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Thrombotic microangiopathy following chimeric antigen receptor T-cell therapy.

INTRODUCTION: Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia and is associated with a variety of conditions and following hematopoietic stem cell transplantation. Chimeric antigen receptor T-cell (CAR-T) therapy is a novel immunotherapeutic approach using genetically modified autologous T cells. CAR-T therapy has been linked with injuries to vascular endothelium, but a direct association between CAR-T and TMA has not been reported. CASE REPORTS: Two cases of TMAs following CAR-T treatment are reported here. In each case, clinical evidence of kidney inju

Cancer-associated thrombosis: an overview.

Venous thromboembolism (VTE) is a common complication in patients with malignant disease. Emerging data have enhanced our understanding of cancer-associated thrombosis, a major cause of morbidity and mortality in patients with cancer. In addition to VTE, arterial occlusion with stroke and anginal symptoms is relatively common among cancer patients, and is possibly related to genetic predisposition. Several risk factors for developing venous thrombosis usually coexist in cancer patients including surgery, hospital admissions and immobilization, the presence of an indwelling central catheter, ch

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… In patients with acute cancer-associated thrombosis and platelet count ≥50 × 10 9 /L, full therapeutic anticoagulation without platelet transfusion is appropriate. … However, platelet transfusion support to maintain a platelet count of ≥50 × 10 9 L just to allow full, therapeutic anticoagulation may not be practical. …

Новое применение XPO1 для лечения миэлофиброза.

Myelofibrosis (MF) — новообразование, характеризующееся конституционными симптомами, прогрессивными цитопентиями и селеногамели. В основе патобологии MF лежит активация мутации на пути JAK/STAT и регулирование цитокинового костного мозга. Хотя многие ингибиторы JAK в настоящее время официально утверждены и обеспечивают значительное улучшение симптомов, эти агенты не имеют курса на изменение потенциала. Кроме того, результаты являются неудовлетворительными для пациентов, которые не справляются с ингибиторами JAK, что подчеркивает необходимость применения новых методов лечения, основанных на исп

Unique Presentation of Bortezomib-Associated Thrombotic Microangiopathy Responsive to Therapeutic Plasma Exchange and Eculizumab Therapy.

Thrombotic microangiopathies (TMA) are a rare group of life-threatening hematological conditions characterized by thrombocytopenia and microangiopathic hemolytic anemia. Although our understanding of the pathophysiology and the availability of diagnostic testing has improved for primary TMAs, such as thrombotic thrombocytopenic purpura, the pathophysiology underlying secondary TMAs, including drug-induced TMAs (DITMAs), remains less clear. In this case report, we present the unique case of a patient with a history of multiple myeloma that presented four months after the initiation of bortezomi

Epidemiology of infections in cancer patients.

Although major advances in the care of cancer patients over the past several decades have resulted in improved survival, infectious complications remain a significant cause of morbidity and mortality. To successfully identify, treat, and prevent infections, a comprehensive understanding of risk factors that predispose to infection and of commonly encountered pathogens is necessary. In addition, clinicians must keep abreast of the changing epidemiology of infections in this population. As therapeutic modalities continue to evolve, as established pathogens become increasingly drug resistant, and

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… Thus, bacterial infections are more likely to occur following platelet transfusions [ 177 ]. …

Stem Cell Mobilization with Ixazomib and G-CSF in Patients with Multiple Myeloma.

(1) Background: High-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) is the standard consolidation strategy for patients with newly diagnosed multiple myeloma (MM) and for a subset of patients with relapsed/refractory disease. For stem cell mobilization, G-CSF alone or in combination with chemotherapy mobilizing agents and/or plerixafor are commonly used. Ixazomib is an oral proteasome inhibitor with less neurotoxic potential, which previously showed the ability to mobilize stem cells in preclinical studies. (2) Methods: Prospective single-center phase 1 study

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… Median time to recovery of platelets to ≥20 G/L and neutrophils to ≥0.5 G/L was 14 and 12 days, respectively. 17 (89%) patients needed platelet transfusions (median of 2 concentrates) and 12 (63%) patients required erythrocyte transfusions (median of 1 concentrate). … transfusions, n (%) | 17 (89%) Number of platelet concentrates, median (range) | 2 (0–13) Patient requiring erythrocyte transfusion, n (%) | 12 (63%) Number of erythrocyte concentrates, median (range) | 1 (0–8) Infectious complications | Febrile episodes, n (%) | 19 (100%) Number of febrile episodes …

Chemotherapy plus therapeutic plasmapheresis with 4% human albumin solution in multiple myeloma patients with acute kidney injury: a prospective, open-label, proof-of-concept study.

