Document 3QkrYN8QNwBYKqgbYwVo6R0XE

RICHARD T. SILVER, M.D. & GREGORY I. BERK, M.D., P.C. 1440 YOU'K AVRNUK NI!W VORK. NliW VOI1K 10021 TEUF.P I1 ON lv. 212-288-5040 TELF-FAN. 212-472-0012 Septemebr 14 1992 James Orsini, M.D. 36 Newark Avenue Belleville, New Jersey 07109 - Dear Dr. Orsini, Re: REDACTED Thank you for referring to our office, regarding further manaaement of his refractory anemia. .As you know, I first met Mr on 8/21/92, at which time he was requiring approximately 4 to 5 units of packed cells monthly to maintain his hemaglobin. Extensive hematologic evaluation by both you and Dr. Alice Cohen revealed the patient to have a severe refractory anemia with ring sideroblasts. At that time, there was no evidence of leukemic transformation, and cytogenic studies on his bone marrow were negative. Of note, was the patient's 40 year history of being employed by Sherwin-Williams, where he was exposed to high concentrations of both lead and benzine. Despite relatively high doses of erythropoietin, . _________ has remained severely transfusion-dependent. The patient returned to my office today, for repeat bone marrow evaluation. His bone marrow aspirate now reveals normal cellularity, with marked dyspoietic and megaloblastic features in his erythyroid maturation. The sideroblastic stain is strongly positive. Of note, there are no excess blasts. Cytogenic and marker studies have been sent on this repeat aspirate, and these reports will follow. Your management of > to date has been entirely appropriate. I appreciate that this is a particularly frustrating situation to both patient and you as there is little to offer aside from transfusion support. > should also be considered for treatment with 5-Azacytatine. This experimental agent have been shown to have had activity in many of the myelodysplastic syndromes'. I am not sure if it has any specific activity, however, in sideroblastic anemias. I have referred Mr. to Dr. Lewis Silverman at Mount Sinai Hospital, who has access to this drug (through the NCI). I thank you for the opportunity to see Mr follow up with you once I hear from Dr. Silverman. I will With Best Wishes, GIB/pw Gregory I. Berk, M.D. 0007-SWP-005803067 CONFIDENTIAL