Takotsubo Syndrome Associated with COVID-19

Objective: The availability of public health information for optimised supportive care is critical during the COVID-19 pandemic. We describe the first case of COVID-19 complicated by Takotsubo cardiomyopathy. Materials and Methods: We report the clinical, laboratory and radiological findings of a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: The nasopharyngeal swab was positive for SARS-CoV-2 and x-ray images demonstrated pathognomonic pneumonia. The patient developed tachycardia and the echocardiogram confirmed the diagnosis of Takotsubo cardiomyopathy. Conclusions: Doctors should be aware of the need to thoroughly study this new infection in order to understand its underlying mechanisms and related complications

Hematopoietic stem cell transplantation for non-Hodgkin lymphomas

High-dose chemotherapy (HDT) followed by autologous bone marrow transplantation (ABMT) has proved to provide significant advantage regarding event-free and overall survival in patients with chemosensitive relapses of aggressive non-Hodgkin's lymphoma (NHL) after conventional therapy. These results encouraged many investigators to use HDT as part of first-line therapy but the results are contradictory. There is no consensus regarding management of relapsed or refractory DLBCL. In follicular lymphomas, autologous stem cell transplantation (SCT) is considered the treatment of choice for young patients with relapsed disease. Autologous SCT has also been evaluated in prospective trials as first-line treatment for high risk patients at diagnosis, but the results are not yet conclusive. In mantle cell lymphoma, autologous stem cell transplantation has been employed as part of first-line therapy. Allo-SCT for patients with lymphoma was first performed in the mid-1980s. The high transplant-related mortality, seen after myeloablative conditioning, discouraged broader interest in this approach and made further research difficult. The generally lower relapse rates after allo-SCT, the association of GvHD with reduced relapse rates, the increase of relapse rates after ex vivo or in vivo T-cell depletion, and the frequent responses to DLIs all support the existence of a graft-vs.-lymphoma effect. However, further data analysis supports the view that not all lymphomas are equal. While slowly proliferating diseases such as follicular lymphoma seem particularly sensitive targets for allogeneic T-cells, results of allo-SCT with aggressive B-cell lymphomas have been less convincing. Patients with these latter diseases obviously need vigorous debulking of their tumor prior to conditioning. Reduced-intensity conditioning fueled a renaissance of allo-SCT as treatment of lymphoma because the lower expected TRM was highly attractive for a patient population where the transplant-related death rate after myeloablative conditioning had, in many instances, exceeded 50%.No final da década de 70, ocorreu o primeiro relato de sucesso com a utilização de quimioterapia de alta dose, seguida de transplante de células-tronco hematopoéticas autólogo (TCTH auto), em pacientes com linfoma não Hodgkin (LNH). Desde então, o TCTH autólogo vem se constituindo em um importante instrumento na estratégia de tratamento dos LNH. Inúmeros estudos, em vários subtipos de linfomas, têm consolidado o papel do TCTH autólogo, principalmente como resgate em recidivas de doença. O melhor momento para a incorporação desta estratégia depende do subtipo do linfoma, do status de doença previamente ao transplante (sensível ou resistente) e de fatores clínico-biológicos associados à doença. Em recidiva sensível de linfoma difuso de grandes células, o TCTH autólogo é a terapia de escolha. Nestes pacientes, o transplante promove taxas de resposta completa em até 50% dos casos, comparado a aproximadamente 15%, quando esse resgate é realizado com protocolos quimioterápicos convencionais. O seu papel como parte da terapia de indução de remissão não está totalmente estabelecido. Em linfomas indolentes, principalmente folicular, é a terapia de escolha nas recidivas sensíveis à quimioterapia de resgate. Em linfomas de células do manto, o TCTH autólogo tem se incorporado à terapia de primeira linha, como consolidação de remissão. As indicações de TCTH alogênico em LNH têm se limitado aos casos de refratariedade ao tratamento convencional e recidiva pós-transplante autólogo, em pacientes jovens e sem comorbidades, em decorrência da alta toxicidade associada à utilização de regimes de condicionamento mieloablativos. A utilização de regimes de condicionamento de intensidade reduzida tem reduzido a toxicidade e ampliado o seu uso nos LNH recidivados ou refratários

Disease-modifying therapies in frontotemporal lobar degeneration.

