AML with BCR-ABL1 Fusion treated with Imatinib, a Hypomethylating Agent and Venetoclax

A patient with history of myelodysplastic syndrome (MDS) presented with multifocal pneumonia and was found to have Philadelphia chromosomepositive (Ph+) acute myeloid leukemia (AML). A tyrosine kinase inhibitor (TKI) was added to decitabine and venetoclax combination, providing a molecular and cytogenetic complete response despite additional cytogenetic and molecular abnormalities. She remains in remission after eleven cycles of treatment. Our report describes the tolerability and success of a triplet regimen that incorporates a TKI to a backbone of decitabine and venetoclax in a patient with high-risk disease and with significant comorbidities

Isocitrate dehydrogenase mutation and risk of venous thromboembolism in glioma: A systematic review and meta-analysis

BACKGROUND: Patients with malignancies including malignant gliomas have a relatively high risk for venous thromboembolism (VTE). Recent evidence has linked isocitrate dehydrogenase (IDH) mutation with reduced VTE risk in malignant glioma. This meta-analysis aims to quantify the association of IDH mutation status with risks of VTE in patients with glioma. METHODS: We searched PubMed, Google Scholar, Medline OVID, Cochrane library, Cumulative Index to Nursing and Allied Health Literature databases to identify relevant studies. The overall odd ratio (OR) was pooled using the random-effects model. We evaluated the statistical heterogeneity using Cochran\u27s Q statistics and I2 tests. We performed subgroup analyses according to age, tumor, study design, and study quality. RESULTS: A total of 2600 patients from 8 studies were included in the meta-analysis. Patients with IDH mutant-type gliomas had a significantly lower risk of VTE (OR: 0.21, 95 % confidence interval [CI]: 0.09-0.46, I2 = 34 %) compared to patients with IDH wild-type gliomas. Among high-grade (III and IV) glioma, VTE events in IDH-mutant gliomas occurred with an OR of 0.28 (95 % CI: 0.14-0.53). No statistically significant decrease in the VTE risk was observed in grade II gliomas with IDH mutation compared to IDH wild-type gliomas, as indicated by the OR of 0.60 (95 % CI: 0.17-2.11). CONCLUSION: IDH mutation is significantly associated with 79 % lower risk of VTE among patients with high-grade glioma compared to IDH wild-type. Our findings suggest the potential utility of IDH mutation status regarding thromboprophylaxis, and the need for further studies to elucidate the mechanism of the association

296P Isocitrate dehydrogenase mutation and risk of venous thromboembolism in glioma: A systematic review and meta-analysis

BACKGROUND: Patients with malignancies including malignant gliomas have a relatively high risk for venous thromboembolism (VTE). Recent evidence has linked isocitrate dehydrogenase (IDH) mutation with reduced VTE risk in malignant glioma. This meta-analysis aims to quantify the association of IDH mutation status with risks of VTE in patients with glioma. METHODS: We searched PubMed, Google Scholar, Medline OVID, Cochrane library, Cumulative Index to Nursing and Allied Health Literature databases to identify relevant studies. The overall odd ratio (OR) was pooled using the random-effects model. We evaluated the statistical heterogeneity using Cochran\u27s Q statistics and I2 tests. We performed subgroup analyses according to age, tumor, study design, and study quality. RESULTS: A total of 2600 patients from 8 studies were included in the meta-analysis. Patients with IDH mutant-type gliomas had a significantly lower risk of VTE (OR: 0.21, 95 % confidence interval [CI]: 0.09-0.46, I2 = 34 %) compared to patients with IDH wild-type gliomas. Among high-grade (III and IV) glioma, VTE events in IDH-mutant gliomas occurred with an OR of 0.28 (95 % CI: 0.14-0.53). No statistically significant decrease in the VTE risk was observed in grade II gliomas with IDH mutation compared to IDH wild-type gliomas, as indicated by the OR of 0.60 (95 % CI: 0.17-2.11). CONCLUSION: IDH mutation is significantly associated with 79 % lower risk of VTE among patients with high-grade glioma compared to IDH wild-type. Our findings suggest the potential utility of IDH mutation status regarding thromboprophylaxis, and the need for further studies to elucidate the mechanism of the association

