8 research outputs found
TREATMENT OF SEPSIS IN NEUTROPENIC PATIENTS
Febrilna neutropenija je Äesta i potencijalno fatalna komplikacija intenzivne citostatske terapije zbog Äega je glavni uzrok nerelapsnog mortaliteta hematoloÅ”kih pacijenata. Važnu skupinu pacijenata Äine oni koji su zbog osnovne bolesti ili ranijih linija lijeÄenja pod rizikom za infekcije specifi Änim uzroÄnicima. Kako se u veÄine pacijenata s febrilnom neutropenijom može postaviti dijagnoza sepse, dijagnostiÄke i terapijske postupke treba primjenjivati kao da je pacijent u sepsi. Bitno je prepoznati visokoriziÄne pacijente jer se incidencija sepse u neutropeniÄnih pacijenata može znatno smanjiti adekvatnom antimikrobnom profilaksom i granulocitnim faktorima rasta. Ako doÄe do sepse, vrlo je važno Å”to ranije zapoÄeti lijeÄenje prema ustanovljenim smjernicama, ali uvijek uzimajuÄi u obzir i individualne karakteristike svakog pacijenta kao i mikrobioloÅ”ku situaciju, Äime se može znatno smanjiti mortalitet i morbiditet ovih pacijenata.Febrile neutropenia is a common and potentially fatal complication of intense cytotoxic therapy, which makes it the main cause of non-relapse mortality in patients with hematologic malignancies. Some of the patients are at risk of specifi c infections due to underlying disease of previous treatment regimens. Considering that most febrile neutropenic patients can be diagnosed with sepsis, diagnosis and treatment should be treated as septic. It is important to recognize patients at high risk since the incidence of sepsis in neutropenic patients can be signifi cantly reduced using antimicrobial prophylaxis and granulocyte growth factors. Once sepsis occurs, prompt treatment according to guidelines, individualized based on the specifi c problems of each patient, and microbiological situation can significantly reduce mortality and morbidity
Mitral and tricuspid valvuloplasty in a patient with myelodysplastic syndrome
MijelodisplastiÄni sindrom (MDS) klonska je bolest matiÄne hematopoetske stanice, koja se oÄituje poremeÄenom proliferacijom, diferencijacijom i sazrijevanjem hematopoeze te displastiÄnim promjenama u koÅ”tanoj srži. U kliniÄkoj slici i laboratorijskim nalazima bolesnika s MDS-om dominira anemija, neÅ”to rjeÄe neutropenija
ili trombocitopenija razliÄitih stupnjeva težine. KardiokirurÅ”ki zahvat u bolesnika s MDS-om velik je izazov jer su neutropenija i trombocitopenija vodeÄi uzroci infekcija i krvarenja tijekom operacije. Malen je broj izvjeÅ”Äa u literaturi koja opisuju kardiokirurÅ”ki zahvat u bolesnika s MDS-om. Prikazujemo 66-godiÅ”nju bolesnicu s MDS-om kod koje je uspjeÅ”no izvedena rekonstrukcija mitralnog i trikuspidalnoga srÄanog zalistka. Bolesnica se javila u hitnu službu zbog otežanog disanja, opÄe slabosti i znakova srÄanog popuÅ”tanja. RadioloÅ”kom obradom verificirani su obostrani pleuralni izljev, izraženije lijevo, i poveÄana sjena srca s naglaÅ”enim vaskularnim hilusima. Daljnjom obradom dokazane su mitralna i trikuspidalna insuficijencija teÅ”kog stupnja pa je bolesnica operirana, a pet godina nakon zahvata ima dobru kvalitetu života. Multidisciplinarnom suradnjom kardiologa, hematologa, anesteziologa i kardiokirurga u bolesnice je uspjeÅ”no izveden kirurÅ”ki zahvat rekonstrukcije mitralne i trikuspidalne valvule. Ovaj prikaz bolesnice upuÄuje na važnost multidisciplinarnog pristupa specifiÄnoj i ranjivoj grupi bolesnika s MDS-om i kardiovaskularnim komorbiditetima.Myelodysplastic syndrome (MDS) is a clonal disease of mutated hematopoietic stem cells characterized by abnormal hematopoietic differentiation and dysplastic bone marrow changes. MDS usually tends to present with anemia, less often with neutropenia and thrombocytopenia of varying degrees. Cardiac surgery in MDS patients is a major challenge because neutropenia and thrombocytopenia are the leading causes of infection and bleeding during the procedure. There are only a few reports of cardiovascular surgery in patients with MDS.
