Mojtaba Akhtari

• MD, FACP
• Professor at Loma Linda University

Background: Zinc (Zn) is an essential micronutrient in erythropoiesis where Zn deficiency has been shown to be a reversible cause of anemia. Zn is involved in multiple processes including iron metabolism, heme synthesis, erythroid cell growth regulation, and erythropoietin signaling. Poor dietary intake and decreased absorption may lead to Zn and o...

Background: Proton pump inhibitors (PPI) are commonly prescribed medications that are well known to cause micronutrient deficiencies. PPIs have been linked to deficiencies in iron, vitamin B12, vitamin C, calcium, and magnesium due to disruption of the stomach's acidic environment. Recent studies have shown Zinc (Zn) deficiency may be a reversible...

Background: Zinc (Zn) is an essential micronutrient used as a catalyst, structural element, and regulatory ion in many metabolic processes including erythropoiesis. Zn is stored in limited quantities, so Zn deficiency is often due to decreased intake and absorption. NHANES found that only 42.5% of patients with advanced age (age >71) had adequate Z...

Background: Zinc (Zn) is an essential micronutrient in erythropoiesis. Zn deficiency has been shown to be a reversible cause of anemia, but Zn is not stored in large quantities in the body, so it is critical to maintain adequate Zn intake through a healthy, balanced diet. Malnourished patients, and those with prior bariatric or bowel surgery may be...

Background: CNS involvement in hematologic malignancies, while uncommon, is often associated with serious complications, leading to worse clinical outcomes. In adult patients, diagnostic lumbar puncture (LP) is not routinely performed due to the absence of initial signs or symptoms of CNS involvement. Consequently, intrathecal methotrexate (IT MTX)...

Background: Zinc (Zn) is an essential micronutrient and is involved in erythropoiesis. It is involved in iron metabolism, heme synthesis, erythroid cell growth, erythropoietin signaling, and erythroid differentiation. Zn deficiency has been recognized in malnourished and morbidly obese individuals. Given the prevalence of malnourishment and obesity...

The advent of Bruton tyrosine kinase inhibitor (BTKi) therapy with ibrutinib introduced a highly effective targeted therapy in the management of chronic lymphocytic leukemia (CLL). However, due to the adverse effect profile some patients cannot tolerate this novel therapy. Newer, more potent and targeted BTK inhibitors such as acalabrutinib have be...

Macrophage activation syndrome (MAS) is a form of secondary hemophagocytic lymphohistiocytosis (HLH) when it occurs in the context of rheumatologic disorders. HLH is a rare and potentially life-threatening syndrome characterized by excessive immune system activation. It is mainly seen in children and can be genetic based or related to infections, m...

Background: Chronic anemia has an estimated prevalence of 5.6% within the US, where 25.3% of patients with chronic kidney disease (CKD) 3-5 have anemia of chronic kidney disease according to NHANES. Anemia in CKD has long been attributed to a decrease in EPO production due to their kidney disease. While iron deficiency is treated in anemia of chron...

Background: Zinc is a necessary micronutrient used as a catalyst, structural element, and regulatory ion in many metabolic processes including erythropoiesis. Chronic anemia has an estimated prevalence of 5.6% within the US according to NHANES. Iron deficiency is considered the most common nutritional deficiency leading to anemia, but other nutriti...

Chromosomal rearrangements, such as translocations, play a significant role in creating chimeric genes and oncofusion proteins initiating leukemogenesis in 52% of acute myeloid leukemia (AML) patients, and are associated with an adverse prognosis. Currently, there are limited targeted therapies available for AML patients with chromosome rearrangeme...

Background: Mantle cell lymphoma (MCL) is a type of non-Hodgkin lymphoma (NHL), classically characterized by the translocation of t(11;14). MCL is typically CD10 negative, often attributed to its pre-germinal nature arising from naïve B cells. Increasing cases of CD10+ MCL suggest the possibility of germinal center-derived pathology. Moreover, a un...

Background: Myelofibrosis (MF) is a myeloid malignancy characterized by clonal hematopoisis, bone marrow fibrosis (BMF) and ineffective extramedullary hematopoiesis, resulting in progressive cytopenias. Thrombocytopenia is both prognostic of poor outcomes and predictive of treatment intolerance with the JAK1/2 inhibitor ruxolitinib, which exacerbat...

Background Selenium (Se) is an essential micronutrient with roles in reproduction, metabolism, immunity, and the cellular cycle, including DNA synthesis and prevention of cell death. Its role in malignancy has also been studied, specifically for esophageal, gastric, lung, prostate cancer. Studies have shown benefit with Se supplementation for those...

