Emergencies in Hematology: Why, When and How I Treat?

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(24), P. 7572 - 7572

Published: Dec. 12, 2024

Hematological emergencies are critical medical conditions that require immediate attention due to their rapid progression and life-threatening nature. As various examples, hypercalcemia, often associated with cancers such as multiple myeloma, can lead severe neurological cardiac dysfunction. Hyperleukocytosis, common in acute myeloid leukemias, increases the risk of leukostasis multiorgan failure. Sickle cell crisis, a complication sickle disease, results from vaso-occlusion, leading pain tissue ischemia. Tumor lysis syndrome, reported cases destruction cancer cells, causes electrolyte imbalances kidney injury. Acute transfusion reactions, fundamental hematological conditions, range mild allergic responses hemolysis shock, requiring prompt management. Disseminated intravascular coagulation, involving excessive coagulation bleeding, is commonly triggered by malignancies, first phases promyelocytic leukemia. Recently, era bispecific antibodies chimeric antigen receptor T cytokine release syndrome manifestation must be recognized promptly treated. Understanding pathophysiology, recognizing clinical manifestations, ensuring adequate diagnostic strategies management approaches for each condition central early intervention improving patient outcomes reducing mortality.

Language: Английский

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BNT162b2 mRNA vaccination affects the gut microbiome composition of patients with follicular lymphoma and chronic lymphocytic leukemia

Biomarker Research, Journal Year: 2025, Volume and Issue: 13(1)

Published: Feb. 10, 2025

Abstract Background In both chronic lymphatic leukemia (CLL) and follicular lymphoma (FL) immunotherapy determines B-depletion that leads to temporary suppression of humoral immunity, which is clinically relevant especially during the COVID-19 pandemic, when most patients in first wave received BNT162b2 vaccine anti-neoplastic treatment. Methods To capture changes immunome microbiome composition CLL FL upon mRNA-based vaccination, we designed a prospective, longitudinal study profile cellular response after exposure vaccine. Results patients, second third administrations increased titer specific antibodies against SARS-CoV-2. vaccination induced expansion central memory CD8 + CD57dim CD279 T cells reduction neutrophil subset myeloid 1 (CD14 − CD15 CD16 dim CD64 CD33 CD38 PDL1 HLA-DR ); cohorts, CD45RA CD27 NK were expanded full cycle vaccination. After genera Collinsella, Gemmiger, Lachnospiraceae, Blautia, Ruminococcus Lactobacillus whereas Faecalibacterium, Enterobacteriacae, Enterococcus decreased. Multivariate analysis failed identify factors associated with communities among considering age, sex, anti-CD20 therapy disease activity. Only alpha diversity was negatively correlated subsets e 5 at baseline positively 6 PICRUSt2 showed how can also affect host health promoting inflammation. The L-lysine biosynthesis pathway more represented L-valine degradation anaerobic purine nucleobases overrepresented cohort. Conclusions Taken together, our findings reveal effect shaping despite receiving treatment for their underlying active disease, highlight importance comprehensive profiling understand immune function these cohorts patients.

Language: Английский

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Debulking Therapy with Obinutuzumab Is Helpful and Safe in Chronic Lymphocytic Leukemia with Extreme Hyperleukocytosis: A Case Report

Onco, Journal Year: 2025, Volume and Issue: 5(1), P. 10 - 10

Published: March 1, 2025

Chronic lymphocytic leukemia (CLL) represents the most frequent in Western world, with an incidence of 4 [...]

Language: Английский

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Immune Response and Breakthrough Infection Risk After SARS-CoV-2 Vaccines in Patients with Hemoglobinopathy: A Single Center Experience

Vaccines, Journal Year: 2025, Volume and Issue: 13(2), P. 111 - 111

Published: Jan. 23, 2025

Background: Immune system impairment is frequently reported in patients affected by hemoglobinopathies due to various mechanisms, including iron accumulation, antigenic stimulation numerous transfusions, chronic hemolysis, and a general hyperinflammatory state. For these reasons, the immune response after vaccine risks being ineffective. Methods: We evaluated anti-spike IgG production two doses of for SARS-CoV-2 hemoglobinopathies. Results: All 114 enrolled (100%) developed adequate antibody production, with median value serum 2184.4 BAU/mL (IQR 1127.4–3502.9). The amount was unrelated any other clinical characteristics evaluated, transfusion dependence or non-transfusion dependence, age, gender, disease type, ferritin, blood count, spleen status, therapy hydroxyurea chelators (in all cases p > 0.05). Moreover, 47 (41.2%) breakthrough infection during first 2 years follow-up vaccination, mildly symptomatic course, without requiring hospitalization experiencing significative drop hemoglobin values, allowing slight delay their regimen. Conclusion: Vaccination against COVID-19 safe effective hemoglobinopathies, ensuring protection from severe infection.

