Evaluation of the MD Anderson tumor score for diffuse large B-cell lymphoma in the rituximab era.

OBJECTIVES: Diffuse large B-cell lymphoma (DLBCL) is an aggressive heterogeneous lymphoma with standard treatment. However, 30%-40% of patients still fail, so we should know which patients are candidates for alternative therapies. IPI is the main prognostic score but, in the rituximab era, it cannot identify a very high-risk (HR) subset. The MD Anderson Cancer Center reported a score in the prerituximab era exclusively considering tumor-related variables: Tumor Score (TS). We aim to validate TS in the rituximab era and to analyze its current potential role. METHODS: From GELTAMO DLBCL registry, we selected those patients homogeneously treated with R-CHOP (n = 1327). RESULTS: Five-years PFS and OS were 62% and 74%. All variables retained an independent prognostic role in the revised TS (R-TS), identifying four different risk groups, with 5-years PFS of 86%, 71%, 50%, and very HR (28%). With a further categorization of three variables of the original TS (Ann Arbor Stage, LDH and B2M), we generated a new index that allowed an improvement in HR assessment. CONCLUSIONS: (a) All variables of the original TS retain an independent prognostic role, and R-TS remains predictive in the rituximab era; (b) R-TS and additional categorization of LDH, B2M, and AA stage (enhanced TS) increased the ability to identify HR subsets.

Medium- and long-range transport events of Alnus pollen in western Mediterranean.

Alnus pollen has been frequently detected in the atmosphere of different airborne sampling sites of Southern Spain. However, Alnus sp. populations are very scarce and fragmented in the area, being restricted to a few river valleys in the southwest, and other further away regions of the Iberian Peninsula. This leads to think that the airborne pollen detected could be mainly the result of a medium- or long-distant transport. So, the aim of this study was to characterize the annual patterns of airborne Alnus pollen detected at three different locations of Malaga province, as well as to determine its possible origin, the pollen dispersion potential of these Alnus isolated populations, and their possible reproductive connectivity. Pollen sampling was conducted by means of three Hirst-type volumetric pollen traps. Samples were mounted and counted following the recommendations of the Spanish Aerobiology Network and the European Aeroallergen Society. The possible pollen sources were detected by means of a combination of meteorological information and backward air trajectories analysis. A high inter-annual variability in the annual pollen integrals was found in all the stations, favouring certain meteorological conditions a long-range transport and, therefore, causing the high concentrations detected in some specific days. Alnus pollen seems to have a heterogeneous origin with prevalence of the long-distant transport, which would suggest a possible reproductive connection among distant populations.

Use and safety of riboflavin and UV light-treated platelet transfusions in children over a five-year period: focusing on neonates.

BACKGROUND: There are very few published reports about the use and safety of pathogen reduction technology (PRT) based on riboflavin and UV light for platelet (PLT) transfusion in children. STUDY DESIGN AND METHODS: A two-part study was conducted: 1) a study investigating the safety of PLTs treated with riboflavin and UV light-PRT transfused to 379 children and 1,980 adults over a 5-year period; 2) an observational study evaluating the efficacy of PLT use in 132 neonates transfused with PRT-treated PLT compared with 99 neonates receiving standard PLTs over two 5-year periods. RESULTS: The rate of adverse reactions related to transfusions with PRT-treated PLTs was found to be slightly higher in adults than in children, although not statistically significant (0.19% vs. 0.12%; p = 0.85). All PLT transfusion events in children were mild. From 2013 to 2017, 379 children received 4,236 riboflavin and UV light-treated PLTs. Hemato-oncology patients received the most PLT transfusions (61.2%), followed by critically ill children in the Pediatric Intensive Care Unit (PICU) (24.6%), and neonates in the Neonatal Intensive Care Unit (NICU) (10.5%). A significant increase in PLT transfusions was found in 132 neonates transfused with 458 PRT-treated PLTs compared with 99 neonates receiving 176 standard PLTs, measuring PLT use/patient (p = 0.031) and total PLT dose/patient (p = 0.041). CONCLUSIONS: Riboflavin and UV light-based PRT for PLTs seems to be safe for children. Neonates required a higher number of PLT transfusions when these were PRT-treated rather than standard. A long-term follow-up for chronically transfused children and randomized clinical trials are needed.

