Acta haematologica
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Case Reports
Combining nilotinib and imatinib improves the outcome of imatinib-resistant blast phase CML.
Imatinib resistance is an important hurdle in the treatment of chronic myeloid leukemia (CML), and CML patients with this drug resistance are often given a dismal prognosis. In this case report, an imatinib-refractory blast phase CML patient was treated with a combination of imatinib and nilotinib. ⋯ These results suggest that combining imatinib and nilotinib treatment may improve the outcome of imatinib-resistant CML patients in the blast phase. We hypothesize regarding the possible mechanism for the effectiveness of the drug combination by reviewing the recent literature.
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Recent studies suggest an increased risk for Pneumocystis jirovecii pneumonia (PJP) in adults receiving short-interval rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) therapy for diffuse large cell B cell lymphoma (DLBCL). This retrospective study evaluates precise PJP incidence and the efficacy of anti-PJP prophylaxis in DLBCL. Patients with DLBCL, aged ≥18 years and treated between December 2004 and December 2010, were included. ⋯ None of the patients receiving P.jirovecii prophylaxis (n = 33) developed PJP, compared with 6.6% of those treated with R-CHOP-14 without such prophylaxis. An older age and R-CHOP administered every 14 rather than every 21 days increased the PJP risk. Trimethoprim/sulfamethoxazole prophylaxis is found to be highly efficient in preventing this life-threatening complication and, therefore, should be recommended for patients receiving the R-CHOP-14 regimen.
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Multicenter Study Clinical Trial
Efficacy and safety of micafungin as an empirical antifungal agent for febrile neutropenic patients with hematological diseases.
This observational study was conducted to document the efficacy and safety of the use of micafungin (Mycamine) as an empirical antifungal agent in febrile neutropenic patients. ⋯ Micafungin has an excellent efficacy (61.7%) and safety profile when used as an empirical antifungal agent in febrile neutropenic patients with hematological disorders.
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Multicenter Study
Intracranial hemorrhage in acute and chronic childhood immune thrombocytopenic purpura over a ten-year period: an Egyptian multicenter study.
Intracranial hemorrhage (ICH) is a rare but major cause of death in immune thrombocytopenic purpura (ITP). The authors reviewed data of 1,840 patient with ITP, from 5 pediatric hematology centers in Egypt from 1997 to 2007, to study the incidence and risk factors of ICH. Ten cases of ICH were identified with a median age at presentation of 7.5 years; 4 patients had acute ITP, 2 persistent and 4 chronic. ⋯ Two children died shortly afterwards due to late referral to a specialized center. Our results suggest that treatment does not prevent ICH and that it can occur at any time during the course of the disease. Delayed referral can be considered a risk factor for unfavorable outcome of ICH, highlighting the importance of teaching sessions for patients and their parents to minimize subsequent morbidity and mortality of ICH in children with ITP.
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A high absolute lymphocyte count (ALC) at diagnosis is known as a surrogate marker of favorable prognosis in newly diagnosed multiple myeloma (MM). Recent studies showed tumor sensitization and enhanced cytotoxicity of bortezomib. We hypothesized that a high ALC before bortezomib treatment would contribute to tumor sensitization and activated cytotoxicity of bortezomib in relapsed MM. ⋯ In the univariate analysis, the low-ALC group before therapy was associated with shorter progression-free survival (PFS) [hazard ratio (HR), 2.780; 95% confidence interval (95% CI) 1.703-4.536, p < 0.001]. Multivariate analysis revealed that a low ALC represented an independent predictive factor for PFS (HR 1.937, 95% CI 1.168-3.212, p = 0.010). A low ALC just before Vel-Dex therapy was associated with a poor prognosis in relapsed MM.