology ; Pilot Projects ; Remission Induction ; Survival Analysis ; Thrombocytopenia/chemically induced ; Thrombocytopenia/pathology
    Chemical Substances Anthracyclines ; Antimetabolites, Antineoplastic ; Cytarabine (04079A1RDZ) ; Azacitidine (M801H13NRU)
    Language English
    Publishing date 2015-09
    Publishing country United States
    Document type Clinical Trial, Phase II ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 196767-8
    ISSN 1096-8652 ; 0361-8609
    ISSN (online) 1096-8652
    ISSN 0361-8609
    DOI 10.1002/ajh.24087
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: The role of lenalidomide in the treatment of patients with chromosome 5q deletion and other myelodysplastic syndromes.

    Melchert, Magda / Kale, Vishakha / List, Alan

    Current opinion in hematology

    2007  Volume 14, Issue 2, Page(s) 123–129

    Abstract: Purpose of review: The aim of this article is to discuss the relevant pathobiologic effects of lenalidomide and the most recent clinical evidence to support its use in patients with myelodysplastic syndrome.: Recent findings: Lenalidomide is an ... ...

    Abstract Purpose of review: The aim of this article is to discuss the relevant pathobiologic effects of lenalidomide and the most recent clinical evidence to support its use in patients with myelodysplastic syndrome.
    Recent findings: Lenalidomide is an immunomodulatory agent with biological activity in several hematologic malignancies, including myelodysplastic syndrome. The precise mechanism yielding benefit in patients with myelodysplastic syndrome and 5q- syndrome is not clear, but various molecular and pathogenic targets have been identified. Enhancement of cellular immunity through T-cell and NK-cell activation and suppression of inflammatory cytokines and pro-angiogenic peptides upon lenalidomide treatment has been demonstrated in in-vitro models of myelodysplastic syndrome. Furthermore, lenalidomide induces a direct cytotoxic effect against 5q- clones in leukemia cell lines and enhances ligand-induced erythropoietin receptor signaling in erythroid progenitors. Clinical trials with lenalidomide in myelodysplastic syndrome have supported the in-vitro evidence of karyotype-dependent activity by demonstration of a high frequency of cytogenetic and pathologic responses in patients with myelodysplastic syndrome and deletion of chromosome 5q. Lenalidomide was approved for the treatment of transfusion-dependent patients with low to intermediate risk myelodysplastic syndrome and chromosome 5q deletion.
    Summary: Lenalidomide is an active immunomodulatory agent for the treatment of myelodysplastic syndrome with encouraging erythropoetic and cytogenetic remitting activity that is karyotype dependent.
    MeSH term(s) Chromosome Deletion ; Chromosomes, Human, Pair 5 ; Humans ; Myelodysplastic Syndromes/drug therapy ; Myelodysplastic Syndromes/genetics ; Thalidomide/analogs & derivatives ; Thalidomide/pharmacology ; Thalidomide/therapeutic use
    Chemical Substances Thalidomide (4Z8R6ORS6L) ; lenalidomide (F0P408N6V4)
    Language English
    Publishing date 2007-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1153887-9
    ISSN 1531-7048 ; 1065-6251
    ISSN (online) 1531-7048
    ISSN 1065-6251
    DOI 10.1097/MOH.0b013e328016847a
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Phase 1 multicenter dose-escalation study of ezatiostat hydrochloride (TLK199 tablets), a novel glutathione analog prodrug, in patients with myelodysplastic syndrome.

    Raza, Azra / Galili, Naomi / Smith, Scott / Godwin, John / Lancet, Jeffrey / Melchert, Magda / Jones, Marsha / Keck, James G / Meng, Lisa / Brown, Gail L / List, Alan

    Blood

    2009  Volume 113, Issue 26, Page(s) 6533–6540

    Abstract: Phase 1 testing of ezatiostat, a glutathione S-transferase P1-1 inhibitor, for the treatment of myelodysplastic syndrome was conducted in a multidose-escalation study. Patients received 10 dose levels (200, 400, 1000, 1400, 2000, 2400, 3000, 4000, 5000, ... ...