Our experience in riboflavin and ultraviolet light pathogen reduction technology for platelets: from platelet production to patient care.

BACKGROUND: Pathogen reduction technology (PRT) enhances blood component safety, but its implementation is hampered by loss of blood quality and cost. STUDY DESIGN AND METHODS: A retrospective study was conducted to investigate the efficacy, safety, and cost of 9673 riboflavin and ultraviolet light-treated platelet (PLT) transfusions given to 1211 patients during a 3-year period. The results were compared with the efficacy, safety, and cost of 6424 nontreated PLT transfusions administered to 1500 patients during a 3-year comparison period before PRT implementation. RESULTS: Despite a similar PLT transfusion dose per unit for both periods (pre-PRT period 3.26 vs. PRT period 3.19), the mean number of PLT concentrates per patient (4.2 vs. 7.8; p = 0.006) and the total dose of PLTs received by patients were higher in the PRT period (13.6 vs. 24.8; p = 0.0002). Hematology and medical and surgical patient categories had the highest PLT use per patient. However, febrile (2.5% vs. 1.2%; p = 0.02) and allergic (0.16% vs. 0.08%; p = 0.01) reactions were lower during the PRT period. The blood center saved €284,805.58 due to a reduction of outdated PLTs from 16.8% to 0.72% after PRT implementation. CONCLUSIONS: Although PRT can improve PLT safety, it can increase the amount of PLTs required for transfusion in some patient categories. The cost of PRT can be partially offset by the savings associated with a lower rate of PLT outdates. This cost reduction can be a key factor in settings where inventory management is challenged by a high percentage of wasted PLTs due to outdating.

Efficacy of the GemOx-R regimen leads to the identification of Oxaliplatin as a highly effective drug against Mantle Cell Lymphoma.

Mantle Cell Lymphoma (MCL) is an aggressive lymphoma subtype that accounts for 6-8% of non-Hodgkin lymphomas. The disease is mostly incurable and characterized by a continuous pattern of relapse. Major changes have recently been implemented in the management of MCL, but continuous relapses still mark this disease as a challenge for clinicians. We previously reported the efficacy of GemOx-R (Gemcitabine, Oxaliplatin and Rituximab) in patients with refractory and relapsing MCL. We present results for a larger series with longer follow-up and including high-risk frontline patients, showing an overall response rate of 83%. The efficacy of each component of GemOx-R was evaluated in a panel of MCL cell lines. Also, patient-derived primary cells were used in ex vivo experiments. The results show that oxaliplatin has a profound effect on cellular viability and is the most effective drug within this regimen. We further present synergistic efficacy of oxaliplatin combined with cytarabine in MCL cells. Interestingly, this synergistic effect was not seen when cisplatin and cytarabine were combined, indicating that among the platinum-derived agents oxaliplatin may be the preferred approach. Taken together our findings suggest that oxaliplatin alone or combined with cytarabine could constitute an alternative backbone for MCL regimens.

A deep learning LSTM-based approach for forecasting annual pollen curves: Olea and Urticaceae pollen types as a case study.

Airborne pollen can trigger allergic rhinitis and other respiratory diseases in the synthesised population, which makes it one of the most relevant biological contaminants. Therefore, implementing accurate forecast systems is a priority for public health. The current forecast models are generally useful, but they falter when long time series of data are managed. The emergence of new computational techniques such as the LSTM algorithms could constitute a significant improvement for the pollen risk assessment. In this study, several LSTM variants were applied to forecast monthly pollen integrals in Málaga (southern Spain) using meteorological variables as predictors. Olea and Urticaceae pollen types were modelled as proxies of different annual pollen curves, using data from the period 1992-2022. The aims of this study were to determine the LSTM variants with the highest accuracy when forecasting monthly pollen integrals as well as to compare their performance with the traditional pollen forecast methods. The results showed that the CNN-LSTM were the most accurate when forecasting the monthly pollen integrals for both pollen types. Moreover, the traditional forecast methods were outperformed by all the LSTM variants. These findings highlight the importance of implementing LSTM models in pollen forecasting for public health and research applications.

