A case of therapy-related acute lymphoblastic leukemia following the treatment of acute myeloid leukemia.

Therapy-related acute lymphoblastic leukemia represents a distinct entity associated with inferior survival compared with de novo acute lymphoblastic leukemia. It consists of a subset of patients who have had exposure to chemotherapy or radiation for a previous malignancy. Here, we describe a case of acute myeloid leukemia who later developed precursor B cell acute lymphoblastic leukemia and discuss the current relevant literature. Our case highlights the importance of classifying therapy-related acute lymphoblastic leukemia as a separate as entity based on its biologic and clinical features.

Evaluating the Response of Palbociclib on Progression-Free Survival in Hormone Receptor-Positive Metastatic Breast Cancer.

BACKGROUND: In patients with hormone receptor-positive metastatic breast cancer, palbociclib has been shown to improve overall survival and progression-free survival (PFS) when combined with endocrine therapy. Dose modification of palbociclib is effective in the management of adverse events. Despite variable clinical response, no predictive biomarkers of efficacy to palbociclib have been identified in metastatic breast cancer. In our study, we aimed to assess the PFS of metastatic breast cancer patients who received dose-reduced palbociclib and compare the results in the non-dose-reduced group. We also evaluated the clinical significance of progesterone receptor (PR) and Ki67 as predictive biomarkers of palbociclib. METHODS: Seventy-six palbociclib-treated metastatic breast cancer patients were included in our study. PFS was compared between dose-reduced and non-dose-reduced groups. PR expression and Ki67 status were assessed by immunohistochemistry. Kaplan-Meier method and log-rank test were used to analyze PFS. RESULTS: Of the 76 patients, 40 (52.6%) experienced dose reduction (DR). Statistical analysis of the results revealed that there were no statistically significant differences observed between dose-reduced (16.5 months) versus non-dose-reduced (17.7 months) patients in PFS (p = 0.5493). For patients with Ki67 ≥14%, PFS was 15.2 months (95% CI: 10.2-22.2 months; p = 0.3024). In patients with PR ≥20%, median PFS was 25.0 months (lower 95% CI: 16.8 months; p = 0.0069). CONCLUSION: Our study indicated that DR of palbociclib is frequently required but does not appear to affect PFS. PR expression was suggested to be a significant predictive factor for palbociclib responsiveness.

COVID19 infection in a patient undergoing treatment for Paroxysmal Nocturnal Hemoglobinuria (PNH) with Ravulizumab.

BACKGROUND: In the recent COVID19 pandemic, patients with hematological disorders were considered at high risk for severe disease. Limited data is available regarding the course of COVID19 infection in this subgroup. CASE PRESENTATION: We describe a case of a 32-year-old man with paroxysmal nocturnal hemoglobinuria (PNH) undergoing treatment with ravulizumab (Ultomiris) who presented with COVID19 infection. He experienced only mild symptoms and had a rapid recovery from COVID19 infection. CONCLUSION: This case may demonstrate the beneficial effects of ravulizumab on complement mediated inflammatory damage linked with COVID19 infection especially in PNH patients.

Presentation and management of the delayed type of hypersensitivity reaction with bendamustine.

Bendamustine, an alkylating agent with cytotoxic properties, has been increasingly employed in the treatment of chronic lymphocytic leukemia (CLL) either as a single agent or combination with rituximab. Although rarely reported, they can potentially cause hypersensitivity reactions with serious consequences. The objective of the case report was to offer a safe and effective bendamustine desensitization protocol to patients with a hypersensitivity reaction to this drug. We report a case of a patient with a CLL who developed a type IV hypersensitivity reaction to bendamustine and who was successfully treated by drug desensitization. A 51-year-old man with CLL was started on chemotherapy with bendamustin-rituximab developed a type IV hypersensitivity reaction 3 days later. A desensitization protocol was developed for the second cycle of bendamustine. This protocol was well tolerated, and no hypersensitivity reaction was observed. The desensitization protocol allowed us to continue the treatment, and to achieve a favorable response of the CLL. Patients with a hypersensitivity reaction to bendamustine can safely receive bendamustine by our rapid desensitization protocol.

Racial Disparities in Menu-Labeling Usage: Analysis of the 2012 Behavioral Risk Factor Surveillance System (BRFSS) Sugar-Sweetened Beverage and Menu-Labeling Module.

OBJECTIVES: Race/ethnic disparities in obesity are widely reported and are often attributed to diet-related factors, such as menu-labeling usage. We aimed to determine whether racial difference exists in menu-labeling usage. METHODS: Data from the 2012 Behavioral Risk Factor Surveillance System were used. Menu labeling was measured from the Sugar-Sweetened Beverages and Menu Labeling module administered in 18 states. We stratified the population into four race/ethnic categories: non-Hispanic whites (reference, n = 66,019, 63%), non-Hispanic blacks (n = 13,623, 13%), Hispanics (n = 14,671, 14%), and others (n = 7336, 7%). Logistic regression was used to examine the racial/ethnic differences in menu-labeling usage. Analyses were conducted adjusting for sociodemographic characteristics, sugar-sweetened beverage intake, and exercise. RESULTS: The prevalence of menu-labeling usage was approximately 55% overall. Hispanics (adjusted odds ratio [AOR], 1.35; 95% confidence interval [CI], 1.14-1.60) and other race/ethnic groups (AOR, 1.39; 95% CI, 1.18-1.64) used menu labeling more compared to non-Hispanic whites. After stratification by race/ethnicity, menu-labeling usage was not associated with exercise or soda consumption among Hispanics, but significant associations were observed among the other three race/ethnic groups. CONCLUSIONS: The findings suggest that participation in healthy behaviors was associated with the higher usage of menu labeling across all racial/ethnic groups except Hispanics. Future studies are needed to explore this mechanism among individuals engaging in unhealthier behavior as well as how it affects Hispanics.