UPMC Physician Resources

Save the Date: Breast Symposium 2015

PITTSBURGH, Dec. 19, 2014 – Breast Symposium 2015: Updates in the Management of Breast Cancer/Breast Disease will be held at the Herberman Conference Center in Pittsburgh, Pa. on Friday, April 24, 2015.

This course is designed to cover the most recent advances in breast health screening and diagnosis including methods of detection, application of new technology, and benign disease and cancer management. Upon completion of the activity, participants should be able to:

  • Discuss the latest breast cancer methods of detection, treatment, surveillance, and research
  • Describe how these advances can be applied to their practice

Who Should Attend
This course is designed for physicians, nurses and other health care professionals practicing in the areas of Primary Care, Gynecology, Radiology, and General Surgery; recommended for any practitioner caring for women.

UPMC Shadyside
Herberman Conference Center
5230 Centre Avenue
Pittsburgh, PA 15232

Course Co-Directors
Marguerite A. Bonaventura, MD
Associate Professor of Surgery
University of Pittsburgh School of Medicine

Gretchen M. Ahrendt, MD
Associate Professor of Surgery
University of Pittsburgh School of Medicine

This activity has been approved for AMA PRA Category 1 Credit.TM

Online registration will be available on the Upcoming Events page at the Center for Continuing Education in the Health Sciences.

Register for the 23rd Annual Clinical Update in Geriatric Medicine

PITTSBURGH, Dec. 19, 2014 – Registration is now open for the 23rd Annual Clinical Update in Geriatric Medicine, March 26–28, 2015.

This award-winning CME conference is designed to help clinicians provide exceptional care for their older patients. Its structure, speakers, and content have been specifically chosen to provide state-of-the-art yet pragmatic approaches to the most common and confounding conditions clinicians face. The conference attracts more than 500 attendees annually.

Who Should Attend
This course is designed for family practitioners, internists, geriatricians, and other health care professionals who provide care to older adults. Previous attendees also will be interested because of the conference’s continually changing topics, speakers, and approach.

Marriott City Center
112 Washington Place
Pittsburgh, PA 15219

To register online, please visit the Upcoming Events page at the Center for Continuing Education in the Health Sciences and click the ‘23rd Annual Clinical Update in Geriatric Medicine′ link.

Improving Lives of Wheelchair Users Focus of Federally Funded Pitt Project to Create Global Network

PITTSBURGH, Dec. 19, 2014 – Of the nearly 70 million people worldwide who require wheelchairs for mobility and function, most lack access to appropriate wheelchairs or services to fix them. Now, a handful of University of Pittsburgh scientists are working with the U.S. Agency for International Development (USAID) under a two-year, $2.3 million sub-award to develop the new International Society of Wheelchair Professionals, a global network to teach and professionalize device repair, build affiliations to put better equipment in the right hands, and ensure a level of standardization, certification, and oversight.

Starting in January, the International Society of Wheelchair Professionals will be launched and administered by faculty members from the Department of Rehabilitation Science and Technology in the University of Pittsburgh’s School of Health and Rehabilitation Sciences. Assistant professors Jon Pearlman, Ph.D., associate director of engineering at the Human Engineering Research Laboratories (HERL), and Rory Cooper, Ph.D., HERL founding director and Distinguished Professor of Rehabilitation Science and Technology, will serve as co-directors.

The organizers intend to create three areas critical to this international network, as outlined in the funding: train people to build capacity for wheelchair service providers around the world; develop international wheelchair standards; and initiate a broad advocacy and outreach campaign to recruit affiliates on every continent.

“For at least the last 30 years, there has been a need for an international society to help improve the quality of wheelchairs, service delivery, and repair as well,” Dr. Cooper said, “and to link consumers, designers, manufacturers, rehabilitation professionals and wheelchair users so that we can all communicate. A rising tide raises all boats, so let’s raise the level for everybody in the world.”

Added Dr. Pearlman: “USAID is part of the federal Department of State, and it tries to spread the mission of the United States internationally. In this case, it’s a grant to the University of Pittsburgh, but to build a network and an ability to professionalize services around the world to contribute to this common goal – which is to improve the lives of wheelchair users.”

Since 2002, USAID has granted more than $45 million to improve wheelchairs and wheelchair services worldwide. This sub-award – Agreement No. APC-GM-0068 — was presented by Advancing Partners & Communities, a five-year cooperative agreement funded by USAID under Agreement No. AIDOAA-A-12-00047, beginning Oct. 1, 2012.

