Infections in Patients With Hematologic Malignancies

2012 ◽  
pp. 428-442
Author(s):  
John W Wilson ◽  
Michelle A Elliott
Keyword(s):  
Infectious Diseases ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Residential Environment ◽  
Diagnosis And Treatment ◽  
Clinical Approach ◽  
Patient Factors ◽  
Definition Of ◽  
Antineoplastic Chemotherapy

The clinical approach to patients with hematologic malignancies and infection requires definition of several patient factors (immunologic competence [or defect], residential environment, and the syndrome), infection factors (its type, location, progress, and pathogen), and treatment factors (medical or surgical or both). Management of patients with hematologic malignancies and infection requires knowledge of general infectious diseases and factors pertaining to the hematologic malignancy, pathophysiology of the hematologic malignancy, types of antineoplastic chemotherapy used in treatment, and immunologic effects of both the malignancy and the associated chemotherapy, and complications and toxicities of both the malignancy and the associated chemotherapy. Diagnosis and treatment of specific infections are reviewed.

Population, Disease, and Evolution

1975 ◽  
Vol 30 ◽  
pp. 1-10 ◽  
Author(s):  
George J. Armelagos ◽  
Alan McArdle
Keyword(s):  
Infectious Diseases ◽  
Essential Elements ◽  
Human Populations ◽  
Clinical Approach ◽  
Small Populations ◽  
Population Parameters ◽  
Biological Factors ◽  
The Social ◽  
Definition Of ◽  
Social And Cultural Factors

The Study of Infectious Disease in human populations has traditionally focused on the biological factors of virulence of the pathogen and the immunity of the host. Since this type of research has been stimulated by the need for the development of treatments for specific diseases, it is not difficult to understand this orientation. The definition of symptoms, differential diagnosis and the isolation of the pathogen are essential elements in the eventual treatment of a disease. The clinical approach to the study of disease was necessarily particularistic. Although population parameters were considered in evaluating the incidence of a disease, the social and cultural factors were seldom dealt with fully. Alland's (1970) study is one of the best attempts to examine the interaction of disease and population in the perspective of adaptation.In this paper, we will review studies which demonstrate the importance of culture in the transmission of infectious diseases, and from this perspective, we will attempt to develop an evolutionary framework for studying disease in human populations. Specifically, we will examine the effect of infectious diseases in small populations and propose models which will allow the measurement of these effects.

Consensus on the change of criteria for cure of acromegaly during the last decade

2011 ◽  
Vol 152 (18) ◽  
pp. 703-708 ◽  
Author(s):  
Gábor László Kovács ◽  
Judit Dénes ◽  
Erika Hubina ◽  
László Kovács ◽  
Sándor Czirják ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Disease Control ◽  
Short Communication ◽  
Consensus Statement ◽  
Diagnosis And Treatment ◽  
Clinical Aspects ◽  
Insulin Like Growth Factor ◽  
Criteria For Diagnosis ◽  
Definition Of

The Acromegaly Consensus Group redefined the consensus criteria for cure of acromegaly. 74 neurosurgeons and experienced endocrinologists summarized the latest results on diagnosis and treatment of acromegaly. In this consensus statement the reliable growth hormone and insulin-like growth factor-1 assays were established. Definition of disease control was discussed based on the available publications and evidence. This short communication summarizes the clinical aspects of consensus criteria for diagnosis and cure of acromegaly based on the original article. Orv. Hetil., 2011, 152, 703–708.

scholarly journals Transplantation of allogeneic CD34+ peripheral blood stem cells in patients with advanced hematologic malignancy

Blood ◽  
1996 ◽  
Vol 88 (11) ◽  
pp. 4132-4138 ◽  
Author(s):  
WI Bensinger ◽  
CD Buckner ◽  
K Shannon-Dorcy ◽  
S Rowley ◽  
FR Appelbaum ◽  
...  
Keyword(s):  
Stem Cells ◽  
Body Weight ◽  
Peripheral Blood ◽  
Hematologic Malignancy ◽  
Chronic Gvhd ◽  
Allogeneic Transplantation ◽  
Hematologic Malignancies ◽  
Peripheral Blood Stem Cells ◽  
Cd34 Cells ◽  
Blood Stem Cells