Effect of meteorological parameters on Poaceae pollen in the atmosphere of Tetouan (NW Morocco).

Poaceae pollen is one of the most prevalent aeroallergens causing allergenic reactions. The aim of this study was to characterise the grass pollen season in Tetouan during the years 2008-2010, to analyse the effect of some meteorological parameters on the incidence of the airborne Poaceae pollen, and to establish forecasting variables for daily pollen concentrations. Aerobiological sampling was undertaken over three seasons using the volumetric method. The pollen season started in April and showed the highest pollen index in May and June, when the maximum temperature ranged from 23 to 27 °C, respectively. The annual pollen score recorded varied from year to year between 2,588 and 5,404. The main pollen season lasted 114-173 days, with peak days occurring mainly in May; the highest concentration reached 308 pollen grains/m(3). Air temperature was the most important meteorological parameter and correlated positively to daily pollen concentration increase. An increase in relative humidity and precipitation was usually related to a decrease in airborne pollen content. External validation of the models performed using data from 2011 showed that Poaceae pollen concentration can be highly predicted (64.2-78.6 %) from the maximum temperature, its mean concentration for the same day in other years, and its concentration recorded on the previous day. Sensitive patients suffering allergy to Poaceae pollen are at moderate to highest risk of manifesting allergic symptoms to grass pollen over 33-42 days. The results obtained provide new information on the quantitative contribution of the Poaceae pollen to the airborne pollen of Tetouan and on its temporal distribution. Airborne pollen can be surveyed and forecast in order to warn the atopic population.

Spatial and temporal distribution of Alternaria spores in the Iberian Peninsula atmosphere, and meteorological relationships: 1993-2009.

This paper provides an updated of airborne Alternaria spore spatial and temporal distribution patterns in the Iberian Peninsula, using a common non-viable volumetric sampling method. The highest mean annual spore counts were recorded in Sevilla (39,418 spores), Mérida (33,744) and Málaga (12,947), while other sampling stations never exceeded 5,000. The same cities also recorded the highest mean daily spore counts (Sevilla 109 spores m(-3); Mérida 53 spores m(-3) and Málaga 35 spores m(-3)) and the highest number of days on which counts exceeded the threshold levels required to trigger allergy symptoms (Sevilla 38 % and Mérida 30 % of days). Analysis of annual spore distribution patterns revealed either one or two peaks, depending on the location and prevailing climate of sampling stations. For all stations, average temperature was the weather parameter displaying the strongest positive correlation with airborne spore counts, whilst negative correlations were found for rainfall and relative humidity.

Analysis of vaccine responses after anti-CD20 maintenance in B-cell lymphoma in the Balearic Islands. A single reference center experience.

