Huma Mansoori, Maria Faraz, Hira Qadir, Anila Rashid, Maria Ali
Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by immature granulocytes in peripheral blood and bone marrow. In 95% of cases, it is always due to the presence of Philadelphia chromosome characterized by the presence of reciprocal translocation between chromosome 9 and 22. However, in 7% -17% of individuals, extramedullary proliferation also occurs, either in skin, lymph nodes, bone or central nervous system (CNS), which could be either myeloid, lymphoid or mixed progenitor in origin...
October 17, 2020: Curēus
Rachael A Fornwalt, Emily P Brigham, R Scott Stephens
Life-threatening complications are frequent after hematopoietic stem cell transplant (HSCT), and optimum critical care is essential to ensuring good outcomes. The immunologic consequences of HSCT result in a markedly different host response to critical illness. Infection is the most common cause of critical illness but noninfectious complications are frequent. Respiratory failure or sepsis are the typical presentations but the sequelae of HSCT can affect nearly any organ system. Pattern recognition can facilitate anticipation and early intervention in post-HSCT critical illness...
January 2021: Critical Care Clinics
Tyler Torrico, Ronald O Crandall, Carlos Meza, Sara Abdijadid
Introduction: Clozapine is the most effective antipsychotic used for treatment resistant schizophrenia and recurrent suicidal behavior in schizophrenia or schizoaffective disorder. However, it has been underutilized due to its adverse reaction profile. Although clozapine is typically associated with neutropenia leading to increased risk of infection (i.e., pneumonia), there have been a few case reports of non-neutropenic, non-infectious drug-induced lung disease (i.e., pneumonitis). Although pneumonia and pneumonitis may have similar clinical presentation, their etiology, management, and treatment are different...
2020: Frontiers in Psychiatry
Hameid Alenazy, Amenah Alghamdi, Ruxandra Pinto, Nick Daneman
BACKGROUND: Candida colonization is a risk factor for the development of invasive candidiasis. We sought to estimate the magnitude of this association, and determine if this information can be used to guide empiric antifungal therapy initiation in critically ill septic patients. METHODS: We systematically reviewed PubMed/MEDLINE and Embase for all published studies evaluating predictors of invasive candidiasis in ICU patients with sepsis. We used meta-analysis to determine pooled odds ratio for invasive candidiasis among colonized versus non-colonized patients...
November 3, 2020: International Journal of Infectious Diseases: IJID
Bora Lim, Juhee Song, Nuhad K Ibrahim, Kimberly B Koenig, Mariana Chavez-MacGregor, Joe E Ensor, Jill Schwartz Gomez, Savitri Krishnamurthy, Abigail S Caudle, Simona F Shaitelman, Gary J Whitman, Vicente Valero
LESSONS LEARNED: The combination of eribulin with FAC/FEC was not superior to the combination of paclitaxel with FAC/FEC and was associated with greater hematologic toxicity. Eribulin followed by an anthracycline-based regimen is not recommended as a standard neoadjuvant therapy in nonmetastatic operable breast cancer. BACKGROUND: Neoadjuvant systemic therapy is the standard of care for locally advanced operable breast cancer. We hypothesized eribulin may improve the pathological complete response (pCR) rate compared with paclitaxel...
November 3, 2020: Oncologist
Shouriyo Ghosh, Mandira Chakraborty, Sambit Samanta, Nilanjan Sinha, Sandeep Saha, Arnab Chattopadhyay, Siddhartha Sankar Roy, Maitreyee Bhattacharyya
Timely administration of appropriate empirical antibiotics in febrile neutropenia is crucial for favourable patient outcomes. There are guidelines in place recommending such antibiotics. However, regional variations and local epidemiological data must be evaluated to tailor the antibiotics for best possible and rational use. In this study, we audited the clinical and microbiological data of febrile neutropenic episodes occurring at a tertiary care haematology institution. Three hundred and ninety-three febrile neutropenic episodes occurring in 123 patients over a 1-year period were analysed for microbial profile, sensitivity and resistance patterns, and finally clinical outcomes...
November 2, 2020: Annals of Hematology
Tariq Ghafoor, Sumaira Khalil, Tanzeela Farah, Shakeel Ahmed, Imtenan Sharif
BACKGROUND: In the developed world, 5-years survival of childhood acute myeloid leukaemia (AML) has improved to 70%. However, the survival rates in the developing world are below 40%. The main contributing factors to these reduced survival rates are a late presentation, malnutrition and high treatment-related mortality. AIM: To document the factors affecting treatment outcome of childhood AML at a tertiary care facility of Pakistan. METHODS AND RESULTS: All newly registered cases of AML under 18 years of age from January 1, 2012 onwards who completed their treatment before November 30, 2019 were included...
