Glofitamab in relapsed/refractory diffuse large B cell lymphoma: Real world data

Abstract INTRODUCT ̇ION Glofitamab is a T-cell-engaging bispecific antibody connecting CD20 on B cells and CD3 on T cells. Although, most of the patients with B-cell non-Hodgkin lymphoma (BNHL) achieve complete response (CR) following firstline treatment with rituximab and chemotherapy, about 40% of patients with diffuse large B-cell lymphoma (DLBCL) is refractory or relapse (R/R). Autologous stem-cell transplantation (ASCT) can cure some of these patients but many patients cannot undergo this procedure. CAR-T therapies are a significant advance but not available in many countries like Turkey. In Phase II expansion study, the overall response rate (ORR) was 51.6% and complete remission (CR) rate was 39.4% in R/R DLBCL patients (Dickinson er al. JCO 2022). In this retrospective study, we aimed to report the outcomes of patients who used glofitamab via compessionate use in Turkey

Immunosupressive therapy in a patient with postpartum acquired hemophilia a: Case presentation

Edinsel faktör inhibitörleri çoğunlukla kan pıh- tılaşma proteinlerini direk olarak engelleyen antikorlardır. Bu antikorlar; hemofili A’daki an- tikor gelişimi, post partum dönem, çeşitli im- münolojik hastalıklarla ilişkili olan durumlar, çeşitli kanserlerle ilişkili olan durumlar ve yaşlı hastalar gibi birçok klinik durumda görülür. Önemli oranda mortalite ve morbiditeye neden olan edinsel hemofili A (AHA); öz geçmiş ve soy geçmişinde kanama hastalığı olmayan, kanama ve uzamış aPTT’si olan hastalarda ayırıcı tanıda düşünülmelidir. Edinsel hemofilinin tedavi stra- tejisi hakkında henüz bir görüş birliği yoktur. Biz burada; immünsupressif tedavi ile başarılı bir şekilde tedavi edilen post partum edinsel (AHA)’lı bir vaka bildirdik.Acquired factor inhibitors are antibodies that inhibit directly blood clotting proteins. These are seen in many clinical situations such as inhi- bitors in hemophilia A, postpartum, in older pa- tients, in association with various immunologic disorders and various malignancies. Acquired hemophilia A which can cause a considerable proportion of mortality and morbidity, should be taken in consideration as a differentional di- agnosis in patients who have prolonged aPTT and bleeding without a personal or family his- tory of bleeding disorder. There is no consensus about the treatment strategy of acquired he- mophilia A yet. We reported a case of postpar- tum acquired hemophilia A who was treated with immunosupressive therapy

C ASE REPORT A case of Cauda Equina syndrome in a leukemic patient due to intrathecal methotrexate A case of Cauda Equina syndrome in a leukemic patient due to intrathecal methotrexate

ABSTRACT The leukemias may cause neurologic dysfunction through either direct invasion of the nervous system or indirectly through cytopenias, or it may occur as a result of the necessarily vigorous treatment programs for leukemia. We report here a 24-year-old acute lymphoblastic leukemia patient who in her second cycle of hyper-CVAD chem therapy regimen (high-dose Ara-C and high-dose methotrexate) received intrathecal methotrexate and two days afterwards was diagnosed as having Cauda Equina syndrome (CES). A lumbo-sacral MRI imaging with gadolinium was performed and there was a remarkable enhancement in the Cauda Equina region, suggesting either leukemic involvement or a type of neurologic complication associated with intrathecal methotrexate treatment. To rule out leukemic involvement, a lumbar puncture was performed and the CSF was free of leukemic cells. There are cases of CES developing after spinal anesthesia reported in the literature, but this is the first report of CES due to intrathecal methotrexate. Key Words: Cauda Equina syndrome, Intrathecal methotrexate, acute lymphoblastic leukemia, complication ÖZET Akut lenfoblastik lösemi hastasında intratekal metotreksata bağlı Cauda Equina sendromu Lösemiler kendileri direk invazyon yoluyla ya da hematolojik parametrelerde oluşturdukları anomalilerle nörolojik bozukluklara yol açabildikleri gibi, lösemi tedavisinde yer alan santral sinir sistemi (SSS) profilaksi rejimleri de nörotok-sisite oluşturabilmektedir. Intratekal kemoterapi, radyoterapi ve yüksek doz Ara-C ya da metotreksat içeren sistemik kemoterapiler SSS tutulumu proflaksisi veya tedavisinde etkindirler. İntratekal (IT) metotreksat tedavisi sonrası menenjial irritasyon bulgularına sık rastlanmakla beraber nadir olarak paralizi veya ensefalopati vakaları da bildirilmiştir. ALL-L1 tanısı konan 24 yaşında bir bayan hastaya Hyper-CVAD (yüksek doz Ara-C ve yüksek doz metotreksat) kemoterapi rejimi uygulanmaya başlandı. Hyper-CVAD kemoterapi rejiminin ikinci kürü sırasında, IT metotreksattan iki gün sonra hastamızda nörojenik mesane ve konstipasyon gelişti. Cauda Equina sendromu tanısı konan hastanın lumbo-sakral MRI görüntülemesinde Kauda Equina bölgesinde opaklaşma olduğu görüldü. Bu sırada yapılan lomber ponksiyon ve serebrospinal sıvı incelemesi ile bu opaklaşmanın lösemik tutuluma bağlı olmadığı kanıtlandı. Literatürde spinal anesteziye sekonder gelişen Cauda Equina sendromu bildirilmiş olsa da, vakamız intratekal metotreksat sonrası görülen ilk Cauda Equina sendromu vakasıdır. Anahtar Sözcükler: Cauda Equina sendromu, intratekal metotreksat, akut lenfoblastik lösemi, komplikasyo