High-Dose Flu Vaccine Superior for Frail Elderly Living in Long-Term Care Facilities

PITTSBURGH, Dec. 18, 2014 – The high-dose flu vaccine is significantly better than the regular flu shot at boosting the immune response to the flu virus in frail, older residents of long-term care facilities, according to the results of a University of Pittsburgh School of Medicine study.

It is the first evaluation of the vaccine in long-term care residents, which is the population most vulnerable to flu-related death. The study, published in the Journal of Infectious Diseases and funded by vaccine-maker Sanofi Pasteur, found that – with the exception of one strain of flu circulating in the 2012-2013 season – the high dose flu vaccine helped participants mount a better immune response to influenza than the standard flu shot.

“The elderly living in long-term care facilities have higher influenza exposure risks, lower immune defenses and a much greater likelihood of flu-related death than the general population,” said lead author David A. Nace, M.D., M.P.H., director of long-term care and flu programs in Pitt’s Division of Geriatric Medicine and chief medical officer for UPMC Senior Communities. “For these reasons, we need more effective flu vaccine options for frail, older adults.”

Each year in the U.S., there are 3,000 to 49,000 influenza-associated deaths, with over 90 percent reported among people aged 65 years and older, according to the U.S. Centers for Disease Control and Prevention. Mortality is 16-fold higher among those 85 years old compared to those 65 to 69 years. Although the influenza vaccine is the best defense against the flu, it is not 100 percent effective. Among the elderly population, clinical efficacy of the standard vaccine is reduced by 17 to 60 percent.

“In a separate randomized controlled trial of community-dwelling adults 65 years of age and older, Fluzone High-Dose vaccine induced higher immune responses and provided superior protection against laboratory-confirmed influenza illness compared with standard-dose influenza vaccine,” said David P. Greenberg, M.D., vice president of scientific and medical affairs and chief medical officer at Sanofi Pasteur U.S., the makers of Fluzone High-Dose. “We are pleased to see the results of this new randomized study demonstrating that the higher immune response to Fluzone High-Dose vaccine extends to frail, older residents of long-term care facilities.”

In December 2009, the U.S. Food and Drug Administration licensed trivalent inactivated influenza vaccine – Sanofi Pasteur’s Fluzone High-Dose – specifically designed for people 65 years and older. The high-dose contains four times the antigen of regular shots.  Antigen is the part of a vaccine that prompts the immune system to make antibodies against flu.

During the 2011-2012 and 2012-2013 flu seasons, Dr. Nace and his colleagues followed 187 people with an average age of 86.7 years living in 15 community-based, long-term care sites in western Pennsylvania, including nursing facilities, assisted or personal care homes, and independent living facilities. To ensure they were among the frail population most vulnerable to flu, only people who needed full or partial assistance in at least one daily self-care activity, such as dressing or grooming, were included.

Participants were randomly selected to receive either a high-dose or standard flu shot at the beginning of the flu season. They were then tested for their antibody response 30 and 180 days after receiving the flu shot. This helped doctors determine how much the vaccine prepared participants’ immune systems for the flu virus and also how much that protection waned by the end of the flu season.

Both the high-dose and standard flu vaccines contain inactivated versions of the three influenza strains that world health officials determine most likely to be circulating in a given flu season.

At 30 days and again at 180 days, the immune response was greater for high-dose compared to the standard vaccine for all the flu strains in both seasons, except strain A/H1N1 in the 2012-2013 season. The researchers noted that A/H1N1 was identical in both seasons, and 26 percent of participants took part in the study both seasons, something that might have caused the lower generation of antibodies to the strain in the second season.

“Historically, the protection from regular influenza vaccine among seniors has been moderate,” said senior author Richard K. Zimmerman, M.D., M.P.H., professor in Pitt’s Department of Family Medicine. “Now an option with better immunologic protection is available, as our study shows.”

The trial did not evaluate whether fewer of the high-dose recipients actually contracted the flu than those receiving the standard vaccine.

“The high-dose vaccine is not a guarantee against contracting the flu, even though it significantly decreases the likelihood,” said Dr. Nace. “That is why it is so important to take a ‘bundled approach’ to preventing flu in long-term care facilities, including vaccination of health care workers, asking people with flu-like illness not to visit residents, practicing proper cough etiquette and hand hygiene, and frequent sanitation of commonly used areas and equipment.”

