Immune Thrombocytopenia Induced by the Chimpanzee Adenovirus-Vectored Vaccine against SARS-CoV-2 Infection

We present a case of immune thrombocytopenia (ITP) induced by the chimpanzee adenovirus-vectored vaccine, without evidence of thrombosis, eight days after vaccine administration. The thrombocytopenia condition improved after administering steroid treatment. This adenovirus vaccine had been reported to induce rare side effects, such as immune thrombotic thrombocytopenia. This case report showed that it could also induce immune thrombocytopenia without the presence of thrombosis. Therefore, we should be cautious of this rare side effect as global vaccine administrations against coronavirus disease increase

Prediction of Target Epidural Blood Patch Treatment Efficacy in Spontaneous Intracranial Hypotension Using Follow-Up MRI

Objectives: Epidural blood patching (EBP) is the mainstay therapy for spontaneous intracranial hypotension (SIH). MRI is used for evaluating spinal CSF leakage. Post-EBP MRI has been. shown to be effective in predicting the efficacy of EBP. However, there are few reports on how post-EBP MRI findings may change with time. The aim of this study was to evaluate the relationship between post-EBP MRI findings at different time points and the corresponding effectiveness of EBP. Methods: We retrospectively reviewed 63 SIH patients who had received target EBP. All patients received an MRI follow-up within 10 days (post-EBP MRI) and at 3 months after EBP (3-month MRI). A sub-group analysis was performed at different post-EBP MRI time points (0–2, 3–6, and 7–10 days). The relationships between the post-EBP MRI findings and the EBP effectiveness were evaluated. Results: Thirty-five (55.56%) patients were assigned to the EBP-effective group, and 28 (44.44%) were assigned to the EBP non-effective group according to the 3-month MRI. Compared to the EBP non-effective group, the EBP-effective group had significantly lower numbers of spinal CSF leakage in the post-EBP MRI (4.49 vs. 11.71; p = 0.000) and greater numbers of leakage improvement (7.66 vs. 2.96; p = 0.003). For patients who received post-EBP MRI during periods of 0–10, 0–2, 3–6, and 7–10 days, the cutoff values of numbers of spinal CSF leakage for predicting EBP failure were 4, 6, 4, and 5, respectively, with an AUC above 0.77. Conclusion: By using post-EBP MRI, which only takes approximately 20 min, predicting EBP efficacy became possible in SIH patients. This study provides cutoff values of numbers of spinal CSF leakage at different follow-up times to serve as clues of if further EBP is needed, which provides the novelty of the current study

Cytomegalovirus management after allogeneic hematopoietic stem cell transplantation: A mini-review

Because of the high incidence of cytomegalovirus (CMV) seropositivity in the population, CMV infection is a common and severe complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Taiwan. Here we propose a CMV management strategy for patients undergoing allo-HSCT from the Taiwanese perspective, which focuses on the epidemiology, diagnosis, monitoring, prophylaxis, and treatment of CMV infection after allo-HSCT. In terms of CMV monitoring, weekly CMV monitoring with the COBAS® AmpliPrep system is the standard approach because the pp65 CMV antigenemia assay has a lower sensitivity than CMV monitoring with the COBAS® AmpliPrep system. However, pp65 CMV antigenemia assay has a better correlation with clinical symptoms in immunocompromised patients. A 14-week prophylactic course of letermovir is recommended for allo-HSCT recipients in Taiwan, especially for recipients of hematopoietic stem cells from mismatched unrelated and haploidentical donors. Preemptive ganciclovir therapy should be initiated when the CMV viral load exceeds 1000 copies/mL, and should not be discontinued until CMV DNA is no longer detected in the blood. For allo-HSCT recipients who have CMV-related diseases, ganciclovir with or without CMV-specific intravenous immunoglobulin is the standard of care. The limited availability of foscarnet, an alternative for patients who are not responsive to or cannot tolerate ganciclovir, is a crucial issue in Taiwan. For pediatric allo-HSCT recipients, more data are needed to propose a CMV management recommendation

Positron Emission Tomography/Computed Tomography False Positivity for Xanthogranulomatous Inflammation in an Adolescent with Hodgkin's Lymphoma

