Immune reconstitution inflammatory syndrome (IRIS) in a patient with neuro pulmonary nocardiosis following hematopoietic cells transplantation (HCT).

Immune reconstitution inflammatory syndrome (IRIS) is increasingly reported in various HIV negative patients with immunosuppression, but the relationship with hematopoietic cell transplantation (HCT) is not well defined. We report a case of IRIS in a patient infected with pulmonary and CNS Nocardiosis following HCT due to primary myelofibrosis.

Baseline Chest Computed Tomography for Early Diagnosis of Invasive Pulmonary Aspergillosis in Hemato-oncological Patients: A Prospective Cohort Study.

Invasive pulmonary aspergillosis (IPA) has dire consequences in hemato-oncological patients. We report our experience with performing routine baseline chest computed tomography for early diagnosis of IPA. We found high rates of proven or probable IPA diagnosed on admission among patients with newly diagnosed acute myeloid leukemia.

Pulmonary hemorrhage: A novel mode of therapy.

Major hemoptysis a potentially life-threatening condition in pulmonology and can originate from both identifiable and unidentifiable sites. Identifiable bleeding sites can be controlled locally by iced saline, vasopressors, laser, electrocautery and balloon tamponade. Bleeding from an unidentifiable source, on the other hand, is much more difficult to control as the bleeding site is not accessible by the bronchoscope. Tranexamic acid (TA), a synthetic anti-fibrinolytic agent, is approved for treatment or prophylaxis of bleeding episodes in hemophilia or following major operative procedures via intravenous or oral routes. Its efficacy in controlling bleeding from mucosal tissue led us to apply it to patients with pulmonary bleeding. Six patients with significant hemoptysis, two who bled during bronchoscopy biopsy and four with spontaneous bleeding (lung cancer, diffuse alveolar hemorrhage, idiopathic pulmonary bleeding, metastatic thyroid carcinoma) were treated with TA. For the two who bled during bronchoscopy, we used a bolus of 500mg/5mL through the bronchoscope working channel, while the latter four received aerosolized TA 500mg/5ml 3-4 times a day. In all cases, the bleeding stopped with the first dose of TA, and the treatment was well tolerated without adverse events. While limited due to the small number of patients, these data show that TA administered either as a bolus through the bronchoscope or via inhalation seems to be effective in controlling severe hemoptysis from both identifiable and unidentifiable bleeding sites. Further clinical studies are needed to evaluate the use of the TA in this set-up.

Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome.

Therapy of Hodgkin disease (HD) is designed to prolong progression-free survival and minimize toxicity. The best regimen to achieve this has not yet been defined. A total of 108 patients with newly diagnosed HD and adverse prognostic factors were prospectively studied between 1999 and 2004. They were assigned to therapy according to defined risk stratification. Patients were defined depending on the International Prognostic Score (IPS). Those with IPS of 3 or higher received 2 cycles of escalated therapy, including bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [EB]). All others received 2 cycles of standard BEACOPP (SB). Subsequent therapy was prospectively assigned following 2 cycles according to results of early interim 67Ga or positron emission tomography/computed tomography (PET/CT). Following a positive interim scan, 4 cycles of EB were administered, whereas 4 cycles of SB were given to patients with a negative scan. The complete remission rate, the 5-year event-free survival (EFS), and overall survival (OS) rates were 97%, 85% and 90%, respectively. Relapse or progression occurred in 27% of patients with interim positive PET/CT versus 2.3% of negative scans (P<.02). Early interim fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT is a useful tool for adjustment of chemotherapy on an individual basis. Similar EFS and OS rates were observed for patients in both risk groups.