Introduction: The use of maintenance approaches with anti-CD20 monoclonal antibodies has improved the outcomes of B-cell indolent lymphomas but may lead to significant peripheral B-cell depletion. This depletion can potentially hinder the serological response to neoantigens. Methods: Our objective was to analyze the effect of anti-CD20 maintenance therapy in a reliable model of response to neoantigens: SARS-CoV-2 vaccine responses and the incidence/severity ofCOVID-19 in a reference hospital. Results: In our series (n=118), the rate of vaccination failures was 31%. Through ROC curve analysis, we determined a cutoff for SARS-CoV-2 vaccine serologic response at 24 months from the last anti-CD20 dose. The risk of severe COVID-19 was notably higher within the first 24months following the last anti-CD20 dose (52%) compared to after this period (just 18%) (p=0.007). In our survival analysis, neither vaccine response nor hypogammaglobulinemia significantly affected OS. While COVID-19 led to a modest mortality rate of 2.5%, this figure was comparable to the OS reported in the general immunocompetent population. However, most patients with hypogammaglobulinemia received intravenous immunoglobulin therapy and all were vaccinated. In conclusion, anti-CD20 maintenance therapy impairs serological responses to SARS-CoV-2 vaccines. Discussion: We report for the first time that patients during maintenance therapy and up to 24 months after the last anti-CD20 dose are at a higher risk of vaccine failure and more severe cases of COVID-19. Nevertheless, with close monitoring, intravenous immunoglobulin supplementation or proper vaccination, the impact on survival due to the lack of serological response in this high-risk population can be mitigated, allowing for the benefits of anti-CD20 maintenance therapy, even in the presence of hypogammaglobulinemia.

Analysis of the predicting variables for daily and weekly fluctuations of two airborne fungal spores: Alternaria and Cladosporium.

Alternaria and Cladosporium are two fungal taxa whose spores (conidia) are included frequently in aerobiological studies of outdoor environments. Both spore types are present in the atmosphere of Malaga (Spain) throughout almost the entire year, although they reach their highest concentrations during spring and autumn. To establish predicting variables for daily and weekly fluctuations, Spearman's correlations and stepwise multiple regressions between spore concentrations (measured using a volumetric 7-day recorder) and meteorological variables were made with results obtained for both spore types in 1996 and 1997. Correlations and regressions were also made between the different taxa and their concentrations in different years. Significant and positive correlation coefficients were always obtained between spore concentrations of both taxa, followed by temperature, their concentrations in different years, sunshine hours and relative humidity (this last in a negative sense). For the two spore types we obtained higher correlation and regression coefficients using weekly data. We showed different regression models using weekly values. From the results and a practical point of view, it was concluded that weekly values of the atmospheric concentration of Alternaria spores can be predicted from the maximum temperature expected and its concentrations in the years sampled. As regards the atmospheric concentration of Cladoposrium spores, the weekly values can be predicted based on the concentration of Alternaria spores, thus saving the time and effort that would otherwise be employed in counting them by optical microscopy.

Variation in human 3D trunk shape and its functional implications in hominin evolution.

This study investigates the contribution of external trunk morphology and posture to running performance in an evolutionary framework. It has been proposed that the evolution from primitive to derived features of torso shape involved changes from a mediolaterally wider into a narrower, and antero-posteriorly deeper into a shallower, more lightly built external trunk configuration, possibly in relation to habitat-related changes in locomotor and running behaviour. In this context we produced experimental data to address the hypothesis that medio-laterally narrow and antero-posteriorly shallow torso morphologies favour endurance running capacities. We used 3D geometric morphometrics to relate external 3D trunk shape of trained, young male volunteers (N = 27) to variation in running velocities during different workloads determined at 45-50%, 70% and 85% of heart rate reserve (HRR) and maximum velocity. Below 85% HRR no relationship existed between torso shape and running velocity. However, at 85% HRR and, more clearly, at maximum velocity, we found highly statistically significant relations between external torso shape and running performance. Among all trained subjects those with a relatively narrow, flat torso, a small thoracic kyphosis and a more pronounced lumbar lordosis achieved significantly higher running velocities. These results support the hypothesis that external trunk morphology relates to running performance. Low thoracic kyphosis with a flatter ribcage may affect positively respiratory biomechanics, while increased lordosis affects trunk posture and may be beneficial for lower limb biomechanics related to leg return. Assuming that running workload at 45-50% HRR occurs within aerobic metabolism, our results may imply that external torso shape is unrelated to the evolution of endurance running performance.

The evolution, form and function of the human respiratory system.

