Aim: Deep vein thrombosis (DVT) is a common clinical condition encountered in the emergency department (ED). The aim of this study was to compare the characteristics and outcomes of patients with ...respect to treatment using novel oral anticoagulants (NOAC).
Materials and Methods: In this retrospective observational study, we analyzed medical records of patients diagnosed with DVT during 2019 in the ED of the Clinical Hospital Dubrava. We identified 295 patients, who comprised 1.2% of all patients examined in the ED.
Results: Women were more frequently diagnosed with DVT (59%) and they were older than the men (median age 69 vs. 62 years, respectively). Patients with proximal deep vein thrombosis (71%) were admitted to the hospital. Two thirds of all patients were treated with NOAC. Rivaroxaban was the most commonly prescribed drug (52% of patients). Control Doppler ultrasound was performed in 58% of the patients, and complete resolution was observed in 63% of the cases. NOACs caused significantly fewer bleeding events than warfarin (3.2% vs. 13.6%, p < 0.05).
Conclusion: Our results demonstrate that patients with DVT can be safely treated with NOACs in an outpatient setting.
Patients with lymphoid malignancies are at increased risk of death or prolonged infection due to COVID-19. Data on the influence of different antineoplastic treatment modalities on outcomes are ...conflicting. Anti-CD20 monoclonal antibodies increase the risk of prolonged infection. It is unclear whether this risk is affected by the choice of the antibody (rituximab vs. obinutuzumab). To elucidate the role of antineoplastic therapy on COVID-19 outcomes, KroHem collected data on patients with lymphoid malignancies diagnosed with COVID-19 between October 2020 and April 2021. A total of 314 patients were identified, 75 untreated, 61 off treatment and 178 on treatment. The mortality rate in untreated and off-treatment patients was 15% and 16%; 9% and 10% had prolonged infection. In the on-treatment group, 3% were still prolonged positive at time of data collection, 62% recovered and 35% died; 42% had prolonged infection. Disease type, use of anti-CD20 monoclonal antibodies, prior autologous stem-cell transplantation (ASCT) and line of treatment did not significantly affect mortality. Mortality was higher in older patients (
= 0.0078) and those treated with purine analogues (
= 0.012). Prolonged COVID-19 was significantly more frequent in patients treated with anti-CD20 monoclonal antibodies (
= 0.012), especially obinutuzumab, and purine analogues (
= 0.012). Age, prior ASCT and treatment line did not significantly affect risk of prolonged infection. These data suggest that increased age and use of purine analogues are main risk factors for increased mortality of COVID-19 in patients with lymphoid malignancies. Obinutuzumab further increases the risk of prolonged disease, but not of death, in comparison to rituximab. Epidemiological considerations should be taken into account when choosing the appropriate antineoplastic therapy for patients with lymphoid malignancies.
Trombocitopenija je česta u virusnim infekcijama, prisutna je u prosječno 18 % oboljelih od bolesti COVID-19, a obično je blaga (u rasponu od 100 do 150 × 10^9/L). Zastupljenija je među teže ...oboljelima i predstavlja neovisan čimbenik rizika za loš ishod i mortalitet. Trombocitopenija je rezultat smanjene proizvodnje i povećane potrošnje trombocita. Smanjenje proizvodnje trombocita može nastati zbog oštećenja hematopoetskih progenitora te zbog oštećenja kapilarne mreže pluća. Povećana je potrošnja trombocita zbog njihove hiperaktivacije i trombotske mikroangiopatije kod kritično bolesnih. U bolesti COVID-19 rjeđe se može razviti i imuna trombocitopenija (ITP) te trombocitopenija uzrokovana različitim lijekovima, uključujući i trombocitopeniju uzrokovanu heparinom (HIT).
