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  • Correspondence

    To the Editor: Hairy-cell leukemia (HCL) is a mature B-cell lymphoid cancer that is commonly treated with purine analogues. Virtually all patients with HCL carry the BRAF V600E mutation, which constitutively activates the MEK–ERK pathway and which can be inhibited in vitro by the mutation…

    • May 24, 2012
    • N Engl J Med 2012; 366:2038-2040
    • Free Full Text

    The authors report a dramatic response to vemurafenib in a patient with hairy-cell leukemia refractory to nucleosides and rituximab.

  • Clinical Therapeutics

    Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…

    • May 24, 2012
    • Maloney D.G.
    • N Engl J Med 2012; 366:2008-2016

      A 62-year-old man receives a diagnosis of diffuse large B-cell lymphoma; treatment with a regimen including the anti-CD20 antibody rituximab is recommended. Rituximab has been shown to improve progression-free survival when added to standard chemotherapy regimens for lymphoma.

    • Original Article

      T-cell large granular lymphocytic leukemia was initially described as a clonal disorder of large granular lymphocytes involving blood, bone marrow, spleen, and liver. This disorder is characterized by the presence of abnormal CD3+CD8+CD57+ lymphocytes corresponding to activated effector cytotoxic T…

      • May 17, 2012
      • Koskela H.L.M., Eldfors S., Ellonen P., et al.
      • N Engl J Med 2012; 366:1905-1913

        T-cell large granular lymphocytic leukemia, a rare clonal cancer with indolent growth characteristics, is often associated with autoimmune disease and neutropenia. According to an international group of collaborators, 40% of patients have somatic mutations that activate STAT3.

      • Images in Clinical Medicine

        Figure 1.

        • April 19, 2012
        • Hajdarbegovic E. and Balak D.
        • N Engl J Med 2012; 366:1526
        • Free Full Text

        A 59-year-old man presented with a weeping mole on his back that had been growing for 8 years. On examination, a 10-cm ulcerated lesion was found on his lower back, and multiple subcutaneous areas of swelling were found in both inguinal regions.

      • Editorial

        Approximately 80% of children with acute lymphoblastic leukemia (ALL) are now cured, with estimates that contemporary treatment may further increase the cure rate to near 90%. Yet this figure is deceptive; for those children with unfavorable features, defined either by disease biology or by…

        • April 12, 2012
        • Rabin K.R.
        • N Engl J Med 2012; 366:1445-1446

          Approximately 80% of children with acute lymphoblastic leukemia (ALL) are now cured, with estimates that contemporary treatment may further increase the cure rate to near 90%.1 Yet this figure is deceptive; for those children with unfavorable features, ...

        • Original Article

          Current treatment for acute lymphoblastic leukemia (ALL) can effect a cure in approximately 80% of children with the disease.– The leading cause of treatment failure is relapse, for which a number of risk factors have been identified, with inadequate therapy being one of the most important.– A…

          • April 12, 2012
          • Schrappe M., Hunger S.P., Pui C.-H., et al.
          • N Engl J Med 2012; 366:1371-1381

            Induction chemotherapy fails to induce a complete remission in only about 2 to 3% of children with ALL. In an analysis of more than 1000 such patients, the authors defined subgroups with a favorable prognosis and those with an unfavorable prognosis.

          • Editorial

            For years, scientists have postulated the evolution of a cancer as a series of acquired mutations and epigenetic alterations that accumulate in a progressive way, beginning with a single transformed cell. Within this process, subclones of cells develop that acquire new properties, giving cells…

            • March 22, 2012
            • Godley L.A.
            • N Engl J Med 2012; 366:1152-1153

              For years, scientists have postulated the evolution of a cancer as a series of acquired mutations and epigenetic alterations that accumulate in a progressive way, beginning with a single transformed cell. Within this process, subclones of cells develop ...

