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Radiation to the lungs

94 4 100 1 ■ 75% experienced improvement in pulmonary hypertension ■ Durable responses achieved with little toxicity

95 1 200 4 ■ Case report with good durable response 93 2 125 5 ■ Resolution of dyspnea and pleural effusions

Radiation for paraspinal/intraspinal EMH

93 5 100-1000 1-5 ■ Excellent and prompt responses to therapy in 4/5

Tumor necrosis factor a (TNF-a) is a cytokine implicated both in the pathogenesis of MMM, as well as in being profibrogenic96 and potentially a direct inhibitor of hematopoiesis,97 and a cause of MMM-associated constitutional symptoms (fatigue and cachexia).98 Etanercept (Enbrel, Immunex, Seattle, WA) is an inhibitor of TNF-a Based on its activity and safety, it was piloted in MMM.99 Twenty-two patients with MMM were prospectively treated with twice-weekly subcutaneous injections of etanercept (25 mg per injection) for up to 24 weeks. The drug was well tolerated and was successful in improving MMM-associated constitutional symptoms in 60% of those enrolled. However, only modest benefit was observed in either improving peripheral cytopenias or reducing splenomegaly (20%).

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