Frontotemporal Lobar Degeneration (FTLD) is characterized by behavioral changes, executive dysfunctions, and language impairment, sustained by different neuropathological patterns. The collective efforts of clinical, pathological and genetic studies have recently opened new insights into the underpinnings of pathological mechanisms of this complex disorder. Different types of inclusions define the new conceptual framework for FTLD classification. Up to now, Tau (FTLDTau-positive), TAR DNA-binding protein (TDP43, FTLD Tau-negative TDP43-positive) have been recognized as the most frequent neuropathological hallmarks of FTLD. In some clinical cases, monogenic forms are identified, mainly due to Microtubule Associated Protein (MAPT) or Granulin (GRN) mutations. No treatments for FTLD are available yet, and off-label medications studies testing potential modifying treatments on the basis of neuropathological positive, inhibitors of Tau kinases or manipulation of Tau-processing haploinsuffciency associated with GRN mutations, has been counteracted into pathological processing of TDP-43 and other key-molecules involved and their consequent translocation from nucleus to cytoplasm, and growing number of potential therapeutic targets. In this continuously new findings on molecular targets and modifying therapies in FTL

Hematopoietic Stem Cell Transplantation For Non-hodgkin Lymphomas [o Transplante De Celulas-tronco Hematopoeticas No Tratamento Dos Linfomas Nao Hodgkin]