We are presenting a 66-year-old MDS patient with a successful reconstruction of the mitral and tricuspid heart valve. The patient presented in the Emergency department with weakness and dyspnea. Radiological workup verified 3rd stage heart failure. Severe mitral and tricuspid insufficiency was verified, after which the patient underwent cardiac surgery, and five years after the procedure has good quality of life. Through the multidisciplinary collaboration of cardiologists, hematologists and cardiac surgeons an operative reconstruction of mitral and tricuspid valve was successfully performed. This case indicates the need for multidisciplinary care for the specific and vulnerable group of MDS patients with cardiovascular comorbidities
Smjernice za dijagnozu i lijeÄenje bolesnika s mijelodisplastiÄnim sindromom [Guidelines for diagnosis and treatment of patients with myelodysplastic syndrome]
Myelodysplastic syndrome Working Group of the Croatian Cooperative Group for Hematologic Diseases (CROHEM), Referral center of the Ministry of Health of the Republic of Croatia for diagnostics and treatment of MDS, as well as the Croatian Society for Haematology of the Croatian Medical Association have made Croatian guidelines for diagnosis and treatment of myelodysplastic syndrome (MDS). MDS is a heterogeneous group of clonal hematopoietic stem cell disorders characterized by ineffective hematopoiesis, dysplasia, cytopenia and risk of transformation to acute myeloid leukemia (AML). Diagnosis is based on morphological characteristics of hematopoietic cells supplemented with the cytogenetic analysis and bone marrow flow cytometry. Due to great differences in the natural course of the disease, i.e. time to progression to AML and the expected time of survival several scoring systems have been developed to determine the disease risk. The treatment of patients with MDS is based on the risk factors of the disease as well as the individual risk of treatment
AUTOLOGOUS STEM CELL TRANSPLANTATION IN REFRACTORY OR RELAPSED DIFFUSE LARGE B CELL LYMPHOMA ā A SINGLE CENTRE EXPERIENCE
Autologna transplantacija perifernih matiÄnih stanica zlatni je standard u lijeÄenju refraktornog ili relapsnoga kemosenzitivnog difuznog B-velikostaniÄnog limfoma u pogodnih bolesnika. Cilj je ovog rada prikazati ishode autologne transplantacije perifernih matiÄnih stanica u bolesnika s refraktornim ili relapsnim ne-Hodgkinovim limfomom difuznoga B-velikostaniÄnog tipa. Retrospektivno smo analizirali podatke 62-je bolesnika lijeÄenih autolognom transplantacijom u naÅ”em centru u razdoblju od 2000. do 2013. godine. VeÄina bolesnika (71%) lijeÄena je kemoterapijom miniBEAM, a svi su primili mijeloablativnu kemoterapiju BEAM s reinfuzijom vlastitih matiÄnih stanica. Ukupna stopa odgovora (komĀpletna i parcijalna remisija) nakon autologne transplantacije iznosila je 75,8%. Medijan ukupnog preživljenja iznosio je 37,2 mjeseca. Medijan preživljenja bez dogaÄaja vezanih uz bolest iznosio je 16,9 mjeseci. Äimbenici statistiÄki znaÄajno povezani s ukupnim preživljenjem bili su aktivnost bolesti prije visokodozne spasonosne terapije, odgovor na spasonosnu terapiju. Internacionalni prognostiÄki indeks, stadij bolesti, odgovor na autolognu transplantaciju perifernih matiÄnih staĀnica te radioterapija nakon autologne transplantacije. LijeÄenje rituksimabom nije bilo statistiÄki znaÄajno povezano s ishodom. U ovoj skupini bolesnika autologna je transplantacija perifernih