Although positron emission tomography/computed tomography (PET/CT) is a sensitive tool for Hodgkin's lymphoma (HL) staging and response evaluation, its role in early detection of disease relapse remains controversial. A high false positivity of routine PET/CT during follow-up may result in unnecessary treatment of HL patients who are in complete remission. Here we report a 15-year-old boy who had a false positive PET/CT result during his follow-up. Debulking surgery was performed for the suspicious lesion, which showed xanthogranulomatous inflammation, fibrosis, old hemorrhage and fibrous adhesion of thymic tissue and pleura, but no residual tumor cells. One year after the surgery, this patient remained well without any evidence of disease relapse. Our case shows that PET/CT could provide false positive imaging in HL patients who are in complete remission after treatment. Tissue biopsy remains the really necessary tool of confirming disease relapse in patients with HL

Optimal Sequence of Irinotecan and Oxaliplatin-Based Regimens in Metastatic Colorectal Cancer: A Population-Based Observational Study.

The optimal sequence of irinotecan and oxaliplatin-based regimens for metastatic colorectal cancer remains unclear. We conducted a population-based observational study by retrospectively reviewing records from Taiwan's National Health Insurance Research Database to explore this issue. Patients aged ≥ 20 years with metastatic colorectal cancer newly diagnosed between 2004 and 2008 (n = 9490) were enrolled in current study. Among these 9490 patients, 3895 patients (41.04%) did not receive any chemotherapy within the first three months after catastrophic illness registration. Patients who received best supportive care were older and had higher Charlson comorbidity indexes and incidences of comorbidities than those who received irinotecan-based regimens, oxaliplatin-based regimens, and 5-fluorouracil/capecitabine alone. Patients who received irinotecan followed by oxaliplatin-based regimens and those who received the reverse sequence were further stratified into arm A (n = 542) and arm B (n = 1156), respectively. The median first time to next treatment was not significantly different between arm A and arm B (210 days vs. 196 days; p = 0.17). However, the median second time to next treatment was longer in arm A than in arm B (155 days vs. 123 days; p = 0.006), which translated into a better overall survival (487 days vs. 454 days; p = 0.02). The crossover rate was higher in arm A than in arm B (47.84% vs. 41.61%; p<0.001). Multivariate Cox regression analyses showed that overall survival was comparable between the two chemotherapy sequences (p = 0.27). Our study suggested that irinotecan followed by oxaliplatin-based regimens might be a better chemotherapy treatment option for metastatic colorectal cancer than the reverse sequence given the higher crossover rate and potential overall survival benefit

Recurrent episodes of hemophagocytic lymphohistiocytosis preceding the diagnosis of subcutaneous panniculitis-like T-cell lymphoma

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease caused by cytokine storm-induced severe inflammation, and malignant lymphoma is the leading cause of HLH in adults. We herein have reported the case of a 28-year-old man afflicted with subcutaneous panniculitis-like T cell lymphoma who presented to our facility complaining of fever, cough and myalgia for one week. Following an examination, the patient was diagnosed with hemophagocytic lymphohistiocytosis according to the diagnostic criteria of HLH 1994 protocol published in 1997. Treatment with the HLH 1994 protocol (chemotherapy with etoposide combined with steroid based regimen) was initiated and the patient recovered well. However, subcutaneous panniculitis-like T cell lymphoma was diagnosed by neck soft tissue biopsy nine months later. Thereafter, this patient then received chemotherapy using the ESHAP regimen for one cycle (etoposide 40 mg/m2 BSA, cisplatin 25 mg/m2 BSA and methylprednisolone 500 mg at day 1 to day 4, and cytarabine 2000 mg/m2 at day 5). Currently, this patient continues his regular follow-up at our hematologic outpatient department

Treatment of Adolescent and Young Adult Acute Lymphoblastic Leukemia with the Pediatric Protocol: Results from a Single Institution in Taiwan

Background: It remains unclear whether pediatric protocols provide a better outcome to adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) than adult protocols in Taiwan. Therefore, we conducted a case-control study to compare the outcome events, disease-free survival (DFS), and overall survival (OS) in Taiwanese AYA patients receiving either pediatric or adult ALL protocols. Methods: Twenty-three Taiwanese AYA patients with ALL were retrospectively reviewed: eight patients received the pediatric ALL protocol modified from the Taiwan Pediatric Oncology Group (mTPOG) regimen, and 15 were treated by using the Cancer and Leukemia Group B study 8811 (CALGB-8811) regimen. Results: The DFS rates for patients in the mTPOG and CALGB-8811 groups were 100% versus 33.3% (p = 0.016) at one year, and 100% versus 22.2% (p = 0.006) at two years, respectively. The OS rates for patients in mTPOG and CALGB-8811 groups were 100% versus 37.0% (p = 0.013) at one year, and 100% versus 22.2% (p = 0.003) at two years, respectively. Conclusions: Our results suggested that the pediatric mTPOG protocol provides AYA ALL patients a better DFS and OS than the adult CALGB-8811 protocol