Thrombocytopenia is frequent in viral infections. Approximately 18% of COVID-19 patients have thrombocytopenia that is usually mild (ranging from 100 to 150 × 10^9/L). It is more common among critically ill whereby it is an independent risk factor for poor outcome and mortality. Both decreased production and increased consumption of platelets may contribute. Decreased platelet production may occur due to a damage to hematopoietic progenitors and capillary network of the lungs. The consumption of platelets is increased due to their hyperactivation and thrombotic microangiopathy. Immune thrombocytopenia (ITP) and drug-induced thrombocytopenia including heparin-induced thrombocytopenia (HIT) can also develop during COVID-19 treatment.
Summary
We retrospectively investigated clinical and prognostic significance of psoas muscle index (PMI) calculated as total psoas muscle area at L3 vertebra level obtained from baseline computed ...tomography (CT) scans in 49 newly diagnosed classical Hodgkinʼs lymphoma (cHL) patients prior to specific treatment. Median PMI was 572.5 mm
2
/m
2
and was significantly higher in males (
P
< 0.001), patients with higher body mass index (BMI,
P
< 0.001), absence of extranodal disease (
P
= 0.037), higher absolute lymphocyte count (
P
= 0.037), higher hemoglobin (
P
= 0.010) and lower lactate dehydrogenase (LDH,
P
= 0.050). There were no significant associations with age, disease subtype, presence of constitutional symptoms, Ann Arbor disease stage, presence of advanced disease or international prognostic score. Patients with lower PMI had significantly worse PFS (hazard ratio HR 4.91;
P
= 0.009). This phenomenon persisted in the multivariate model (HR = 5.09;
P
= 0.042) adjusted for International Prognostic Score (IPS) and chemotherapy type.
(1) Background: This study aimed to examine the difference in efficacy and toxicity of involved-field (IFRT) and involved-site radiotherapy (ISRT) fields in infradiaphragmal aggressive non-Hodgkin ...lymphoma patients. (2) Methods: In total, 140 patients with infradiaphragmal lymphoma treated between 2003 and 2020 were retrospectively evaluated. There were 69 patients (49%) treated with IFRT, and 71 (51%) patients treated with ISRT. The median dose in the IFRT group was 36 Gy, (range 4-50.4 Gy), and in the ISRT group, it was 30 Gy (range 4-48 Gy). (3) Results: The median follow-up in the IFRT group was 133 months (95% CI 109-158), and in the ISRT group, it was 48 months (95% CI 39-57). In the IFRT group, locoregional control was 67%, and in the ISRT group, 73%. The 2- and 5-year overall survival (OS) in the IFRT and ISRT groups were 79% and 69% vs. 80% and 70%, respectively (
= 0.711). The 2- and 5-year event-free survival (EFS) in the IFRT and ISRT groups were 73% and 68% vs. 77% and 70%, respectively (
= 0.575). Acute side effects occurred in 43 (31%) patients, which is more frequent in the IFRT group, 34 (39%) patients, than in the ISRT group, 9 (13%) patients,
> 0.01. Late toxicities occurred more often in the IFRT group of patients, (10/53) 19%, than in the ISRT group of patients, (2/37) 5%, (
= 0.026). (4) Conclusions: By reducing the radiotherapy volume and the doses in the treatment of infradiaphragmatic fields, treatment with significantly fewer acute and long-term side effects is possible. At the same time, efficiency and local disease control are not compromised.
To compare the outcomes of Croatian patients with mantle cell lymphoma (MCL) who started treatment in 2007 and 2008 (historical cohort) and of those who started treatment between 2015 and 2017 ...(recent cohort).
The historical cohort consisted of 40 patients who started treatment with rituximab in 2007 and 2008. Data on the recent cohort, consisting of 89 patients, were collected retrospectively from the electronic databases of Croatian hospitals with hematology units. Demographic characteristics and data on induction regimens, autologous stem cell transplantation (ASCT), and rituximab maintenance in the first remission, event-free survival (EFS), and overall survival (OS) were available for both cohorts, and data on cell morphology, mantle cell international prognostic index (MIPI), and Ki67 expression only for the recent cohort.
