Huddle Up: Using Mediation to Help Settle the National Football League Labor Dispute

In a patient transferred from Togo to Cologne, Germany, Lassa fever was diagnosed 12 days post mortem. Sixty-two contacts in Cologne were categorised according to the level of exposure, and gradual infection control measures were applied. No clinical signs of Lassa virus infection or Lassa specific antibodies were observed in the 62 contacts. Thirty-three individuals had direct contact to blood, other body fluids or tissue of the patients. Notably, with standard precautions, no transmission occurred between the index patient and healthcare workers. However, one secondary infection occurred in an undertaker exposed to the corpse in Rhineland-Palatinate, who was treated on the isolation unit at the University Hospital of Frankfurt. After German authorities raised an alert regarding the imported Lassa fever case, an American healthcare worker who had cared for the index patient in Togo, and who presented with diarrhoea, vomiting and fever, was placed in isolation and medevacked to the United States. The event and the transmission of Lassa virus infection outside of Africa underlines the need for early diagnosis and use of adequate personal protection equipment (PPE), when highly contagious infections cannot be excluded. It also demonstrates that larger outbreaks can be prevented by infection control measures, including standard PPE

The treatment of older Hodgkin lymphoma patients

The outcome of patients with Hodgkin lymphoma (HL) has dramatically improved over the past decades and continues to improve with the development of novel targeted therapies, such as the immunoconjugate brentuximab vedotin and the checkpoint inhibitors nivolumab and pembrolizumab. Moreover, with the use of response-adapted strategies using positron-emission-tomography (PET), the overall intensity of treatment for most patients can be reduced, resulting in less acute and late toxicity. However, these advances are mainly restricted to younger patients, as advances in patients above the age of 60 years ('older' patients) have been much less pronounced. Furthermore, about one third of all HL patients are among the older population, but only 5-10% of the patients treated in current HL clinical trials are >= 60 years old. HL in older patients is characterized by aggressive disease and unfavourable prognostic features as B symptoms and predominance of advanced stages. In addition, tolerance to curative chemotherapy is drastically reduced in older patients resulting in excessive toxicity and insufficient treatment due to therapy delays and dose reductions. Therefore, there is a significant unmet medical need in older HL patients for less toxic and effective therapies, and an important gap of knowledge concerning this growing population of patients. Recent advances on epidemiology, characteristics and treatment of older HL patients will be summarized in this article

Emerging drugs for Hodgkin's lymphoma

Importance of the field: Although to date most patients with Hodgkin's lymphoma (HL) can be cured, the current treatment is associated with acute and long-term complications such as infertility, cardiovascular damage and secondary malignancies. Moreover, novel effective therapies are urgently needed for elderly patients and for patients relapsing after high-dose chemotherapy. Areas covered in this review: Currently emerging promising approaches include drugs targeting cell surface structures by mAbs and immunotoxins, as well as small molecules targeting intracellular proteins. This article includes clinical trials published within the past 3 decades and early results reported in international conferences. What the reader will gain: This article summarizes the biological basis and early clinical data on emerging drugs for HL. Take home message: To date, several new drugs are being tested for HL that are expected to change the approach in both first-line and relapsed patients

Hodgkin lymphoma in elderly patients

Purpose of reviewWe aim to summarize the current knowledge on the treatment of elderly Hodgkin lymphoma patients with a focus on evidence from clinical trials and novel drugs.Recent findingsFor elderly Hodgkin lymphoma patients above 60 years without precluding comorbidities a curative treatment approach is warranted. Early favorable stage patients should receive two cycles of multiagent chemotherapy followed by 20 Gy localized radiotherapy. Early unfavorable stage patients should receive four cycles of multiagent chemotherapy followed by 30 Gy localized radiotherapy. For advanced stage patients six cycles of multiagent chemotherapy can be recommended and should be followed by localized radiotherapy on residual disease manifestations. Relapsed or refractory patients should be treated in an individually tailored approach that considers both the patient's objectives and comorbidities. The antibody-drug conjugate brentuximab vedotin is a very effective option for elderly patients with a high response rate albeit limited durability. Anti-programed cell death protein 1 antibodies might also be effective in elderly Hodgkin lymphoma patients with a mechanism of action distinct from chemotherapy.SummaryIn conclusion, the goal of treatment in newly diagnosed elderly Hodgkin lymphoma patients is curative whenever possible and prospective and retrospective evidence has shown that this is feasible for all disease stages with a variety of multiagent chemotherapy regimen. Relapsed and refractory elderly Hodgkin lymphoma patients can mostly only be treated with the goal of palliation. However, it remains to be seen if novel substances and new combination regimen are able to change that