matiÄnih stanica bila uÄinkovita u postizanju remisije i preživljenja, Å”to je dobar i oÄekivan ishod navedenog postupka. NaglaÅ”avamo da je i u skupini bolesnika s kemorezistentnom boleÅ”Äu autologna transplantacija bila uÄinkovita u 32,5% bolesnika.Autologous stem cell transplantation represents the gold standard in chemosensitive diffuse B large cell lymphoma in relapse or in refractory setting. The aim of this study was to present the outcome of peripheral autologous stem cell transplantation in patients with refractory or relapsed diffuse large B cell lymphoma. We retrospectively analysed the data of 62 patients, who underwent this procedure for the period 2000ā2013. The majority of patients (71%) were treated with miniBEAM salvage chemotherapy and all received BEAM myeloablative protocol followed by the stem cell reinfusion. The overall response rate for autologous transplantation was 75.8%. Median overall survival was 37.2 months. Median event-free survival was 16.9 months. Factors associated with overall survival were state of disease prior to salvage chemotherapy, chemosensitivity of disease, International prognostic index, disease activity at the relapse, response to autologous transplantation and post-transplantation radiotherapy. The use of rituximab was not significantly correlated to the outcome. In this patient group autologous stem cell transplantation was found to be effective in achieving remission and survival showing the adequate role of this procedure in this clinical setting. We stress out that autologous stem cell transplantation was effective in 32.5% patients with chemorefractory disease after salvage therapy
GUIDELINES FOR DIAGNOSIS AND TREATMENT OF PATIENTS WITH MYELODYSPLASTIC SYNDROME
Radna skupina za mijelodisplastiÄni sindrom Hrvatske kooperativne grupe za hematoloÅ”ke bolesti (KROHEM),
Referalni centar Ministarstva zdravlja Republike Hrvatske za dijagnostiku i lijeÄenje mijelodisplastiÄnog sindroma te
Hrvatsko hematoloÅ”ko druÅ”tvo Hrvatskoga lijeÄniÄkog zbora izradili su hrvatske smjernice za dijagnozu i lijeÄenje
mijelodisplastiÄnog sindroma (MDS). MDS je heterogena grupa klonskih bolesti matiÄne hematopoetske stanice karakteriziranih
neuÄinkovitom hematopoezom, displazijom, citopenijom i rizikom od transformacije u akutnu mijeloiÄnu leukemiju
(AML). Dijagnoza se postavlja na temelju morfoloŔkih karakteristika stanica hematopoeze uz nadopunu citogenetskom
analizom i imunofenotipizacijom koŔtane srži. Zbog velikih razlika u prirodnom tijeku bolesti, odnosno u vremenu
do progresije u AML i u oÄekivanom preživljenju razvijeno je viÅ”e sustava bodovanja kojima se odreÄuje stupanj rizika
od bolesti. LijeÄenje pacijenta s MDS-om temelji se na stupnju rizika od bolesti i individualnom riziku od lijeÄenjaMyelodysplastic syndrome Working Group of the Croatian Cooperative Group for Hematologic Diseases
(CROHEM), Referral center of the Ministry of Health of the Republic of Croatia for diagnostics and treatment of MDS, as
well as the Croatian Society for Haematology of the Croatian Medical Association have made Croatian guidelines for
diagnosis and treatment of myelodysplastic syndrome (MDS). MDS is a heterogeneous group of clonal hematopoietic stem
cell disorders characterized by ineffective hematopoiesis, dysplasia, cytopenia and risk of transformation to acute myeloid
leukemia (AML). Diagnosis is based on morphological characteristics of hematopoietic cells supplemented with the cytogenetic