This paper presents an updated view on the morphological and functional significance of the human respiratory system in the context of human evolutionary anatomy. While usually the respiratory system is treated either from a craniofacial perspective, mostly in the context of nasal evolution and air-conditioning, or from a postcranial perspective featuring on overall thoracic shape changes, here we pursue a holistic perspective on the form, function, integration, and evolutionary change of the entire organismal system in hominins. We first present a brief review of the most important morphological structures, their function, and its potential integration and interaction with the nasal cavity and thoracic skeleton. This is followed by an overview of the most important improvements in methods for the comparative study in recent humans and fossil hominins. We then overview and list a compendium of hominin fossil material currently available for the study. We propose four functional categories of hominin respiratory system configurations that differ potentially with respect to size, shape, biomechanics and/or bioenergetics. Finally, we discuss these and speculate on possible ways for future research into an anatomical system that, despite its under-investigated status, is central to the understanding of the form and functions of the hominin organism and its paleobiology.

Environmental drivers of the seasonal exposure to airborne Alternaria spores in Spain.

Alternaria conidia have high allergenic potential and they can trigger important respiratory diseases. Due to that and to their extensive detection period, airborne Alternaria spores are considered as a relevant airborne allergenic particle. Several studies have been developed in order to predict the human exposure to this aeroallergen and to prevent their negative effects on sensitive population. These studies revealed that some sampling locations usually have just one single Alternaria spore season while other locations generally have two seasons within the same year. However, the reasons of these two different seasonal patterns remain unclear. To understand them better, the present study was carried out in order to determine if there are any weather conditions that influence these different behaviours at different sampling locations. With this purpose, the airborne Alternaria spore concentrations of 18 sampling locations in a wide range of latitudinal, altitudinal and climate ranges of Spain were studied. The aerobiological samples were obtained by means of Hirst-Type volumetric pollen traps, and the seasonality of the airborne Alternaria spores were analysed. The optimal weather conditions for spore production were studied, and the main weather factor affecting Alternaria spore seasonality were analysed by means of random forests and regression trees. The results showed that the temperature was the most relevant variable for the Alternaria spore dispersion and it influenced both the spore integrals and their seasonality. The water availability was also a very significant variable. Warmer sampling locations generally have a longer period of Alternaria spore detection. However, the spore production declines during the summer when the temperatures are extremely warm, what splits the favourable period for Alternaria spore production and dispersion into two separate ones, detected as two Alternaria spore seasons within the same year.

The International Prognostic Index Is Associated with Outcomes in Diffuse Large B Cell Lymphoma after Chimeric Antigen Receptor T Cell Therapy.

CD19-targeted chimeric antigen receptor (CAR) T cells have shown excellent activity against relapsed and refractory (R/R) diffuse large B cell lymphoma (DLBCL). CAR T cell therapy is associated with early toxicities, including cytokine release syndrome and neurotoxicity. The incidence and severity of these toxicities has been associated in part with baseline disease and patient characteristics, which also may impact overall survival (OS) and progression-free survival (PFS). However, there are limited data on patient selection and how to better predict toxicities or outcomes. Indexes used in patients with DLBCL, such as the International Prognostic Index (IPI and age-adjusted IPI [aaIPI]) and in transplantation recipients, such as the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), have not been evaluated in this setting. Here we evaluated 4 indices- IPI, aaIPI, HCT-CI, and the Charlson Comorbidity Index (CCI)-and their associations with early CAR T cell related-toxicities and outcomes. We demonstrated an association between high-risk IPI or aaIPI and inferior PFS in patients with R/R DLBCL treated with CAR T cell therapy. We also found an association between aaIPI and IPI with OS and neurotoxicity, respectively. CCI was not associated with toxicities or outcomes, and owing to the small sample size, we could not draw a conclusion regarding associations with the HCT-CI. Both the IPI and aaIPI are widely used tools that can now provide better information to guide selection of patients who would best benefit from CD19 CAR T cell therapy.

Infection during the first year in patients treated with CD19 CAR T cells for diffuse large B cell lymphoma.

