István Benedek, Erzsébet Lázár, Annamária Pakucs, Judit-Beáta Köpeczi, István Benedek, Szende Jakab and Johanna Sándor-Kéri
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.
Erzsébet Lázár, Judit-Beáta Köpeczi, Enikő Kakucs, István Benedek, Szende Jakab, Annamária Pakucs, Cezara Tudor and István Benedek
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.
Szende Jakab, Erzsébet Lázár, István Benedek, Judit Beáta Köpeczi, Annamária Pakucs and István Benedek
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.
Szilvia Pál, Andreea Dana Fișuș, Doina Pop, Annamária Pakucs, István Benedek and Karin Horváth
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.
András Mester, Adriana Mitre, Erzsébet Lázár, István Benedek, Johanna Kéri, Annamária Pakucs and István Benedek
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. .
István Benedek, Erzsébet Lázár, Judit Beáta Köpeczi, István Benedek, Aliz Beáta Tunyogi, Szende Jakab and Annamária Pakucs
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.
István Benedek, István Benedek, Judit Beáta Köpeczi, Johanna Sándor Kéri, Annamária Pakucs, Szende Jakab and Erzsébet Lázár
Plasma cell leukemia (PCL) is one of the most aggressive monoclonal gammopathies, being characterized by the presence of more than 20% of plasma cells in the peripheral blood and an absolute number of these cells of more than 2×109, with different morphology, from young elements to mature cells. The incidence of PCL varies between 2–4% among multiple myeloma (MM) patients. In comparison with MM, PCL appears more often in younger patients. The following article describes the case of a 49-year-old female patient diagnosed with PCL which needed urgent control of the clinical manifestations due to its irreversible complications. Urgent autologous stem cell transplantation is recommended in this group of patients.
Eszter Mild, Erzsébet Lázár, Judit-Beáta Köpeczi, Enikő Kakucs, Marius Găzdac, Annamária Pakucs, Cezara Tudor and István Benedek
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.
Balázs Oltean-Péter, Szilamér Korodi, István Benedek, Erzsébet Lázár, Johanna Kéri, Annamária Pakucs, István Kovács, Lehel Bordi, Adriana Mitre, Imre Benedek, Theodora Benedek and István Benedek
Recent studies demonstrated that despite restoration of the sinus rhythm, patients with a positive history of atrial fibrillation (AF) are still at risk of thromboembolic events. The primary objective of this study is to identify new imaging-derived biomarkers provided by modern imaging technologies, such as cardiac computed tomography angiography, delayed enhancement magnetic resonance imaging, or speckle tracking echocardiography, as well as hematological biomarkers, associated with the risk of intracavitary thrombosis in patients with AF, in order to identify the imaging-derived characteristics associated with an increased risk of cardioembolic events. Imaging data collected will be post-processed using advanced techniques of computational modeling, in order to fully characterize the degree of structural remodeling and the amount of atrial fibrosis. The primary endpoint of the study is represented by the rate of thromboembolic events. The rate of cardiovascular death, the rate of major adverse cardiovascular events, and the rate of AF recurrence will also be determined in relation to the degree of structural remodeling and atrial fibrosis.
Annamária Pakucs, Erzsébet Lázár, Judit Beáta Köpeczi, Enikő Kakucs, István Benedek, Marius Găzdac, Eszter Mild, Cezara Tudor and István Benedek
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.