High-dose chemotherapy (HDT) followed by autologous bone marrow transplantation (ABMT) has proved to provide significant advantage regarding event-free and overall survival in patients with chemosensitive relapses of aggressive non-Hodgkin's lymphoma (NHL) after conventional therapy. These results encouraged many investigators to use HDT as part of first-line therapy but the results are contradictory. There is no consensus regarding management of relapsed or refractory DLBCL. In follicular lymphomas, autologous stem cell transplantation (SCT) is considered the treatment of choice for young patients with relapsed disease. Autologous SCT has also been evaluated in prospective trials as first-line treatment for high risk patients at diagnosis, but the results are not yet conclusive. In mantle cell lymphoma, autologous stem cell transplantation has been employed as part of first-line therapy. Allo-SCT for patients with lymphoma was first performed in the mid-1980s. The high transplant-related mortality, seen after myeloablative conditioning, discouraged broader interest in this approach and made further research difficult. The generally lower relapse rates after allo-SCT, the association of GvHD with reduced relapse rates, the increase of relapse rates after ex vivo or in vivo T-cell depletion, and the frequent responses to DLIs all support the existence of a graft-vs.-lymphoma effect. However, further data analysis supports the view that not all lymphomas are equal. While slowly proliferating diseases such as follicular lymphoma seem particularly sensitive targets for allogeneic T-cells, results of allo-SCT with aggressive B-cell lymphomas have been less convincing. Patients with these latter diseases obviously need vigorous debulking of their tumor prior to conditioning. Reduced-intensity conditioning fueled a renaissance of allo-SCT as treatment of lymphoma because the lower expected TRMwas highly attractive for a patient population where the transplant-related death rate after myeloablative conditioning had, in many instances, exceeded 50%.32SUPPL. 1106114Fisher, R.I., Miller, T.P., O'Connor, O.A., Diffuse aggressive lymphoma (2004) Hematology Am Soc Hematol Educ Program, pp. 221-236Philip, T., Guglielmi, C., Hagenbeek, A., Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma (1995) N Engl J Med, 333 (23), pp. 1540-1545Blay, J., Gomez, F., Sebban, F., The International Prognosis Index correlates to survival in patients with aggressive lymphoma in relapse: Analysis of the PARMA trial. 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(not necessary in that order) (2006) Hematology Am Soc Hematol Educ Program, pp. 303-310Laport, G.G., The role of Hematopoietic cell transplantation for follicular non-Hodgkin's lymphoma (2006) Biol Blood Marrow Transplant, 12, pp. 59-65. , 1 Suppl 1Le, G.S., De, G.S., Volteau, C., Autologous stem cell transplantation as treatment of choice for follicular lymphoma patients in first relapse: Final analysis of the outcome of 175 patients treated in the GELA/GOELAMS FL 2000 Study (2008) Blood (ASH Annual Meeting Abstracts) 112: Abstract, p. 773Ladetto, M., Corradini, P., Vallet, S., High-rate of clinical and molecular remissions in follicular lymphoma patients receiving high-dose sequential chemotherapy and autografting at diagnosis: A multicenter, prospective study by the Gruppo Italiano Trapianto Midollo Osseo (GITMO) (2002) Blood, 100 (5), pp. 1559-1565Ladetto, M., de Marco, F., Benedetti, F., Prospective, multicenter randomized GITMO/IIL trial comparing intensive (R-HDS) versus convencional (CHOP-R) chemoimunotherapy in high-risk follicular lymphoma at diagnosis: The superior disease control of R-HDS does not translate into an overall survival advantage (2008) Blood, 111 (8), pp. 4004-4013Deconinck, E., Foussard, C., Milpied, N., High-dose therapy followed by autologous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: A randomized multicenter study by GOELAMS (2005) Blood, 105 (10), pp. 3817-3823Lenz, G., Dreyling, M., Shiegnitz, E., Myeloablative radio-chemotherapy followed by autologous stem cell transplantationin first remission prolongs progression-free surival in follicular lymphoma: Results of a prospective, randomized trial of the German Low-Grade Lymphoma Study Group (2004) Blood, 104 (9), pp. 2667-2674Hiddemann, W., Buske, C., Kneba, M., Autologous stem cell transplantation after myeloablative therapy in first remission may be benefical in patients with advanced stage follicular Lymphoma after front-line therapy whit R_CHOP (2008) An Analysis of Two Consecutive Studies of The German Low Grade Lymphoma Study Group (GLSG). Blood (ASH Annual Meeting Abstracts), 112, p. 772. , AbstractRomaguera, J.E., Fayad, L., Rodriguez, M.A., High rate of durable remissions alter treatment of newly diagnosed aggressive mantle-cell lymphoma with rituximab plus hyper-CVAD alternating whit rituximab plus high-dose metrotexate and cytarabine (2005) J Clin Oncol, 23 (28), pp. 7013-7023Hermann, A., Hoster, E., Zwingers, T., Improved of overall survival in advanced stage mantle cell lymphoma (2009) J Clin Oncol, 27 (4), pp. 511-518Geisler, C.H., Kolstad, A., Laurell, A., Long-term progression-free survival of mantle cell lymphoma after intensive front-line imunochemotherapy with in vivo-purged stem cell rescue: A nonrandomized phase 2 multicenter study by the Nordic Lymphoma Group (2008) Blood, 112 (7), pp. 2687-2693Hoster, E., Dreyling, M., Klapper, W., A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma (2008) Blood, 111, pp. 558-565Tam, C.S., Basset, R.R., Ledesma, C., Mature results of The MD Anderson Cancer Center risk-adapted transplantation strategy in mantle cell lymphoma (2009) Blood, 113 (18), pp. 4144-4152Bertz, H., Illerhaus, G., Veelken, H., Finke, J., Allogeneic hematopoietic stem-cell transplantation for patients with relapsed or refractory lymphomas: Comparison of high-dose conventional conditioning versus fludarabine-based reduced-intensity regimens (2002) Ann Oncol, 13 (9), pp. 135-139Pasquini, M.C., Wang, Z., (2007) Current Use and Outcome of Hematopoietic Stem Cell Transplantation: Part II - CIBMTR Summary SlidesVan, B.K., Carreras, J., Zhang, M.J., Reduced intensity versus myeloablative conditioning for HLA-matched sibling transplantation in follicular lymphoma (2005) Blood, p. 106Robinson, S.P., Goldstone, A.H., Mackinnon, S., Chemoresistent or aggressive lymphoma predicts for a poor outcome following reduced-intensity allogeneic progenitor cell transplantation: An ananlysis from the Lymphoma Working Party of the European Group Blood and Bone Marrow Transplantation (2002) Blood, 100 (13), pp. 4310-4316If, K., Saliba, R.M., Hosing, C.M., Autologous stem cell vs Non-myeloablative allogeneic transplantation (NMT) after high-dose rituximab-containing conditioning regimens for relapsed chemosensitive follicular lymphoma(FL) (2005) Blood, 106, p. 48. , AbstractMorris, E., Thomson, K., Craddock, C., Outcomes after alemtuzumab-containing reduced-intensity allogeneic transplantation regimen for relapsed and refractory non-Hodgkin lymphoma (2004) Blood, 104 (13), pp. 3865-3871Faulkner, R.D., Craddock, C., Byrne, J.L., BEAM alemtuzumab reduced-intensity allogeneic stem transplantation for lympho-prolipferatives diseases: GVHD, toxicity and survival in 65 patients (2004) Blood, 103 (2), pp. 428-434Corradini, P., Zallio, F., Mariotti Jr, et al. Effect of age and previous autologous transplantation on nonrelapse mortality and survival in patients treated with reduced-intensity conditioning and allografting for advanced hematologic malignancies (2005) J Clin Oncol, 23 (27), pp. 6690-6698Maris, M.B., Sandmaier, B.M., Storer, B., Allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning for relapsed or refractory follicular lymphoma (2005) Blood, 106, p. 1130. , AbstractKhouri, I.F., McLaughlin, P., Saliba, R.M., Eight-year experience with allogeneic stem cell transplantation for relapsed follicular lymphoma after nonmyeloablative conditioning with fludarabine, cyclophosphamide, and rituximab (2008) Blood, 111 (12), pp. 5530-5536Shustov, A.R., Savage, K.J., Does High-dose therapy and autologous hematopoietic stem cell transplantation have a role in the primary treatment of peripheral T-cell linfomas? ASH evidence-based review 2008 (2008) Hematology Am Soc Hematol Educ Program, pp. 39-41Corradini, P., Dodero, A., Zallio, F., Graft-versus-lymphoma effect in relapsed peripheral T-cell non-Hodgkin's lymphomas after reduced-intensity conditioning followed by allogeneic transplantation of hematopoietic cells (2004) J Clin Oncol, 22 (11), pp. 2172-2176Wulf, G.G., Hasenkamp, J., Jung, W., Reduced intensity conditioning and allogeneic stem cell transplantation after salvage therapy integrating alemtuzumab for patients with relapsed peripheral T-cell non-Hodgkin's lymphoma (2005) Bone Marrow Transplant, 36 (3), pp. 271-273Guyatt, G.H., Oxman, A.D., Kunz, R., What is quality of evidence and why is it important to clinicians? (2008) BMJ, 336 (7651), pp. 995-99