Severe Haemolytic Anaemia Resulting from a Malpositioned Haemodialysis Catheter

Severe haemolytic anaemia is a rare complication of haemodialysis that is often difficult to recognize, especially when there are other potential differential diagnoses. Here, we present the case of 19-year-old man on haemodialysis who developed severe haemolytic anaemia while recovering from acute renal failure secondary to rhabdomyolysis. Other causes of haemolytic anaemia such as thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome were ruled out. As his blood counts were dropping on days following haemodialysis, haemolysis secondary to the mechanical sheering effect of the catheter was considered and his haemodialysis catheter was exchanged, which led to the resolution of anaemia. Learning points: Haemodialysis-related haemolysis can be due to the mechanical sheering effect of the catheter/tubing, and overheating or contamination of the dialysate fluid.Most cases of catheter or faulty tubing-related haemolysis need a high level of suspicion for diagnosis and normally resolve with correction of the underlying mechanical issue.Due to the rarity of the phenomenon, it is very important to rule out other life-threatening causes of haemolytic anaemia, such as disseminated intravascular coagulation and thrombotic thrombocytopenic purpura

Role of cytokines produced by T helper immune-modulators in dengue pathogenesis: A systematic review and meta-analysis

Background and objectives: Modulation of the immune reaction is essential in the development of various diseases, including dengue\u27s Cytokine Tsunami , an increase in vascular permeability with concomitant severe vascular leakage. We aim to identify the role of T-helper (Th) cells, Th2 and Th7, with their related cytokines in dengue pathogenesis. Material and methods: Nine electronic databases and manual search were applied to detect available publications. A meta-analysis using a fixed- or random-effect model was performed to measure standardized mean difference (SMD) with 95% confidence interval (CI). The National Institute of Health (NIH) tools for observational cohort, cross-sectional, and case-control studies were used to examine the risk of bias. The protocol was recorded in PROSPERO with CRD42017060230. Results: A total of 38 articles were found including 19 case-control, 11 cross-sectional and 8 prospective cohort studies. We indicated that Th2 cytokines (IL-4, IL-6, IL-8) and Th17 cytokine (IL-17) in dengue patients were notably higher than in a healthy control group in acute phase (SMD = 1.59, 95% CI [0.68, 2.51], p = 0.001; SMD = 1.24, 95% CI [0.41, 2.06], p = 0.003; SMD = 1.13, 95% CI [0.61, 1.66], p\u3c0.0001; SMD = 1.74, 95% CI [0.87, 2.61], p\u3c0.0001), respectively. Conclusions: This study provides evidence of the significant roles of IL-4, IL-6, IL-8, IL-10 and IL-17 in the pathogenesis of developing a severe reaction in dengue fever. However, to fully determine the association of Th cytokines with dengue, it is necessary to perform further studies to assess kinetic levels during the duration of the illness

CLO21-016: Incidence, Risk Factors, and Prognostic Implications of Peri-Transplant Orthostatic Hypotension in Patients With Multiple Myeloma

Background: Orthostatic hypotension (OH) is a well-recognized phenomenon occurring in multiple myeloma (MM) patients undergoing autologous stem cell transplant (ASCT) that poses a morbidity and mortality threat due to increased risk of falls. Surprisingly, few studies have examined its incidence, risk and protective factors, and prognostic implications. Methods: This was a retrospective, single-center study of 226 consecutive newly diagnosed MM patients who were admitted for first ASCT between June 2012 to April 2014 at Dana Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA. Patients with AL amyloidosis were excluded. Orthostatic vital signs were checked on Monday, Wednesday and Friday. Median time to onset of OH, progression free survival (PFS), overall survival (OS), and time to discharge were estimated using the Kaplan-Meier method. Univariable and multivariable logistic regression were used to investigate factors associated with the development of OH. Results: Overall, 165/226 (73%) patients were diagnosed with OH during the course of their hospital admission for ASCT. Fifty-one patients were found to have OH on the day of first orthostatic vitals check, making it impossible to distinguish whether OH was pre-existent or developed during the transplant admission. Excluding these 51 patients, 114/175 (65%) patients developed OH during the peri-transplant period, at a median of 7 days post ASCT (range; 6–8). Of these patients, only eleven were found to have moderate to severe dehydration as defined by weight loss ≥ 5% body weight, suggesting OH could not be simply be explained by volume depletion. Multivariable analysis revealed three risk factors (white race, gabapentin, antihypertensives) and two protective factors (antihistamine, proton pump inhibitor) associated with the development of peri-transplant OH that were independent of significant fluid losses. Further, we found that OH did not significantly impact length of hospitalization, progression free and overall survival. Conclusions: New onset OH occurs frequently (65%) during the peri-transplant period in MM patients undergoing ASCT (median time of onset of 7 days post ASCT). White race, use of gabapentin and antihypertensives were identified as risks factors, while use of antihistamines and proton pump inhibitor were identified as protective factors