No abstract

Chimeric antigen receptor T-cell (CAR-T) therapy is an effective new treatment for hematologic malignancies. Two anti-CD19 CAR-T products, namely axicabtagene ciloleucel and tisagenlecleucel, have been approved for the management of relapsed/refractory large B-cell lymphoma after two lines of systemic therapy. Additionally, tisagenlecleucel is indicated for refractory acute lymphoblastic leukemia in pediatric patients and young adults up to 25 years of age. CAR-T cells are undoubtedly a major breakthrough therapy in hematooncology resulting in up to 90% response rate with durable remissions in population with refractory high-risk disease. However, there are serious side effects resulting from CAR-T therapy, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Manifestations of CRS mostly include fever, hypotension, hypoxia, and end organ dysfunction. Neurologic toxicities are diverse and include encephalopathy, cognitive defects, dysphasia, seizures, and cerebral edema. Since the symptoms are potentially severe, practitioners need to familiarize themselves with the unique toxicities associated with these therapies. In this article, we present a practical guideline for diagnosis, grading and management of CRS and CAR-T neurotoxicity. In addition, infectious complications and late toxicities including prolonged cytopenias and hypogammaglobulinemia are discussed.

Despite the well-defined role of autologous haematopoietic stem cell transplantation (autoHCT) in the treatment of patients with relapsed or refractory Hodgkin lymphoma (HL), relapse remains the main cause of transplant failure. We retrospectively evaluated long-term outcome and prognostic factors affecting survival of 132 patients with refractory (n = 89) or relapsed HL (n = 43) treated with autoHCT following modified BEAM. With a median follow-up of 68 months, the 10-year overall survival (OS) and progression-free survival (PFS) were 76 and 66 %, respectively. The 10-year cumulative incidence of second malignancies was 7 %. In multivariate analysis, age ≥45 years, more than one salvage regimens and disease status at transplant worse than CR were factors predictive for poor OS. In relapsed HL, age at transplant, response duration (<12 vs. ≥12 months) and the number of salvage regimens were independent predictors for PFS. In the refractory setting, disease status at autoHCT and the number of salvage regimens impacted PFS. The number of risk factors was inversely correlated with PFS in both relapsed and refractory HL (p = 0.003 and <0.001, respectively). The median PFS for patients with >1 risk factor in the relapsed and refractory setting was 5 and 11 months, respectively, in comparison with the median PFS not reached for patients with 0–1 risk factor in both settings. We conclude that high proportion of patients with relapsed/refractory HL can be cured with autoHCT. However, the presence of two or more risk factors helps to identify poor prognosis patients who may benefit from novel treatment strategies.

Aim of the study:To evaluate the presence and severity of anxiety and depressive symptoms in patients who recently recovered from coronavirus disease 2019 . Material and methods: In this cross-sectional observational study, patients who had recovered from COVID-19 were assessed between February and April 2021. The symptoms reported by patients were evaluated using a questionnaire developed by the authors based on the National Institute for Health and Care Excellence (NICE) guidelines. The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were used to assess their depressive symptoms and anxiety. Results: Of the 102 patients, 45 (44%) were men, and the mean age (± standard deviation -SD) was 52 ±13 years. The mean time interval (±SD) between COVID-19 diagnosis and the examination was 56 ±18 days. Seventy-eight (76%) patients were treated at home, while 24 (23.5%) were hospitalized. Fatigue, cognitive impairment ("brain fog"), breathlessness, and cough were the most frequently reported complaints. Median scores of the BDI, state-anxiety (STAI 1) and trait-anxiety (STAI 2) were 7 (interquartile range, IQR = 10), 38 (IQR = 13), and 40.5 (IQR = 14), respectively. Mild depressive symptoms were observed in almost 30% of patients. Women scored significantly higher than men. Conclusions: Patients who have recently recovered from COVID-19 show increased anxiety and depressive symptoms, the intensity of which was more pronounced in women. From the clinical perspective, physicians should be aware of the anxiety and depressive symptoms of the post-COVID-19 syndrome. Depression and anxiety in patients recently recovered from coronavirus disease (COVID-19)Objawy depresji i lęku u pacjentów po przebyciu choroby koronawirusowej

No abstract