We report the case of a 13-year-old girl with multiple recurrences of an aneurysmal bone cyst of the distal fibula successfully treated with denosumab and curettage. Aneurysmal bone cysts are locally aggressive lesions with high rates of recurrence. The novel use of denosumab with curettage in a long bone showed a favorable outcome with no adverse events or signs of recurrence three years after treatment.
Background Although patients with acute myeloid leukemia (AML) were shown to have an increased risk of thrombosis, no thrombosis risk assessment scoring system has been developed for AML patients. The Khorana Risk Score (KRS), which has been widely used for thrombosis risk assessment in the clinical setting, was developed on the basis of solid tumor data and has not been validated among AML patients. This study aims to validate the use of the KRS as a thrombosis risk-scoring system among patients with AML. Methods Using data from H. Lee Moffitt Cancer Center and Research Institution’s Total Cancer Care Research Study, we retrospectively identified patients who were histologically confirmed with AML from 2000 to 2018. Clinical and laboratory variables at the time of AML diagnosis were characterized and analyzed. The thrombotic event rate was estimated with the Kaplan-Meier method and compared using the log-rank test. Results A total of 867 AML patients were included in the analysis. The median age at AML diagnosis was 75 years (range, 51–96), and the majority were male (65%, n = 565). A total of 22% ( n = 191), 51% ( n = 445), 24% ( n = 207), and 3% ( n = 24) of patients had a KRS of 0, 1, 2, and 3, respectively. A total of 42 thrombotic events (3% [ n = 6/191] with a KRS of 1; 5% [ n = 23/445] with a KRS of 2; 6.3% [ n = 13/207] with a KRS of 3) were observed, with a median follow-up of 3 months (range, 0.1–307). There was no statistical difference in the risk of thrombosis between these groups ( P = .1949). Conclusions Although there was an increased risk of thrombosis associated with a higher KRS among AML patients with a KRS of 1 to 3, the difference was not statistically significant. Furthermore, only a few patients were found to have a KRS > 3, and this was largely due to pancytopenia, which is commonly associated with AML. These results indicate the need for a better thrombotic risk-scoring system for AML patients.
Objectives: Positively charged amino acids (AA) such as arginine/lysine are coinfused with radiolabeled somatostatin analogs to reduce rates of nephrotoxicity. In the phase 3 NETTER-1 trial, commercial AA formulations were used in association with 177 Lu-DOTA-0-Tyr3-Octreotate (DOTATATE). These formulations were also used in an early-access program (EAP) before regulatory approval of 177 Lu-DOTATATE. Our program transitioned to compounded L-arginine 2.5%/L-lysine 2.5% in 0.9% NaCl after commercial approval of 177 Lu-DOTATATE. We sought to compare rates of nausea/vomiting with arginine/lysine versus commercial parenteral AA formulations.Methods: Rates of nausea/vomiting of all 20 EAP patients who received commercial AAs (15% Clinisol) were compared with the first 29 patients to receive 177 Lu-DOTATATE after commercial approval and coinfused with arginine/lysine. Other parameters reviewed included infusion rates, need for PRN nausea medications, and other toxicities.Results: Seventeen percent of patients who received compounded arginine/lysine experienced nausea, compared with 100% of patients in the EAP group (P < 0.0001). Infusion-related reactions occurred in 3% of the arginine/lysine cohort versus 35% in the EAP group. Infusion durations were substantially shorter in the arginine/lysine cohort (reduced by 61%).Conclusions: Coinfusions of arginine/lysine with radiolabeled somatostatin analogs result in substantially lower rates of nausea/vomiting compared with commercial AA formulations designed for parenteral nutrition.
INTRODUCTION Thrombotic episodes represent significant morbidity and mortality in patients with hematologic malignancies and may be influenced by several risk factors. Current predictive and prognostic models do not take into account several risk factors. Furthermore, prophylactic and therapeutic management of thrombosis remains to be standardized for patients with AML. Few studies report the impact of catheters to the likelihood of thrombosis. We comprehensively report our institution's experience with thrombosis in AML patients. METHODS The Total Cancer Care (TCC) database was used to retrospectively chart review patients with histologically confirmed AML from 2000 to 2018. Several parameters were extracted including but not limited to history of thrombosis and recurrences, chemotherapy regimens, and laboratory values for significant events. All statistical analyses were performed using SPSS v24.0 and GraphPad Prism 7. RESULTS: A total of 1101 patients were diagnosed with either de novo (516, 46.87%) or secondary (584, 53.04%) AML. The median age of diagnosis was 75 years (52, 95) and men were the majority, 726 (65.94%). In terms of cytogenetics, 25 (2.27%) had good/favorable, 616 (55.95%) had intermediate, and 334 (41.75%) had poor cytogenetics. At the time of diagnosis, CBC revealed median WBC of 3 (0, 420), ANC 1 (0, 132), Plt 52 (1, 996), and hgb 9 (1, 15). Median ECOG score was 1. 159, 14.4% patients had a history of thrombosis prior to AML diagnosis; with a median of 1 episode of thrombosis (1, 4). After AML diagnosis 70 patients had one episode of thrombosis, 9 had two episodes, and 2 patients had three recurrent episodes. As far as the first-line induction therapy, 247 (22.43%) patients received 7+3, 12 (1.08%) received CLAG, 36 (3.27%) received hypomethylating agents, and the remaining 227 (2.06%) received other therapies such as clinical trials or off-label drugs. Repeat cycles of therapies were also recorded. In terms of growth factor use after AML diagnosis, 132 (11.99%) used EPO, 209 (18.98%) G-CSF, 32 (2.90%) GM-CSF, and 778 (70.66%) used any other growth factor not mentioned. Out of the 139 episodes of thrombosis, 81 (58.3%) were venous, and 58 (41.7%) were arterial. Among the venous, 45 (55.6%) were lower extremities, 21 (25.9%) were upper extremities, and 10 (12.3%) were pulmonary embolus. Among the arterial thrombosis, 27 (46.6) were coronary events, 23 (39.7%) were cerebral events. Only 15 patients had catheter-associated thrombosis events, 11 (73.3%) were PICC, and 2 (13.3%) were Port lines or central lines. In terms of management, 39 patients were on temporary anticoagulation, 60 patients were on indefinite anticoagulation, and 522 were not on any anticoagulation. In terms of complications, 3 patients had minor bleeding, 1 had major bleeding, 2 had HIT and the large majority of 419 had no complications of anticoagulation. CONCLUSIONS: Thrombosis both venous and arterial events manifest during treatment for leukemias. PICCs lines are associated with more catheter associated thrombosis events than ports. Further prospective studies are needed to evaluate the risk of both arterial and venous thrombosis in patients with acute leukemia. Further risk mitigation strategies are needed. Disclosures Komrokji: Novartis: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Celgene: Honoraria, Research Funding; Novartis: Honoraria, Speakers Bureau; Celgene: Honoraria, Research Funding; Novartis: Honoraria, Speakers Bureau.
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