Recent advances and novel agents for FLT3 mutated acute myeloid leukemia.

Acute myeloid leukemia (AML) is a devastating hematologic malignancy that affects both older adults as well as children. Treatments available for AML largely depend on cytotoxic agents and often the only curative option is an allogeneic bone marrow transplant, an option limited to young persons and associated with high morbidity and mortality. There is an urgent need for the identification of new myeloid targets and an understanding of the key genetic mutations involved in disease progression and prognosis. One such mutation is the internal tandem duplication (ITD) in the FMS-like tyrosine kinase receptor-3 (FLT3) gene which confers an inferior outcome that is attributed to a higher relapse rate. In this review, we evaluate the FLT3-ITD mutation and discuss the recent data regarding emerging approaches using FLT3 inhibitors for the treatment of AML.

Use of conjugated estrogens in life-threatening gastrointestinal bleeding in hemodialysis patients--a review.

Hormonal agents (estrogen and progesterone) are being studied for their use in bleeding. This observance was initially explored in a patient with hereditary hemorrhagic telangiectasia (HHT) with epistaxis had variation in bleeding depending on her menstrual cycles.(1) Thus, hormonal therapy was initially used in patients with HHT to control episodes of epistaxis.(2) The literature on hormonal therapy in patients with life-threatening bleeding from gastrointestinal (GI) lesions is very limited. There are a few clinical trials in patients with chronic bleeds. However, no definite guidelines exist on their use in life-threatening GI bleeding in patients with uremia. Here, we describe a case with a life-threatening GI bleeding requiring multiple endoscopies and intensive care unit stay that responded to conjugated estrogens. We have done extensive research on English medical literature on PubMed and Google Scholar on the use of hormonal therapy for GI bleeding in patients with renal failure, and here we present the data as a review.

Role of vitamin A in the evolution of cholesteatoma.

The role of vitamin A in the maintenance of epithelial integrity is well known. Several animal studies have dealt with the induction of cholesteatoma in vitamin A deficiency states and prevention and treatment of otitis media with vitamin A treatment. We treated five patients of cholesteatoma with vitamin A oral supplements and no other treatment and found significant resolution of cholesteatoma in four patients. Though this may not be an explanation in every case of cholesteatoma, our study highlights that there is a subset of patients with vitamin A deficient cholesteatoma who could substantially benefit from intervention with this wonderful vital amine.