Background Chronic Lymphocytic Leukemia (CLL) is the most prevalent adult leukemia and is characterized by the accumulation of small and mature appearing lymphocytes in blood, lymphoid tissue, and bone marrow. Chemoimmunotherapy and targeted therapies can improve overall survival and the duration of remission; however, CLL is prone to relapse, ther...

Background: The anemia highly associated with myelodysplastic syndrome (MDS) has been linked to numerous transcriptional factor regulation abnormalities, specifically SMAD 2/3 upregulation that forms an inhibitory feedback loop to downregulate erythrocyte stimulation (ESA), which can have therapeutic implications. There is evidence that zinc contri...

Ophthalmic and neurologic involvement are rare complications of CLL, with few cases reported in the literature. We report a case of CLL with leukemic infiltration of the optic nerve and review of literature focusing on management and outcomes. A patient with heavily pretreated CLL presented to our hospital with progressive eye pain and was found to...

Chronic myelogenous leukemia (CML) is a hematologic malignancy with unique significance to the field of hematology and oncology, specifically due to the development of tyrosine kinase inhibitors (TKIs). CML often presents with nonspecific symptoms, and the quality of life in patients with CML has drastically improved as a result of TKIs. However, c...

Introduction/background: Central nervous system (CNS) relapse is an infrequent but serious and challenging complication of diffuse large B-cell lymphoma (DLBCL) that carries a dismal prognosis. While several risk factors have been identified to stratify the risk for CNS relapse including the 2015 CNS internal Prognostic index (CNS-IPI), controvers...

e19531 Background: Central nervous system (CNS) relapse is an infrequent but serious and challenging complication in diffuse large B-cell lymphoma (DLBCL) that carries a dismal prognosis. While several risk factors have been identified to stratify the risk for CNS relapse including the 2015 CNS internal Prognostic index (CNS-IPI), controversy still...

Introduction: COVID-19 particularly impacted patients with co-morbid conditions, including cancer. Patients with melanoma have not been specifically studied in large numbers. Here, we sought to identify factors that associated with COVID-19 severity among patients with melanoma, particularly assessing outcomes of patients on active targeted or imm...

Deep venous thrombosis (DVT) is a complication of myeloproliferative neoplasms (MPNs). However, DVTs in unusual sites such as portal vein thrombosis (PVT) are rare and may be the first clinical manifestation of occult MPNs. There is a need for increasing awareness of such manifestations; so, here we discuss a patient who presented with new portal v...

Importance Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with ca...

Myeloproliferative neoplasms (MPN), which include primary myelofibrosis (PMF) and essential thrombocytopenia (ET), are characterized by the clonal proliferation of mature blood cells as a result of the overactivation of the JAK/STAT pathway. Extramedullary hematopoiesis (EMH), a common complication of PMF, occurs due to the dysregulation of the bon...

Mantle cell lymphoma (MCL) is a rare and aggressive non-Hodgkin’s B cell lymphoma characterized by the translocation t(11;14) (q13;32) and overexpression of CCND1 . MCL is immunophenotypically identified as CD20 ⁺ , CD5 ⁺ , CyclinD1+, CD43 ⁺ , CD10 ⁻ , BCL6 ⁻ , and CD23 ⁻ . It is often distinguished from B cell lymphomas of germinal center cell ori...

Importance: Non-Hispanic Black individuals experience a higher burden of COVID-19 than the general population; hence, there is an urgent need to characterize the unique clinical course and outcomes of COVID-19 in Black patients with cancer. Objective: To investigate racial disparities in severity of COVID-19 presentation, clinical complications,...

Chronic myeloid leukemia (CML) is a clonal myeloproliferative neoplasm (MPN) that accounts for 10% of pregnancy-associated leukemias. The Philadelphia chromosome balanced translocation, t (9:22) (q34; q11.2), is the classic mutation seen in CML. The BCR-ABL oncoprotein encoded by this mutation is a constitutively active tyrosine kinase. Tyrosine ki...

Introduction Opioid analgesics are commonly used to manage moderate to severe cancer related pain. However long-term use of opioids has been known to lead to several unintended side effects, including opioid induced hyperalgesia (OIH) which is defined as the paradoxical increase in pain sensitization to pain stimulus following opioid exposure. Curr...

Importance The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. Objective To quantify spatiotemporal variation in COVID-19 outc...