The recent cohort had significantly better two-year EFS and OS (EFS 58% vs 40%, P=0.014; OS 80% vs 56%, P=0.009), especially in patients below 65. In univariate analysis, induction regimen, ASCT, and maintenance were significant prognostic factors for EFS and the former two for OS. In the multivariate analysis, only ASCT remained significant. Bendamustine+rituximab (BR) induction improved the outcomes of non-transplantable patients over R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, steroid). Blastoid morphology and high MIPI were adverse prognostic factors for EFS and OS.
In the last decade, the outcome of newly diagnosed MCL patients improved. ASCT in the first remission was the main contributor in transplantable patients and BR in non-transplantable. Regularly updated national guidelines may help in a timely adoption of new treatments, thus improving the results.
Purpose
Data on efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients are scarce. We therefore performed this retrospective study to analyse our experience with ...radiotherapy exclusively to infradiaphragmal fields.
Materials and methods
we retrospectively evaluated 101 patients treated between 2003 and 2014. Median dose was 36 Gy, range 4 to 54 Gy. Medium dose per fraction was 2 Gy, range 1.5 to 7 Gy.
Results
After a median follow-up of 66 months (range 1–211 months), we observed lymphoma recurrence in 38 patients (38%), five in the RT field and 33 out-of-field. Recurrences were significantly more frequent in the salvage group (17 out-of-field and 4 in-field in 31 patients) than in adjuvant group (16 out-of-field and 1 in-field in 70 patients;
p
< 0.001).
The 2-, 5- and 10-year event-free survival (EFS) rates were 62%, 56% and 54%. The 2-, 5- and 10-year overall survival (OS) rates for the entire group of patients are 73%, 60% and 54%, respectively. Acute side effects occurred in 43 (43%) patients, most frequent gastrointestinal in 26 (26%) patients. Late side effects occurred in 12 (12%) of all patients, 6 of 23 (26%) followed up for more than 10 years. Six patients developed secondary cancers, four gastrointestinal disturbances, two diabetes mellitus and three renal failure.
Conclusion
Radiotherapy is an effective and safe treatment option for patients with infradiaphragmatic lymphoma providing excellent local disease control with minimal late toxicity. Infradiaphragmatic lymphoma localization should not be regarded as a contraindication for use of radiotherapy. However, patients should be monitored for a secondary malignancy.
To assess the benefit of rituximab with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-DA-EPOCH) regimen as a first-line treatment for patients with diffuse ...large B-cell lymphoma (DLBCL) presenting with unfavorable or aggressive features, and autologous stem cell transplantation (ASCT) as a part of the first-line treatment for selected DLBCL patients with additional aggressive features.
We retrospectively analyzed 75 newly diagnosed DLBCL patients with Ki-67+≥80% or International Prognostic Index ≥2 who were treated with R-DA-EPOCH between 2005 and 2015. Of 24 DLBCL patients with additional aggressive features (Ki-67+≥90% or age-adjusted IPI≥2) who were planned to receive consolidation with ASCT, 17 patients underwent the procedure. We determined the overall response rate (ORR), complete remission (CR), partial remission (PR), 5-year overall survival (OS), and progression free survival (PFS) in all DLBCL patients and specifically those planned to receive ASCT.
All 75 patients included in the analysis started one or more cycles of therapy. The ORR, CR, and PR rates were 80%, 55%, and 25%, respectively. The response was non-evaluable in 10 of 75 patients due to treatment discontinuation. The OS and PFS rates for all 75 patients were 70% and 61%, respectively, and 80% and 79%, respectively, for 24 planned-to-receive-ASCT patients. Age (≤65 vs >65 years) had no prognostic impact on OS and PFS (P=0.994 and P=0.827, respectively).
Our retrospective analysis of one of the largest DLBCL patient cohorts outside the US National Cancer Institute showed that R-DA-EPOCH is a very effective therapeutic option as a first-line treatment of DLBCL patients with unfavorable prognostic features irrespective of their age. ASCT provided additional benefit for DLBCL patients with additional aggressive features.
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