scholarly journals Successful outcome of disseminated candida tropicalis osteomyelitis on remission induction for childhood Philadelphia chromosome–positive acute lymphoblastic leukemia

2020 ◽  
Author(s):  
Lichun Xie ◽  
Qingling Long ◽  
Guichi Zhou ◽  
Si-xi Liu ◽  
Feiqiu Wen
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Candida Tropicalis ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Successful Outcome ◽  
Remission Induction ◽  
Recommended Treatment ◽  
Fungal Osteomyelitis ◽  
The Right ◽  
All Treatment

Abstract Invasive fungal infection (IFI) is one of the most challenging complications in children with acute lymphoblastic leukemia (ALL) treatment, but acute fungal osteomyelitis (OM) is rarely encountered. Here, we describe a case of Candida tropicalis osteomyelitis in a 10-year-old patient with Philadelphia chromosome (Ph)–positive ALL. He was on remission induction therapy at the time of neutropenia, and abscess developed in the right arm. The blood and bone cultures were positive for Candida tropicalis. Antibiotics and anti-fungal were started. A magnetic resonance of the arm reveal in intraosseous abscess, suggestive of OM. Surgical irrigation and debridement of the bone were performed immediately. The patient was effectively treated with antifungal therapy and ALL treatment. Now he is full recovery, having complete clinical remission but with sequelae visible by MRI. He is taking oral posaconazole for consolidation until disappearance of the lesion shadows on MRI and having subsequent cycles of chemotherapy in parallel. The recommended treatment for candida osteomyelitis in Ph-positive ALL patients is fungicidal agent combined with surgery and modification chemotherapy with dasatinib. Using combined modalities of treatment seem to be crucial in the successful management of Ph-positive ALL.

scholarly journals Successful Outcome of Disseminated Candida Tropicalis Osteomyelitis on Remission Induction for Childhood Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia - Case Report

2020 ◽  
Author(s):  
Lichun Xie ◽  
Qingling Long ◽  
Guichi Zhou ◽  
Si-xi Liu ◽  
Feiqiu Wen
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Magnetic Resonance ◽  
Candida Tropicalis ◽  
Kinase Inhibitor ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Successful Outcome ◽  
Remission Induction ◽  
Successful Management ◽  
All Treatment

Abstract Background: Invasive fungal infection (IFI) is one of the most challenging complications in children with acute lymphoblastic leukemia (ALL) treatment, but acute fungal osteomyelitis (OM) is rarely encountered. Case presentation: Here, we describe a case of Candida tropicalis osteomyelitis in a 10-year-old patient with Philadelphia chromosome (Ph)–positive ALL. He was on remission induction therapy at the time of neutropenia, and abscess developed in the right arm. The blood and bone cultures were positive for Candida tropicalis. Antibiotics and anti-fungal were given. A magnetic resonance of the arm revealed in intraosseous abscess, suggestive of OM. Surgical irrigation and debridement of the bone were performed immediately. The patient was effectively treated with antifungal therapy and ALL treatment. Now he full recovered into complete clinical remission but with sequelae visible by Magnetic Resonance Imaging (MRI). He took oral posaconazole for consolidation until disappearance of the lesion shadows on MRI and received subsequent cycles of chemotherapy in parallel. Conclusions: In the successful management of Ph-positive ALL, dasatinib the second-generation Abl–tyrosine kinase inhibitor is crucial. The recommended treatment for candida osteomyelitis in Ph-positive ALL patients are fungicidal agent combined with surgery and modification chemotherapy with dasatinib. Using combined modalities of treatment seem to be crucial in the successful management of Ph-positive ALL.

scholarly journals High incidence of disseminated intravascular coagulation during remission induction of adult patients with acute lymphoblastic leukemia [see comments]

