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Chronic Lymphocytic Leukemia

Practice Editing Here (Nov 15th in-class Wiki session work)

 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).

Task:


 * 1) Find a peer-reviewed journal article on PubMed. Practice inserting your citation in the above space using the "cite" tool
 * 2) Choose one "B-level" medical article on Wikipedia from the following list: https://wp1.openzim.org/#/project/Medicine/articles?quality=B-Class&importance=High-Class
 * 3) Practice editing live on Wikipedia by finding a typo in the text or improving the clarity/readability of a sentence by adjusting a few words in a sentence.

First Sentence

 * 1) Original sentence: “Research in 2008 is comparing different forms of bone marrow transplants to determine which patients are the best candidates and which approach is best in different situations.”
 * 2) Proposed change: In light of new therapies such as targeted agents, the role of bone marrow transplants is decreasing. According to a Clinical Practice Guideline by Kharfan-Dabaja et al. (2016) bone marrow transplants are not recommended as a front-line therapy, and only recommended in specific cases where front-line therapies have either failed or there is a lack of response to BCL-2 inhibitors.
 * 3) Rationale: The original sentence had been previously marked for updating, as the statement discusses future research from a date 12 years in the past. In truth, as the article by Pérez-Carretero et al. (2021) describes, the treatment options for Chronic Lymphocytic Leukemia have evolved considerably over time, such that bone marrow transplantation is no longer playing a large role in treatment, aside from special cases described in the clinical practice guidelines by Kharfan-Dabaja et al (2016). This fact demonstrates that the information proposed in the original statement is due to be updated to reflect the knowledge shared in current literature.
 * 4) Controversy or varied opinions: Although current practice guidelines do not recommend forms of bone marrow transplantation in front-line therapies, there are still circumstances identified within the clinical practice guidelines that ultimately recommend treatments such as allogeneic hematopoietic cell transplantation, such as when there is a lack of response after beta cell receptor (BCR) inhibitors. Therefore, it may be viewed as diminutive towards the previous statement indicating that research was being conducted to identify which persons would be best candidates for this type of therapy. However, in my research to update the topic, I was unable to find substantial research into the discovery of which patients would benefit from forms of bone marrow transplantations the most, and I deduced that the focus of research shifted from bone marrow transplantation therapies after reviewing the literature and in particular reading the article by Pérez-Carretero et al. (2021).
 * 5) Critique of sources: For the clinical practice guidelines by Kharfan-Dabaja et al (2016), the authors had no financial interests or conflicts of interest to disclose. The review by Pérez-Carretero et al. (2021) had no conflicts of interest to disclose. While it is difficult to ascertain, one potential source of bias that could potentially apply to both articles could be a publication bias, as the 2016 clinical practice guidelines used Medline via PubMed exclusively for their selection of articles. The selection of articles is not explicitly stated for the 2021 review.

Second Sentence

 * 1) Original sentence: “In the United States during 2014, about 15,720 new cases are expected to be diagnosed, and 4,600 patients are expected to die from CLL.”
 * 2) Proposed change: According to the American Cancer Society (2021) in the United States 13,040 males and 8,210 females are expected to be newly diagnosed with CLL in 2021. In that same year, 2,620 males and 1,700 females are expected to die from CLL.
 * 3) Rationale: The original statistics were pulled from the National Institute of Health (NIH). The statistics were based on data from 2014 and were therefore outdated by 6 years. The statistics should be edited to reflect the current statistics available on CLL case diagnoses and mortality. Moreover, the American Cancer Society provides a more detailed statistical breakdown that will allow the updated literature to reflect the diagnosis and mortality numbers complete but also brokendown by sex: male and female numbers respectively.
 * 4) Controversy or varied opinions:  There is no particular ambiguity or controversy that has been identified with the proposed change. However, there may be concern with respect to the geographical representation of the population statistics provided. Unfortunately, the majority of the research available focused widely on prognostic model research of CLL. Therefore, it was difficult to find available data on CLL statistics on a worldwide scale. A search was conducted via the Data Collection database of the World Health Organization (WHO) in an effort to obtain data that was not limited to just the United States; however most of the research available only yields data on cancer diagnoses and mortality rate and does not specify rates associated with CLL.
 * 5) Critique of sources: The statistical information provided was published on behalf of a major medical/scientific authority: the American Cancer Society. In addition, the source is a recent publication in that it was published within the year of 2021. Moreover, the article accurately summarizes biomedical information with regards to the new cases and deaths associated with CLL ensuring to differentiate case counts from other leukemia related cancers such as acute lymphocytic leukemia, acute myeloid leukemia, chronic myeloid leukemia and others. It is important to note that the statistics are estimates, the American Cancer Society (2021) states that the “estimated new cases are based on 2003 - 2017 incidence data reported by the North American Association of Central Registries (NAACCR).” Moreover, the “deaths are based on 2004 - 2018 US mortality data, National Center for Health Statistics, Centers for Disease Control and Prevention (American Cancer Society, 2021).” While this isn’t necessarily a concern with the source, it is important information to consider when accounting for the estimation accuracy of the statistical data provided.

