RESUMEN
OBJECTIVES: We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies. METHODS: BtIFI in patients with ≥ 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions. RESULTS: 121 episodes of BtIFI were documented, of which 41 (33.9%) were proven; 53 (43.8%), probable; and 27 (22.3%), possible. The most frequent prior antifungals included posaconazole (32.2%), echinocandins (28.9%) and fluconazole (24.8%)-mainly for primary prophylaxis (81%). The most common haematologic malignancy was acute leukaemia (64.5%), and 59 (48.8%) patients had undergone a hematopoietic stem-cell transplantation. Invasive aspergillosis, principally caused by non-fumigatus Aspergillus, was the most frequent BtIFI with 55 (45.5%) episodes recorded, followed by candidemia (23, 19%), mucormycosis (7, 5.8%), other moulds (6, 5%) and other yeasts (5, 4.1%). Azole resistance/non-susceptibility was commonly found. Prior antifungal therapy widely determined BtIFI epidemiology. The most common cause of BtIFI in proven and probable cases was the lack of activity of the prior antifungal (63, 67.0%). At diagnosis, antifungal therapy was mostly changed (90.9%), mainly to liposomal amphotericin-B (48.8%). Overall, 100-day mortality was 47.1%; BtIFI was either the cause or an essential contributing factor to death in 61.4% of cases. CONCLUSIONS: BtIFI are mainly caused by non-fumigatus Aspergillus, non-albicans Candida, Mucorales and other rare species of mould and yeast. Prior antifungals determine the epidemiology of BtIFI. The exceedingly high mortality due to BtIFI warrants an aggressive diagnostic approach and early initiation of broad-spectrum antifungals different than those previously used.
Asunto(s)
Candidemia , Neoplasias Hematológicas , Infecciones Fúngicas Invasoras , Humanos , Antifúngicos/uso terapéutico , Estudios Prospectivos , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/epidemiología , Hongos , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/tratamiento farmacológico , Candidemia/tratamiento farmacológico , AspergillusRESUMEN
Primary mediastinal large B-cell lymphoma (PMBCL) is a rare aggressive B-cell lymphoma characterized by the frequent presence of amplification and translocation events at 9p24.1, resulting in the expression of the programmed cell death-1 (PD-1) ligands PD-L1 and PD-L2. Pembrolizumab, a humanized anti-PD-1 monoclonal antibody, binds PD-1 and blocks this interaction, enhancing the activity of the immune system against tumor cells, and has shown activity in PMBCL and in some cases of primary and secondary central nervous system (CNS) lymphoma. We report the case of a 40-year-old woman diagnosed with relapsed PMBCL and secondary CNS involvement who responded to pembrolizumab monotherapy, allowing for a later allogeneic stem cell transplant.
Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Neoplasias del Sistema Nervioso Central/terapia , Linfoma de Células B/terapia , Neoplasias del Mediastino/terapia , Trasplante de Células Madre , Adulto , Aloinjertos , Antígeno B7-H1/antagonistas & inhibidores , Antígeno B7-H1/genética , Antígeno B7-H1/metabolismo , Neoplasias del Sistema Nervioso Central/genética , Neoplasias del Sistema Nervioso Central/metabolismo , Neoplasias del Sistema Nervioso Central/patología , Cromosomas Humanos Par 9/genética , Cromosomas Humanos Par 9/metabolismo , Femenino , Humanos , Linfoma de Células B/genética , Linfoma de Células B/metabolismo , Linfoma de Células B/patología , Neoplasias del Mediastino/genética , Neoplasias del Mediastino/metabolismo , Neoplasias del Mediastino/patología , Proteínas de la Membrana/antagonistas & inhibidores , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Proteínas de Neoplasias/antagonistas & inhibidores , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/metabolismo , Translocación Genética , Proteínas Supresoras de Tumor/antagonistas & inhibidores , Proteínas Supresoras de Tumor/genética , Proteínas Supresoras de Tumor/metabolismoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Enfermedades Hematológicas/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Enfermedades Hematológicas/complicaciones , Pronóstico , Linfoma/terapia , España/epidemiología , BetacoronavirusAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Diagnóstico Tardío , Asignación de Recursos para la Atención de Salud , Accesibilidad a los Servicios de Salud , Neoplasias Hematológicas/diagnóstico , Pandemias/prevención & control , Neumonía Viral/prevención & control , Índice de Severidad de la Enfermedad , Enfermedad Aguda , Adulto , Anciano , COVID-19 , Femenino , Neoplasias Hematológicas/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , SARS-CoV-2 , EspañaAsunto(s)
