We report three cases of invasive Geotrichum capitatum infection in patients with acute leukemia for which an enzyme-linked immunosorbent assay (ELISA) for Aspergillus galactomannan was positive, with no evidence of aspergillosis. Supernatants obtained from suspensions of 17 G. capitatum strains gave positive reactions with the Aspergillus galactomannan ELISA. These clinical and laboratory data seem to suggest that G. capitatum produces a soluble antigen that is cross-reactive with Aspergillus galactomannan.Aspergillus galactomannan detection by a sandwich enzymelinked immunosorbent assay (ELISA) is widely used throughout the world in diagnosing invasive aspergillosis, and it has been introduced among the international microbiological criteria for the diagnosis of this fungal infection in immunocompromised hosts (2, 11). A major problem with the detection of circulating galactomannan is the occurrence of false-positive results, which, in some cases, have been shown to be related to cross-reactivity with other opportunistic fungi (11). We report cases of three acute-leukemia patients who developed disseminated infection by Geotrichum capitatum for which ELISA for Aspergillus galactomannan was positive, with no evidence of aspergillosis.Patient 1 was a 7-year-old child with acute lymphoblastic leukemia in second relapse who underwent salvage chemotherapy in February 2004. Ten days after this treatment, the patient developed fever and periorbital edema; broad-spectrum antibiotics and liposomal amphotericin B were administered. A week later, several serum samples were positive for galactomannan antigen and caspofungin was added. A computedtomography scan showed an abscess of the cerebral base starting from the ethmoidal plan and involving the hypophyseal region. Therefore, a surgical debridement was performed; G. capitatum was isolated from samples of pus, liquor, and bone (identification was performed with the VITEK system [bioMerieux Italia, Rome, Italy]). Galactomannan antigen was detected in the pus. Histology of a bone fragment disclosed necrotic tissue in which mycotic invasion was evident. On periodic acid-Schiff-and Grocott-stained sections, the fungi consisted of septate hyphae, slightly bent with parallel disposition and only occasional branching at a wide acute angle or budding at a right angle. A few spores and fragmentation of the mycelium in arthroconidia were also observed. Caspofungin was replaced with voriconazole. Within a few days, the patient's clinical condition improved and galactomannan antigen, for which tests were previously constantly positive, disappeared from the blood. Two months after surgery, while under voriconazole treatment, the child underwent two consecutive aploidentical bone marrow transplants from his father and his mother, but after a few weeks, the child died from sepsis of an unknown origin. Serum galactomannan antigen was no longer detected.Patient 2 was a 9-year-old girl with a diagnosis of myelodysplasia secondary to acute lymphoblastic leukemia and who underwent an allog...
Background: Venetoclax in combination with hypomethylating agents (HMA) is revolutionizing the therapy of acute myeloid leukemia (AML). However, evidence on large sets of patients is lacking, especially in relapsed or refractory leukemia. Methods:AVALON is a multicentric cohort study that was conducted in Italy on patients with AML who received venetoclax-based therapies from 2015 to 2020.The study was approved by the ethics committee of the participating institution and was conducted in accordance with the Declaration of Helsinki. The effectiveness and toxicity of venetoclax + HMA in 190 (43 newly diagnosed, 68 refractory, and 79 relapsed) patients with AML are reported here. Results:In the newly diagnosed AML, the overall response rate and survival confirmed the brilliant results demonstrated in VIALE-A. In the relapsed or refractory AML, the combination demonstrated a surprisingly complete remission rate (44.1% in refractory and 39.7% in relapsed evaluable patients) and conferred to treated patients a good expectation of survival. Toxicities were overall manageable, and most incidents occurred in the first 60 days of therapy. Infections were confirmed as the most common nonhematologic adverse event.Conclusions: Real-life data show that the combination of venetoclax and HMA offers an expectation of remission and long-term survival to elderly, newly diagnosed patients, and to relapsed or chemoresistant AML, increasing the chance of cure through a TODISCO ET AL.-993 different mechanism of action. The venetoclax + HMA combination is expected to constitute the base for triplet combinations and integration of target therapies. Our data contribute to ameliorate the understanding of venetoclax + HMA effectiveness and toxicities in real life.
Liver plasmacytoma is a very rare form of solitary plasmacytoma, in fact the presence of plasma cells in the liver is generally associated with a more aggressive form of multiple myeloma. We report an unusual case of liver plasmacytoma without systemic disease, diagnosed by percutaneous needle biopsy of the hepatic lesion, treated with six courses of melphalan and prednisone who achieved a good clinical remission after five years of follow-up.
BACKGROUND Current treatment regimens for Waldenström macroglobulinemia (WM) are based on the use of oral alkylating agents. Recently, however, other more costly agents have been proposed for the treatment of WM. In the current study, the authors report on results obtained using oral melphalan, cyclophosphamide, and prednisone (MCP) to treat 72 patients with WM, and they compare these results (and the associated costs) with those observed using more aggressive protocols. METHODS Between July 1973 and April 2002, the authors documented overexpression of the immunoglobulin M paraprotein in 317 consecutive patients. Of these, 100 had newly diagnosed WM, and the 72 who were symptomatic were treated using the MCP protocol. Response rate, overall survival (OS), response duration, freedom from progression (FFP), event‐free survival (EFS) duration, toxicity, and cost per course in Euro and U.S. dollars were evaluated for patients receiving this regimen. RESULTS Seventy‐one of 72 patients (99%) were evaluable. Of these patients, 55 (77%) achieved a response; 7 others (10%) experienced disease stabilization, and the remaining 9 (13%) experienced disease progression. After a median follow‐up of 72 months (range, 3–195 months), the median durations of EFS, FFP, response, and OS were 47, 55, 64, and 66 months, respectively. No World Health Organization Grade III or IV toxicities were observed, and side effects were limited to transient nausea, emesis, and mild neutropenia. The cost per course of the MCP regimen was $16, similar to that of standard protocols involving chlorambucil and much less than that of more aggressive protocols (price range, $91–11091) proposed for the treatment of WM. CONCLUSIONS Like chlorambucil‐based protocols, the MCP regimen is a cost‐effective and safe option for the treatment of patients with WM. Furthermore, the results obtained do not appear to be inferior to those yielded by more expensive, aggressive, and toxic intravenous protocols. Cancer 2005. © 2004 American Cancer Society.
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