Patients Age 40 Years and Younger With Multiple Myeloma Have the Same Prognosis as Older Patients: An Analysis of Real-World Patients' Evidence From Latin America.

PURPOSE: Multiple myeloma (MM) is a highly heterogeneous, incurable disease most frequently diagnosed in the elderly. Therefore, data on clinical characteristics and outcomes in the very young population are scarce. PATIENTS AND METHODS: We analyzed clinical characteristics, response to treatment, and survival in 103 patients with newly diagnosed MM age 40 years or younger compared with 256 patients age 41-50 years and 957 patients age 51 years or older. RESULTS: There were no statistical differences in sex, isotype, International Scoring System, renal involvement, hypercalcemia, anemia, dialysis, bony lesions, extramedullary disease, and lactate dehydrogenase (LDH). The most used regimen in young patients was cyclophosphamide, bortezomib, dexamethasone, followed by cyclophosphamide, thalidomide, dexamethasone and bortezomib, thalidomide, dexamethasone. Of the patients age 40 years or younger, only 53% received autologous stem-cell transplant (ASCT) and 71.1% received maintenance. There were no differences in overall survival (OS) in the three patient cohorts. In the multivariate analysis, only high LDH, high cytogenetic risk, and ASCT were statistically associated with survival. CONCLUSION: In conclusion, younger patients with MM in Latin America have similar clinical characteristics, responses, and OS compared with the elderly.

Why do patients with antiphospholipid syndrome bleed? A clinical paradox.

Although worldwide-known criteria of antiphospholipid syndrome include thrombotic and obstetric events, a moderate number of patients manifest with bleeding episodes during course of the disease, which is typically attributed to the long-term anticoagulation. However, these haemorrhagic manifestations sometimes are part of pathophysiological changes that might occur secondary to the disease that involves endothelial activation, platelets dysfunction and blood clot factors misfunction. Recognizing these mechanisms of bleeding is crucial not only due to the need of treatment change or adding, but also because of changes in the disease' prognosis. In this review, we attempted to explain those complications, from its mechanism to a treatment approach, in order for physicians to be able to recognize patients with antiphospholipid syndrome and haemorrhagic manifestations, and to understand that, beyond over-anticoagulation, there are some other mechanisms that can trigger this complication and thus carry out a better diagnostic and therapeutic approach.

Neumonía por coinfección de Aspergillus fumigatus y Pneumocystis jirovecii en un paciente no VIH: Reporte de caso / Pneumonia due to Aspergillus fumigatus and Pneumocystis jirovecii coinfection in a non-HIV- infected patient: Case report

RESUMEN La aspergilosis pulmonar invasiva es una enfermedad presente principalmente en pacientes inmunocomprometidos con alta carga de mortalidad. La neumonía por Pneumocystis jirovecii es una infección oportunista potencialmente mortal que afecta a pacientes inmunocomprometidos por diversas etiologías. La coinfección por estos patógenos en pacientes inmunocompetentes es inusual. Reportamos un caso de un paciente sin las causas tradicionales de inmunocompromiso en el desarrollo de una neumonía en coinfección por Aspergillus fumigatus y Pneumocystis jirovecii.

ABSTRACT Invasive pulmonary aspergillosis is a condition that mainly occurs in immunosuppressed patients, and it has a high mortality rate. Pneumonia caused by Pneumocystis jirovecii is a potentially lethal opportunistic infection affecting immunosuppressed patients with different etiology. Coinfection by Aspergillus and P. jirovecii in immunocompetent patients is unusual. We report a case of a patient with no common causes of immunosuppression who developed pneumonia coinfection caused by Aspergillus fumigatus and Pneumocystis jirovecii.

Non-Cirrhotic Portal Hypertension in a Patient With Colonic Carcinoma Treated With Oxaliplatin.

Oxaliplatin is a chemotherapeutic agent with direct toxic action on deoxyribonucleic acid (DNA), which is known to cause an arrest in its synthesis and inducing cell death. It is a crucial medication for colorectal carcinoma, and in combination with other medications has demonstrated to exhibit synergism, managing to increase patients' survival, especially when compared to monotherapy with 5-fluoracil. Neurotoxicity is its most well-known adverse effect. However, other less frequent secondary effects have been described in case reports, among them liver injury, which is usually secondary to liver sinusoid injury. Despite the wide frequency of the use of this drug, the relationship of oxaliplatin with the development of portal non-cirrhotic hypertension is largely unknown, which translates into a sub-diagnosis, representing an additional risk to patients who develop this complication. We present the case of an adult patient, who during treatment with the FOLFOX scheme for colorectal carcinoma, presents signs suggestive of portal hypertension, without other risk factors besides the administration of oxaliplatin.

Oxaliplatin-Induced Thrombotic Microangiopathy in a Patient with Stage IV Gallbladder Carcinoma: Primary Association or Multiple Hits?

Thrombotic microangiopathies (TMA) include a variety of vascular disorders characterized by the presence of microthrombi, coagulopathy by platelet activation and consumption, and systemic damage. The most frequent secondary causes are infections and some medications. However, the presence of chemotherapeutic agents is not so common, and the induction of TMA by oxaliplatin is poorly understood, with few published case reports. We present the case of a patient with a history of gallbladder carcinoma, in whom findings compatible with TMA were documented, and with a temporal and sole relation to oxaliplatin.

A Patient With Human Herpesvirus 8-Positive Multicentric Castleman's Disease Who Met Criteria for TAFRO Syndrome: Controversy in Practice?

Multicentric Castleman's disease (MCD) is a known entity with characteristics of lymphoproliferative syndrome, characterized by cytokine activation. Its association with human immunodeficiency virus (HIV) is frequently described, as well as its positivity for human herpesvirus 8 (HHV-8). However, some negative patients for the latter (called idiopathic MCD), may have an aggressive spectrum of the disease (characterized by the presence of cytopenia, renal failure, anasarca and organomegaly), known as TAFRO syndrome (thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly). We present the case of a young patient recently diagnosed with HIV infection, in whom MCD was found, and with an aggressive course despite treatment, who met criteria for TAFRO syndrome despite HHV-8 positivity.