October 2020: Cancer reports
Julie Ng, Fei Guo, Anna E Marneth, Sailaja Ghanta, Min-Young Kwon, Joshua Keegan, Xiaoli Liu, Kyle T Wright, Baransel Kamaz, Laura A Cahill, Ann Mullally, Mark A Perrella, James A Lederer
Patients with immune deficiencies from cancers and associated treatments represent a growing population within the intensive care unit with increased risk of morbidity and mortality from sepsis. Mesenchymal stromal cells (MSCs) are an integral part of the hematopoietic niche and express toll-like receptors, making them candidate cells to sense and translate pathogenic signals into an innate immune response. In this study, we demonstrate that MSCs administered therapeutically in a murine model of radiation-associated neutropenia have dual actions to confer a survival benefit in Pseudomonas aeruginosa pneumo-sepsis that is not from improved bacterial clearance...
October 13, 2020: Blood Advances
Senmin Chen, Sixi Liu, Xiuli Yuan, Huihui Wang, Feiqiu Wen
Bloodstream infection (BSI) is a serious complication in pediatric hematology-oncology patients. To evaluate the clinical significance of C-reactive protein (CRP), procalcitonin (PCT), albumin, fibrinogen, and D-dimer as potential biomarkers to differentiate among various subtypes of BSIs in pediatric patients with hematological and oncological diseases, we retrieved and analyzed the medical records of pediatric hematology-oncology patients diagnosed with BSI at our hospital between January 2016 and December 2017...
September 15, 2020: Journal of Pediatric Hematology/oncology
Junhong Jung, Sumin Kim, Jun-Sang Park, Choi-Ryang Lee, Jae-Ho Jeon, Ik-Jae Kwon, Hoon Myoung
Oral and maxillofacial infection is a common complication in patients undergoing chemotherapy. The treatment of oral diseases in such patients differs from that administered to healthy patients. This paper reports a case of acute osteomyelitis of odontogenic origin following a recent chemotherapy session. The patient's condition was life-threatening because of neutropenic fever and sepsis that developed during the inpatient supportive care. However, the patient showed prompt recovery within 40 days following the use of appropriate antibiotics and routine dressing, without the requirement for surgical treatment, except tooth extraction...
August 2020: Journal of Dental Anesthesia and Pain Medicine
M J L Mastboom, W Lips, K van Langevelde, M Mifsud, C Ng, C L McCarthy, N A Athanasou, C L M H Gibbons, M A J van de Sande
INTRODUCTION: Recurrence rates remain high after surgical treatment of diffuse-type Tenosynovial Giant Cell Tumour (TGCT). Imatinib Mesylate (IM) blocks Colony Stimulating Factor1 Receptor (CSF1R), the driver mechanism in TGCT. The aim of this study was to determine if IM reduces the tumour metabolic activity evaluated by PET-CT and to compare this response with the response seen on MR imaging. MATERIALS AND METHODS: 25 Consecutive patients treated with IM (off label use) for locally advanced (N = 12) or recurrent (N = 13) diffuse-type TGCT were included, 15 male and median age at diagnosis 39 (IQR 31-47) years...
August 26, 2020: Surgical Oncology
Courtney D DiNardo, Abhishek Maiti, Caitlin R Rausch, Naveen Pemmaraju, Kiran Naqvi, Naval G Daver, Tapan M Kadia, Gautam Borthakur, Maro Ohanian, Yesid Alvarado, Ghayas C Issa, Guillermo Montalban-Bravo, Nicholas J Short, Musa Yilmaz, Prithviraj Bose, Elias J Jabbour, Koichi Takahashi, Jan A Burger, Guillermo Garcia-Manero, Nitin Jain, Steven M Kornblau, Philip A Thompson, Zeev Estrov, Lucia Masarova, Koji Sasaki, Srdan Verstovsek, Alessandra Ferrajoli, William G Weirda, Sa A Wang, Sergej Konoplev, Zhining Chen, Sherry A Pierce, Jing Ning, Wei Qiao, Farhad Ravandi, Michael Andreeff, John S Welch, Hagop M Kantarjian, Marina Y Konopleva
BACKGROUND: Venetoclax combined with hypomethylating agents is a new standard of care for newly diagnosed patients with acute myeloid leukaemia (AML) who are 75 years or older, or unfit for intensive chemotherapy. Pharmacodynamic studies have suggested superiority of the longer 10-day regimen of decitabine that has shown promising results in patients with high-risk AML in phase 2 trials. We hypothesised that venetoclax with 10-day decitabine could have improved activity in patients with newly diagnosed AML and those with relapsed or refractory AML, particularly in high-risk subgroups...
September 4, 2020: Lancet Haematology
Andrew M Peseski, Mitchell McClean, Steven D Green, Cole Beeler, Heiko Konig
INTRODUCTION: Febrile neutropenia represents one of the most common treatment-associated complications in the management of acute myeloid leukemia (AML) and is considered an oncologic emergency. Rapid and detailed workup as well as the initiation of empiric broad-spectrum antibiotic therapy is critical to avoid sepsis and to reduce mortality. Although a definitive source of infection is frequently not identified, the severely immunosuppressed status of the AML patient undergoing cytotoxic therapy results in a high risk for a wide array of bacterial, fungal and viral etiologies...