Third Sentence

 * 1) Original sentence(s): The Research Directions section of the Wikipedia article states: “Research is also investigating therapies targeting B cell receptor signaling. Syk inhibitor fostamatinib is in trials.”
 * 2) Proposed change(s): Syk inhibitors fostamatinib and entospletinib are currently in trials. *Wiki-link on word entospletinib.”
 * 3) Rationale for proposed change: The sentence regarding Syk inhibitors has been flagged as needing an “update”, as it references findings from 2014. Upon further investigation, evidence for the use of fostamatinib appears to still be in the trial phase. However, an updated systematic review by Farooqui, et al. explored novel therapies for chronic lymphocytic leukemia (CLL) and identified entospletinib (a different Syk inhibitor) as showing promising results in clinical trials. This review is relatively recent (i.e. from July 2020) and discusses many different therapies for CLL – however, fostamatinib is not mentioned. With not much progress reportedly being made for fostamatinib use in the past seven years, I figure it is plausible that other therapies, such as entospletinib, have surfaced as either comparable or improved therapeutic options. Since all of this evidence is preliminary, I figure the best course of action is to keep fostamatinib in the article as a therapeutic option but also add entospletinib into the conversation. This serves to address the current note on Wikipedia regarding whether there have been any updates to fostamatinib use. In addition, my change also flags another Syk inhibitor that has clearly been added into the mix as a potential therapeutic option during trials over the past few years.
 * 4) Area of controversy: With any pharmaceuticals listed in research directions, there may be controversy with regards to whether there is strong enough evidence for it to noted on Wikipedia. This makes sense when you consider the inherent issues with drug research (e.g. conflicts of interest and validity of trials) and the implications of researchers looking for study inspiration and/or citizens making decisions about their own treatment. I chose to add the entospletinib therapy into the mix because it is also at the clinical trial stage, which matches the strength of evidence provided for fostamatinib. I also think providing two options for syk inhibitor research helps to give important context that there is not yet one Syk inhibitor treatment that has been proven superior over the other.
 * 5) Critique of source: The methodology used in this systematic review contains a number of strengths. This includes the performance of a comprehensive literature search which consisted of three scientific databases and one clinical trials site, along with a date of last search. Inclusion and exclusion criteria were also clearly established. With regards to article screening, this was done independently by three reviewers at the title/abstract stage. Full-text review was then performed by two reviewers with a third consulted for any disagreements. One point of concern is that no information was provided on the data extraction process. However, a major source of potential bias is that there was no quality assessment performed for the included articles in this systematic review. This raises concerns for how much we can trust the results of the individual studies included and thus leads to questioning of the validity of any conclusions made in this paper. In other words, further research on entospletinib should be performed (as suggested by its addition into the research section).

What to post on the Wikipedia article talk page (part of assignment 3)

 * This will also be covered on Nov 15th in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2021/Talk Page Template