RESUMO
Multiple myeloma is a malignant plasma cells dyscrasia that mainly affects patients older than 65 years. These patients are at a higher risk for venous thromboembolism (VTE) because of cancer status, intrinsic risk factors, and exposure to prothrombotic therapies. The risk for VTE appears higher during the first months of myeloma treatment and decreases over time. Exposure to immunomodulatory drugs (IMIDs) such as thalidomide or lenalidomide in association with high doses of dexamethasone or anthracyclin-based chemotherapy is associated with a four-fold increased risk for VTE. Low-dose aspirin, preventive-dose of low molecular weight heparin (LMWH) or vitamin K antagonists were tested for primary prevention of VTE in myeloma patients receiving chemotherapy. The International Myeloma Working Group (IMWG) suggests stratifying VTE risk to decide which patients should receive VTE prevention. Then, the IMWG suggests giving low-dose aspirin to low VTE risk patients and LMWH or vitamin K antagonists to patients at high risk for VTE. For daily practice, it seems reasonable to start preventive doses of LMWH for 3 to 6 months in ambulatory myeloma patients receiving combined therapy with IMID and in all myeloma patients admitted to hospital.
Assuntos
Anticoagulantes/uso terapêutico , Mieloma Múltiplo/complicações , Trombose Venosa/complicações , Antineoplásicos/efeitos adversos , Aspirina/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Fatores de Risco , Trombose Venosa/prevenção & controleAssuntos
Neoplasias do Sistema Nervoso Central/patologia , Linfoma/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Nervoso Central/terapia , Quimioterapia Adjuvante , Progressão da Doença , Resistencia a Medicamentos Antineoplásicos , Humanos , Linfoma/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Transplante de Células-Tronco , Resultado do TratamentoAssuntos
Medicamentos Biossimilares/administração & dosagem , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Linfoma/terapia , Mieloma Múltiplo/terapia , Transplante de Células-Tronco de Sangue Periférico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Talidomida/análogos & derivados , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Cisplatino/administração & dosagem , Citarabina/administração & dosagem , Etoposídeo/administração & dosagem , Transplante de Células-Tronco Hematopoéticas , Doença de Hodgkin/terapia , Humanos , Lenalidomida , Prednisona/administração & dosagem , Recidiva , Indução de Remissão , Talidomida/administração & dosagem , Transplante AutólogoRESUMO
INTRODUCTION: The hyalohyphomycetes, Fusarium spp, are very common in our environment. Some of them have been recognized as being opportunistic agents responsible for localized as well as generalized infections, especially in the case of malignant blood diseases. Their poor sensitivity to standard antifungal therapeutics makes them very dangerous. We report a case of cutaneous and systemic fusariosis due to Fusarium moniliforme in a patient with acute lymphoblastic leukemia. CASE-REPORT: A 20 year-old male student was suffering from acute type 6 myeloblastic leukemia. During the second consolidation schedule with a combined therapy of aracytine and amsacrine, this patient whose food diet was exclusively based on cereals, showed evidence of febrile aplasia, associated with myalgia, abdominal pain and diarrhoea. Microbiological samples were sterile. Ten days later, we noted the appearance of painful, diffuse and purple dermohypodermal cutaneous nodules surrounded by an erythematous ring. Histological and microbiological examination of the hypodermis biopsies of the skin nodules revealed invasion by Fusarium moniliforme. Treatment with voriconazole in association with transfusions of leukocytes led to clinical and microbiological cure. DISCUSSION: In our case report, the clinical pattern starting with digestive symptoms suggested dissemination from a digestive site, which is very unusual in Europe. In our patient, the malnutrition, together with a diet exclusively based on contaminated cereals in a context of malignant hemopathy, resulted in the colonization of the digestive tract by these moulds and the aplasia-inducing chemotherapy schedules enhanced their pathogen potential.
Assuntos
Fusarium/patogenicidade , Micoses/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adulto , Amsacrina/administração & dosagem , Antifúngicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Citarabina/administração & dosagem , Dieta , Humanos , Hospedeiro Imunocomprometido , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Pirimidinas/uso terapêutico , Triazóis/uso terapêutico , VoriconazolRESUMO
INTRODUCTION: Among the filamentous fungi of the Hyphomycete class, Annellospore group, the Scopulariopsis genera presently includes 16 species considered as opportunist pathogens. We report some unusual cutaneous manifestations due to Scopulariopsis brevicaulis in an immunodepressed patient. OBSERVATION: A 67 year-old man presented with a lymphomatous form of Waldenström's macroglobulinemia. During chemotherapy with medullar aplasia, inflammatory cutaneous nodules appeared on the forearm and leg. Microbiological and histological examinations identified Scopulariopsis brevicaulis. The patient improved with rapid remission from aplasia using hematopoietic growth factors and treatment with itraconazole. COMMENTS: In a patient in medullar aplasia, the rapid onset of an extra-ungual cutaneous localization (forearm and leg) of a Scopulariopsis brevicaulis infection, without systemic involvement, suggests that the cutaneous inoculation occurred through scratching (from the nails) or from another cutaneous origin. Prolonged neutropenia enhanced the pathogenicity of this mycosis. The mycological and histological examinations are fundamental to confirm the diagnosis.