CD19-targeted chimeric antigen receptor (CAR) T cell therapy is an effective treatment for diffuse large B cell lymphoma (DLBCL). In addition to cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS), B cell aplasia and hypogammaglobulinemia are common toxicities predisposing these patients to infections. We analyzed 60 patients with DLBCL treated with FDA-approved CD19 CAR T cells and report the incidence, risk factors, and management of infections during the first year after treatment. A total of 101 infectious events were observed, including 25 mild, 51 moderate, 23 severe, 1 life-threatening, and 1 fatal infection. Bacteria were the most common causative pathogens. The cumulative incidence of overall, bacterial, severe bacterial, viral, and fungal infection at 1 year were 63.3%, 57.2%, 29.6%, 44.7%, and 4%, respectively. In multivariate analyses, the use of systemic corticosteroids for the management of CRS or ICANS was associated with an increased risk of infections and prolonged admission. Impaired performance status and history of infections within 30 days before CAR T cell therapy was a risk factor for severe bacterial infection. In conclusion, infections were common within the first 60 days after CAR T cell therapy, however, they were not associated with an increased risk of death.

DLBCL patients treated with CD19 CAR T cells experience a high burden of organ toxicities but low nonrelapse mortality.

Cytokine release syndrome (CRS) immune effector cell-associated neurotoxicity syndrome are the most notable toxicities of CD19 chimeric antigen receptor (CAR) T-cell therapy. In addition, CAR T-cell-mediated toxicities can involve any organ system, with varied impacts on outcomes, depending on patient factors and involved organs. We performed detailed analysis of organ-specific toxicities and their association with outcomes in 60 patients with diffuse large B-cell lymphoma (DLBCL) treated with CD19 CAR T cells by assessing all toxicities in organ-based groups during the first year posttreatment. We observed 539 grade ≥2 and 289 grade ≥3 toxicities. Common grade ≥3 toxicities included hematological, metabolic, infectious, and neurological complications, with corresponding 1-year cumulative incidence of 57.7%, 54.8%, 35.4%, and 18.3%, respectively. Patients with impaired performance status had a higher risk of grade ≥3 metabolic complications, whereas elevated lactate dehydrogenase was associated with higher risks of grade ≥3 neurological and pulmonary toxicities. CRS was associated with higher incidence of grade ≥3 metabolic, pulmonary, and neurologic complications. The 1-year nonrelapse mortality and overall survival were 1.7% and 69%, respectively. Only grade ≥3 pulmonary toxicities were associated with an increased mortality risk. In summary, toxicity burdens after CD19 CAR T-cell therapy were high and varied by organ systems. Most toxicities were manageable and were rarely associated with mortality. Our study emphasizes the importance of toxicity assessment, which could serve as a benchmark for further research to reduce symptom burdens and improve tolerability in patients treated with CAR T cells.

Extraction and quantification of Ole e 1 from atmospheric air samples: An optimized protocol.

Olive pollen is the main cause of pollinosis in Mediterranean countries. The immunological analysis of Ole e 1, the major allergen of Olea europaea, has usually carried out by means of ELISA (Enzyme-Linked ImmunoSorbent Assay). However, most published works only specify the methodology related to antigen quantifications, but not the related to protein extraction. Furthermore, the results obtained are not compared with different buffers or modifications of them. The main aim of this study is to obtain an optimized and reproducible ELISA protocol for quantifications of Ole e 1 in the atmosphere. The study of Ole e 1 allergen and olive pollen in the atmosphere of Malaga (Spain) was carried out by means of an automatic multi-vial cyclonic sampler and a Hirst volumetric pollen trap, respectively. ELISA was tuned up on the basis of previously published protocols to quantify this allergen. Variations in the concentrations of capture and detection antibodies, as well as in the buffers used to carry out the extraction, were evaluated. The highest protein extraction was obtained when a modified buffer was applied. The correlation analysis between daily pollen concentrations and allergen quantifications showed highly significant values. The ELISA protocol, together with the buffer combination proposed in this work, considerably reduced the concentrations of capture and detection antibodies used for quantifying Ole e 1 in the atmosphere, allowing detect this allergen even in days in which the airborne pollen concentration was very low or null.