            • Original Article

              Previous studies have highlighted the clinical and biologic heterogeneity of acute myeloid leukemia (AML).– However, a relatively small number of cytogenetic and molecular lesions have sufficient relevance to influence clinical practice. The prognostic relevance of cytogenetic abnormalities has…

              • March 22, 2012
              • Patel J.P., Gönen M., Figueroa M.E., et al.
              • N Engl J Med 2012; 366:1079-1089

                Malignant cells in most patients with acute myeloid leukemia have mutations. Cytogenetic classification yields some prognostic information, but the intermediate-risk group is heterogeneous. Mutational analysis identifies intermediate-risk patients who may benefit from high-dose therapy.

              • Original Article

                The myelodysplastic syndromes, a heterogeneous group of diseases characterized by ineffective hematopoiesis, are the most common cause of acquired bone marrow failure in adults. Secondary acute myeloid leukemia (AML) develops in approximately one third of persons with myelodysplastic syndromes.…

                • March 22, 2012
                • Walter M.J., Shen D., Ding L., et al.
                • N Engl J Med 2012; 366:1090-1098

                  Whole-genome sequencing of samples from seven subjects with secondary acute myeloid leukemia identified somatic mutations. These data, together with genotype analysis of the antecedent myelodysplastic syndromes (MDS), revealed the clonal evolution of MDS and secondary AML.

                • Clinical Implications of Basic Research

                  Occasionally, two research disciplines converge at precisely the right moment and propel each other forward. Such is the case with a screen for growth regulators in acute myeloid leukemia and a small molecule synthesized to disrupt protein recognition of the histone code, recently reported by Zuber…

                  • March 8, 2012
                  • Godley L.A. and Le Beau M.M.
                  • N Engl J Med 2012; 366:960-961

                    The protein BRD4 binds acetylated histones (mediators of chromatin structure), which, when bound, can activate the MYC oncogene. A recent study implicated BRD4 in sustaining cells in AML. Treating these cells with a BRD4 inhibitor reduced MYC expression and elicited cell death.

                  • Original Article

                    Twenty years ago, the standard strategy in the case of patients with stage IA or IIA nonbulky Hodgkin's lymphoma included staging by means of laparotomy and subtotal nodal radiation therapy. With this treatment, 70 to 80% of patients were cured, but they remained at risk for premature death from…

                    • February 2, 2012
                    • Meyer R.M., Gospodarowicz M.K., Connors J.M., et al.
                    • N Engl J Med 2012; 366:399-408
                    • CME

                    In patients with limited-stage Hodgkin's disease, ABVD chemotherapy alone resulted in a higher rate of long-term (12-year) survival than either radiation therapy alone or radiation therapy plus ABVD chemotherapy, with significantly fewer late treatment-related deaths.

                  • Editorial

                    Extensive radiation therapy was the first therapeutic advance in the treatment of early-stage Hodgkin's lymphoma. More recently, less extensive radiation therapy in combination with chemotherapy has resulted in the lowest reported rates of early relapse. The HD10 trial (ClinicalTrials.gov number,…

                    • February 2, 2012
                    • Straus D.J.
                    • N Engl J Med 2012; 366:470-471

                      Extensive radiation therapy was the first therapeutic advance in the treatment of early-stage Hodgkin's lymphoma. More recently, less extensive radiation therapy in combination with chemotherapy has resulted in the lowest reported rates of early relapse. ...

                    • Correspondence

                      To the Editor: Despite the poor prognosis of T-cell lymphomas, the genetic basis of these cancers is poorly defined. We have found acquired TET2 mutations in both human myeloid cancers and T-cell lymphoma. TET proteins are involved in the epigenetic control of transcription, at least through the…

                      • January 5, 2012
                      • N Engl J Med 2012; 366:95-96
                      • Free Full Text

                      A substantial fraction of T-cell lymphomas carry mutations in two genes — TET2 and DNMT3A — that are involved in DNA methylation. The co-occurrence of these mutations suggests that inhibitors of DNA methylation could possibly have antitumor effects in such patients.

                    • Editorial

                      Massively parallel sequencing of cancer genomes is revealing a panoramic view of the genetic drivers of human neoplasms. In this issue of the Journal, Wang et al. describe an analysis of the coding sequences of samples from 91 patients with chronic lymphocytic leukemia. The disease is characterized…

                      • December 29, 2011
                      • Ebert B. and Bernard O.A.
                      • N Engl J Med 2011; 365:2534-2535

                        Massively parallel sequencing of cancer genomes is revealing a panoramic view of the genetic drivers of human neoplasms. In this issue of the Journal, Wang et al.1 describe an analysis of the coding sequences of samples from 91 patients with chronic ...

