Chronic hepatitis virus infection in patients with multiple myeloma: clinical characteristics and outcomes

OBJECTIVES: Cytotoxic agents and steroids are used to treat lymphoid malignancies, but these compounds may exacerbate chronic viral hepatitis. For patients with multiple myeloma, the impact of preexisting hepatitis virus infection is unclear. The aim of this study is to explore the characteristics and outcomes of myeloma patients with chronic hepatitis virus infection. METHODS: From 2003 to 2008, 155 myeloma patients were examined to determine their chronic hepatitis virus infection statuses using serologic tests for the hepatitis B (HBV) and C viruses (HCV). Clinical parameters and outcome variables were retrieved via a medical chart review. RESULTS: The estimated prevalences of chronic HBV and HCV infections were 11.0% (n = 17) and 9.0% (n = 14), respectively. The characteristics of patients who were hepatitis virus carriers and those who were not were similar. However, carrier patients had a higher prevalence of conventional cytogenetic abnormalities (64.3% vs. 25.0%). The cumulative incidences of grade 3-4 elevation of the level of alanine transaminase, 30.0% vs. 12.0%, and hyperbilirubinemia, 20.0% vs. 1.6%, were higher in carriers as well. In a Kaplan-Meier analysis, carrier patients had worse overall survival (median: 16.0 vs. 42.4 months). The prognostic value of carrier status was not statistically significant in the multivariate analysis, but an age of more than 65 years old, the presence of cytogenetic abnormalities, a beta-2-microglobulin level of more than 3.5 mg/L, and a serum creatinine level of more than 2 mg/ dL were independent factors associated with poor prognosis. CONCLUSION: Myeloma patients with chronic hepatitis virus infections might be a distinct subgroup, and close monitoring of hepatic adverse events should be mandatory

Evaluation of prognostic factors and the role of chemotherapy in unfavorable carcinoma of unknown primary site: a 10-year cohort study

<p>Abstract</p> <p>Background</p> <p>Carcinoma of unknown primary site (CUP) has a poor prognosis and the prognostic factors in these patients are not well established. Furthermore, there are no selection criteria for patients who should benefit from chemotherapy.</p> <p>Methods</p> <p>The medical records of 179 CUP patients who were treated at Taipei Veterans General Hospital from 2000 to 2009 were reviewed. Factors associated with survival were determined by Kaplan-Meier analysis. Differences between the groups with and without palliative chemotherapy were analyzed.</p> <p>Results</p> <p>Univariate analysis revealed multiple prognostic factors, including performance status, lung metastasis, number of metastatic organs, serum albumin, corrected serum calcium, lactate dehydrogenase (LDH), sodium, and cholesterol levels, palliative chemotherapy, and white blood cell and lymphocyte counts. Multivariate analysis showed that performance status < 2, serum albumin level ≥ 3.5 g/dl, corrected serum calcium level < 10.7 mg/dl, single metastatic organ, and palliative chemotherapy were independent factors of better prognosis. Patients with better performance status, higher serum albumin, and lower serum LDH levels had significantly greater benefit from palliative chemotherapy.</p> <p>Conclusions</p> <p>Certain patients with unfavorable CUP will have better survival. Identification of patients with unfavorable CUP who could benefit from palliative chemotherapy warrants future prospective studies.</p

Successful Treatment of Synchronous Solitary Ipsilateral Axillary Lymph Node Metastasis from Non-Small Cell Lung Cancer with Radical Resection and Perioperative Chemotherapy

Lung cancer is the leading cause of death from cancer worldwide. Almost 60% of patients with non-small cell lung cancer present with metastasis at the time of diagnosis. Without treatment, the median survival for patients with metastatic non-small cell lung cancer is only 3-4 months. While targeted therapy has improved median overall survival to 12 months and even longer in patients with driver mutations, most patients with initial response to targeted agents ultimately develop disease progression. On the other hand, several studies have shown resection of solitary brain or adrenal metastases may achieve long-term survival in selected patients. However, in patients with solitary extra-cranial, extra-adrenal metastases, the results of metastasectomy have rarely been reported. Herein, we report a case of synchronous solitary axillary lymph node metastasis from non-small cell lung cancer. Surgical resection of both the primary lung tumor and metastasis combined with perioperative chemotherapy achieved prolonged disease-free survival in this case. To date, the optimal treatment strategy for patients with solitary distant lymph node metastases and resectable primary lung tumors has not been established. The addition of metastasectomy to primary lung cancer surgery may provide a chance for long-term survival for such patients