analysis and bone marrow fl ow cytometry. Due to great differences in the natural course of the disease, i.e. time
to progression to AML and the expected time of survival several scoring systems have been developed to determine the
disease risk. The treatment of patients with MDS is based on the risk factors of the disease as well as the individual risk of
treatment
GUIDELINES FOR DIAGNOSIS AND TREATMENT OF PATIENTS WITH MYELODYSPLASTIC SYNDROME
Radna skupina za mijelodisplastiÄni sindrom Hrvatske kooperativne grupe za hematoloÅ”ke bolesti (KROHEM),
Referalni centar Ministarstva zdravlja Republike Hrvatske za dijagnostiku i lijeÄenje mijelodisplastiÄnog sindroma te
Hrvatsko hematoloÅ”ko druÅ”tvo Hrvatskoga lijeÄniÄkog zbora izradili su hrvatske smjernice za dijagnozu i lijeÄenje
mijelodisplastiÄnog sindroma (MDS). MDS je heterogena grupa klonskih bolesti matiÄne hematopoetske stanice karakteriziranih
neuÄinkovitom hematopoezom, displazijom, citopenijom i rizikom od transformacije u akutnu mijeloiÄnu leukemiju
(AML). Dijagnoza se postavlja na temelju morfoloŔkih karakteristika stanica hematopoeze uz nadopunu citogenetskom
analizom i imunofenotipizacijom koŔtane srži. Zbog velikih razlika u prirodnom tijeku bolesti, odnosno u vremenu
do progresije u AML i u oÄekivanom preživljenju razvijeno je viÅ”e sustava bodovanja kojima se odreÄuje stupanj rizika
od bolesti. LijeÄenje pacijenta s MDS-om temelji se na stupnju rizika od bolesti i individualnom riziku od lijeÄenjaMyelodysplastic syndrome Working Group of the Croatian Cooperative Group for Hematologic Diseases
(CROHEM), Referral center of the Ministry of Health of the Republic of Croatia for diagnostics and treatment of MDS, as
well as the Croatian Society for Haematology of the Croatian Medical Association have made Croatian guidelines for
diagnosis and treatment of myelodysplastic syndrome (MDS). MDS is a heterogeneous group of clonal hematopoietic stem
cell disorders characterized by ineffective hematopoiesis, dysplasia, cytopenia and risk of transformation to acute myeloid
leukemia (AML). Diagnosis is based on morphological characteristics of hematopoietic cells supplemented with the cytogenetic
analysis and bone marrow fl ow cytometry. Due to great differences in the natural course of the disease, i.e. time
to progression to AML and the expected time of survival several scoring systems have been developed to determine the
disease risk. The treatment of patients with MDS is based on the risk factors of the disease as well as the individual risk of
treatment
GUIDELINES FOR DIAGNOSIS AND TREATMENT OF PATIENTS WITH MYELODYSPLASTIC SYNDROME
Radna skupina za mijelodisplastiÄni sindrom Hrvatske kooperativne grupe za hematoloÅ”ke bolesti (KROHEM),
Referalni centar Ministarstva zdravlja Republike Hrvatske za dijagnostiku i lijeÄenje mijelodisplastiÄnog sindroma te
Hrvatsko hematoloÅ”ko druÅ”tvo Hrvatskoga lijeÄniÄkog zbora izradili su hrvatske smjernice za dijagnozu i lijeÄenje
mijelodisplastiÄnog sindroma (MDS). MDS je heterogena grupa klonskih bolesti matiÄne hematopoetske stanice karakteriziranih
neuÄinkovitom hematopoezom, displazijom, citopenijom i rizikom od transformacije u akutnu mijeloiÄnu leukemiju
(AML). Dijagnoza se postavlja na temelju morfoloŔkih karakteristika stanica hematopoeze uz nadopunu citogenetskom
analizom i imunofenotipizacijom koŔtane srži. Zbog velikih razlika u prirodnom tijeku bolesti, odnosno u vremenu
