ASH Highlights- Foggy Brain: Side Effect or Vitamin Deficiency?

Marina Sampanes Peed

Many of us in the MPN world have experienced:

  • read a page and can’t recall what you just read
  • forget events, tasks, or activities that you used to remember
  • difficulty in thinking clearly

We jokingly call it “chemo brain” and chalk it up to various medications. But what if it’s caused by something else?

According to Catriona Jamieson, MD, PhD, University of California San Diego Cancer Center, it is well-documented that deficiency of thiamine pyrophosphate deficiency (vitamin B-1) causes what we refer to as “chemo brain” or “foggy brain.” Extreme cases of thiamine deficiency can cause Wernicke’s encephalopathy (biochemical lesions on the brain), that affect vision, confusion, and memory.

Causes of thiamine (Vitamin B-1) deficiency

The body doesn’t produce essential vitamins; they must be ingested through eating healthy foods to maintain normal health.

Cancer cells metabolize faster than normal cells and they draw upon the body’s nutrient resources including glucose and micronutrients such as vitamins niacin, folic acid, pantothenic acid, pyridoxine, biotin riboflavin, and thiamine (Vitamin B1).

It’s quite common for patients to forget their nutritional needs when appetite is suppressed due to splenomegaly or certain medications.

Just one of these factors is enough to cause foggy thinking. When experiencing disease progression, the cancer cells are dominating the use critical nutrients.

Weigh the Risks

An association between cancer and low thiamine levels is demonstrated in several reports. The use of supplemental vitamins to modulate cancer rates has been promoted and discounted for years.

Some argue thiamine supplements may contribute to tumor cell survival, proliferation, and chemotherapy resistance.   Other studies suggest that very high dose thiamine produces growth inhibition of malignant cells.

What’s the answer?

Like many other elements, there is no single one size fits all answer. Talk with your hematologist about possible thiamine deficiency. If it’s low, proper dosage of Vitamin B-1 might clear the fog. Vitamins are medicine for your body, so It is important to make any changes with the knowledge and guidance of your physician.For more information check out these articles:

The Role of Thiamine in Cancer: Possible Genetic and Cellular Signaling Mechanisms

Linking Vitamin B1 with Cancer Cell Metabolism


Treatment Decision Support Tool Analysis Suggests Many Clinicians Suboptimally Manage Patients With PV and MF

Many clinicians suboptimally manage patients with polycythemia vera (PV) and myelofibrosis (MF), according to an analysis of data captured from an online tool developed by Clinical Care Options (CCO) in collaboration with a panel of PV and MF experts. The analysis was presented by Ryan Topping, PhD, at the 59th ASH Annual Meeting & Exposition in Atlanta, Georgia.

Treatment for PV and MF continues to be refined, resulting in educational gaps for many healthcare providers (HCPs) who manage these conditions. In collaboration with a panel of PV and MF experts, CCO developed an online treatment decision support tool to assist HCPs in making optimal management choices for patients with PV and MF. HCPs were asked to enter patient case details into the decision support tool and were surveyed on their intended treatment for the case. They were then provided with management choices for that case from the expert panel.

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Questions to ask your Hematologist

The MPN Yoga Study: A Patient’s Story

MPN Patient Amy Wang Manning, Portland, Oregon

Amy Wang Manning.

As I typed one day at work this past spring, my left pinkie suddenly didn’t feel right. A moment later, my left thumb curled under; I couldn’t straighten it except by pulling it with my right hand. Then my entire left hand stiffened into a useless claw. And a tingling sensation was spreading rapidly up my left arm and to my shoulder. I told my boss I needed medical attention. Soon I was in a hospital emergency room, undergoing an MRI.
I didn’t have a stroke that March day. But several weeks later, a hematologist oncologist gave me a diagnosis I’d never heard of: essential thrombocytosis (ET), based on the clot I’d experienced, along with a platelet count of over 1 million and a positive test for the JAK2 mutation. He said I’d probably had ET for as long as 20 years. Suddenly, a lot of health symptoms and setbacks that I’d experienced over that time period made sense.
While I researched essential thrombocytosis online, I stumbled across a call for participants in a pilot study at Arizona State University. The researchers wanted to investigate whether patients with essential thrombocytosis and other myeloproliferative neoplasms could find some relief from symptoms such as pain, fatigue and insomnia by using a mobile app for guided meditation.
While I hadn’t experienced much pain, I’d been having bouts of fatigue and I’d struggled for years with insomnia, which seemed to be worsening. I had practiced yoga and found it helpful in managing my emotional, mental and physical health, so meditation seemed appealing. It certainly couldn’t hurt. And the eight-week study wasn’t asking much of participants: Fill out a few questionnaires, keep a daily sleep log, and wear a Fitbit to track my daily activity. I applied to the study and was accepted. The daily meditation sessions turned out to be very reasonable, just 10 minutes a day.
Now that the study’s finished, I feel calmer and more able to handle whatever comes my way with this disease. I continue to meditate with the app I tested. If nothing else, I am now better equipped to take a deep breath, let go of what I cannot control, and just focus on the moment – this moment, in which I am still here, living.