Ifosfamide-Induced Fanconi's Syndrome

Ifosfamide is an alkylating antineoplastic prodrug used to treat many solid tumors. The metabolism of ifosfamide is via CYP450 3A4 and 2B6 and produces active ifosfamide mustard, the toxic metabolite acrolein and chloroacetaldehyde (CAA). Additionally, CAA is believed to induce proximal tubular dysfunction which results in Fanconi's syndrome. It is a condition not commonly encountered in adults receiving ifosfamide but relatively common in children. Herein, we have reported a 25-year-old woman with a history of synovial sarcoma with multiple lung metastasis and repetitive locoregional recurrence. She received chemotherapy with high dose ifosfamide as her antineoplastic treatment. Before her 4th cycle of chemotherapy, the patient's pre-chemotherapy evaluation revealed proteinuria, glucosuria, phosphateuria, hypophosphatemia and non-anion gap metabolic acidosis. The above conditions were consistent with Fanconi's syndrome. We treated her with electrolyte supplement and close monitoring of the noted laboratory abnormalities. Fortunately, the laboratory abnormality gradually resolved. Our case highlights the rare potential complication of ifosfamide, especially in patients who had received a high cumulive dose. To avoid this rare but potentially debilitating condition, patients whose cumulative ifosfamide dose reaches threshold should be closely monitored

Revisiting of Preoperative Blood Ordering Policy—A Single Institute's Experience in Taiwan

If unnecessary blood orders can be reasonably waived, it will reduce both workload and financial expenditure. A review of the surgical blood ordering practice is, therefore, mandatory. Methods: Routine preoperative blood orders were retrospectively audited. After receiving the requests, we usually performed only type and screen tests without crossmatching until an actual need for transfusion occurred. Transfusion probability (number of patients transfused ÷ number of procedures ×100) was calculated. One unit of donation was defined as 500 mL whole blood. If surgical procedures were associated with insignificant blood loss (number of units transfused ≤ 1) and transfusion probability was less than 5%, then it was considered to be safe to disregard a preoperative blood order. Results: The blood ordering practices for 5,472 patients who received various surgical procedures were reviewed over a period of 48 operation days. Neither preoperative requests for preparation of red cells nor transfusion was made in 3,482 patients. Preoperative requests for preparation of red cells were made in 1,990 patients, but only 751 (37.74%) actually received blood transfusion on the day of the operation. Analysis showed that it would have been safe to disregard a preoperative blood order for ophthalmic surgery, ear surgery, nose surgery (endoscopic sinus surgery, submucosal turbinectomy), microlaryngoscopic surgery, tracheostomy, thyroidectomy, mastectomy, laparoscopic cholecystectomy, hemicolectomy, hernioplasty, arthroscopic surgery, laminectomy, laparoscopically assisted vaginal hysterectomy, vasec-tomy and varicose vein surgery. Conclusion: A review of preoperative blood orders has identified certain surgical procedures with insignificant blood loss and low transfusion probability, for which preoperative blood orders may be safely disregarded in order to reduce unnecessary laboratory workload while not jeopardizing patient safety

Macroenzyme Creatine Kinase in the Era of Modern Laboratory Medicine

Among the conditions in which creatine kinase (CK)-MB activity is elevated in the absence of myocardial injury or infarction, macroenzyme (macro) CK merits special attention from clinicians. We present 2 cases, 1 with macro CK type 1 and the other with macro CK type 2, to stress the common clinical situations and diagnostic dilemma that clinicians encounter when evaluating patients with macro CK. Moreover, the rare conditions associated with macro CK, and the phenomenon of spuriously high CK-MB activity out of proportion to total CK, are discussed. The biochemical characteristics, clinical significance and potential implications of macro CK are reviewed within the scope of modern laboratory medicine