Blood ◽  
1992 ◽  
Vol 79 (5) ◽  
pp. 1305-1310 ◽  
Author(s):  
AH Sarris ◽  
S Kempin ◽  
E Berman ◽  
J Michaeli ◽  
C Little ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Disseminated Intravascular Coagulation ◽  
De Novo ◽  
Sinus Thrombosis ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Temporal Association ◽  
Remission Induction ◽  
Time Interval ◽  
Intravascular Coagulation

Abstract We determined the incidence and complications of disseminated intravascular coagulation (DIC) at presentation and during remission induction of previously untreated adults with acute lymphoblastic leukemia (ALL) or de novo Philadelphia chromosome-positive ALL (PCALL) seen at Memorial Hospital between January 1, 1978 and December 31, 1989. DIC was diagnosed in the presence of (1) low fibrinogen (less than or equal to 160 mg/dL), (2) prolonged prothrombin time (PT) and falling fibrinogen, or (3) prolonged PT and positive fibrin split products (FSP). L-Asparaginase was not used during remission induction. Among adequately screened patients with ALL, DIC was detected in 7 of 58 (12%) before initiation of chemotherapy and in 35 of 45 (78%) during remission induction. DIC was not simply the result of infection because clinical and laboratory signs of infection were absent in 16 patients, whereas only 2 of the 22 febrile patients with DIC had positive cultures. Among the 38 patients with DIC at presentation or during remission induction, serious complications were seen in 13 in temporal association with DIC (pulmonary embolus in one, sagittal sinus thrombosis in three, and serious hemorrhage in nine) and were major factors in the deaths of three patients. Among the 10 patients with thorough screening but no evidence of DIC there was only one hemorrhage during the same time interval. In patients with PCALL, DIC was detected in 9% at presentation and in 80% during remission induction. We conclude that DIC is rare at presentation but common during remission induction of adult ALL and PCALL and may be associated with significant thrombotic and hemorrhagic complications. We suggest daily screening for DIC during the first 14 days of remission induction. The treatment of DIC in ALL and PCALL should be a subject of future clinical studies.

scholarly journals High incidence of disseminated intravascular coagulation during remission induction of adult patients with acute lymphoblastic leukemia [see comments]

Blood ◽  
1992 ◽  
Vol 79 (5) ◽  
pp. 1305-1310
Author(s):  
AH Sarris ◽  
S Kempin ◽  
E Berman ◽  
J Michaeli ◽  
C Little ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Disseminated Intravascular Coagulation ◽  
De Novo ◽  
Sinus Thrombosis ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Temporal Association ◽  
Remission Induction ◽  
Time Interval ◽  
Intravascular Coagulation

We determined the incidence and complications of disseminated intravascular coagulation (DIC) at presentation and during remission induction of previously untreated adults with acute lymphoblastic leukemia (ALL) or de novo Philadelphia chromosome-positive ALL (PCALL) seen at Memorial Hospital between January 1, 1978 and December 31, 1989. DIC was diagnosed in the presence of (1) low fibrinogen (less than or equal to 160 mg/dL), (2) prolonged prothrombin time (PT) and falling fibrinogen, or (3) prolonged PT and positive fibrin split products (FSP). L-Asparaginase was not used during remission induction. Among adequately screened patients with ALL, DIC was detected in 7 of 58 (12%) before initiation of chemotherapy and in 35 of 45 (78%) during remission induction. DIC was not simply the result of infection because clinical and laboratory signs of infection were absent in 16 patients, whereas only 2 of the 22 febrile patients with DIC had positive cultures. Among the 38 patients with DIC at presentation or during remission induction, serious complications were seen in 13 in temporal association with DIC (pulmonary embolus in one, sagittal sinus thrombosis in three, and serious hemorrhage in nine) and were major factors in the deaths of three patients. Among the 10 patients with thorough screening but no evidence of DIC there was only one hemorrhage during the same time interval. In patients with PCALL, DIC was detected in 9% at presentation and in 80% during remission induction. We conclude that DIC is rare at presentation but common during remission induction of adult ALL and PCALL and may be associated with significant thrombotic and hemorrhagic complications. We suggest daily screening for DIC during the first 14 days of remission induction. The treatment of DIC in ALL and PCALL should be a subject of future clinical studies.