As no unified treatment protocol or evidence yet exists for plasmapheresis without plasma, this study explored the outcomes of using 4% human albumin (ALB) solution as a replacement solution in patients undergoing plasma exchange for multiple myeloma (MM) patients with acute kidney injury (AKI). This study was prospectively registered (ChiCTR2000030640 and NCT05251896). Bortezomib-based chemotherapy plus therapeutic plasmapheresis (TPP) with 4% human ALB solution was assessed for three years in patients with MM aged >18 years, with AKI according to the Kidney Disease Improving Global Outcomes

The 44th Annual Meeting of the European Society for Blood and Marrow Transplantation: Physicians Poster Sessions

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Daratumumab in patients with immune thrombocytopenia: a single-center, open-label, phase 2 trial.

BACKGROUND: Immune thrombocytopenia is an autoimmune bleeding disorder. Daratumumab, a human monoclonal antibody targeting CD38 glycoprotein, is currently under clinical investigation as a potential therapy for autoimmune diseases. This trial aimed to evaluate the efficacy and safety of daratumumab in adults with immune thrombocytopenia. METHODS: This single-center, open-label, phase 2 trial enrolled patients with a platelet count <30 × 109 platelets per L during the screening period. The study protocol comprised a 4-week screening phase, an 8-week treatment course, and a 16-week follow-up pe

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… Rescue therapies, including TPO-RAs, IVIg, glucocorticoids, platelet transfusions, and anti-CD20 monoclonal antibodies, were permitted in cases of inadequate response or clinically significant bleeding. … During the study period, 22 (35%) of 63 patients required rescue interventions, including glucocorticoids (n = 2 [3%]), IVIG (n = 11 [17%]), TPO-RAs (n = 17 [27%]), anti-CD20 monoclonal antibodies [n = 9 [14%]), platelet transfusions (n = 2 [3%]), orelabrutinib (n = 1 [2%]), and splenectomy (n = 1 [2% …

Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: a prospective observational study of 1,978 consecutive catheterizations.

BackgroundA central venous catheter (CVC) currently represents the most frequently adopted intravenous line for patients undergoing infusional chemotherapy and/or high-dose chemotherapy with hematopoietic stem-cell transplantation and parenteral nutrition. CVC insertion represents a risk for pneumothorax, nerve or arterial punctures. The aim of this prospective observational study was to explore the safety and efficacy of CVC insertion under ultrasound (US) guidance and to confirm its utility in clinical practice in cancer patients.MethodsConsecutive adult patients attending the oncology-hemat

Proceedings of Reanimation 2022, the French Intensive Care Society International Congress.

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… Both preventive and therapeutic platelet transfusions (PT) are not fully supported by high levels of evidence and the benefits of platelet transfusion remain subject to debates in some settings. This study aims to describe the efficacy of PT in ICU, and its impact on patients’ outcomes. … CO-02 Platelet transfusion in ICU: are we applying guidelines? …

Chidamide in Combination With DCAG With or Without Venetoclax for Relapsed/Refractory Acute Myeloid Leukemia.

INTRODUCTION: Currently, there are only a few avaailable treatment options for patients with relapsed and refractory acute myeloid leukemia (R/R AML). METHODS: We conducted a single-center, phase 1 prospective study (ChiCTR2200065634) to evaluate the efficacy and safety of chidamide, demethylating drugs (azacitidine), cytarabine, aclacinomycin, and G-CSF plus venetoclax (CDCAG-VEN) in patients with R/R AML. The previous CDCAG regimen was used as a historical control to compare its efficacy and safety. Thirty and 22 patients received one course of CDCAG with or without a 14-day course of venet

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… The CDCAG‐VEN‐treated and CDCAG patients received packed red cell transfusions of 9.5 and 10.2 units ( p = 0.282) and had a platelet transfusion rate of 9.2 and 10.0 units, respectively ( p = 0.322). …

Primary Thromboprophylaxis in Patients with Malignancies: Daily Practice Recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO), the Society of Thrombosis and Hemostasis Research (GTH), and the Austrian Society of Hematology and Oncology (ÖGHO).

Patients with cancer, both hematologic and solid malignancies, are at increased risk for thrombosis and thromboembolism. In addition to general risk factors such as immobility and major surgery, shared by non-cancer patients, cancer patients are exposed to specific thrombotic risk factors. These include, among other factors, cancer-induced hypercoagulation, and chemotherapy-mediated endothelial dysfunction as well as tumor-cell-derived microparticles. After an episode of thrombosis in a cancer patient, secondary thromboprophylaxis to prevent recurrent thromboembolism has long been established

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… Antithrombotic therapy and platelet transfusions in hematologic malignancy patients presenting chemotherapy-induced thrombocytopenia: A French survey. Transfusion. 2017;57:1717–1723. doi: 10.1111/trf.14120. 106. …

Enasidenib in the treatment of relapsed/refractory acute myeloid leukemia: an evidence-based review of its place in therapy.