RAGE acts as an oncogenic role and promotes the metastasis of human lung cancer

RAGE (receptor for advanced glycation end-product) is thought to be associated with metastasis and poor prognosis of various types of cancer. However, RAGE is constitutively expressed in the normal lung and down-regulated in cancerous lung, while the opposite evidence shows that RAGE-mediated signaling contributes to the tumorigenesis of lung cancer. Therefore, the role of RAGE in lung cancer progression is still unclear to be further investigated. In this study, RAGE-overexpressed stable clones of human lung cancer A549 cells and two local lung adenocarcinoma cell lines CL1-0 and CL1-5 were utilized to verify the effect of RAGE on lung cancer cells while the in vivo xenograft animal model was further performed to evaluate the role of RAGE in the progression of lung cancer. The growth of A549 cells was inhibited by RAGE overexpression. p53-dependent p21CIP1 expression contributed to RAGE-induced growth inhibition by suppressing CDK2 kinase activity and retinoblastoma protein (RB) phosphorylation in vitro. On the other hand, RAGE overexpression promoted migration, invasion, and mesenchymal features of lung adenocarcinoma cells through ERK signaling. Furthermore, an in vivo xenograft experiment indicated that RAGE promoted the metastasis of lung cancer cells with p21CIP1 up-regulation, ERK activation, and the changes of EMT markers. Regarding to the involvement of tumor-associated macrophage (TAM) in the microenvironment, we monitored the expressions of TAM markers including CD68 and CD163 as well as angiogenesis marker CD31 in xenograft slice. The data showed that RAGE might induce the accumulation of TAM in lung cancer cells and further accelerate the in vivo tumor growth. In summary, our study provides evidence indicating the distinct in vitro and in vivo effects of RAGE and related mechanisms on tumor growth and metastasis, which shed light on the oncogenic role of RAGE in lung cancer

Early Colonoscopy Confers Survival Benefits on Colon Cancer Patients with Pre-Existing Iron Deficiency Anemia: A Nationwide Population-Based Study

<div><p>This study aimed to examine the prognostic significance of pre-existing iron deficiency anemia (IDA) and the benefits of early colonoscopy in patients with colon cancer, since these have not been clearly established to date. Using the Taiwanese National Health Insurance Research Database, we retrieved and retrospectively reviewed the records of patients aged ≥55 years who were diagnosed with colon cancer between 2000 and 2005. The patient cohort was divided into two groups: patients with (n = 1,260) or without (n = 15,912) an IDA diagnosis during ≤18 months preceding the date of colon cancer diagnosis. We found that diabetes (27.9% vs. 20.3%, p<0.0001), cardiovascular disease (61.6% vs. 54.7%, p<0.001), and chronic kidney disease (4.6% vs. 2.2%, p<0.0001) were more common among patients with IDA than among those without IDA. The median overall survival times for patients with IDA and those without IDA were 4.6 and 5.7 years, respectively (p = 0.002). Patients who underwent colonoscopy ≤30 days, 31–90, and ≥91 days after IDA diagnosis showed median overall survival times of 5.79, 4.43, and 4.04 years, respectively (p = 0.003). Delayed colonoscopy was an independent factor associated with poor overall survival (adjusted hazard ratio, 1.28; 95% confidence interval, 1.07–1.53; p = 0.01). In conclusion, colon cancer patients with IDA were more likely to experience comorbidities than were those without IDA. Pre-existing IDA was a poor prognostic factor in adult men and postmenopausal women who had colon cancer. Early colonoscopy could improve overall survival possibly by facilitating early diagnosis and treatment.</p></div

Comparison of Clinical Characteristics of Metastatic Colorectal Cancer Patients According to Front-line Treatment.

<p>SD: standard deviation; CCI: Charlson comorbidity index; CVD: cardiovascular disease; CKD: chronic kidney disease.</p><p>^aANOVA for continuous variables</p><p>^bChi-square test for categorical variables.</p><p>Comparison of Clinical Characteristics of Metastatic Colorectal Cancer Patients According to Front-line Treatment.</p