scholarly journals An Unusual Hematologic Manifestation in a COVID-19 Patient Treated with COVID-19 Convalescent Plasma

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S92-S92
Author(s):  
C Andrzejewski ◽  
S R Chakraborty ◽  
L Stoddart ◽  
V Johari
Keyword(s):  
Clinical Outcomes ◽  
High Titer ◽  
Lymphocytic Leukemia ◽  
Post Discharge ◽  
Treatment Naïve ◽  
Initial Drop ◽  
Wbc Count ◽  
Improved Outcome

Abstract Introduction/Objective A subset of Chronic Lymphocytic Leukemia (CLL) patients with COVID-19 may manifest rapid elevations in lymphocyte counts and poor clinical outcomes. Here we report our observations regarding this unusual hematologic manifestation in a CLL patient after he experienced a COVID-19 convalescent plasma (CCP) transfusion reaction. Methods/Case Report 56-year-old A Rh- male with stable, treatment-naive CLL (13q deletion positive) diagnosed three years prior was admitted for COVID-19 hypoxia. Before developing COVID-19, baseline white blood cell (WBC) count was stable (~ 64 K/ mm3). Due to worsening hypoxia he was treated with an ARh+ High Titer CCP unit, Remdesivir, tocilizumab, and dexamethasone. The Blood Bank was notified of a possible CCP reaction and performed its standard workup which was adjudicated to be a febrile TACO reaction. During this evaluation it was noted that the patient’s WBC count had initially decreased to 46 K/ mm3, but rose on HD 3, to 78.4 K/mm3 and by discharge on HD 10 had increased to 200 K/ mm3. Flow cytometry revealed a B cell CLL immunophenotype. Post discharge day (PDD) 6 he developed herpes zoster. On post-discharge day (PDD) 7 his WBC count was 124K/mm3. By PDD 77 his WBC count had returned to baseline (~50 K/mm3). Results (if a Case Study enter NA) NA Conclusion The pt’s initial drop in his WBC count followed by a gradual rise has been observed in patients with severe COVID-19 independent of CCP infusion. Lymphocytosis in a subset of CLL patients with COVID-19 has been reported (termed “COVID-19 Induced Lymphocytosis” (CIL)) and, in contrast to our patient with an improved outcome, has been associated with severe/fatal outcomes. Of note these other patients did not receive CCP. Mechanisms related to CIL are unknown. Such poor clinical outcomes heighten the need for further studies of CIL. The role of CCP in affecting this process, if any, also merits further clarification.

scholarly journals The evidence for glutamine use in the critically-ill

2001 ◽  
Vol 60 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Richard D. Griffiths
Keyword(s):  
Immune Function ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Endogenous Production ◽  
Metabolic Role ◽  
Functional Implications ◽  
Improved Outcome

Research into the metabolic role of glutamine in trauma and sepsis brings evidence to suggest a conditional deficiency occurs because increased and altered tissue demands exceed endogenous production. Such a deficiency has functional implications, and the restorative provision of parenteral glutamine has been shown to offer improved clinical outcomes in a variety of conditions. In the critically-ill it is associated with improvements in immune function, and improved survival from infection leading to an overall improved outcome.

scholarly journals Lenalidomide in the Treatment of Chronic Lymphocytic Leukemia

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Agostino Cortelezzi ◽  
Mariarita Sciumè ◽  
Gianluigi Reda
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Mechanism Of Action ◽  
Clinical Investigation ◽  
Progression Free Survival ◽  
Lymphocytic Leukemia ◽  
Free Survival ◽  
Treatment Naïve ◽  
Combination Regimens ◽  
Gradual Dose

The application of nucleoside analogue-based chemotherapy and immunotherapy with rituximab or alemtuzumab has increased both response rate and survival in patients with Chronic Lymphocytic Leukemia (CLL). However, because none of these therapies is curative, sequential therapeutic regimens are required. The majority of patients with relapsed or refractory CLL carry poor prognostic factors and show shorter overall survival and resistance to standard treatment. Numerous drugs have recently been approved for CLL therapy and many novel agents are under clinical investigation. The role of the tumor microenvironment and of immune dysfunction in CLL have allowed to enlarge the therapeutic armamentarium for CLL patients. This article will provide a comprehensive summary regarding mechanism of action, efficacy and safety of lenalidomide in CLL patients. Relevant clinical trials using lenalidomide alone or in combinations are discussed. Lenalidomide shows good activity also in relapsed/refractory or treatment-naive CLL patients. Definitive data from ongoing studies are needed to validate overall and progression-free survival. The toxicity profile might limit lenalidomide use because it can result in serious side effects, but largely controlled by gradual dose escalation. Further understanding of the exact mechanism of action in CLL will allow more efficacious use of lenalidomide alone or in combination regimens.

scholarly journals Is there a role for anti-CD20 antibodies in CLL?