                      • Original Article

                        Chronic lymphocytic leukemia is an incurable disease characterized by extensive clinical heterogeneity despite a common diagnostic immunophenotype (surface expression of CD19+, CD20+dim, CD5+, CD23+, and sIgMdim). Whereas the course of disease is indolent in some patients, it is steadily…

                        • December 29, 2011
                        • Wang L., Lawrence M.S., Wan Y., et al.
                        • N Engl J Med 2011; 365:2497-2506

                          CLL is a heterogeneous disease with a variable clinical course and response to therapy. New genetic lesions have been noted in subgroups of patients through whole-exome and whole-genome sequencing. An abnormality in RNA splicing has been found in 15% of patients.

                        • Perspective

                          Richard Feynman, the eminent physicist, once said that "great ideas . . . do not last unless they are passed purposely and clearly from generation to generation." In 1979, Horace Freeland Judson, in his magnificent The Eighth Day of Creation, passed to his generation the great ideas of molecular…

                          • December 22, 2011
                          • Schwartz R.
                          • N Engl J Med 2011; 365:2353-2355
                          • Audio

                          In his Pulitzer Prize–winning book, Siddhartha Mukherjee explores the great ideas of oncology, up to the development of imatinib. But the research direction set by imatinib has yielded few useful drugs; its model seems to be the wrong roadmap for finding magic bullets.

                        • Correspondence

                          To the Editor: In December 2010, results from three randomized, phase 3 trials of treatments for multiple myeloma showed an excess of hematologic cancers among patients with multiple myeloma who received lenalidomide maintenance therapy (see Table 1 in the Supplementary Appendix, available with the…

                          • December 8, 2011
                          • N Engl J Med 2011; 365:2241-2242
                          • Free Full Text

                          Acute leukemia after myeloma has been attributed to exposure to alkylating agents. However, leukemia is now being seen in patients receiving lenalidomide maintenance therapy. Patients with monoclonal gammopathy of undetermined significance also have an increased risk of leukemia without ever being treated.

                        • Editorial

                          The therapeutic use of cells from healthy donors or patients is increasing. Decades ago, transfusion medicine and bone marrow transplantation provided the first successful cell therapeutics and established the foundations for cell delivery. Clinical investigation soon uncovered the double-edged…

                          • November 3, 2011
                          • Sadelain M.
                          • N Engl J Med 2011; 365:1735-1737

                            The therapeutic use of cells from healthy donors or patients is increasing. Decades ago, transfusion medicine and bone marrow transplantation provided the first successful cell therapeutics and established the foundations for cell delivery. Clinical ...

                          • Original Article

                            Although cellular therapies may be effective in cancer treatment, their potential for expansion, damage of normal organs,– and malignant transformation is a source of concern. In contrast, the toxic effects of small molecules usually diminish once the drugs are withdrawn. One approach to…

                            • November 3, 2011
                            • Di Stasi A., Tey S.-K., Dotti G., et al.
                            • N Engl J Med 2011; 365:1673-1683
                            • Free Full Text

                            The introduction of a transgene into human donor T cells that can kill the cells when dimerization is induced by a pharmacologic agent has improved prospects for the exploitation of T-cell graft-versus-tumor effects while controlling graft-versus-host disease.

                          • Clinical Practice

                            Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 26-year-old…

                            • October 13, 2011
                            • Diller L.
                            • N Engl J Med 2011; 365:1417-1424
                            • CME
                            • Full Text Audio

                            This article provides guidance for care of adult survivors of childhood acute lymphoblastic leukemia, the most common childhood cancer. Treatments are associated with increased late risks of several other conditions; surveillance and patient education strategies are reviewed.

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                          Medical Meetings Pediatrics Conferences and Meetings

                          2012 Certifying Examinations of the American Board of Pediatrics

                          The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

                          Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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