Abstract Sixteen patients with advanced hematologic malignancies were transplanted with HLA-identical allogeneic peripheral blood stem cells (PBSCs) that were selected for CD34+ cells by an avidin-biotin immunoadsorption technique. The median age of patients was 48 years (range, 37 to 67). Patients received 12.0 or 13.2 Gy of total body irradiation followed by 120 mg/kg of cyclophosphamide. Normal donors received 16 mg/kg of granulocyte-colony stimulating factor on days 1 to 6 followed by PBSC harvests on days 4 to 7. PBSC harvests were processed each day on a single avidin-blotin column containing an antibody to the CD34 antigen and processed cells were infused without cryopreservation daily for 4 consecutive days. Prophylaxis against graft-versus-host disease (GVHD) consisted of cyclosporine alone for 5 patients and CSA plus methotrexate for 11 patients. A median of 18.64 (6.74 to 34.97) x 10(8) CD34+ cells/kg patient body weight were collected from each donor. A median of 8.96 (2.62 to 17.34) x 10(8) CD34+ cells/kg patient body weight were recovered after avidin-biotin adsorption which represented a median CD34+ cell yield of 53% (18% to 77%) with a median purity of 62% (34% to 82%). There was a reduction in CD3+ cells from a median of 557.26 (227.73 to 677.77) x 106/kg to 0.73 x 10(4)/kg (0.40 to 3.65), in CD4+ cells from 351.72 (194.47 to 520.11) x 10(6)/kg to 0.40 (0.15 to 1.03) x 10(4)/kg and in CD8+ cells from 169.74 (53.34 to 325.83) x 10(6)/ kg to 0.32 (0.12 to 2.71) x 10(4)/kg representing a median 2.8 (2.19 to 3.14) log reduction in T cells. One patient died of infection on day 3 posttransplant and was unevaluable for recovery of neutrophils. The median day to recovery of 500 neutrophils/mL was 15 (8 to 26) in the remaining 15 patients. Six of 16 patients falled to achieve a platelet count of 20,000/mL before death on days 3 to 97 of transplant-related complications. The median day to achieving platelets of 20,000 mL in the remaining 10 patients was 11 (7 to 31). Eight of 16 patients (50%) died between 3 and 97 days posttransplant, 7 of transplant-related causes, and 1 of progressive disease. Grade 2–4 acute GVHD occurred in 12 out of 14 (86%) and grades 3–4 in 6 out of 14 (43%) evaluable patients. Six of 8 evaluable patients developed clinical chronic GVHD and 1 developed subclinical chronic GVHD. Bone marrow and/or peripheral blood chimerism studies in 12 evaluable patients showed 97% to 100% donor type in 11 patients with 1 patient in relapse showing 40% donor cells 60 to 90 days posttransplant. Four of 16 patients (25%) are alive and disease-free 312 to 576 days after transplant. There were no episodes of graft failure or rejection. This study shows that allogeneic transplantation using CD34+ selected PBSC results in prompt and sustained engraftment. CD34+ selection, as employed in this preliminary study, however, resulted in an apparently higher rate of acute and chronic GVHD. However, The sample size is quite small and precludes a more definitive conclusion regarding GVHD.

scholarly journals Proliferation through activation: hemophagocytic lymphohistiocytosis in hematologic malignancy

2017 ◽  
Vol 1 (12) ◽  
pp. 779-791 ◽  
Author(s):  
Eric J. Vick ◽  
Kruti Patel ◽  
Philippe Prouet ◽  
Mike G. Martin
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Hematologic Malignancy ◽  
Lymphocytic Infiltration ◽  
Hematologic Malignancies ◽  
Interferon Γ ◽  
Host Immune System ◽  
T Helper ◽  
T Helper 1 ◽  
Factor Α ◽  
Necrosis Factor