Additional co-authors on this study are Chyongchiou Jeng Lin, Ph.D., Stacey Saracco, R.N., and Roberta M. Churilla, R.N., C.R.N.P., all of Pitt; and Ted M. Ross, Ph.D., of the Vaccine & Gene Therapy Institute of Florida.

In addition to the grant from Sanofi Pasteur, funding for this study was provided by the University of Pittsburgh Claude D. Pepper Older Americans Independence Center through National Institutes of Health grant P30 AG024827.

Expert in Immune Responses in Stem Cell Transplantation Joins UPCI

PITTSBURGH, Dec. 17, 2014 – Warren Shlomchik, M.D., a leading expert in investigating the immunologic mechanisms underlying graft-versus-host-disease (GVHD), a common complication for some stem cell transplant patients, has been named director of stem cell transplantation and cell therapies for the University of Pittsburgh’s Division of Hematology-Oncology and University of Pittsburgh Cancer Institute (UPCI), a partner with UPMC CancerCenter, and UPCI’s scientific director of hematopoietic malignancies.

Dr. Shlomchik’s appointment is effective March 1, 2015. He will also serve as a professor of medicine and immunology at the University of Pittsburgh School of Medicine. He comes to Pittsburgh from Yale Cancer Center at the Yale University School of Medicine, where he had been on the senior faculty for 16 years.

“Warren’s work has been invaluable in helping researchers understand more about the mechanisms of GVHD. His main priorities here in Pittsburgh will be to continue to conduct innovative, ground-breaking lab-based science and to oversee the translation of that science into investigator-initiated clinical trials, which will be a huge advance for our transplant and hematopoietic malignancies clinical research program,” said Edward Chu, M.D., chief of the Division of Hematology/Oncology and deputy director of UPCI.

Dr. Shlomchik is a leading expert in GVHD, a well-established complication that can occur after a stem cell or bone marrow transplant in which the newly transplanted donor cells attack the transplant recipient’s body. At Pitt, Dr. Shlomchik will continue his research on GVHD mechanisms as well as work to develop novel immunologic-based and cell therapy approaches to circumvent and/or overcome the development of GVHD.

“We’ve been very fortunate at UPCI this year to add several renowned researchers to our ranks, including Dr. Shlomchik,” said Nancy E. Davidson, M.D., director of UPCI and UPMC CancerCenter. “The decision of these researchers to come here shows that we are serious about the work we are doing to unravel the mysteries of cancer and take those findings directly to our patients.”

Dr. Shlomchik earned his bachelor of arts at Harvard University and his medical degree at the University of Pennsylvania. He completed his residency in internal medicine at New York Hospital/Cornell Medical Center and was a fellow at the University of Pennsylvania in hematology-oncology.

Pitt Team Publishes New Findings from Mind-Controlled Robot Arm Project

PITTSBURGH, Dec. 16, 2014 – In another demonstration that brain-computer interface technology has the potential to improve the function and quality of life of those unable to use their own arms, a woman with quadriplegia shaped the almost human hand of a robot arm with just her thoughts to pick up big and small boxes, a ball, an oddly shaped rock, and fat and skinny tubes.

The findings by researchers at the University of Pittsburgh School of Medicine, published online today in the Journal of Neural Engineering, describe, for the first time, 10-degree brain control of a prosthetic device in which the trial participant used the arm and hand to reach, grasp, and place a variety of objects.

“Our project has shown that we can interpret signals from neurons with a simple computer algorithm to generate sophisticated, fluid movements that allow the user to interact with the environment,” said senior investigator Jennifer Collinger, Ph.D., assistant professor, Department of Physical Medicine and Rehabilitation (PM&R), Pitt School of Medicine, and research scientist for the VA Pittsburgh Healthcare System.

In February 2012, small electrode grids with 96 tiny contact points each were surgically implanted in the regions of trial participant Jan Scheuermann’s brain that would normally control her right arm and hand movement.

Each electrode point picked up signals from an individual neuron, which were then relayed to a computer to identify the firing patterns associated with particular observed or imagined movements, such as raising or lowering the arm, or turning the wrist. That “mind-reading” was used to direct the movements of a prosthetic arm developed by Johns Hopkins Applied Physics Laboratory.