Language: Английский

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Lenalidomide plus Dexamethasone Combination as First-Line Oral Therapy of Multiple Myeloma Patients: A Unicentric Real-Life Study

Cancers, Journal Year: 2023, Volume and Issue: 15(16), P. 4036 - 4036

Published: Aug. 9, 2023

Based on the results obtained in clinical trials, use of combination lenalidomide and dexamethasone (Len/Dex) has become a potential therapeutic choice for newly diagnosed multiple myeloma (NDMM) ineligible autologous stem cell transplantation. This study evaluated 89 frail NDMM patients treated with first-line oral association. At last follow-up, 34 out (38.2%) were alive, 22 still treatment Len/Dex. Among 73 evaluable who received at least two cycles, overall response rate was 71% (N = 52). The disease control rate, defined as any level to therapy, occurred 71 (97%). We reported one or more adverse events grade 3 4 (G3/4) 65.2% 58) patients, prevalence hematological toxicity (24 patients), leading an discontinuation cases. In univariate analysis, high ISS, serum β2-microglobulin, creatinine clearance <30 mL/min negatively impact OS, while depth positively impacts OS. Moreover, G3-4 anemia, frailty score, ECOG PFS. conclusion, elderly benefit from Len/Dex also era monoclonal antibodies, ensuring increased PFS OS where is often limited usually not very effective.

Language: Английский

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Tixagevimab/Cilgavimab as Pre-Exposure Prophylaxis against COVID-19 for Multiple Myeloma Patients: A Prospective Study in the Omicron Era

Diseases, Journal Year: 2023, Volume and Issue: 11(3), P. 123 - 123

Published: Sept. 18, 2023

Background: tixagevimab/cilgavimab, distributed under the name "Evusheld", was first available pre-exposure prophylaxis for COVID-19 other than vaccination. It received an EUA from FDA after sufficient trial data showed efficacy in preventing SARS-CoV-2 infections and subsequent severe disease. Its potential benefits high-risk immunocompromised patients generated a lot of interest. Individuals with multiple myeloma fall into this category, as they are characterized by attenuated immune responses and, some cases, vaccines have limited efficacy. Methods: single-center, prospective study included consecutive myeloma. All individuals were considered due to their underlying Baseline demographic clinical characteristics, well regarding infection antibodies, collected. Patients administered two intramuscular 150 mg doses Evusheld monitored during follow-up period. Results: one hundred eleven analysis, median age 64 years (range 58-69) fifty-three females (47.7%). Fourteen (12.6%) had prior history all vaccinated either three or four mRNA-based vaccines. An increase observed neutralizing-antibody levels before tixagevimab/cilgavimab administration, 92.6% 97.3%. The high sustainable, level 95.4% at 3 months post administration. Overall, nine (8.1%) diagnosed period, 31 days. There no SARS-CoV-2- infection-related hospitalizations deaths. monoclonal antibody combination tolerated, infusion-related reactions major adverse events, pain injection site only reported 33 (30%). Conclusions: (Evusheld) seemed beneficial myeloma, who presented low incidence initial Omicron wave. No new safety concerns emerged. However, novel combinations antibodies against circulating variants deemed necessary view emergence tolerance.

Language: Английский

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Baseline IgM Amounts Can Identify Patients with Poor Outcomes: Results from a Real-Life Single-Center Study on Classical Hodgkin Lymphoma

Cancers, Journal Year: 2024, Volume and Issue: 16(4), P. 826 - 826

Published: Feb. 18, 2024

Hodgkin Lymphoma (HL) is characterized by an inflammatory background in which the reactive myeloid cells may exert immune-suppressive effect related to progression of disease. Immunoglobulin M first antibody isotype produced during immune response, also plays immunoregulatory role. Therefore, we investigated if, as a surrogate defective B cell function, it could have any clinical impact on prognosis. In this retrospective, observational, single–center study, evaluated 212 newly diagnosed HL patients, including 132 advanced-stage. A 50 mg/dL level IgM at baseline resulted 84.1% sensitivity and 45.5% specificity for predicting complete response whole cohort (area under curve (AUC) = 0.62, p 0.013). multivariate analysis, ≤ presence large nodal mass (<7 cm) were independent variables able predict outcome, while, after two cycles treatment, PET-2 status predictors PFS. The amount diagnosis valuable prognostic factor much earlier than PET-2, can provide information PET-2-negative patients. This help identify different classes risk treatment failure baseline.

Language: Английский

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Breakthrough infection after SARS-CoV-2 vaccines in patients with hemoglobinopathies and blood-transfusion management: a single Center experience

Research Square (Research Square), Journal Year: 2023, Volume and Issue: unknown

Published: Sept. 14, 2023

Purpose Immune system impairment is frequently reported in patients affected by hemoglobinopathies due to various mechanisms, including iron accumulation, antigenic stimulation numerous transfusions, chronic hemolysis, and a hyperinflammatory state. The immune response after vaccine could be ineffective. Methods We evaluated the anti-spike IgG production 2 doses of for SARS-CoV-2 hemoglobinopathies, reporting risk breakthrough infections, monitoring outcome severe disease or complications related basal hematological disease. Results All 114 enrolled developed adequate antibody production, with median value serum anti-S 2184.4 BAU/mL. amount was unrelated any other clinical characteristics evaluated, transfusion dependence, age, gender, type, ferritin, blood count, spleen status, therapy hydroxyurea chelators (p > 0.05). Moreover, 47 (41.2%) infection during follow-up, all mildly symptomatic course, without requiring hospitalization experiencing significative drop hemoglobin values, allowing slight delay their regimen. Conclusion Vaccination has been an effective safe tool this category patients, preventing complications. Watchful waiting strategy can safely ensured, guaranteeing better management components.

Language: Английский

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