Italfarmaco Announces Givinostat Clinical Trial Presentations at the 59th American Society of Hematology (ASH) Annual Meeting

MILAN–(BUSINESS WIRE)–Italfarmaco Group, a specialty pharmaceutical company, today announced both an oral and a poster presentation at the 59th American Society of Hematology (ASH) Meeting & Exposition held in Atlanta, Georgia from December 9 – 12, 2017. The presentations cover data from Italfarmaco’s Phase II development program for its proprietary compound Givinostat, in development to treat Polycythemia Vera, a rare blood disease with orphan drug designation. Italfarmaco will announce the results through a press release following the presentations.

Oral Presentation

Title: A Two-Part Study of Givinostat in Patients with Polycythemia Vera: The Maximum Tolerated Dose Selection and the Proof of Concept Final Results

Presenter: Prof. Alessandro Rambaldi

Session Name: 634. Myeloproliferative Syndromes: Clinical: Phase I/II Trials of Novel Agents in MPNs

Date & Time: Saturday, December 9, 2017: 4:00-4:15 PM EST

Location: Bldg C, Lvl 2, C208-C210 (Georgia World Congress Center)

Link to the ASH conference abstract:

Go To MPN Clinical Trials

ASH Presentation-Personalized Medicine in Blood Cancers

Foundation Medicine and Collaborators to Present New Data at the American Society of Hematology (ASH) Annual Meeting that Supports Use of FoundationOne®Heme to Advance Personalized Medicine in Blood Cancers

— New data demonstrate the value of comprehensive genomic profiling for informing clinical care and guiding use of targeted therapies, autologous stem cell transplantation and immunotherapy —

CAMBRIDGE, Mass.–(BUSINESS WIRE)–Foundation Medicine, Inc. (NASDAQ:FMI) today announced that new data generated with FoundationOne®Heme, its comprehensive genomic profiling (CGP) assay for hematologic malignancies and sarcomas, will be presented at the American Society of Hematology (ASH) Annual Meeting. Data from a broad range of blood cancers, including acute myeloid leukemia (AML), myeloproliferative neoplasms (MPN), and non-Hodgkin lymphoma (NHL), including primary central nervous system lymphoma (PCL), demonstrate the value of integrating FoundationOneHeme into clinical care. The data presented is expected to demonstrate the potential for CGP to improve disease classification, to offer personalized prognostic information and to support therapeutic treatment decision making by informing treating physicians about the use of novel treatment options, including cancer immunotherapies.

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ASH Abstract: MPNs and Depressive Symptoms, Diagnosis, and Associations

Patients with a myeloproliferative neoplasm (MPN) diagnosis experience a high systemic symptom burden and a spectrum of physical, financial, mental and emotional stressors. The impact of mood disturbances in MPN patient is not well understood. It was recently identified by our study team that symptoms of depression coexist with the prevalent and debilitating symptom of fatigue in patients with MPNs. The purpose of this study is to comprehensively describe the experience of depressive symptoms in MPN patients.

Methods: A 70-item internet based national survey regarding fatigue and mood symptoms was developed by MPN investigators and patient/advocates and refined by the Mayo Clinic Survey Research Center. The Patient Health Questionnaire-2 (PHQ) was completed by all respondents and utilized to assess symptoms of depression. Survey responses were compared between those who endorsed having current symptoms of depression (defined as a PHQ-2 score ≥ 3) and those without symptoms of depression (defined as a PHQ-2 score < 3).

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Impact Biomedicines to Present Retrospective Data on Fedratinib at the 2017 ASH Annual Meeting

SAN DIEGO — November 27, 2017 — Impact Biomedicines today announced that retrospective data on fedratinib, a potent and highly selective oral small molecule JAK2 kinase inhibitor that is being developed initially for the treatment of myelofibrosis (MF) and polycythemia vera (PV), will be presented in a poster at the 59th American Society of Hematology (ASH) Annual Meeting, taking place on December 9-12, 2017 in Atlanta, GA.
The details of the presentation are as follows:
Session: 634 – Myeloproliferative Syndromes: Clinical: Poster III
Poster Title: Case Series of Potential Wernicke’s Encephalopathy in Patients treated with Fedratinib
Presenter: John Hood, Ph.D.
Date: Monday, December 11, 2017
Presentation time: 6:00-8:00 PM ET
Location: Georgia World Congress Center, Bldg A, Lvl 1, Hall A2
About Impact Biomedicines
Impact Biomedicines (“Impact”) is pioneering the development of life changing treatments for patients with complex cancers. The Company’s pipeline is centered around fedratinib, a potent and highly selective oral small molecule, JAK2 kinase inhibitor that is being developed initially for the treatment of myelofibrosis (MF) and polycythemia vera (PV).

