Fatal lymphoproliferation and acute monocytic leukemia-like disease following infectious mononucleosis in the elderly

Three elderly patients are reported, in whom serologically confirmed recent infectious mononucleosis is followed by fatal lymphoproliferation (case 1), by acute monocytic leukemia (case 2), and by acute probably monocytic leukemia (case 3)

High-risk additional chromosomal abnormalities at low blast counts herald death by CML

Blast crisis is one of the remaining challenges in chronic myeloid leukemia (CML). Whether additional chromosomal abnormalities (ACAs) enable an earlier recognition of imminent blastic proliferation and a timelier change of treatment is unknown. One thousand five hundred and ten imatinib-treated patients with Philadelphia-chromosome-positive (Ph+) CML randomized in CML-study IV were analyzed for ACA/Ph+ and blast increase. By impact on survival, ACAs were grouped into high risk (+8, +Ph, i(17q), +17, +19, +21, 3q26.2, 11q23, -7/7q abnormalities; complex) and low risk (all other). The presence of high- and low-risk ACAs was linked to six cohorts with different blast levels (1%, 5%, 10%, 15%, 20%, and 30%) in a Cox model. One hundred and twenty-three patients displayed ACA/Ph+ (8.1%), 91 were high risk. At low blast levels (1-15%), high-risk ACA showed an increased hazard to die compared to no ACA (ratios: 3.65 in blood; 6.12 in marrow) in contrast to low-risk ACA. No effect was observed at blast levels of 20-30%. Sixty-three patients with high-risk ACA (69%) died (n = 37) or were alive after progression or progression-related transplantation (n = 26). High-risk ACA at low blast counts identify end-phase CML earlier than current diagnostic systems. Mortality was lower with earlier treatment. Cytogenetic monitoring is indicated when signs of progression surface or response to therapy is unsatisfactory

The long shadow of early-change patterns: a 3-year follow-up after the use of a web-based intervention for mild to moderate depressive symptoms

Web-based interventions can be effective in treating depressivesymptoms. Patients with risk not responding to treatment havebeen identified by early change patterns. This study aims to examinewhether early changes are superior to baseline parameters in pre-dicting long-term outcome. In a randomized clinical trial with 409individuals experiencing mild to moderate depressive symptomsusing the web-based intervention deprexis, three latent classeswere identified (early response after registration, early responseafter screening and early deterioration) based on early change inthe first four weeks of the intervention. Baseline variables and theseclasses were included in a Stepwise Cox Proportional Hazard MultipleRegression to identify predictors associated with the onset of remis-sion over 36-months. Early change class was a significant predictor ofremission over 36 months. Compared to early deterioration afterscreening, both early response after registration and after screeningwere associated with a higher likelihood of remission. In sensitivityand secondary analyses, only change class consistently emerged asa predictor of long-term outcome. Early improvement in depressionsymptoms predicted long-term outcome and those showing earlyimprovement had a higher likelihood of long-term remission. Thesefindings suggest that early changes might be a robust predictor forlong-term outcome beyond baseline parameters