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A case of mistaken identity: When lupus masquerades as primary myelofibrosis.

SAGE Open Med Case Rep

August 2016

Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Leukemia Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Hematologic Oncology & Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.

Introduction: Autoimmune myelofibrosis is an uncommon hematologic disease characterized by anemia, bone marrow myelofibrosis, and an autoimmune feature. Myelofibrosis is often associated with other conditions, including infections, nutritional/endocrine dysfunction, toxin/drug exposure, and connective tissue diseases, including scleroderma and systemic lupus erythematosus. Absence of clonal markers (JAK2) and heterogeneity of the symptoms often complicate the diagnosis.

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Recent studies have indicated the Musashi2/NUMB pathway as the key regulator of differentiation in chronic myeloid leukemia; however, a comparison of both gene expressions has not yet been made in myelodysplastic syndrome (MDS) and in acute myeloid leukemia (AML). We herein, demonstrate a statistically significant down-modulation of NUMB expression level in high-risk MDS and AML, compared with control individuals. MSI2 expression was significantly reduced in low and high-risk MDS compared with normal control samples.

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MDM2/p53 pathway plays an important role in the control of apoptotic and proliferation mechanisms, and alterations in this pathway have been described in myelodysplastic syndromes (MDS). We investigated the frequency of MDM2 SNP309, TP53 Arg72Pro polymorphisms in de novo MDS and the association of these polymorphisms with clinical characteristics. Our results showed that the frequencies of genotypes for MDM2 SNP309 and TP53 Arg72Pro did not differ between MDS and healthy controls and that these polymorphisms were not associated with clinical and laboratory parameters, disease progression and overall survival, suggesting that MDM2 and TP53 polymorphisms are not involved in risk for MDS, or in the clinical and laboratory characteristics of the disease.

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BCR-ABL kinase activates downstream signaling pathways, including the PI3K-Akt/mTOR and the MAPK pathway. IRS1 has been previously described as constitutively phosphorylated and associated with BCR-ABL in K562 cells, suggesting that IRS1 has role in the BCR-ABL signaling pathways. In this study, we analyzed the effect of IRS1 silencing, by shRNA-lentiviral delivery, in K562 cells, a CML cell line that presents the BCR-ABL.

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Introduction: Imatinib mesylate is a tyrosine kinase inhibitor used to treat chronic myeloid leukemia (CML) throughout all the phases of the disease. In most cases, this drug is well tolerated; however, some cases experience side effects.

Results And Discussion: Skin rashes and oral lesions are uncommon and appear to be dose-dependent.

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