Importance COVID-19 is a life-threatening illness for many patients. Prior studies have established hematologic cancers as a risk factor associated with particularly poor outcomes from COVID-19. To our knowledge, no studies have established a beneficial role for anti–COVID-19 interventions in this at-risk population. Convalescent plasma therapy may...

Cardiotoxicity is a well-established complication of multiple cancer therapeutics, and the one of the most prominent effects that limits the use of these agents is in the form of left ventricular dysfunction, otherwise known as chemotherapy-induced cardiomyopathy (CIMP). Because CIMP can worsen patient outcomes and interfere with a patient's life-s...

Current treatment approaches for older adult patients with acute myeloid leukemia (AML) are often toxic and lack efficacy. Active vitamin D3 (1,25(OH)2D3) has been shown to induce myeloid blast differentiation but at concentrations that have resulted in unacceptable, off-target hypercalcemia in clinical trials. In our study, we found that the combi...

Acute myeloid leukemia (AML) is a devastating hematologic malignancy that affects the hematopoietic stem cells. The 5-year overall survival (OS) of patients with AML is less than 30%, highlighting the urgent need to identify new therapeutic targets. Here, we analyze gene expression datasets for genes that are differentially overexpressed in AML cel...

Introduction The Philadelphia chromosome is associated with a poor prognosis in patients with acute lymphoblastic leukemia (ALL). While modern day therapies including allogeneic hematopoietic stem cell transplantation (HSCT) have led to significant improvements in overall survival (OS) for this population, these treatments have variable accessibili...

Introduction: The Philadelphia chromosome is associated with a poor prognosis in patients with acute lymphoblastic leukemia (ALL). Prior to the use of hematopoietic stem cell transplantation (HSCT) and tyrosine kinase inhibitors (TKIs), Philadelphia-positive (Ph+) ALL patients were found to have an overall survival (OS) rate of less than 20% over t...

In an effort to identify target genes in acute myeloid leukemia (AML), we compared gene expression profiles between normal and AML cells from various publicly available datasets. We identified CD99, a gene that is up-regulated in AML patients. In 186 patients from The Cancer Genome Atlas AML dataset, CD99 was over-expressed in patients with FLT3-IT...

Outcome of patients with Acute Myeloid Leukemia (AML) remains dismal and the need for new therapies is high. We recently found CD99 to be upregulated in AML and showed that CD99 loss of function by siRNA or anti-CD99 antibody decreased proliferation of AML cells. Here, we investigate the functional role of CD99 wild type isoform (WT) in AML with th...

7024 Background: Philadelphia Chromosome-Positive (Ph+) disease is associated with a poor prognosis in acute lymphoblastic leukemia (ALL). Recent studies have shown that the eradication of minimal residual disease (MRD) in this population leads to improved survival outcomes. While hematopoietic stem cell transplantation (HSCT) has demonstrated clin...

e18506 Background: Sapanisertib (SAP) is an oral small molecule dual mTOR complex 1 and 2 (TORC1/2) inhibitor that showed activity in lymphoid neoplasms. It blocks a feedback loop involving mTORC2 activation when TORC1 is selectively inhibited (Yun S et al, Blood 2016). SAP induces apoptosis of malignant lymphoid cells in vitro and in xenografts, w...

Background: While haploidentical transplantation has led to the near-universal availability of donors, several challenges for this form of transplant still exist. This study sought to investigate the rates of infection-related mortality and other complications following haploidentical vs nonhaploidentical transplant. Methods: We conducted a retrosp...

Background The Philadelphia chromosome is associated with a poor prognosis in acute lymphoblastic leukemia (ALL). While hematopoietic stem cell transplantation (HSCT) has been regarded as a favorable treatment option in adult Philadelphia‐positive (Ph+) ALL, its benefit is less clear in the era of newer generation tyrosine kinase inhibitors (TKIs)...

High dose chemotherapy (HDT) followed by autologous hematopoietic cell transplantation (auto-HCT) is an effective treatment for relapsed/refractory (R/R) non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Historically, carmustine, etoposide, cytarabine, and melphalan (BEAM) has been shown to improve progression free survival (PFS) and overall su...

Introduction Ocular graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplantation (HSCT), affecting 40-60% of patients within 3 years after transplant. While the most common clinical manifestation is dry eye disease (DED), ocular GVHD can result in epithelial changes in the cornea that contribute to...

Haploidentical hematopoietic cell transplantation (haplo-HCT) has become an increasingly popular alternative to traditional HLA-matched hematopoietic cell transplant more recently. Cytokine release syndrome (CRS) is an observed phenomenon that occurs as a consequence of haplo-HCT with recent data suggesting a relationship between the severity of CR...