do progresije u AML i u oÄekivanom preživljenju razvijeno je viÅ”e sustava bodovanja kojima se odreÄuje stupanj rizika
od bolesti. LijeÄenje pacijenta s MDS-om temelji se na stupnju rizika od bolesti i individualnom riziku od lijeÄenjaMyelodysplastic syndrome Working Group of the Croatian Cooperative Group for Hematologic Diseases
(CROHEM), Referral center of the Ministry of Health of the Republic of Croatia for diagnostics and treatment of MDS, as
well as the Croatian Society for Haematology of the Croatian Medical Association have made Croatian guidelines for
diagnosis and treatment of myelodysplastic syndrome (MDS). MDS is a heterogeneous group of clonal hematopoietic stem
cell disorders characterized by ineffective hematopoiesis, dysplasia, cytopenia and risk of transformation to acute myeloid
leukemia (AML). Diagnosis is based on morphological characteristics of hematopoietic cells supplemented with the cytogenetic
analysis and bone marrow fl ow cytometry. Due to great differences in the natural course of the disease, i.e. time
to progression to AML and the expected time of survival several scoring systems have been developed to determine the
disease risk. The treatment of patients with MDS is based on the risk factors of the disease as well as the individual risk of
treatment
GUIDELINES FOR DIAGNOSIS AND TREATMENT OF PATIENTS WITH MYELODYSPLASTIC SYNDROME
Radna skupina za mijelodisplastiÄni sindrom Hrvatske kooperativne grupe za hematoloÅ”ke bolesti (KROHEM),
Referalni centar Ministarstva zdravlja Republike Hrvatske za dijagnostiku i lijeÄenje mijelodisplastiÄnog sindroma te
Hrvatsko hematoloÅ”ko druÅ”tvo Hrvatskoga lijeÄniÄkog zbora izradili su hrvatske smjernice za dijagnozu i lijeÄenje
mijelodisplastiÄnog sindroma (MDS). MDS je heterogena grupa klonskih bolesti matiÄne hematopoetske stanice karakteriziranih
neuÄinkovitom hematopoezom, displazijom, citopenijom i rizikom od transformacije u akutnu mijeloiÄnu leukemiju
(AML). Dijagnoza se postavlja na temelju morfoloŔkih karakteristika stanica hematopoeze uz nadopunu citogenetskom
analizom i imunofenotipizacijom koŔtane srži. Zbog velikih razlika u prirodnom tijeku bolesti, odnosno u vremenu
do progresije u AML i u oÄekivanom preživljenju razvijeno je viÅ”e sustava bodovanja kojima se odreÄuje stupanj rizika
od bolesti. LijeÄenje pacijenta s MDS-om temelji se na stupnju rizika od bolesti i individualnom riziku od lijeÄenjaMyelodysplastic syndrome Working Group of the Croatian Cooperative Group for Hematologic Diseases
(CROHEM), Referral center of the Ministry of Health of the Republic of Croatia for diagnostics and treatment of MDS, as
well as the Croatian Society for Haematology of the Croatian Medical Association have made Croatian guidelines for
diagnosis and treatment of myelodysplastic syndrome (MDS). MDS is a heterogeneous group of clonal hematopoietic stem
cell disorders characterized by ineffective hematopoiesis, dysplasia, cytopenia and risk of transformation to acute myeloid
leukemia (AML). Diagnosis is based on morphological characteristics of hematopoietic cells supplemented with the cytogenetic
analysis and bone marrow fl ow cytometry. Due to great differences in the natural course of the disease, i.e. time
to progression to AML and the expected time of survival several scoring systems have been developed to determine the
disease risk. The treatment of patients with MDS is based on the risk factors of the disease as well as the individual risk of
treatment