Within a week of the surgery, Ms. Scheuermann could reach in and out, left and right, and up and down with the arm to achieve 3D control, and before three months had passed, she also could flex the wrist back and forth, move it from side to side and rotate it clockwise and counter-clockwise, as well as grip objects, adding up to 7D control. Those findings were published in The Lancet in 2012.

“In the next part of the study, described in this new paper, Jan mastered 10D control, allowing her to move the robot hand into different positions while also controlling the arm and wrist,” said Michael Boninger, M.D., professor and chair, PM&R, and director of the UPMC Rehabilitation Institute.

To bring the total of arm and hand movements to 10, the simple pincer grip was replaced by four hand shapes: finger abduction, in which the fingers are spread out; scoop, in which the last fingers curl in; thumb opposition, in which the thumb moves outward from the palm; and a pinch of the thumb, index and middle fingers. As before, Ms. Scheuermann watched animations of and imagined the movements while the team recorded the signals her brain was sending in a process called calibration. Then, they used what they had learned to read her thoughts so she could move the hand into the various positions.

“Jan used the robot arm to grasp more easily when objects had been displayed during the preceding calibration, which was interesting,” said co-investigator Andrew Schwartz, Ph.D., professor of Neurobiology, Pitt School of Medicine. “Overall, our results indicate that highly coordinated, natural movement can be restored to people whose arms and hands are paralyzed.”

After surgery in October to remove the electrode arrays, Ms. Scheuermann concluded her participation in the study.

“This is been a fantastic, thrilling, wild ride, and I am so glad I’ve done this,” she said. “This study has enriched my life, given me new friends and coworkers, helped me contribute to research and taken my breath away. For the rest of my life, I will thank God every day for getting to be part of this team.”

The team included John E. Downey, BS, Elizabeth Tyler-Kabara, M.D., Ph.D., and Michael Boninger, M.D., all of the University of Pittsburgh School of Medicine; and lead author Brian Wodlinger, Ph.D., now of Imagistx, Inc. The project was funded by the Defense Advanced Research Projects Agency, the Department of Veterans Affairs, and the UPMC Rehabilitation Institute.

Health Care Gaps Narrow as More Patients of All Races Receive Recommended Treatment, Study Finds

PITTSBURGH, Dec. 11, 2014 – Racial and ethnic disparities in the quality of U.S. hospital care for patients with heart attack, heart failure and pneumonia shrank considerably between 2005 and 2010, as more patients of all races received recommended treatments, according to a national analysis by several institutions, including the University of Pittsburgh School of Medicine.

The study, published in the New England Journal of Medicine, found that care for blacks and Hispanics became better and more equitable when comparing hospitals principally serving whites to hospitals principally serving minorities and when comparing changes in care over time within the same hospitals. The work was supported by the Centers for Medicare & Medicaid Services (CMS).

“It is heartening that we found higher quality of care overall and large reductions in racial and ethnic disparities in health care for patients with these common conditions,” said senior author Michael Fine, M.D., M.Sc., professor of medicine at the University of Pittsburgh School of Medicine and staff physician at the Veterans Affairs Pittsburgh Healthcare System. “However, it is critically important to demonstrate that these improvements in care are accompanied by better patient outcomes. Further studies are needed to investigate if racial and ethnic disparities in mortality have also decreased over time.”

Dr. Fine also directs the Center for Health Equity Research and Promotion (CHERP) at the VA Pittsburgh Healthcare System, which is focused on detecting, understanding and reducing disparities in health and health care in vulnerable populations.

Dr. Fine and his co-investigators looked at more than 12 million acute care hospitalizations over the five-year span and found that, as quality of care improved and hospitals did a better job providing and performing recommended treatments and procedures, so did racial and ethnic equity. Nine major disparities evident in 2005 had mostly or totally disappeared by the end of 2010.

“This is happening because hospitals that disproportionately serve minority patients improved faster, and it’s also the case that individual hospitals are delivering more equal care to white and minority patients over time,” said lead author Amal Trivedi, M.D., M.P.H., an associate professor in Brown University’s School of Public Health and a hospitalist at the Providence Veterans Affairs Medical Center.

Widespread evidence remains for racial, ethnic and socioeconomic disparities in medicine, Dr. Trivedi acknowledged, noting that the results of his team’s analysis, while very positive, address only a narrow spectrum of care delivery. But they suggest that when hospitals strive to improve quality, they can improve equity.

