ABSTRACT
Acute Myeloid Leukemia is a clonal proliferative disorder whose incidence increases with age. While studies have shown that the elderly medically unfit patients have poorer outcomes with intensive chemotherapy, a vast majority of them are deemed ineligible for intensive chemotherapy. Multiple studies have also shown that poor performance status prior to treatment initiation affects the prognosis. An accurate comprehensive assessment is hence vital to the selection of such patients. The chemotherapy agents that have been used for AML in the medically unfit patients have also changed significantly in the past few years. In this review we focus on the importance of comprehensive geriatric assessment prior to chemotherapy initiation among patients who are 75 years and older and the treatment approaches available for the medically unfit, Acute Myeloid Leukemia patients.
Subject(s)
Antineoplastic Agents , Leukemia, Myeloid, Acute , Humans , Aged , Leukemia, Myeloid, Acute/therapy , Antineoplastic Agents/therapeutic use , Prognosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic useABSTRACT
The occurrence of T-cell acute lymphoblastic leukemia (T-ALL), on a background of preexisting Philadelphia-negative Myeloproliferative neoplasm is rare. Among the few reported cases where no deep molecular sequencing was performed, it was difficult to ascertain whether these leukemia's occurred de-novo or were due to the clonal progression of underlying MPN. We present a case of a 49-year-old man with a history of essential thrombocythemia who subsequently developed T-ALL. By utilizing next generation sequencing we were able to determine that these two entities originated from two distinct clones and were likely random events. We report the outcome and review the literature.
Subject(s)
Acute Kidney Injury , Multiple Myeloma , Tumor Lysis Syndrome , Acute Kidney Injury/chemically induced , Acute Kidney Injury/diagnosis , Humans , Hydrazines/adverse effects , Multiple Myeloma/complications , Multiple Myeloma/drug therapy , Multiple Myeloma/pathology , Triazoles , Tumor Lysis Syndrome/diagnosis , Tumor Lysis Syndrome/etiologySubject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Leukemia, Myeloid/etiology , Multiple Myeloma/therapy , Myelodysplastic Syndromes/etiology , Aged , Female , Humans , Leukemia, Myeloid/therapy , Male , Middle Aged , Myelodysplastic Syndromes/therapy , Survival Analysis , Transplantation, Autologous/adverse effectsABSTRACT
The SARS-CoV-2 virus responsible for the COVID-19 pandemic can result in severe or fatal disease in a subset of infected patients. While the pathogenesis of severe COVID-19 disease has yet to be fully elucidated, an overexuberant and harmful immune response to the SARS-CoV-2 virus may be a pivotal aspect of critical illness in this patient population. The inflammatory cytokine, IL-6, has been found to be consistently elevated in severely ill COVID-19 patients, prompting speculation that IL-6 is an important driver of the pathologic process. The inappropriately elevated levels of inflammatory cytokines in COVID-19 patients is similar to cytokine release syndrome (CRS) observed in cell therapy patients. We sought to describe outcomes in a series of severely ill patients with COVID-19 CRS following treatment with anti-IL-6/IL-6-Receptor (anti-IL-6/IL-6-R) therapy, including tocilizumab or siltuximab. At our academic community medical center, we formed a multi-disciplinary committee for selecting severely ill COVID-19 patients for therapy with anti-IL-6 or IL-6-R agents. Key selection criteria included evidence of hyperinflammation, most notably elevated levels of C-reactive protein (CRP) and ferritin, and an increasing oxygen requirement. By the data cutoff point, we treated 31 patients with anti-IL-6/IL-6-R agents including 12 who had already been intubated. Overall, 27 (87%) patients are alive and 24 (77%) have been discharged from the hospital. Clinical responses to anti-IL-6/IL-6-R therapy were accompanied by significant decreases in temperature, oxygen requirement, CRP, IL-6, and IL-10 levels. Based on these data, we believe anti-IL-6/IL-6-R therapy can be effective in managing early CRS related to COVID-19 disease. Further study of anti-IL-6/IL-6-R therapy alone and in combination with other classes of therapeutics is warranted and trials are underway.
ABSTRACT
We retrospectively reviewed the impact of impaired renal function (eGFR < 45 ml/min/SA) on post-transplant outcomes in patients receiving ASCT for AL amyloidosis. Patients were grouped into two cohorts, those with normal renal function (NRF) eGFR ≥ 45 ml/min (n = 568) and those with impaired renal function (IRF) eGFR < 45 ml/min (n = 87). Patients with IRF had higher renal stage (>Stage 1: 100% IRF vs 37% NRF, p < 0.0001) and the majority received conditioning with melphalan <200 mg/m2 (70% IRF vs 21% NRF, p < 0.0001). Forty-four patients (6.7%) required dialysis within 100 days of ASCT. Renal stage predicted for dialysis institution within 100 days of ASCT (3% Stage I vs 10% Stage II vs 22% Stage III, p < 0.0001). Dialysis within 100 days was higher in the IRF cohort (16% for IRF cohort vs 6% for NRF cohort, p = 0.0007. Patients with impaired renal function were more likely to be admitted to hospital (80% IRF vs 70% NRF, p = 0.03). The 100-day mortality was higher in the IRF cohort (14% IRF cohort vs 5% NRF cohort, p = 0.008). Median OS and PFS were similar between the two cohorts. Impaired renal function predicts for a higher rate of hospitalization, progression to dialysis and early mortality in patients receiving ASCT for AL amyloidosis.