Gelatinous bone marrow transformation (GBMT) is a rare pathologic entity of unclear etiology characterized by adipose cell atrophy, focal hematopoietic tissue hypoplasia, and a distinct eosinophilic substance that stains with Alcian blue at pH 2.5. It is traditionally described in the context of malnutrition and cachexia from generalized disease an...

Abstract Acute myeloid leukemia (AML) is a heterogeneous hematological malignancy in which the only curative approach is allogeneic stem cell transplant (Allo-HSCT). The recognition and elimination of leukemic clones by donor T-cells contribute significantly to Allo-HSCT success. FLT3-ITD, a common mutation in AML, is associated with poor prognosis...

Introduction: Ocular graft-versus-host disease (GvHD) is a common complication of allogeneic hematopoietic stem cell transplantation (alloHSCT), typically affecting 40-60% of patients within 3 years after alloHSCT. The most common clinical manifestation is dry eye disease (DED), which may lead to secondary epithelial changes in the cornea such as f...

Background: Acute Myeloid Leukemia (AML) is a hematological malignancy with a 5-yr survival rate of 27%. This indicates an urgent need to identify better therapies. We previously analyzed various gene expression data sets of normal hematopoietic vs AML cells and reported that CD99 is upregulated in AML. CD99 loss of function by siRNA or monoclonal...

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment option for high-risk patients with Acute Myeloid Leukemia (AML). The curative potential of this treatment is likely attributed to the graft versus leukemia (GvL) effect, in which donor T lymphocytes target persistent leukemic cells, by identifying AML-specific...

Introduction: The presence of the Philadelphia chromosome has historically been associated with a poor prognosis in patients with acute lymphoblastic leukemia (ALL). Prior studies had demonstrated that the 5-year overall survival (OS) rate among adult patients with Philadelphia-chromosome positive (Ph+) ALL was 25% compared to 41% in Philadelphia-c...

Background: High dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is an effective choice of treatment for relapsed/refractory non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Historically, carmustine, etoposide, cytarabine, and melphalan (BEAM) has been the most widely used conditioning regimen...

Background: Acute Myeloid Leukemia (AML) is a devastating and heterogeneous, hematological malignancy characterized by uncontrolled proliferation of undifferentiated myeloid progenitor cells-blasts. AML cells are highly oxidized compared to healthy hematopoietic stem cells; thus, mechanisms contributing to this oxidation state represent an opportun...

Introduction: Haploidentical hematopoietic stem cell transplantation (HSCT) is a potentially curative intervention for various malignant and non-malignant hematological conditions. Its use has led to the near universal availability of donors, but major challenges compared to HLA-matched related donor (MRD) and HLA-matched unrelated donor (MUD) tran...

Acute Myeloid Leukemia is a devastating and heterogeneous, hematological malignancy characterized by the uncontrolled proliferation of undifferentiated myeloid progenitor cells-blasts. Mutations in certain mitochondrial proteins, such as IDH2 have been shown to contribute to leukemogenesis. However, the role of mutations in mitochondrial-encoded El...

Preclinical animal studies have demonstrated an association between maternal use of tyrosine kinase inhibitors and embryofetal toxicity; yet, multiple clinical case series have reported normal pregnancy outcomes and healthy infants in women on these medications during the course of their pregnancy. We describe a case of a woman with chronic myeloid...

Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by clonal proliferation and block of differentiation of myeloid precursors. Overall survival for patients with AML remains dismal (<50% for younger patients and <10% for older patients) due to high relapse rate. In search for novel therapeutic targets in AML, we co...

Myelofibrosis (MF) is a myeloid malignancy associated with a heavy symptomatic burden that decreases quality of life and presents a risk for leukemic transformation. While there are limited curative treatments, the recent discovery of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway dysregulation has led to many...

Adult B-acute lymphoblastic leukemia (B-ALL) does not share the favorable prognosis seen in pediatric patients with the same disease. Less than 50% of patients experience long-term survival and for those adults over age 60, long-term survival is only 10%. At time of relapse, 5-year prognosis is a dismal 7%. Novel and less toxic agents are urgently...

Chronic myeloid leukemia (CML) accounts for approximately 15% of adult leukemias. Forty percent of patients with CML are asymptomatic, in whom the disease is detected solely based on laboratory abnormalities. Since the introduction of tyrosine kinase inhibitor therapy in 2001, CML has become a chronic disease for the majority of patients. Primary c...