Comparative Cost Analysis Of Intravenous And Subcutaneous Administration Of Rituximab In Lymphoma Patients.

PURPOSE: The availability of different routes of administration of rituximab, with different dosing and times of infusion in the day care unit, raises the question of which formulation would be the best in terms of direct cost, particularly with the approval of new intravenous (IV) rituximab biosimilars. We aim to retrospectively compare the direct costs of IV and subcutaneous (SC) rituximab in lymphoma, considering drug cost, pharmacy handling and occupation in day care unit in Son Espases University Hospital during 2017, now that the IV biosimilar is available. PATIENTS AND METHODS: The data were collected from Oncosafety®-AVIDA for doses and SAP® for economic data. The costs of occupation are published by the Local Health Service. RESULTS: In 2017, 527 cycles were prescribed for 103 patients with lymphoma: 141 IV and 386 SC. Median doses were 690 mg and 1400 mg with a median cost of the drug of 1458.45€ and 1334.77€ for IV and SC routes, respectively. The nurse handling costs were 4.49€ and 2.24€, respectively. The cost of the day care unit occupation was 493€ and 123€, respectively. Overall, the median total cost per cycle was 1955.94€ for the IV, 1460.01€ for the SC and 1729€ for the biosimilar (p<0.001). The sensitivity analysis showed that it would be necessary for the cost of the IV biosimilar to be 34% lower than the price of SC rituximab to make a difference. CONCLUSION: This study shows a reduction in the cost with the administration of SC rituximab in real life compared with using the IV original rituximab and the biosimilar. This information is relevant for healthcare managers and administrations and applies only in the case of drugs with SC original presentations still not available in their correspondent biosimilars.

Rhabdomyosarcoma debut masquerading as acute lymphoblastic leukemia: A case report and review of the literature.

Bone marrow infiltration by alveolar rhabdomyosarcoma is uncommon, some cases can mimicry acute leukemia at presentation and mislead the diagnosis. The integration of diagnostics tests and techniques in uncommon malignancies is important to suspect and reach the diagnosis and avoid delay on treatment. We report a case of alveolar rhabdomyosarcoma bone marrow infiltration associated with hemophagocytosis and cell cannibalism, mimicking acute leukemia at presentation.

Complete response associated with lenalidomide and celecoxib in a case of primary refractory Hodgkin lymphoma.

Hodgkin lymphoma (HL) represents ~11% of all lymphoma cases. This disease occurs in young adults, but also affects people over 55 years of age. Despite the fact that >80% of all newly diagnosed patients under 60 will achieve a sustained complete response (CR), 5%-10% of HL patients are refractory to initial treatment and 10%-30% of patients will eventually relapse after an initial CR. The treatment recommendation for primary refractory or relapsed HL patients is salvage therapy followed by high-dose chemotherapy and autologous stem cell transplantation. Following this approach, a significant part will still relapse at any moment. Thus, further research and new drugs or combinations are required. Overexpression of COX-2 has been associated with poor prognosis in relapse/refractory HL patients, so it could be a potential therapeutic target in HL. For this purpose, several drugs may have a role: specific COX-2 inhibitors such as celecoxib or other anti-inflammatory drugs such as lenalidomide may further inhibit lipopolysaccharide-mediated induction of COX-2. Moreover, lenalidomide and COX-2 inhibitors (celecoxib) have been tested in solid tumors with encouraging results. We present a case of a young female diagnosed with a heavily pretreated HL nodular sclerosis subtype who, after failing six treatment lines, only achieved clinical and radiological CR after six cycles of lenalidomide/celecoxib that resulted in an event-free survival of 22 months. We explain the rationale of using this chemotherapy regimen and our patient follow-up.