RESUMEN
We describe the first reported pediatric patient to our knowledge with a spindle cell pseudotumor caused by Mycobacterium genavense in a hematopoietic stem cell transplant recipient, and review the literature of such an entity in the transplant population.
Asunto(s)
Enfermedad Injerto contra Huésped/terapia , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Histiocitos/microbiología , Inmunosupresores/efectos adversos , Ganglios Linfáticos/microbiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Micobacterias no Tuberculosas/patogenicidad , Acondicionamiento Pretrasplante/efectos adversos , Abdomen , Adolescente , Alemtuzumab , Profilaxis Antibiótica , Antibióticos Antituberculosos/uso terapéutico , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Trasplante de Médula Ósea/efectos adversos , Líquido del Lavado Bronquioalveolar/microbiología , Ciclosporina/efectos adversos , Ciclosporina/uso terapéutico , Diabetes Mellitus Tipo 1/congénito , Diabetes Mellitus Tipo 1/cirugía , Diarrea/cirugía , Enfermedades Genéticas Ligadas al Cromosoma X/cirugía , Rechazo de Injerto/cirugía , Humanos , Enfermedades del Sistema Inmune/congénito , Enfermedades del Sistema Inmune/cirugía , Inmunosupresores/uso terapéutico , Ganglios Linfáticos/patología , Masculino , Melfalán/efectos adversos , Melfalán/uso terapéutico , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/patología , Ácido Micofenólico/efectos adversos , Ácido Micofenólico/uso terapéutico , Micobacterias no Tuberculosas/aislamiento & purificación , Fotoféresis , Reacción en Cadena de la Polimerasa , Acondicionamiento Pretrasplante/métodos , Vidarabina/efectos adversos , Vidarabina/análogos & derivados , Vidarabina/uso terapéuticoRESUMEN
Cytotoxic chemotherapy dosages are traditionally calculated according to body surface area (BSA). No guidelines exist for chemotherapy dosing of acute myeloid leukemia (AML) patients at extremes of weight. We investigated the efficacy and safety of chemotherapy dosed according to BSA based on actual body weight (ABW) among under/normal weight, overweight, and obese AML patients. AML patients (excluding acute promyelocytic leukemia) treated with anthracycline and cytarabine-based remission induction chemotherapy from 2002 to 2009 at Cleveland Clinic were divided into three body mass index (BMI) groups: under/normal weight (BMI ≤ 24.9), overweight (BMI 25.0-29.9), and obese (BMI ≥ 30.0). Among 247 AML patients, 81 (33%) were under/normal weight, 81 (33%) were overweight, and 85 (34%) were obese. Complete remission (CR) rates were similar among these groups (69.1, 79.0, and 76.5%, respectively; P = 0.321), as was median survival (10.7, 16.7, and 14.2 months, respectively, P = 0.352) and 30-day mortality (3.7, 2.5, 7.1%, respectively, P = 0.331). There was no difference among groups in days to neutrophil or platelet recovery, hospitalization days for induction chemotherapy, and bacteremia. After adjustment for confounders (age, sex, BMI, white blood cells, cytogenetic risk, etiology, and bacteremia), overall survival was significantly shorter for normal weight compared to overweight (P = 0.006) and obese (0.038) patients. Response rates and adverse events were not significantly different among AML patients of all weight classes when induction chemotherapy was dosed according to ABW. Induction chemotherapy in these patients can be safely dosed using ABW.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/mortalidad , Obesidad/tratamiento farmacológico , Obesidad/mortalidad , Adulto , Anciano , Antraciclinas/administración & dosificación , Antraciclinas/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Índice de Masa Corporal , Citarabina/administración & dosificación , Citarabina/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Quimioterapia de Inducción/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Individuals who carry the CYP2C19*17 gain-of-function allele have lower voriconazole exposure and are therefore at risk of failing therapy. Utilizing CYP2C19 genotype to optimize voriconazole dosage may be a cost-effective method of improving treatment outcomes. However, there are limited data describing what initial voriconazole dosage should be used in those with increased CYP2C19 metabolic capacity. Herein, we present a case report of a pediatric CYP2C19 rapid metabolizer (i.e., CYP2C19*1/*17) requiring a voriconazole dosage of 14 mg/kg twice daily (usual pediatric dosage ranges from 7 to 9 mg/kg twice daily). This case report supports the clinical utility of using CYP2C19 genotype to guide voriconazole dosing, and provides data for establishing an initial voriconazole dose in pediatric CYP2C19 rapid metabolizers.
Asunto(s)
Antifúngicos/administración & dosificación , Antifúngicos/farmacocinética , Citocromo P-450 CYP2C19/genética , Citocromo P-450 CYP2C19/metabolismo , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Aspergilosis Pulmonar Invasiva/metabolismo , Voriconazol/administración & dosificación , Voriconazol/farmacocinética , Niño , Monitoreo de Drogas , Femenino , Humanos , Huésped Inmunocomprometido , Aspergilosis Pulmonar Invasiva/cirugía , Variantes Farmacogenómicas , Medicina de Precisión , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras B/terapiaRESUMEN
PURPOSE: Takotsubo cardiomyopathy is discussed as an alternative diagnosis to acute coronary syndrome (ACS) for emotionally and physically stressed patients with transient apical akinesis or dyskinesis of the left ventricle (LV) in the absence of coronary artery disease (CAD). SUMMARY: The name takotsubo cardiomyopathy refers to the hallmark shape of the LV during initial presentation. The apical portion of the heart balloons out, while the base of the heart has preserved systolic function. It is estimated that 0.5-2% of all patients with ACS symptoms may have takotsubo cardiomyopathy. Symptoms mimic those of a myocardial infarction (MI), and the evaluation of cardiac biomarkers, including troponin, may show a mild increase. Clinical symptoms are generally similar to ACS symptoms. While chest pain and dyspnea are most common, other features, such as cardiogenic shock, are rarer. A case example is described in which a 52-year-old white woman presented herself with complaints of chest pain and shortness of breath. She explained that the chest pain started after an argument with her supervisor. An electrocardiogram showed ST-segment elevation, and the patient was treated for ST-segment elevation MI. A left ventriculogram showed severe apical hypokinesis as well as anterolateral akinesis with a normal anterobasal segment, which led to the diagnosis of takotsubo cardiomyopathy. For patients with complications such as congestive heart failure, standard supportive care for takotsubo cardiomyopathy may include diuretics and vasodilators. In general, vasopressors and inotropes should be avoided because of the association of this syndrome with massive catecholamine release. CONCLUSION: Takotsubo cardiomyopathy may be an alternative diagnosis to ACS for emotionally and physically stressed patients with transient-apical akinesis or dyskinesis of the LV in the absence of CAD. Because the exact pathophysiology has not been fully elucidated, the optimal management continues to evolve.