Moznosti ovlivneni vyskytu febrilnich epizod a delky hospitalizace u neutropenickych nemocnych.

Intensive therapy (with or without peripheral blood stem cell transplantation - PBSCT) of patients with haematologic malignancies is often very complicated. In this study the following problems were studied with the conclusions: 1. Application of granulocyte-colony stimulating factor (G-CSF) after autologous PBSCT: individual, patient-dependant criteria (e.g. the first day when absolute neutrophil count was below 0,5x109/1) could be optimal for starting the G-CSF application. 2. Causative factors for prolonged hospitalisation beyond the point of engraftment in patients after autologous PBSCT: in spite of rapid engraftment other complications, especially persisting non-haematologic toxicities and infections, remain important limitations for further reduction of the length of patient's hospitalisation. 3. Some aspects that can influence the incidence of febrile episodes and length of hospitalisation in neutropenic patients. A retrospective analysis of two types of antibacterial prophylaxis was performed in patients after allogeneic bone marrow transplantation with conclusions, that the addition of trimethoprim/sulphamethoxazole to fluoroquinolone appears to be inexpensive, non toxic, well-tolerated and effective preventive regimen able to decrease the incidence of G-sepsis. The practical impact of this adapted combination could come in the future. Guidelines for diagnosis and therapy of fever of undetermined origin are also presented.Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi

Persistent splenomegaly during imatinib therapy and the definition of complete hematological response in chronic myelogenous leukemia

International audienceSplenomegaly belongs among typical findings on physical examination in patients with newly diagnosed chronic myelogenous leukemia (CML) (1). Its disappearance is a part of achieving complete hematological response (CHR), that is nowadays (when second generation of tyrosine kinase inhibitors are available) of particular interest during imatinib treatment. However, the kinetics of the disappearance of splenomegaly in patients with CML has still never been studied. We have analyzed 20 out of 245 patients with newly diagnosed chronic phase CML that had a still palpable spleen at the 3rd month of imatinib therapy in terms of treatment response at 18 months from the start of therapy. Our analysis have showed that eight (40%) of these 20 patients had achieved a treatment response at these time points. Moreover 11 patients had still a palpable splenomegaly at the 6th month after the start of imatinib therapy and 6 (54%) of them had a therapeutic response at the 18th month, suggesting that slower spleen shrinkage in patients with newly diagnosed chronic phase CML does not necessarily mean the failure of the therapy in the future

Invasive infections due to Saprochaete and Geotrichum species: Report of 23 cases from the FungiScope Registry

Saprochaete and Geotrichum spp. are rare emerging fungi causing invasive fungal diseases in immunosuppressed patients and scarce evidence is available for treatment decisions. Among 505 cases of rare IFD from the FungiScope\u2122 registry, we identified 23 cases of invasive infections caused by these fungi reported from 10 countries over a 12-year period. All cases were adults and previous chemotherapy with associated neutropenia was the most common co-morbidity. Fungaemia was confirmed in 14 (61%) cases and deep organ involvement included lungs, liver, spleen, central nervous system and kidneys. Fungi were S.\ua0capitata (n=14), S.\ua0clavata (n=5), G.\ua0candidum (n=2) and Geotrichum spp. (n=2). Susceptibility was tested in 16 (70%) isolates. All S.\ua0capitata and S.\ua0clavata isolates with the exception of one S.\ua0capitata (MIC 4\ua0mg/L) isolate had MICs>32\ua0mg/L for caspofungin. For micafungin and anidulafungin, MICs varied between 0.25 and >32\ua0mg/L. One case was diagnosed postmortem, 22 patients received targeted treatment, with voriconazole as the most frequent first line drug. Overall mortality was 65% (n=15). Initial echinocandin treatment was associated with worse outcome at day 30 when compared to treatment with other antifungals (amphotericin B \ub1 flucytosine, voriconazole, fluconazole and itraconazole) (P=.036). Echinocandins are not an option for these infections

Characteristics and outcome of patients with acute myeloid leukaemia and t(8;16)(p11;p13):results from an International Collaborative Study*

In acute myeloid leukaemia (AML) t(8;16)(p11;p13)/MYST3–CREBBP is a very rare abnormality. Previous small series suggested poor outcome. We report on 59 patients with t(8;16) within an international, collaborative study. Median age was 52 (range: 16–75) years. AML was de novo in 58%, therapy-related (t-AML) in 37% and secondary after myelodysplastic syndrome (s-AML) in 5%. Cytogenetics revealed a complex karyotype in 43%. Besides MYST3–CREBBP, whole-genome sequencing on a subset of 10 patients revealed recurrent mutations in ASXL1, BRD3, FLT3, MLH1, POLG, TP53, SAMD4B (n = 3, each), EYS, KRTAP9-1 SPTBN5 (n = 4, each), RUNX1 and TET2 (n = 2, each). Complete remission after intensive chemotherapy was achieved in 84%. Median follow-up was 5·48 years; five-year survival rate was 17%. Patients with s-/t-AML (P = 0·01) and those with complex karyotype (P = 0·04) had an inferior prognosis. Allogeneic haematopoietic cell transplantation (allo-HCT) was performed in 21 (36%) patients, including 15 in first complete remission (CR1). Allo-HCT in CR1 significantly improved survival (P = 0·04); multivariable analysis revealed that allo-HCT in CR1 was effective in de novo AML but not in patients with s-AML/t-AML and less in patients exhibiting a complex karyotype. In summary, outcomes of patients with t(8;16) are dismal with chemotherapy, and may be substantially improved with allo-HCT performed in CR1