•Pulmonary embolism (PE) is infrequent in MPN patients.•Presentation and outcomes of PE in MPNs are similar to non-MPN PE patients.•sPESI is not prognostic in MPNs.
We retrospectively investigated a cohort of 176 myelofibrosis patients (128 primary-PMF; 48 secondary-SMF) from five hematology centers. The presence of chronic kidney disease (CKD) was determined in ...addition to other clinical characteristics. CKD was present in 26.1% of MF patients and was significantly associated with older age (
P
< 0.001), higher WBC (
P
= 0.015), and its subsets (neutrophil, monocyte, and basophil counts), higher platelets (
P
= 0.001), lower albumin (
P
= 0.018), higher serum uric acid (
P
= 0.001), higher LDH (
P
= 0.022), and the presence of CV risk factors (
P
= 0.011). There was no significant association with driver mutations, degree of bone marrow fibrosis, PMF/SMF, or DIPSS risk categories (
P
> 0.05 for all analyses). The presence of CKD was significantly associated with shorter time to arterial (HR = 3.49;
P
= 0.041) and venous thrombosis (HR = 7.08;
P
= 0.030) as well as with shorter overall survival (HR 2.08;
P
= 0.009). In multivariate analyses, CKD (HR = 1.8;
P
= 0.014) was associated with shorter survival independently of the DIPSS (HR = 2.7;
P
< 0.001); its effect being more pronounced in lower (HR = 3.56;
P
= 0.036) than higher DIPSS categories (HR = 2.07;
P
= 0.023). MF patients with CKD should be candidates for active management aimed at the improvement of renal function. Prospective studies defining the optimal therapeutic approach are highly needed.
Elderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are ...under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performed to address the patient's fitness and decide whether to pursue a curative or palliative approach. The ABVD regimen is poorly tolerated in unfit patients, with high treatment-related mortality. Alternative chemotherapy approaches have been explored, with mixed results obtained concerning their feasibility and toxicity in phase II trials. The introduction of brentuximab vedotin-based regimens led to a paradigm shift in first- and further-line treatment of elderly Hodgkin lymphoma patients, providing adequate disease control within a broader patient population. As far as checkpoint inhibitors are concerned, we are only just beginning to understand the role in the treatment of this population. In relapsed/refractory settings there are few options, ranging from autologous stem cell transplantation in selected patients to pembrolizumab, but unfortunately, palliative care is the most common modality. Importantly, published studies are frequently burdened with numerous biases (such as low numbers of patients, selection bias and lack of geriatric assessment), leading to low level of evidence. Furthermore, there are few ongoing studies on this topic. Thus, elderly Hodgkin lymphoma patients are hard to treat and represent an unmet need in hematologic oncology. In conclusion, treatment needs to be personalized and tailored on a case-by-case basis. In this article, we outline treatment options for elderly Hodgkin lymphoma patients.
This cohort study aimed to determine patterns of glycemic fluctuation and changes in metabolic parameters during and after corticosteroid administration in newly diagnosed diffuse large B-cell ...lymphoma (DLBCL) patients treated with R-CHOP chemotherapy.
The study was performed in 20 patients of whom 11 had diabetes and 9 were nondiabetics. Anthropometric parameters were collected, and blood samples were taken four times during the study to analyze metabolic parameters. Capillary glucose was measured seven times a day (fasting, before mean meals, postprandial, and before bedtime) to evaluate the glycemic profile.
In all 20 patients, acute glucocorticoid administration resulted in the elevation of average glucose levels, dominantly postprandial in the afternoon which correlates with corticosteroid peak action. In 7 out of 11 diabetics, prandial insulin was started during corticosteroid administration and discontinued afterward. Although none of our nondiabetic patients met diabetes criteria, evident is the elevation in average glycemia levels six weeks after corticosteroid administration. Potentially, even transient corticosteroid administration reduces insulin sensitivity and contributes to later glycemic disturbances. HbA1c levels were higher at the end of the study while fructosamine levels were higher during the study.
Patients and health-care professionals need to be aware of corticosteroid-induced hyperglycemia. We recommend identifying risk factors, measuring glycemia before, during, and after corticosteroid administration, and starting the adequate therapy as soon as possible.
To investigate the prognostic contribution of absolute neutrophil (ANC), lymphocyte (ALC), platelet count and their ratios, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), to ...thrombotic risk in patients with prefibrotic and overt fibrotic myelofibrosis (MF).
We retrospectively analyzed a cohort of 256 patients with prefibrotic (85 patients) and overt fibrotic MF (171 patients) treated in six Croatian hematological centers.
Prefibrotic compared to overt fibrotic MF patients presented with significantly higher ALC, platelet count and PLR, and experienced longer time to thrombosis (TTT). Among prefibrotic patients, ANC > 8.33 × 10
/L (HR 13.08,
= 0.036), ALC > 2.58 × 10
/L (HR 20.63,
= 0.049) and platelet count > 752 × 10
/L (HR 10.5,
= 0.043) remained independently associated with shorter TTT. Among overt fibrotic patients, ANC > 8.8 × 10
/L (HR 4.49,
= 0.004), ALC ≤ 1.43 × 10
/L (HR 4.15,
= 0.003), platelet count ≤ 385 × 10
/L (HR 4.68,
= 0.004) and chronic kidney disease (HR 9.07,
< 0.001) remained independently associated with shorter TTT.
Prognostic properties of ANC, ALC and platelet count are mutually independent and exceed those of NLR and PLR regarding thrombotic risk stratification. ALC and platelet count associate in opposite directions with thrombotic risk in prefibrotic and overt fibrotic MF patients.
PDF