    Abstract Phase 1 testing of ezatiostat, a glutathione S-transferase P1-1 inhibitor, for the treatment of myelodysplastic syndrome was conducted in a multidose-escalation study. Patients received 10 dose levels (200, 400, 1000, 1400, 2000, 2400, 3000, 4000, 5000, and 6000 mg) of ezatiostat tablets in divided doses on days 1 to 7 of a 21-day cycle for a maximum of 8 cycles. The safety and pharmacokinetics of ezatiostat were evaluated. Forty-five patients with low to intermediate-2 International Prognostic Scoring System risk myelodysplastic syndrome were enrolled. No dose-limiting toxicities were observed. The most common grade 1 or 2, respectively, treatment-related adverse events were nonhematologic: nausea (56%, 9%), diarrhea (36%, 7%), vomiting (24%, 7%), abdominal pain (9%, 0%), constipation (4%, 9%), anorexia (3%, 7%), and dyspepsia (3%, 7%). Concentration of the primary active metabolite, TLK236, increased proportionate to ezatiostat dosage. Seventeen hematologic improvement (HI) responses by International Working Group criteria were observed at dose levels of 200 to 6000 mg/day with 11 HI responses at doses of 4000 to 6000 mg/day. HI responses occurred in all lineages including 3 bilineage and 1 complete cytogenetic response. Decreased number of red blood cell and platelet transfusions and in some cases transfusion independence were attained. Extended dose schedules of ezatiostat tablets are under investigation.
    MeSH term(s) Abdominal Pain/chemically induced ; Aged ; Aged, 80 and over ; Biotransformation ; Dose-Response Relationship, Drug ; Female ; Fever/chemically induced ; Food-Drug Interactions ; Gastrointestinal Diseases/chemically induced ; Glutathione/administration & dosage ; Glutathione/adverse effects ; Glutathione/analogs & derivatives ; Glutathione/pharmacokinetics ; Glutathione/therapeutic use ; Humans ; Male ; Maximum Tolerated Dose ; Middle Aged ; Myelodysplastic Syndromes/drug therapy ; Neutropenia/chemically induced ; Prodrugs/administration & dosage ; Prodrugs/adverse effects ; Prodrugs/pharmacokinetics ; Prodrugs/therapeutic use ; Tablets
    Chemical Substances Prodrugs ; TLK-236 ; Tablets ; gamma-Glu-S-BzCys-PhGly diethyl ester ; Glutathione (GAN16C9B8O)
    Language English
    Publishing date 2009-04-27
    Publishing country United States
    Document type Clinical Trial, Phase I ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 80069-7
    ISSN 1528-0020 ; 0006-4971
    ISSN (online) 1528-0020
    ISSN 0006-4971
    DOI 10.1182/blood-2009-01-176032
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Intranasal insulin suppresses food intake via enhancement of brain energy levels in humans.

    Jauch-Chara, Kamila / Friedrich, Alexia / Rezmer, Magdalena / Melchert, Uwe H / G Scholand-Engler, Harald / Hallschmid, Manfred / Oltmanns, Kerstin M

    Diabetes

    2012  Volume 61, Issue 9, Page(s) 2261–2268

    Abstract: Cerebral insulin exerts anorexic effects in humans and animals. The underlying mechanisms, however, are not clear. Because insulin physiologically facilitates glucose uptake by most tissues of the body and thereby fosters intracellular energy supply, we ... ...

    Abstract Cerebral insulin exerts anorexic effects in humans and animals. The underlying mechanisms, however, are not clear. Because insulin physiologically facilitates glucose uptake by most tissues of the body and thereby fosters intracellular energy supply, we hypothesized that intranasal insulin reduces food consumption via enhancement of the neuroenergetic level. In a double-blind, placebo-controlled, within-subject comparison, 15 healthy men (BMI 22.2 ± 0.37 kg/m(2)) aged 22-28 years were intranasally administered insulin (40 IU) or placebo after an overnight fast. Cerebral energy metabolism was assessed by (31)P magnetic resonance spectroscopy. At 100 min after spray administration, participants consumed ad libitum from a test buffet. Our data show that intranasal insulin increases brain energy (i.e., adenosine triphosphate and phosphocreatine levels). Cerebral energy content correlates inversely with subsequent calorie intake in the control condition. Moreover, the neuroenergetic rise upon insulin administration correlates with the consecutive reduction in free-choice calorie consumption. Brain energy levels may therefore constitute a predictive value for food intake. Given that the brain synchronizes food intake behavior in dependence of its current energetic status, a future challenge in obesity treatment may be to therapeutically influence cerebral energy homeostasis. Intranasal insulin, after optimizing its application schema, seems a promising option in this regard.
    MeSH term(s) Administration, Intranasal ; Adult ; Blood Glucose/metabolism ; Brain/drug effects ; Brain/metabolism ; Cross-Over Studies ; Double-Blind Method ; Eating/drug effects ; Energy Intake/drug effects ; Energy Metabolism/drug effects ; Humans ; Insulin/administration & dosage ; Magnetic Resonance Spectroscopy ; Male
    Chemical Substances Blood Glucose ; Insulin
    Language English
    Publishing date 2012-05-14
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 80085-5
    ISSN 1939-327X ; 0012-1797
    ISSN (online) 1939-327X
    ISSN 0012-1797
    DOI 10.2337/db12-0025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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