Hematology ◽  
2021 ◽  
Vol 2021 (1) ◽  
pp. 68-75
Author(s):  
Harsh R. Shah ◽  
Deborah M. Stephens
Keyword(s):  
Clinical Trials ◽  
Kinase Inhibitors ◽  
Residual Disease ◽  
Progression Free Survival ◽  
Antagonistic Effect ◽  
Lymphocytic Leukemia ◽  
Treatment Naïve ◽  
Anti Cd20 ◽  
Cd20 Antibodies

Abstract Anti-CD20 monoclonal antibodies (mAbs) have revolutionized the treatment of chronic lymphocytic leukemia (CLL) by improving survival of patients with CLL in conjunction with chemotherapy. However, the novel targeted agents such as Bruton tyrosine kinase inhibitors (BTKis) and venetoclax have now mostly replaced chemotherapy in frontline treatment of CLL. Several clinical trials have been conducted to examine the role of anti-CD20 mAbs in combination with BTK inhibitors and venetoclax. Addition of rituximab to ibrutinib does not improve progression-free survival (PFS) of treatment-naive patients with CLL, possibly related to ibrutinib's antagonistic effect on anti-CD20 antibodies. Alternatively, addition of a glycoengineered anti-CD20 mAb obinutuzumab to a more selective BTKi acalabrutinib may improve PFS but does not improve overall survival of patients with CLL in the frontline setting, pending long-term follow-up. Thus, we suggest that the addition of an anti-CD20 mAb to a BTKi is of most benefit to patients with autoimmune cytopenia or rapidly progressive disease. In contrast to BTKis, combination of fixed-duration venetoclax and anti-CD20 mAb can induce deep remission with high rates of undetectable minimal residual disease, correlating with improved survival of patients with CLL in both frontline and relapsed/refractory settings. In this review, we discuss clinical trials of BTKis and venetoclax that have investigated the role of anti-CD20 mAbs in frontline and relapsed settings of CLL treatment. We also provide an algorithm suggesting how anti-CD20 mAbs may be incorporated in the treatment of patients with CLL, including specific scenarios.

scholarly journals Cause and effect relationship between application of deuterium-depleted water and improvement of chronic lymphocytic leukemia

2021 ◽  
Vol 6 (9) ◽  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Anticancer Effect ◽  
Normal Range ◽  
Conventional Chemotherapy ◽  
Cervical Lymph Nodes ◽  
Trisomy 12 ◽  
Deuterium Depleted Water ◽  
Wbc Count

The anticancer effect of deuterium depletion has been proved in various types of cancer in combination with conventional therapies. Here we report a case study of a patient diagnosed in 2006 with chronic lymphocytic leukemia (CLL). His stage at diagnosis did not require the immediate conventional therapy and so he started consuming deuterium-depleted water (DDW). Significant changes occurred already during the first three months; WBC count dropped from 16x103 cells/µL to 7.7x103 cells/µL, to the normal range and the cervical lymph nodes regressed. He continued drinking DDW uninterruptedly in the first three years (1,231 days) and periodically in the subsequent 11 years. PLT count significantly increased from 108x103 /µL to 232x103 /µL after two years’ DDW-consumption. CD5+/CD19+ percentage showed significant decrease from 69% to 4% and the rate of chromosome trisomy 12 in interphase blood cells was reduced from 40% to 7% in the first three years. The study confirms that deuterium depletion as a single treatment is effective and delays the use of conventional chemotherapy.

Linguistic Interactions: A Therapeutic Consideration for Adults With Aphasia

2008 ◽  
Vol 17 (3) ◽  
pp. 93-98
Author(s):  
Lynn E. Fox
Keyword(s):  
Clinical Outcomes ◽  
Social Contexts ◽  
Interaction Models ◽  
Social Communities ◽  
Wernicke's Aphasia ◽  
Communication Challenges ◽  
Therapeutic Consideration ◽  
Patterns Of Interaction ◽  
Structural Language

Abstract Linguistic interaction models suggest that interrelationships arise between structural language components and between structural and pragmatic components when language is used in social contexts. The linguist, David Crystal (1986, 1987), has proposed that these relationships are central, not peripheral, to achieving desired clinical outcomes. For individuals with severe communication challenges, erratic or unpredictable relationships between structural and pragmatic components can result in atypical patterns of interaction between them and members of their social communities, which may create a perception of disablement. This paper presents a case study of a woman with fluent, Wernicke's aphasia that illustrates how attention to patterns of linguistic interaction may enhance AAC intervention for adults with aphasia.

The role of multiplicity in a cult: A case study

1987 ◽  
Author(s):  
William A. Worrall ◽  
Ann W. Stockman

Endangered Butterflies and their Non-Native Host Plants: Examining Shifting Values of Belonging in Restoration

2019 ◽  
Vol 3 (1) ◽  
pp. 1-9
Author(s):  
Robert M. Anderson ◽  
Amy M. Lambert
Keyword(s):  
Ecological Restoration ◽  
Native Species ◽  
Puget Sound ◽  
A Value ◽  
The Social ◽  
Remote Island ◽  
Scientific Truth ◽  
Native Host

The island marble butterfly (Euchloe ausonides insulanus), thought to be extinct throughout the 20th century until re-discovered on a single remote island in Puget Sound in 1998, has become the focus of a concerted protection effort to prevent its extinction. However, efforts to “restore” island marble habitat conflict with efforts to “restore” the prairie ecosystem where it lives, because of the butterfly’s use of a non-native “weedy” host plant. Through a case study of the island marble project, we examine the practice of ecological restoration as the enactment of particular norms that define which species are understood to belong in the place being restored. We contextualize this case study within ongoing debates over the value of “native” species, indicative of deep-seated uncertainties and anxieties about the role of human intervention to alter or manage landscapes and ecosystems, in the time commonly described as the “Anthropocene.” We interpret the question of “what plants and animals belong in a particular place?” as not a question of scientific truth, but a value-laden construct of environmental management in practice, and we argue for deeper reflexivity on the part of environmental scientists and managers about the social values that inform ecological restoration.

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