scholarly journals Successful outcome of disseminated Candida tropicalis osteomyelitis on remission induction for childhood Philadelphia chromosome–positive acute lymphoblastic leukaemia-case report

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Lichun Xie ◽  
Qingling Long ◽  
Guichi Zhou ◽  
Sixi Liu ◽  
Fei-Qiu Wen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Acute Lymphoblastic Leukaemia ◽  
Candida Tropicalis ◽  
Lymphoblastic Leukaemia ◽  
Philadelphia Chromosome ◽  
Remission Induction ◽  
Resonance Imaging ◽  
Successful Management ◽  
All Treatment

Abstract Background Invasive fungal infection (IFI) is one of the most challenging complications in children undergoing acute lymphoblastic leukaemia (ALL) treatment, but acute fungal osteomyelitis (OM) is rarely encountered. Case presentation Here, we describe a case of Candida tropicalis osteomyelitis in a 10-year-old patient with Philadelphia chromosome (Ph)-positive ALL. He was on remission induction therapy at the time of neutropenia, and an abscess developed in his right arm. The blood and bone cultures were positive for C. tropicalis. Antibiotics and antifungals were administered. Magnetic resonance imaging of the arm revealed an intraosseous abscess, suggestive of OM. Surgical irrigation and debridement of the bone were performed immediately. The patient was effectively treated with antifungal therapy and ALL treatment. He has fully recovered into complete clinical remission but with visible sequelae on magnetic resonance imaging (MRI). He took oral posaconazole for consolidation until disappearance of the lesion shadows on MRI and received subsequent cycles of chemotherapy in parallel. Conclusions In the successful management of Ph-positive ALL, dasatinib, a second-generation Abl-tyrosine kinase inhibitor, is crucial. The recommended treatment for Candida osteomyelitis in Ph-positive ALL patients is a fungicidal agent combined with surgery and modification chemotherapy with dasatinib. The use of combined modalities of treatment seems to be crucial in the successful management of Ph-positive ALL.

scholarly journals Precision medicine in acute lymphoblastic leukemia

2020 ◽  
Vol 14 (6) ◽  
pp. 689-700 ◽  
Author(s):  
Ching-Hon Pui
Keyword(s):  
Targeted Therapy ◽  
Acute Lymphoblastic Leukemia ◽  
T Cell ◽  
High Risk ◽  
Cellular Therapy ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Dose Intensity ◽  
Remission Induction ◽  
T Cell Therapy

AbstractThe cure rate of childhood acute lymphoblastic leukemia (ALL) has exceeded 90% in some contemporary clinical trials. However, the dose intensity of conventional chemotherapy has been pushed to its limit. Further improvement in outcome will need to rely more heavily on molecular therapeutic as well as immuno-and cellular-therapy approaches together with precise risk stratification. Children with ETV6-RUNX1 or hyperdiploid > 50 ALL who achieve negative minimal residual disease during early remission induction are suitable candidates for reduction in treatment. Patients with Philadelphia chromosome (Ph)-positive or Ph-like ALL with ABL-class fusion should be treated with dasatinib. BH3 profiling and other preclinical methods have identified several high-risk subtypes, such as hypodiplod, early T-cell precursor, immature T-cell, KMT2A-rearranged, Ph-positive and TCF-HLF-positive ALL, that may respond to BCL-2 inhibitor venetoclax. There are other fusions or mutations that may serve as putative targets, but effective targeted therapy has yet to be established. For other high-risk patients or poor early treatment responders who do not have targetable genetic lesions, current approaches that offer hope include blinatumomab, inotuzumab and CAR-T cell therapy for B-ALL, and daratumumab and nelarabine for T-ALL. With the expanding therapeutic armamentarium, we should start focus on rational combinations of targeted therapy with non-overlapping toxicities.

Sign in / Sign up

Export Citation Format

Share Document