Incyte Announces Pivotal Clinical Trial of Ruxolitinib for Treatment of ET

WILMINGTON, Del.–(BUSINESS WIRE)–Nov. 15, 2017– Incyte Corporation (Nasdaq:INCY) today announced that the first patient has been treated in the RESET pivotal trial evaluating ruxolitinib (Jakafi®) compared to anagrelide for the treatment of patients with essential thrombocythemia (ET) who are resistant to or intolerant of hydroxyurea (HU).

“We are pleased to treat the first patient in our pivotal trial evaluating ruxolitinib as a treatment for ET, a rare blood cancer that can lead to life-threatening complications,” said Steven Stein, M.D., Chief Medical Officer, Incyte. “We look forward to building on the clinical evidence for ruxolitinib and to advancing this trial to help address the needs of higher-risk patients with ET, who are resistant to or intolerant of HU and currently have limited treatment options.”

ET is a rare, chronic blood cancer, part of a group of related blood cancers known as myeloproliferative neoplasms (MPNs), characterized by increased platelet production, a white cell count above the normal range, persistently elevated platelet counts with normal red blood cell mass and the absence of prominent bone marrow fibrosis.1 An increased platelet count can increase the risk of thrombosis. Thrombosis can, in turn, lead to serious health problems including heart attack or stroke. Vascular complications and transformation to myelofibrosis (MF) or acute myeloid leukemia (AML) are the major causes of increased morbidity and mortality in patients with ET.2,3

About the RESET Study

The randomized, double-blind, double-dummy pivotal study (NCT03123588) is evaluating the safety and efficacy of ruxolitinib versus anagrelide as a treatment of patients with ET. The study is expected to enroll approximately 120 patients, 18 years or older, diagnosed with ET who are resistant to or intolerant of HU, with a screening platelet count of >650 × 109/L and white blood cell (WBC) count of >11.0 × 109/L.

The primary endpoint of this study is the proportion of patients who achieve platelet and WBC control over 1 year of follow-up. Key secondary endpoints include safety and tolerability and the proportion of patients who achieve complete remission (CR) or partial remission (PR). For more information about the study, please visit

About Jakafi® (ruxolitinib)

Ruxolitinib is a first-in-class JAK1/JAK2 inhibitor approved by the U.S. Food and Drug Administration, as Jakafi® (ruxolitinib), for treatment of people with polycythemia vera (PV) who have had an inadequate response to or are intolerant of hydroxyurea.

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Effective treatment of low-dose decitabine in MDS/MPNs

Objective: Primary myelofibrosis (PMF) is one of the Philadelphia negative myeloproliferative neoplasms (MPN). The main clinical features are obvious physical symptoms and symptomatic splenomegaly. It may be converse to leukemia and has a shortened life expectancy. Nowadays, the therapy for PMF is aimed at maintaining comfort and there is no curative treatment. PMF with myelodysplastic syndrome (MDS), called MDS/MPN-u, is rare and the treatment is complex. In this study, we want to discuss an effective treatment for MDS/MPN via a case report and literature review.
Materials and methods: A female patient was diagnosed with MDS/MPN through bone marrow cytology, immunology, cell genetics, molecular biology, and pathology. She received thalidomide and prednisone as initial treatment. Ten months later, the first-line therapy had failed, she presented with clinically relevant pancytopenia and increased blasts in bone marrow. Because decitabine is one of the first-line treatments for MDS and the patient was frail, she received low-dose decitabine as second-line therapy. Decitabine was administered at 15 mg/m2 once a week for 3 weeks, in a 4 week cycle. If there was improvement the treatment interval was prolonged.
Result: After one cycle, the blasts in bone marrow were decreased to 0.5%. After four cycles, she felt comfortable and hematological improvement was achieved. The treatment interval was prolonged. After eight cycles, the spleen reduced to 2 cm under the rib, and she achieved complete hematological remission. After ten cycles, the mutation of JAK2/V617F expression was decreased from 60.63% to 0.01%. During the therapy, the patient presented with grade III–IV hematological toxicity after the first two cycles, but there were no side effects after subsequent cycles.
Conclusion: Our research showed that low-dose decitabine may be an effective treatment for MDS/MPN, especially in improving physical symptoms and achieving hematological remission. Besides, it may be possible to reverse positive JAK2 mutation.

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