Fibrilación Atrial , Neoplasias , Accidente Cerebrovascular , Anticoagulantes , Humanos , Pacientes InternosRESUMEN
Atrial fibrillation (AF) and cancer are common disorders in the general population but there are few studies in patients with both diseases. More specifically, there are scarce data on AF in patients with non-Hodgkin lymphoma (NHL). We assessed the incidence, predictive factors, management, and survival impact of AF in a cohort of patients with NHL from a single institution between 2002 and 2016 (n = 747). Twenty-three patients were diagnosed with AF before and 40 after the diagnosis of NHL (of the later, 16 were secondary to an extracardiac comorbidity and 24 unrelated to any triggering event [primary AF]). The 5-year cumulative incidence of new-onset AF was 4% (95% confidence interval [CI] 3-6%). Age and hypertension were the only predictive factors for the development of AF. Management of AF was heterogeneous, primarily with anti-vitamin K agents but also antiplatelet therapy in a significant proportion of patients. Among the 63 patients, there were six episodes of ischemic stroke/transient ischemic attack and four venous thromboembolic events, with four major bleeding episodes. Overall survival (OS) was inferior in patients with AF (HR 0.1, 95% CI 0.01-0.7, p = 0.02), largely due to secondary AF. We conclude that the incidence of new-onset AF in NHL patients seemed somewhat higher than in the general population, although with similar predictive factors. The management was heterogeneous, and the risk of ischemic and hemorrhagic events did not seem higher than in cancer-free patients. Survival was particularly poor for patients with secondary AF.
Asunto(s)
Fibrilación Atrial/epidemiología , Fibrilación Atrial/terapia , Linfoma no Hodgkin/epidemiología , Linfoma no Hodgkin/terapia , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Comorbilidad , Femenino , Humanos , Incidencia , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/diagnóstico , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Análisis de SupervivenciaAsunto(s)
Fibrilación Atrial , Neoplasias , Accidente Cerebrovascular , Tromboembolia , Anticoagulantes , HumanosRESUMEN
BACKGROUND: The CLLflow score was recently suggested as an improvement over the Moreau score (MS) for the diagnosis and classification of B-cell lymphoproliferative disorders (B-LPD). METHODS: We determined the CLLflow score in peripheral blood or bone marrow of a series of cases with an inconclusive immunophenotype, including samples with a MS of 3 (n = 52) and CD5-positive with a score of 2 (n = 38). As controls, B-LPD with a MS of 0-1 (n = 95), CD5-negative score 2 (n = 24), and score 4-5 (i.e., chronic lymphocytic leukemia [CLL], n = 166) were included. RESULTS: The CLLflow score was positive (suggestive of CLL) in all CLL cases and negative in all MS <2, regardless of CD200-positivity, which occurred in 31% (29/95) of cases. The CLLflow score was positive in 71%, 29%, and 8% of samples with a MS 3, CD5-positive score 2, and CD5-negative score 2, respectively. DISCUSSION: Our results suggest that the CLLflow is useful in the differential diagnosis of cases with inconclusive immunophenotype. © 2018 International Clinical Cytometry Society.
Asunto(s)
Citometría de Flujo , Inmunofenotipificación , Leucemia Linfocítica Crónica de Células B/diagnóstico , Leucemia Linfocítica Crónica de Células B/inmunología , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/inmunología , HumanosRESUMEN
BACKGROUND: The Moreau score is essential for the diagnosis of B-cell lymphoproliferative disorders (B-LPD). METHODS: We assessed the consistency of the Moreau score in a series of 138 patients with at least two samples involved by a B-LPD (316 samples) other than germinal center-derived malignancies, hairy cell leukemia, and mantle cell lymphomas. Patients with evidence of two distinct B-LPDs were also excluded. RESULTS: We found 53 inconsistencies in 44 of 138 (32%) patients. FMC7 was the most inconsistent (18 cases) and CD5 the least (5 cases). CD200 was inconsistent in 6 of 67 (9%) cases. The most important predictive factor for the finding of antigenic inconsistencies was sampling of a different anatomic site. Other factors, including number of samples, time between samples, or cytogenetic group, were not predictive. For the most part, these inconsistencies did not appear to be clinically relevant. CONCLUSION: Inconsistencies in the Moreau score are common, supporting the importance of integrated laboratory diagnosis. However, the practical implications of these antigenic inconsistencies are probably limited.