Introduction: Acute myeloid leukemia (AML) remains a disease with high mortality, especially for older patients and those with relapsed/refractory (R/R) disease. With recent advances in molecular testing, targeting particular leukemogenic mutations such as those occurring in isocitrate dehydrogenase (IDH) became possible. Enasidenib is a new small-molecule inhibitor of mutant isocitrate dehydrogenase-2 (IDH2). Aim: The objective of this article is to review the evidence for the use of enasidenib in R/R AML, as well as to outline future directions of enasidenib therapy. Evidence Review: Enaside

Case report and review: Angiosarcoma with thrombocytopenia after total hip arthroplasty.

Total hip arthroplasty (THA) is a common treatment for osteoarthritis and is also performed for other conditions, such as secondary arthritis due to developmental dysplasia of the hip. Various THA types may be complicated by osteolysis and an inflammatory pseudotumor due to an adverse reaction to metal debris. Rarely, THA has been associated with malignant tumors, but their causality remains unclear. In this case report, we describe a female patient with developmental dysplasia of the hip. She had undergone left metal-on-polyethylene THA, acetabular revision of the THA, and left total knee art

Comparable outcomes using propylene glycol-free melphalan for autologous stem cell transplantation in multiple myeloma.

Autologous stem cell transplantation (ASCT) remains a mainstay in the treatment of multiple myeloma (MM). While the procedure is generally safe, toxicities associated with high-dose melphalan conditioning are common and significantly affect patient quality of life. Recently, a propylene glycol-free melphalan formulation (PG-free MEL; Evomela®) was approved by the United States Food and Drug Administration as an ASCT-conditioning regimen for MM. PG-free MEL is more soluble and stable than propylene glycol-solubilized melphalan (PG-solubilized MEL; Alkeran®). As such, there is speculation that i

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… Platelet engraftment was defined as platelets >20,000/mL for 3 consecutive days, with the absence of a platelet transfusion in the preceding 7 days. The Mann-Whitney U test and Fisher’s Exact test were used to compared continuous and categorical variables, respectively. … Packed red blood cell and platelet transfusion utilization was comparable as well. Further, there were no significant differences in the incidence of neutropenic fevers, bacteremia, or peri-engraftment syndrome requiring systemic corticosteroid treatment ( Table 3 ). …

Progression-Free Survival of a Patient with Advanced Hepatocellular Carcinoma Treated with Adoptive Cell Therapy Using Natural Killer Cells: A Case Report.

Adoptive cell therapy (ACT) is a promising treatment that is considered safe and efficient. Natural killer (NK) cells play an important role in the innate immune system and destroy target cells such as tumor cells without prior sensitization. Here, we report a 59-year-old man with advanced diffuse hepatocellular carcinoma (HCC) who underwent 17 courses of NK cell treatment from March 2017 to July 2018. Although he presented with progressive disease, his hydrothorax and ascites decreased, and his state of mind, appetite and quality of life were markedly improved after treatment versus at admiss

Double Relapsed and/or Refractory Multiple Myeloma: Clinical Outcomes and Real World Healthcare Costs.

Double relapsed and/or refractory multiple myeloma (DRMM), MM that is relapsed and/or refractory to bortezomib and lenalidomide, carries a poor prognosis. The healthcare costs of DRMM have not previously been reported. We analyzed detailed medical resource utilization (MRU) costs, drug costs and outcomes for 39 UK patients receiving standard DRMM therapy. Median OS in this cohort was 5.6 months. The mean cost of DRMM treatment plus MRU until death was £23,472 [range: £1,411-£90,262], split between drug costs £11,191 and other resource use costs £12,281. The cost per assumed quality-adjusted li

The Role of Real-World Evidence in UK Reimbursement: Case Study of Lenalidomide in Myelodysplastic Syndrome Deletion 5q.

BackgroundUncertainty within cost-effectiveness analysis, often driven by lack of mature data from large clinical trials, plays a key role in decisions made by the National Institute for Health and Care Excellence (NICE), particularly for early access medicines and orphan drugs.ObjectivesIn this case study, we used real-world evidence to address the uncertainty in the cost-effectiveness case for lenalidomide in transfusion-dependent low- and intermediate-1-risk myelodysplastic syndrome (MDS) deletion 5q [del(5q)], affecting a small but unique subpopulation with an orphan disease.MethodsAs part

Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases.

BACKGROUND: Africans have an increased risk for multiple myeloma (MM) compared to other races. Reports from Africa are few and involve small cohorts, but suggest significant epidemiological and clinical differences from Caucasian patients. OBJECTIVE: This report describes the clinic-pathological features of MM patients in Ghana at diagnosis, and the factors affecting their survival. METHODS: A retrospective review of 169 MM cases diagnosed in a Ghanaian tertiary hospital from 2002-2016. RESULTS: Median age was 58 years, with 29% ≤50 years. One-third presented >12 months after onset of sympt