AbstractHemophagocytic lymphohistiocytosis (HLH) is a syndrome of cytokine-driven immune activation. Cardinal features include fever, hemophagocytosis, hepatosplenomegaly, lymphocytic infiltration, and hypercytokinemia that result in multisystem organ dysfunction and failure. Familial HLH is genetically driven, whereas secondary HLH (SHL) is caused by drugs, autoimmune disease, infection, or cancer. SHL is associated with worse outcomes, with a median overall survival typically of less than 1 year. This reflects difficulty in both diagnostic accuracy and in establishing reliable treatments, especially in cases of malignancy-induced SHL, which have significantly worse outcomes. Malignancy-induced HLH is seen almost exclusively with hematologic malignancies, constituting 97% of cases in the literature over the past 2 years. In these situations, the native immune response driven by CD8 T cells produces an overabundance of T helper 1 cytokines, notably interferon-γ, tumor necrosis factor-α, and interleukin-6, which establish a positive feedback loop of inflammation, enhancing replication of hematologic malignancies while leaving the host immune system in disarray. In this paper, we present 2 case studies of secondary HLH driven by HM, followed by a review of the literature discussing the cytokines driving HLH, diagnostic criteria, and current treatments used or undergoing investigation.

What Is Anaphylaxis? Pediatric Residents’ Perception and Treatment of Anaphylactic Reactions

2020 ◽  
Vol 60 (1) ◽  
pp. 25-31
Author(s):  
Ronald M. Ferdman
Keyword(s):  
Allergic Reaction ◽  
Clinical Outcomes ◽  
Diagnosis And Treatment ◽  
Organ Involvement ◽  
Allergy Clinic ◽  
Pediatric Residents ◽  
Criteria For Diagnosis ◽  
Definition Of ◽  
Single Organ

To assess knowledge regarding symptoms and treatment of anaphylaxis, a vignette of a child having an allergic reaction to a peanut was presented to residents in an allergy clinic. Twelve sets of clinical outcomes ranging from severe multi-organ to mild single organ involvement were described, and residents were asked if each symptom set met criteria for diagnosis of anaphylaxis, whether epinephrine should be administered acutely and prescribed at follow-up, and whether peanuts should be avoided in the future. Of cases that met the definition of anaphylaxis 28.8% were incorrectly diagnosed, in 13.6% of cases they would allow peanuts to be eaten again, and in 23.9% of cases they would not prescribe epinephrine at follow-up. In 26.1% of cases meeting criteria for acute anaphylaxis residents would not administer epinephrine. Deficits regarding the diagnosis and treatment of anaphylaxis by residents were identified, and increased educational efforts are needed.

scholarly journals NEW TENDENCIES IN DIAGNOSTICS AND TREATMENT OF DISEASES OF THE CERVIX (LITERATURE REVIEW)

2018 ◽  
pp. 114-117
Author(s):  
A. V. Boychuk ◽  
V. S. Shadrina ◽  
O. I. Chlibovska ◽  
B. O. Onyskiv ◽  
O. O. Fedchenko
Keyword(s):  
Diagnostic Method ◽  
Modern Method ◽  
Cellular Protein ◽  
Vaginal Flora ◽  
Diagnosis And Treatment ◽  
Adequate Treatment ◽  
Cervical Epithelium ◽  
Apoptosis Index ◽  
Definition Of ◽  
Degree Of Severity

In the problem of resolving the pathology of the cervix in recent years, a lot of information about etiology, causes of origin, diagnosis and treatment has been accumulated. The article summarizes the new possibilities of diagnosis and treatment of the pathology of the cervix, which contributes to a significant improvement in the resolution of the problem of the pathology of the cervix. There are 4 main groups of etiologic factors that lead to morphofunctional changes in the cervical epithelium. In the course of a violation of the transformation of the epithelialization of the cylindrical epithelium, the violation of local and humoral immunity is important. The definition of apoptosis index is a new modern method for predicting the development of precancerous and cervical cancer. Routine but informative methods for diagnosing cervical pathologies such as cytological and colposcopic, in recent years, have been replenished with an important immunohistochemical diagnostic method for detecting p161NK4a cellular protein, as well as by fluorescence spectrometry. The presented complex of diagnostic researches allows us to choose the method of adequate treatment of pathological processes taking into account the age of the patient, the nature and degree of severity of epithelial changes, the type of cervical and vaginal flora, as well as the hormonal status of the patient and concomitant pathology.

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