Using data publicly reported to CMS through the Inpatient Quality Reporting Program, the team looked at the performance rates by race and ethnicity for 17 procedures that are recommended to improve patient outcomes, such as giving an aspirin to heart attack patients, a flu vaccination to pneumonia patients or clearing a blood clot in an artery of heart attack patients within 90 minutes.

The overall range of improvements was between 3.4 and 58.3 percentage points. At the beginning of 2005, there were nine metrics – three among blacks and six among Hispanics – for which there were white vs. minority gaps greater than five percentage points. By 2010 all the gaps had narrowed significantly. Gaps between blacks and whites tightened by 8.5 to 11.8 percentage points. Disparities between whites and Hispanics narrowed by 6.2 to 15.1 percentage points.

Dr. Trivedi noted that hospitals self-report this data, which has become tied to their federal compensation. Federal authorities have audited the veracity of some, but not all, of it.

In addition to Drs. Trivedi and Fine, the paper’s other authors are Wato Nsa, M.D., Ph.D., and Allen Ma, Ph.D., both of the Oklahoma Foundation for Medical Quality; Dale W. Bratzler, D.O., M.P.H., of the University of Oklahoma Health Sciences Center; Leslie R. M. Hausmann, Ph.D., and Maria K. Mor, Ph.D., both of the VA CHERP and Pitt; Jonathan S. Lee, M.D., of Pitt; and Kristie Baus, M.S., R.N., and Fiona Larbi, M.S., R.N., both of CMS.

This research was funded by CMS contract HHSM-500-2011-OK10C.

Drug Developed at Pitt Proves Effective Against Antibiotic-Resistant ‘Superbugs’

PITTSBURGH, Dec. 10, 2014 – A treatment pioneered at the University of Pittsburgh Center for Vaccine Research (CVR) is far more effective than traditional antibiotics at inhibiting the growth of drug-resistant bacteria, including so-called “superbugs” resistant to almost all existing antibiotics, which plague hospitals and nursing homes.

The findings, announced online in the journal Antimicrobial Agents and Chemotherapy and funded by the National Institutes of Health, provide a needed boost to the field of antibiotic development, which has been limited in the last four decades and outpaced by the rise of drug-resistant bacterial strains.

“Very few, if any, medical discoveries have had a larger impact on modern medicine than the discovery and development of antibiotics,” said senior author Ronald C. Montelaro, Ph.D., professor and co-director of Pitt’s CVR. “However, the success of these medical achievements is being threatened due to increasing frequency of antibiotic resistance. It is critical that we move forward with development of new defenses against the drug-resistant bacteria that threaten the lives of our most vulnerable patients.”

Each year in the U.S., at least 2 million people are infected with drug-resistant bacteria, and at least 23,000 die as a direct result of these infections, according to the U.S. Centers for Disease Control and Prevention.

On the tail end of HIV surface protein, there is a sequence of amino acids that the virus uses to “punch into” and infect cells. Dr. Montelaro and his colleagues developed a synthetic and more efficient version of this sequence – called engineered cationic antimicrobial peptides, or “eCAPs”—that can be chemically synthesized in a laboratory setting.

The team tested the two leading eCAPs against a natural antimicrobial peptide (LL37) and a standard antibiotic (colistin), the latter being used as a last-resort antibiotic against multidrug resistant bacterial infections. The scientists performed the tests in a laboratory setting using 100 different bacterial strains isolated from the lungs of pediatric cystic fibrosis patients of Seattle Children’s Hospital and 42 bacterial strains isolated from hospitalized adult patients at UPMC.

The natural human antimicrobial peptide LL37 and the colistin drug each inhibited growth of about 50 percent of the clinical isolates, indicating a high level of bacterial resistance to these drugs. In marked contrast, the two eCAPS inhibited growth in about 90 percent of the test bacterial strains.

“We were very impressed with the performance of the eCAPs when compared with some of the best existing drugs, including a natural antimicrobial peptide made by Mother Nature and an antibiotic of last resort,” said Dr. Montelaro. “However, we still needed to know how long the eCAPs would be effective before the bacteria develop resistance.”

The team challenged a highly infectious and pathogenic bacterium called Pseudomonas aeruginosa – which flourishes in medical equipment, such as catheters, and causes inflammation, sepsis and organ failure – with both the traditional drugs and eCAPs in the lab.

The bacterium developed resistance to the traditional drugs in as little as three days. In contrast, it took 25 to 30 days for the same bacterium to develop resistance to the eCAPs. In addition, the eCAPs worked just as effectively at killing Pseudomonas aeruginosa after it became resistant to the traditional drugs.