Chronic myeloid leukemia (CML) accounts for approximately 15% of adult leukemias. Forty percent of patients with CML are asymptomatic, in whom the disease is detected solely based on laboratory abnormalities. Since the introduction of tyrosine kinase inhibitor therapy in 2001, CML has become a chronic disease for the majority of patients. Primary c...

Chronic hepatitis C virus (HCV) infection, that affects 3% of world’s population, is associated with several hematological manifestations mainly benign cytopenias, coagulopathy and lymphoproliferative diseases. Immune or non‑immune‑mediated thrombocytopenia is a major challenge in chronic HCV infected patients especially in the setting of an advanc...

Central nervous system complications (CNSC) can be the cause of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). We aimed to determine the incidence of CNSC and its impact on survival. This retrospective cohort study included patients with hematologic disorders who received allo-HSCT bet...

Immune-mediated cytopenias are a well-described complication of pregnancy. Appropriate recognition and treatment are important in order to limit maternal and fetal morbidity and mortality. First line treatment options are fairly well-established for these entities. Refractory disease may be difficult to manage because treatment choices are limited...

Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy with features of both a myeloproliferative neoplasm and a myelodysplastic syndrome. Even though extramedullary leukemic infiltration is common in CMML patients, lymph node involvement has rarely been reported in the literature. We present an unusual case of a 72-year-old fe...

Chemotherapy-induced thrombocytopenia causes nearly two-thirds of cases of hrombocytopenia in the cancer setting In patients receiving chemotherapy thrombocytopenia leads to dose reductions in 15% of treatment cycles and chemotherapy delays in 6% of cycles In this issue of ONCOLOGY Dr Kuter insightfully summarizes the differential diagnosis and man...

Understanding the mortality patterns of patients with lymphoma and myeloma, who have undergone autologous hematopoietic stem cell transplantation (ASCT) might identify improvement opportunities. The present retrospective study included patients with lymphoma and myeloma, aged ≥ 18 years, who had undergone ASCT from 1983 to 2010 at the University of...

This book discusses different aspects of neutropenia including drug-induced neutropenia, which is quite common, and neutropenia in chemotherapy-treated patients. The authors offer an all-encompassing approach to the pathobiology and treatment of neutropenic disorders. This book reviews current information concerning neutropenia. There have been sig...

Congenital bone marrow failure syndromes (CBMFS) are generally diagnosed in infancy and early childhood, but may go unrecognized until adulthood. These syndromes are increasingly being diagnosed into adulthood, possibly due to the availability of genetic testing. We describe a young gentleman diagnosed with acute myelogenous leukemia (AML) who unde...

Felty’s syndrome (FS) is characterized by the triad of seropositive rheumatoid arthritis (RA) with destructive joint involvement, splenomegaly and neutropenia. Current data shows that 1-3 % of RA patients are complicated with FS with an estimated prevalence of 10 per 100,000 populations. The complete triad is not an absolute requirement, but persis...

Background: The tumor lysis syndrome (TLS) has been reported to be common in hematologic malignancies, particularly those associated with a high proliferative index, high tumor burden, and highly effective therapy. The classification proposed by Cairo and Bishop (Cairo MS, Bishop M. Br J Haematol 2004; 127:3-11) provides criteria that define labora...

Background: The tumor lysis syndrome (TLS) has been reported to be common in hematologic malignancies, particularly those associated with a high proliferative index, high tumor burden, and highly effective therapy. The classification proposed by Cairo and Bishop (Cairo MS, Bishop M. Br J Haematol 2004; 127:3-11) provides criteria that define labora...

Philadelphia chromosome-positive acute myeloid leukemia (Ph(+)-AML) has a poor response to anthracycline- and cytarabine-containing regimens, high relapse rate, and dismal prognosis. Although therapy with imatinib and allogeneic stem cell transplantation (allo-SCT) is promising, relatively short follow-up limits understanding of long-term results o...

Background: Ponatinib is a tyrosine kinase inhibitor (TKI) indicated for the treatment of Ph+ chronic myeloid leukemia (CML) or acute lymphocytic leukemia (ALL) in the absence of other appropriate TKI therapies or presence of the T315I BCR-ABL mutation. Hematologic toxicity can result in dose reductions, interruptions and discontinuation of drug th...

Monoclonal gammopathies are heterogeneous group of disorders characterized by unregulated production and deposition of monoclonal (M) protein or paraproteins by proliferation of a clone of plasma cells or B lymphocytes. Paraproteins are consist of two same class and subclass heavy polypeptide chains (G, M, or A) and two same type light polypeptide...

Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies tha...