September 7, 2020: Expert Review of Anti-infective Therapy
Anish Paudel, Rashmi Dhital, Gabriel Areoye, Sijan Basnet, Niranjan Tachamo
Introduction: Gilteritinib is a FLT3 kinase inhibitor approved for FLT3-mutated acute myeloid leukemia (AML). We present a case of febrile neutropenia and neutrophilic dermatosis consistent with Sweet's syndrome (SS). Case history: A 55-year-old woman presented with fever and skin lesions after 4 weeks of initiation of Gilteritinib for AML. She was febrile, pancytopenic and neutropenic with absolute neutrophil count (ANC) of 0.1x10E3/UI. Examination revealed reddish and violaceous rashes on her extremities...
June 14, 2020: Journal of Community Hospital Internal Medicine Perspectives
James Peek, Jiayi Xu, Han Wang, Shraddha Suryavanshi, Matthew Zimmerman, Riccardo Russo, Steven Park, David S Perlin, Sean F Brady
Semi-synthetic rifamycin derivatives such as rifampicin (Rif) are first line treatments for tuberculosis and other bacterial infections. Historically, synthetic modifications made to the C-3/C-4 region of the rifamycin naphthoquinone, like those seen in Rif, have yielded the biggest improvements in pharmacological properties. However, modifications found in natural product rifamycin congeners occur at other positions in the structure. The kanglemycins (Kangs) are a family of rifamycin congeners with a unique collection of natural modifications including a dimethylsuccinic acid appended to their polyketide backbone...
August 10, 2020: ACS Infectious Diseases
Valeria Fabre, Eili Klein, Alejandra B Salinas, George Jones, Karen C Carroll, Aaron M Milstone, Joe Amoah, Yea-Jen Hsu, Avinash Gadala, Sanjay Desai, Amit Goyal, David Furfaro, Jacquelyn Zimmerman, Susan Lin, Sara E Cosgrove
Background: Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. Methods: Before-after study evaluating the impact of a diagnostic stewardship program to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded...
August 5, 2020: Journal of Clinical Microbiology
Shylah M Moore Pardo, Raj H Patel, Asha Ramsakal, John Greene
Corynebacterium jeikeium is a multidrug-resistant gram-positive bacterium of the human skin flora and one of the most clinically important nondiphtherial corynebacteria in the acute care setting. C. jeikeium can cause different forms of infections, especially in immunocompromised patients with underlying risk factors and comorbidities. C. jeikeium was initially described in 1976 as a highly resistant coryneform bacteria causing severe sepsis in patients with hematologic malignancies and profound neutropenia...
June 22, 2020: Curēus
Federica Calò, Pilar Retamar, Pedro María Martínez Pérez-Crespo, Joaquín Lanz-García, Adrian Sousa, Josune Goikoetxea, José María Reguera-Iglesias, Eva León, Carlos Armiñanzas, Maria Angeles Mantecón, Jesús Rodríguez-Baño, Luis Eduardo López-Cortés
BACKGROUND: Catheter-related bloodstream infections (CRBSIs) increase morbidity and mortality, prolong hospitalization and generate considerable medical costs. Recent guidelines for CRBSI recommend empirical therapy against Gram-positive bacteria (GPB) and restrict coverage for Gram-negative bacteria (GNB) only to specific circumstances. OBJECTIVES: To investigate predictors of GNB aetiology in CRBSI and to assess the predictors of outcome in patients with CRBSI...
October 1, 2020: Journal of Antimicrobial Chemotherapy
Amanda G Blouin, Meier Hsu, Martin Fleisher, Lakshmi V Ramanathan, Stephen M Pastores
BACKGROUND: We evaluated the diagnostic utility of procalcitonin (PCT) in predicting bacterial bloodstream infections (BSI) in critically ill cancer patients with and without neutropenia. We also investigated the role of PCT as a prognostic marker of supportive modalities (vasopressors, invasive mechanical ventilation, and renal replacement therapy (RRT)) in the intensive care unit (ICU). METHODS: We retrospectively analyzed 2,200 PCT and blood cultures from adult cancer patients with suspected sepsis...
July 14, 2020: Clinica Chimica Acta; International Journal of Clinical Chemistry
Ernese Gjafa, Kenrick Ng, Tami Grunewald, Myria Galazi, Erik Skyllberg, Peter Wilson, Constantine Alifrangis, Jonathan Shamash
BACKGROUND: Bleomycin, Etoposide and Cisplatin (BEP) chemotherapy is the conventional treatment regimen for patients with germ cell tumours. The regimen is highly emetogenic and immunosuppressive. High dose steroids are often prescribed with this regimen as antiemetic prophylaxis but may have adverse effects in the context of immunosuppression. OBJECTIVE: To investigate whether the use of a steroid-sparing antiemetic protocol (substituting dexamethasone with olanzapine) affects the incidence of neutropenia and associated hospital admissions in patients receiving BEP chemotherapy...
July 15, 2020: BJU International
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