“We plan to continue developing the eCAPs in the lab and in animal models, with the intention of creating the least-toxic and most effective version possible so we can move them to clinical trials and help patients who have exhausted existing antibiotic options,” said Dr. Montelaro.

Additional researchers on this study are Berthony Deslouches, M.D., Ph.D., Jonathan D. Steckbeck, Ph.D., M.B.A., Jodi K. Craigo, Ph.D., and Yohei Doi, M.D., all of Pitt; and Jane L. Burns, M.D., of Seattle Children’s Research Institute.

This research was supported by NIH grants P30DK072506, R01AI104895, R21AI107302 and P30 DK089507, as well as funds from Pitt’s Center for Vaccine Research and Cystic Fibrosis Research Center.

Newly-Identified Gene Mutation Could Help Explain How Breast Cancer Spreads

SAN ANTONIO, Dec. 9, 2014 – A newly-identified genetic mutation could increase our understanding of how breast cancer spreads and potentially guide treatment options for women with the disease, according to a study from Magee-Womens Research Institute (MWRI) and the University of Pittsburgh Cancer Institute (UPCI) presented today at the 2014 San Antonio Breast Cancer Symposium.

This research represents the most comprehensive analysis to date of genomic changes that occur in breast cancer progression and indicate the extensive changes that happen during the spread of the disease.

Researchers from MWRI and UPCI sequenced frozen breast tumor samples from six patients, beginning with the primary tumor when the cancer was first diagnosed through the progression of metastatic disease.  Using multiple sequencing techniques, the team identified a new gene created by two separate genes that fused together as a result of unstable DNA.  This fusion gene was identified in a metastatic tumor sample and is believed to play a part in the spread of the original breast cancer.

“We applied all of our sequencing technologies to the tumors in order to understand the changes that occur between the first breast cancer occurrence and late-stage disease,” said Ryan Hartmaier, a research instructor at the University of Pittsburgh and lead author of the study.

Since several types of breast cancer are fueled by the hormone estrogen, estrogen blocking treatment is often recommended to prevent the disease from spreading. However, the fusion gene identified did not  respond to estrogen blocking treatment, contributing to the breast cancer’s spread.

“This research helps us further understand the genomic landscape of metastatic breast cancer,” said Adrian Lee, Ph.D., the study’s senior author, director of the Women’s Cancer Research Center and professor of pharmacology, chemical biology and human genetics Pitt. “The new class of genetic changes identified take us another step further in personalized medicine and could change the way we treat certain patients if we are able to identify who will develop this genetic mutation.”

New Drug Therapy A Safe, Effective Option for Elderly Patients with Acute Myeloid Leukemia

PITTSBURGH, Dec. 8, 2014 – Seventy percent of elderly patients with acute myeloid leukemia (AML) who were treated with a combination of drugs aimed to make chemotherapy treatments effective and less toxic achieved remission or a slowing of disease progression, according to research at the University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter. The findings were presented Sunday at the 56th American Society of Hematology Annual Meeting in San Francisco.

The research is important because most elderly patients diagnosed with AML can’t tolerate the aggressive chemotherapy needed and tend to have more aggressive disease than younger patients, making prognosis poor. So researchers, led by UPCI’s Annie Im, M.D., an assistant professor of medicine in Pitt’s Division of Hematology/Oncology, examined whether an epigenetic strategy using the drugs decitabine followed by cytarabine would help make other treatments more tolerable by reactivating genes that had previously been silenced by the malignancy.

“Outcomes are really poor in elderly patients who have AML because the only therapies we have are often too toxic to offer as treatment options, and the unmet need for novel therapies is dire,” Dr. Im said. “But we have shown that using this therapy in this patient population is safe and effective.”

In the study, 23 patients were evaluated after receiving what’s called an induction therapy of decitabine intravenously for five days followed by a standard dose of cytarabine intravenously for five days. Fourteen patients had complete remission and five patients had a complete remission with delayed bone marrow recovery. All patients except for two received two cycles of induction.

Researchers believe the drugs work because they help reactivate genes that had been silenced by the malignancy. In addition, evidence suggests that epigenetic priming by decitabine enhances the efficacy of cytarabine. The next phase of the trial will examine overall survival and the rate of adverse events, and include epigenetic correlative studies.

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