title: Surprising results of a supportive integrated therapy in myelofibrosis.
abstract: OBJECTIVE
  Myelofibrosis (MF) is characterized by shortened survival and a greatly compromised quality of life. Weight loss and cachexia seem to be the most important factors influencing survival in patients with MF. The aim of this study was to assess the efficacy of an integrated supportive therapy in improving cachexia and MF-related symptoms.
  
  
  METHODS
  We reported on a case of a patient with MF who presented with weight loss and cachexia associated with severe anemia, fatigue, fever, and bone pain. The circulating levels of inflammatory, oxidative stress parameters, hepcidin, and erythropoietin were evaluated and were above normal ranges. The patient was treated with a multitargeted approach specifically developed for cachexia including oral l-carnitine, celecoxib, curcumin, lactoferrin, and subcutaneous recombinant human erythropoietin (EPO)-α.
  
  
  RESULTS
  Surprisingly, after 1 y, cachexia features improved, all MF symptoms were in remission, and inflammatory and oxidative stress parameters, hepcidin, and EPO were reduced.
  
  
  CONCLUSIONS
  Because our protocol was targeted at inflammation and the metabolic state, its effectiveness may emphasize the role of inflammation in the pathogenesis of MF symptoms and demonstrates a need for the study of new integrated therapeutic strategies.
authors.affiliation: Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Cagliari, Italy. Electronic address: A.maccio@tin.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macciò
authors.affiliation: Division of Medical Oncology, NS Bonaria Hospital, San Gavino, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Gramignano
authors.affiliation: Department of Medical Sciences "Mario Aresu", University of Cagliari, Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Madeddu
mesh_terms: D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D002097:C-Reactive Protein / Q000378:metabolism; D002100:Cachexia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002331:Carnitine / Q000627:therapeutic use; D000068579:Celecoxib / Q000627:therapeutic use; D003474:Curcumin / Q000627:therapeutic use; D004921:Erythropoietin / Q000627:therapeutic use; D005221:Fatigue / Q000188:drug therapy / Q000209:etiology; D005293:Ferritins / Q000097:blood; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D064451:Hepcidins / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007501:Iron / Q000097:blood; D007781:Lactoferrin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D010349:Patient Compliance; D055728:Primary Myelofibrosis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D011788:Quality of Life; D017382:Reactive Oxygen Species / Q000378:metabolism; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D015431:Weight Loss
chemical_list: D064451:Hepcidins; D015850:Interleukin-6; D017382:Reactive Oxygen Species; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D004921:Erythropoietin; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron; D007781:Lactoferrin; D003474:Curcumin; D000068579:Celecoxib; D002331:Carnitine
keywords: Cachexia; Inflammation; Myelofibrosis; Nutritional support; Quality of life