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  • Author: Annamária Pakucs x
  • Internal Medicine x
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Abstract

This study presents a new method of combined growth factor mobilization with increased dose (15 μg/kg) of filgrastim and standard mono dose of plerixafor in subjects with multiple myeloma, Hodgkin or non-Hodgkin lymphoma. Efficient mobilization is a key factor in the treatment of this group of patients, because autologous transplantation can be performed in cases in which we succeed to obtain a minimally sufficient number of stem cells. Autologous stem cell transplantation is included in the current standard treatment of multiple myeloma and in the relapsed cases of lymphomas.

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), representing up to 30 percent of all lymphomas. DLBCL is a fast-growing, aggressive form of NHL, which can appear as a transformation from a less aggressive form of lymphoma or can be de novo pathology. The following article describes the case of a 55-year-old female patient who developed a DLBCL as a second malignancy after an R-CHOP-treated marginal zone splenic lymphoma. This was followed by the transformation of the DLBCL into an aggressive acute lymphoblastic leukemia, for which the patient needed aggressive treatment according to the international acute lymphoblastic leukemia protocol.

Abstract

Background: Lacrimal drainage system lymphomas are rare, accounting for less than 10% of lacrimal sac tumors. They often appear as a secondary involvement within the confines of systemic lymphoproliferative disorders, therefore detailed ophthalmological examination and auxiliary testing is necessary to have an accurate diagnosis.

Case report: We present the case of a 72-year-old woman with a medical history of chronic lymphocytic leukemia and small lymphocytic lymphoma. She presented to the ophthalmology clinic with a painful, discharging swelling in the right lacrimal sac area. Magnetic resonance imaging revealed a mass in the right nasolacrimal duct. A right external dacryocystorhinostomy was performed. The histological findings led to a diagnosis of small lymphocytic lymphoma.

Conclusions: Special attention is required in cases of known systemic hematological disorders that associate with nasolacrimal duct obstruction or epiphora. Quick recognition and a full history with multidisciplinary clinical and diagnostic workup are fundamental to plan the treatment.

Abstract

Iron deficiency and anemia affect approximately half of the chronic heart failure patients and they are associated with increased hospitalization rate, lower functional capacity, lower quality of life, and higher mortality. The exact mechanism of iron deficiency in heart failure patients is still not fully understood. Current guidelines recommend ferritin as the most accurate serum biomarker for the diagnosis of iron deficiency. The use of erythropoiesis-stimulating agents is no longer recommended because of the lack of improvement on mortality or hospital readmission rate, and it was associated with a higher rate of thromboembolic events. Intravenous iron replacement therapy is safe and generally well tolerated, with fewer side effects compared to oral administration. Large randomized studies with ferric carboxymaltose demonstrated its effectiveness and superiority to oral administration, and it was associated with a decreased rate of hospitalization rate and worsening heart failure, and improvement of functional capacity and quality of life. Intravenous iron supplementation for chronic heart failure is strongly recommended by European guidelines. Further studies are needed for a better knowledge of this complex pathology and determination of the long-term safety and effectiveness of iron administration in chronic heart failure patients. .

Abstract

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder, which can involve the hematopoietic stem cell or early progenitor cells, without the loss of their capacity to differentiate. Typically, CML has three clinical phases: a chronic phase, an accelerated phase, and an aggressive transformation in blast crisis, analogous to acute leukemia. The following article presents the case of a 49-year-old patient diagnosed with Philadelphia-negative CML in blastic transformation, where after multiple conventional acute leukemia induction chemotherapy regimens an unrelated allogeneic hematopoietic stem cell transplant was performed.

Abstract

Multiple myeloma accounts for 10% of the hematologic malignancies and is characterized by a single clone of plasma cells producing a monoclonal protein. The aim of this review is to summarize the current treatment methods of multiple myeloma. In the last 15 years, the incidence of myeloma has increased in patients younger than 65 years, thus treatment became even more important in order to obtain a long lasting remission or plateau phase. The treatment of this disease is complex and focuses not only on increasing the patients’ survival, but also improving their quality of life.

Abstract

Background: High-dose chemotherapy and autologous stem cell transplantation have become a standard curative treatment in various hematologic malignancies. Many factors can affect the success of mobilization and hematopoietic stem cell harvesting.

Aim: The aim of this study was to analyze factors that lead to mobilization failure.

Material and Methods: We conducted a retrospective study on 19 patients with failure of stem cell harvesting. All patients were administered high doses of GCS-F (filgrastim, 15 μg/kg/day) and 0.24 mg/kg of plerixafor on day +5 or +10 of harvesting.

Results: The median age of the study population was 51 years (range 35–67) and 52.6% (n = 10) were males. The study group included 4 (21%) subjects with multiple myeloma, 6 (31.5%) with Hodgkin lymphoma, 8 cases (42.1%) with non-Hodgkin lymphoma and 1 patient with chronic lymphocytic leukemia. Each patient received 2.78 (range 1–5) lines of chemotherapy, administered in 11.57 (range 2 to over 20) cycles of treatment.

Conclusion: In hematologic malignancies it is very important to collect stem cells in time, in order to reduce mobilization failure. As we have shown in our studied cases, multiple lines of polychemotherapy with or without radiotherapy lead to mobilization failure.

Abstract

Multiple myeloma represents a challenge for hematologists because it has become more frequent at a young age in recent years. This is why autologous stem cell transplantation is included in the standard treatment of myeloma patients. We present the case of a 39-year-old patient who was diagnosed with non-secretory myeloma with double autologous transplantation and underwent neurosurgery for spinal cord compression caused by a plasmocytoma at D5 level. We present the evolution and complexity of this very difficult case.

Abstract

Introduction: Autologous hematopoietic stem cell transplantation (ASCT) represents a standard therapy in the management of hematologic malignancies such as malignant lymphomas and has used for approximately three decades. The aim of this study was to determine the occurring post-ASCT complications and their impact on the patients’ recovery for a better management.

Material and methods: An observational retrospective study was performed during a five-year period between 2012 and 2017, involving 58 classical Hodgkin lymphoma and 36 non-Hodgkin lymphoma patients, who underwent ASCT in the Bone Marrow Transplantation Unit of Tîrgu Mureş. The main analyzed complications were: infections, bleeding, hydroelectrolytic disorders, and hypoalbuminemia.

Results: After data analysis we found that 17 patients (18%) presented microbiologically confirmed infection, 10 patients (11%) presented clinically non-significant bleeding, 39 patients (42%) presented electrolyte disorders, and 33 patients (36%) presented hypoalbuminemia, obtaining a positive correlation between the rate of adverse events after ASCT with age (r = 0.9914, p = 0.0009) and the average hospitalization period (r = 1, p <0.00001).

Conclusions: The identification of adverse events and their correlation with the patients’ clinical outcome can lead to better patient management and a faster recovery after ASCT.

Abstract

Stem cells are undifferentiated cells that can divide and become differentiated. Hematopoietic stem cells cannot transform into new stem cells such as cardiomyocytes or new heart valves, but they act through paracrine effects, by secreting cytokines and growth factors that lead to an increase in contractility and overall improved function. In this case report, we present how autologous stem cell transplantation can bring two major benefits: the first refers to hematological malignancy and the second is about the improvement of the heart condition. We present the case of a 60-year-old patient diagnosed with multiple myeloma suffering from a bi-valve severe condition in which autologous stem cell transplantation led to the remission of the patient’s malignant disease and also improved the heart function.