Pharmacologic Therapies to Prevent Relapse of Acute Myeloid Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation

Relapse is the main cause of mortality in patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Adverse cytogenetic or molecular risk factors, as well as refractory disease or persistent measurable residual disease (MRD) at the time of transplantation are associated with an increased risk of recurrence. Salvage therapy for AML relapse after allo-HSCT is often limited to chemotherapy, donor lymphocyte infusions and/or second transplants and is rarely successful. Effective post-transplant preventive intervention in high risk AML may be crucial. The most frequent and promising approach is the use of post-transplant maintenance with hypomethylating agents or with FLT3 tyrosine kinase inhibitors when the target is present. Moreover, IDH1/IDH2 inhibitors and BCL-2 inhibitors in combination with other strategies are promising approaches in the maintenance setting. Here we summarize the current knowledge about the preemptive and prophylactic use of pharmacologic agents after allo-HSCT to prevent relapse of AML

Primary small cell carcinoma of the breast: a case report

Abstract Background Neuroendocrine breast cancer is a rare entity that was defined in 2003 by the World Health Organization as a separate breast cancer subtype. The diagnosis of neuroendocrine breast cancer requires the presence of neuroendocrine features in at least 50% of malignant cells, the exclusion of non-mammary primary tumors, as well as the presence of an in situ component in breast histology. The treatment and prognosis of neuroendocrine breast cancer are still not well established. Small cell carcinoma of the breast is a subtype of neuroendocrine cancer, resembling small cell carcinoma of the lung. It has a very poor prognosis and warrants treatment with platinum-based chemotherapy. Case presentation We herein report the case of a 47-year-old white woman with a left breast mass that was found to be an early-stage, high-grade small cell carcinoma of the breast. Positron emission tomography-computed tomography imaging excluded any other primary disease. Our patient underwent a left total mastectomy with sentinel lymph node biopsy and received cisplatin-based adjuvant chemotherapy. Our patient remains free of disease to date. Conclusions This case report sheds light on a rarely described disease and provides a comprehensive approach to diagnosis and management. Neuroendocrine carcinoma of the breast is a well-defined histologic subtype of breast cancer. Small cell carcinoma of the breast is a rare subtype of neuroendocrine breast cancer. Due to the rarity of this entity, prognosis has still not been well established, and treatment has not been standardized, cisplatin-based treatment has been used in this case similar to small cell carcinoma of the lung

Enoxacin degradation by photo-Fenton process combined with a biological treatment optimization and improvement of by-products biodegradability

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Mucormycoses pulmonaires au cours des traitements de leucémies aiguës. Analyse rétrospective d’une série de 25 patients

International audienceIntroductionIn acute leukaemia (AL), the occurrence of pulmonary mucormycosis (PM), the incidence of which is increasing, as a result of chemotherapy induced marrow aplasia, remains a life threatening complication.MethodsAnalysis of clinical, biological and thoracic CT characteristics of patients with PM developing during the treatment of AL between 2000 and 2015. Day 0 (D0) was defined as the day with first CT evidence of PM.ResultsAmong 1193 patients, 25 cases of PM were recorded during 2099 episodes of bone marrow aplasia. At time of diagnosis of PM, 24/25 patients had been neutropenic for a median of 12 days. None of the patients had diabetes mellitus. On initial CT (D0), the lesion was solitary in 20/25 cases and a reversed halo sign (RHS) was observed in 23/25 cases. From D1 to D7, D8 to D15 and after D15, RHS was seen in 100 %, 75 % and 27 % of cases, respectively. A tissue biopsy was positive in 17/18 cases. The detection of circulating Mucorales DNA in serum was positive in 23/24 patients and in 97/188 serum specimens between D-9 and D9. Bronchoalveolar lavage contributed to diagnosis in only 3/21 cases. The antifungal treatment was mainly based on liposomal amphotericin B combined with, or followed by, posaconazole. A pulmonary surgical resection was performed in 9/25 cases. At 3 months, 76 % of patients were alive and median overall survival was 14 months.ConclusionIn AL, early use of CT could improve the prognosis of PM. The presence of a RHS on CT suggests PM and is an indication for prompt antifungal treatment.IntroductionLa survenue d’une mucormycose pulmonaire (MP), dont l’incidence augmente au cours des aplasies chimio-induites des leucémies aiguës (LA), reste une complication redoutable.MéthodesAnalyse des caractéristiques clinico-biologiques et des scanners thoraciques (CT) des MP survenues au cours des traitements de LA entre 2000 et 2015. Le premier CT pathologique définissait le jour 0 (j0) de la MP.RésultatsParmi 1193 patients, 25 MP furent observées au cours de 2099 aplasies. Au diagnostic de MP, 24/25 patients étaient neutropéniques depuis une durée médiane de 12jours. Aucun patient n’était diabétique. Sur le CT de j0, l’atteinte pulmonaire était unique dans 20 cas et le signe du halo inversé (RHS) présent dans 23/25 cas. La fréquence du RHS était de 100 % entre j1 et j7 puis 75 % entre j8 et j15 et 27 % après j15. Une biopsie tissulaire était positive dans 17/18 cas. La présence d’ADN circulant de Mucorales sur sérum était observée chez 23/24 patients et dans 97/188 sérums entre j-9 et j9. Le lavage bronchoalvéolaire n’était contributif que dans 3/21 cas. Le traitement reposait majoritairement sur l’amphotéricine B liposomale combinée ou relayée par le posaconazole. Une résection pulmonaire chirurgicale était associée dans 9/25 cas. La survie à 3 mois post-MP était de 76 % et la médiane de survie de 14 mois.ConclusionAu cours des LA, le pronostic de la MP peut être amélioré par la réalisation précoce du CT permettant d’évoquer la MP en présence d’un RHS et ainsi de débuter le traitement le plus tôt possible

First case of proven invasive pulmonary infection due to Trichoderma longibrachiatum in a neutropenic patient with acute leukemia

IF 1.606 (2017)International audienceTrichoderma species are saprophytic filamentous fungi that can be found all over the word. These fungi show increasing medical importance as opportunistic human pathogens, particularly in immunocompromised patients. Invasive infections due to Trichoderma are rare and definitive diagnosis is complex to achieve because of the lack of specific diagnosis tools. We report in this work the first proven case of invasive pulmonary infection due to T. longibrachiatum in a 69-year-old white male with hematologic malignancy. The patient was successfully treated initially with voriconazole alone followed by a combination of voriconazole and caspofungine