Pharmacotherapy of Hodgkin lymphoma: standard approaches and future perspectives

Introduction: Hodgkin lymphoma (HL) is a lymphoid malignancy with an incidence of 2 - 3/100,000/year. Young adults are most often affected. Due to the development of highly active multi-agent chemotherapy protocols and the optimization of radiotherapy (RT) fields and doses, HL has become one of the malignancies with the highest cure rates. As treatment efficacy can hardly be improved, the major goal of clinical HL research consists in decreasing therapy-associated acute and long-term toxicity. To this end, treatment stratification based on interim positron emission tomography and the implementation of targeted drugs such as the antibody-drug conjugate brentuximab vedotin are currently being evaluated in prospective trials. Areas covered: This article reviews recent randomized Phase III and larger Phase II trials including HL patients. Expert opinion: In early stage HL, excellent results are achieved with a brief chemotherapy followed by involved-field RT. Patients with advanced HL should receive six to eight cycles of chemotherapy optionally followed by localized RT. In relapsed disease, high-dose chemotherapy followed by autologous stem cell transplantation represents the standard of care for most patients. The use of novel drugs and imaging tools that currently undergo evaluation may optimize HL treatment

Ten things the hematologist wants you to know about CAR-T cells

Achromatopsia (ACHM), also known as rod monochromatism or total color blindness, is an autosomal recessively inherited retinal disorder that affects the cones of the retina, the type of photoreceptors responsible for high-acuity daylight vision. ACHM is caused by pathogenic variants in one of six cone photoreceptor-expressed genes. These mutations result in a functional loss and a slow progressive degeneration of cone photoreceptors. The loss of cone photoreceptor function manifests at birth or early in childhood and results in decreased visual acuity, lack of color discrimination, abnormal intolerance to light (photophobia), and rapid involuntary eye movement (nystagmus). Up to 90% of patients with ACHM carry mutations in CNGA3 or CNGB3, which are the genes encoding the alpha and beta subunits of the cone cyclic nucleotide-gated (CNG) channel, respectively. No authorized therapy for ACHM exists, but research activities have intensified over the past decade and have led to several preclinical gene therapy studies that have shown functional and morphological improvements in animal models of ACHM. These encouraging preclinical data helped advance multiple gene therapy programs for CNGA3- and CNGB3-linked ACHM into the clinical phase. Here, we provide an overview of the genetic and molecular basis of ACHM, summarize the gene therapy-related research activities, and provide an outlook for their clinical application

The Unique Characteristics and Management of Patients Over 60 Years of Age with Classic Hodgkin Lymphoma

In recent decades, the prognosis of Hodgkin lymphoma has been substantially improved, but these successes have been restricted to younger patients and could not be translated into a major benefit for older patients, especially those with advanced-stage disease. Major problems in treating older patients include a different biology, frailty, comorbidities, and poorer tolerance of therapy. Additionally, these patients are often excluded from randomized trials, so an evidence-based standard of care is lacking. Importantly, the proportion of older patients with HL will increase over the next 50 years. Currently, ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine) is considered to be the gold standard, even though it has some toxicity in older patients and prospective data are not available. Thus, further studies are required, including the assessment of comorbidities and the incorporation of new drugs such as immunomodulatory agents, antibody-drug conjugates, mTOR inhibitors, or histone deacetylase (HDAC) inhibitors

Batten down the hatches: CAR T-cells - immuno-oncology meets intensive care medicine

CAR T-cell treatment has brought a significant benefit for patients with relapsed and refractory lymphoma and even long lasting remissions seem to be possible. Despite the good results CAR T-cell treatment is associated with severe and potentially life-threatening adverse effects. Patients regularly develop Cytokine Release Syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) after the transfusion of CAR T-cells. In addition to these immunological reactions patients can develop severe and life-threatening infections and other related adverse effects. Due to the increasing number of patients receiving CAR T-cells and the upcoming clinical trials more and more patients will potentially require intensive care treatment for the adverse effects after CAR T-cell treatment. The management of these patients requires an extensive diagnostic workup and complex treatment. An interdisciplinary team of hematologist, intensivist and others like neurologist and palliative medicine consultants is crucial for the best treatment of these patients. Together with the increasing number of patients this can lead to logistical issues for the intensive care departments of centers offering CAR T-cell therapies