A review of current induction strategies and emerging prognostic factors in the management of children and adolescents with acute lymphoblastic leukemia

Introduction: Acute lymphoblastic leukemia is the most frequent hematologic malignancy in children. Almost 95% of children potentially achieve a complete remission after the induction treatment, but over the last years, new insights in the genomic disease profile and in minimal residual disease detection techniques have led to an improvement in the prognostic stratification, identifying selected patients’ subgroups with peculiar therapeutic needs. Areas covered: According to a comprehensive search of peer-review literature performed in Pubmed, in this review we summarize the recent evidences on the induction treatment strategies comprised in the children acute lymphoblastic leukemia scenario, focusing on the role of key drugs such as corticosteroids and asparaginase and discussing the crucial significance of the genomic characterization at baseline which may drive the proper induction treatment choice. Expert opinion: Current induction strategies already produce durable remissions in a significant proportion of standard-risk children with acute lymphoblastic leukemia. A broader knowledge of the biologic features related to acute lymphoblastic leukemia subtypes with worse prognosis, and an optimization of targeted drugs now available, might lead to the achievement of long-term molecular remissions in this setting

A Reporting Framework for Describing and a Typology for Categorizing and Analyzing the Designs of Health Care Pay for Performance Schemes

Table S1. Search strategy output for Cochrane database. This table details the search strategy employed to identify relevant studies and reviews used in the manuscript. This includes the database searched, years covered, and number of citations. Table S2. Summary of identified reviews. This table outlines the relevant reviews and P4P evaluation studies identified from our search strategy, which informed our reporting framework and typology. Table S3. Search strategy output for economic theories to inform the P4P typology. This table details the search strategy employed to identify relevant economic theories that were used to construct the P4P typology. This includes the database searched, years covered, and number of citations. Table S4. Application of the typology on selected identified P4P schemes. This table outlines the results of applying the P4P typology to categorized identified P4P schemes. Table S5. P4P studies used in testing the inter-rater reliability of the P4P typology. This table list out the P4P studies that were selected for the raters to apply the P4P typology. Table S6. Rater population. This table describes the rater population i.e. qualifications, research experience, and experience with P4P in healthcare. Table S7. Sources of disagreement between raters. This table highlights the items on the P4P typology that were sources of disagreement between he raters. Table S8. An example of source of disagreement between raters (risk). This table details text extracts from the sample P4P study and describes the reason for disagreement between raters testing the P4P typology. (DOCX 127 kb

Complete remission obtained with azacitidine in a patient with concomitant therapy related myeloid neoplasm and pulmonary mucormycosis

Mucormycosis is the third cause of invasive mycosis after candidiasis and aspergillosis in AML patients, representing a poor prognostic factor associated with a high rate of fatal outcome. We report a case of a patient with AML and a concomitant pulmonary mucormycosis at diagnosis, who obtained a complete remission both of her AML and of the fungal infection. The incidence of the infection at the onset of leukemia is extremely unusual, and, to our knowledge, the sporadic cases reported in the literature are included in heterogeneous series retrospectively examined. In our case, Liposomal Amphotericin B as single agent appeared incapable of controlling the infection, so anti-infective therapy was intensified with posaconazole and simultaneously antileukemic treatment with 5-azacitidine was started, with the understanding that the only antifungal treatment would not have been able to keep the infection under control for a long time if not associated with a reversal of neutropenia related to the disease. We observed a progressive improvement of the general conditions, a healing of pneumonia and a complete remission of the leukemic disease, suggesting that a careful utilization of the new compounds available today, in terms of both antifungal and antileukemic treatment, may offer a curative chance a patient who would have otherwise been considered unfit for a potentially curative therapeutic strategy