scholarly journals Case Report: Remdesivir and Convalescent Plasma in a Newly Acute B Lymphoblastic Leukemia Diagnosis With Concomitant Sars-CoV-2 Infection

2021 ◽  
Vol 9 ◽  
Author(s):  
Giovanni Battista Dell'Isola ◽  
Matteo Felicioni ◽  
Luigi Ferraro ◽  
Ilaria Capolsini ◽  
Carla Cerri ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Immunosuppressive Treatment ◽  
Pulmonary Involvement ◽  
Severe Neutropenia ◽  
Rapid Resolution ◽  
Life Saving ◽  
Leukemia Diagnosis ◽  
The Stability ◽  
Challenging Situation

Introduction: The spread of Covid-19 has worsened the prognosis of oncology patients, interrupting or delaying life-saving therapies and contextually increasing the risk of severe SARS-CoV-2 infections. Acute lymphoblastic leukemia (ALL) is the most frequent cancer in pediatric age and the management of this disease with concomitant SARS-COV-2 infection represents a challenging situation.Case presentation: We present the case of a 6-year-old female newly diagnosed with ALL during a documented SARS-CoV-2 infection. Our patient was admitted 20 days after SARS-CoV-2 detection for evening-rise fever. Laboratory testing showed severe neutropenia while chest x-ray detected moderate pulmonary involvement. Acute lymphoblastic leukemia diagnosis was made through morphological and molecular analysis on bone marrow aspirate. Given the stability of the blood count and clinical conditions, antiviral therapy with Remdesivir and Convalescent Plasma was started before antileukemic treatment, obtaining a rapid resolution of the infection.Conclusion: In our experience, the treatment with Remdesivir and Convalescent Plasma led to a rapid resolution of Sars-Cov-2 infection. Our case did not present any adverse event to the therapy. Thus, this treatment could be considered in patients with malignancies, in order to accelerate the resolution of the infection and begin immunosuppressive treatment safely. Further studies are required to confirm this hypothesis.

Successful Engrafment After HLA Identical Granulocyte Transfusion As Support Therapy in a Septic Shock Patient with Acute Lymphoblastic Leukemia

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4507-4507
Author(s):  
Roberto Ovilla ◽  
Claudia Barrera-Carmona ◽  
Nicolas Guzman-Bouilloud ◽  
Elizabeth Buganza-Torio ◽  
Rosa Jimenez-Alvarado ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Septic Shock ◽  
Acute Lymphoblastic Leukemia ◽  
Bone Marrow Transplant ◽  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Immunosuppressive Treatment ◽  
Marrow Transplant ◽  
Granulocyte Transfusion ◽  
Shock State

Abstract Abstract 4507 A 53 years old male started in February 2010 with ecchymosis, petechiae and spontaneous gum bleeding. He was diagnosed with acute lymphoblastic leukemia, and was started on HYPER-CVAD, in combination with anti-tumoral lysis syndrome measures and antimicrobial, antiviral y antifungal prophylaxis. After finishing HYPER-CVAD phase A, he developed severe myelosuppression even with the use of G-CSF, 72 hours later he presented with abdominal cramping, fever up to 38.2°C and hypotension, with a high clinical suspicion of neutropenic colitis; his mean arterial pressure average was 45 mmHg, he was started on intravenous colloids, dobutamine and norepinephrine drips. Because of severe myelosuppression, septic shock and myocardial depression, a granulocyte transfusion without previous mobilization was performed with an identical sibling donor with concomitant use of granulocytic colony stimulation factor. Severe myelosuppression was maintained during 7 days, however shock state was reversed some hours after performing granulocyte transfusion, without infectious signs, 36 hours later a mononuclear cell infusion was performed from the same donor, with previous 2 days G-CSF mobilization. A gradual increase in leukocyte number appeared, with 400, 900 and finally 1900. A new bone marrow aspiration was performed, where hematopoietic recovery was confirmed from his sister's cells with confirmation by karyotype and microsatellites. He was then considered bone marrow grafted HLA compatible. On April 2010 he presented with acute diarrheic syndrome secondary to a CMV infection, he was started on ganciclovir and intravenous immunoglobulin. On May he presented an Aspergillus pneumonia that was treated both clinically with antifungal therapy and surgically with thoracoscopy to remove the fungi lesion. On October 2010 he started with graft versus host manifestations on the skin and in the liver. He started immunosuppressive treatment with Prednisone and Sirolimus. On November he developed anogenital herpes zoster infection. After this complication, every GVHD manifestation ceded. Now, 28 months post-bone marrow transplant he presents full remission with no evidence of leukemia. Granulocyte transfusion is an uncommon technique. Preferably it should be done with and identical donor. In this case report, the justification of the procedure was to be able to achieve a remission from a potentially irreversible septic shock; this was successfully done, in an unexpected clinical scenario with severe life threatening, and in a casual manner, the patient achieved a successfully bone marrow transplant, and now 30 months post-granulocyte infusion the patient is free from any evidence of disease. Disclosures: No relevant conflicts of interest to declare.

Successful Treatment of Refractory Acute Lymphoblastic Leukemia with Tisagenlecleucel in the Setting of Life-Threatening Infection

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5125-5125
Author(s):  
Keith J August ◽  
Terrie Flatt ◽  
Erin Marie Hall ◽  
Doug Myers
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
B Cell ◽  
Bone Marrow Aspirate ◽  
Lymphoblastic Leukemia ◽  
Severe Neutropenia ◽  
Active Infection ◽  
Post Infusion ◽  
Life Threatening ◽  
Cell Acute Lymphoblastic Leukemia

Tisagenlecleucel is a CD19 directed immunotherapy approved for the treatment of young patients with relapsed or refractory precursor B-cell acute lymphoblastic leukemia (ALL). The most important toxicity related to tisagenlecleucel therapy is cytokine release syndrome (CRS). CRS is an exaggerated systemic inflammatory response that occurs frequently along with T-cell expansion following the administration of tisagenlecleucel. Tisagenlecleucel guidelines recommend delaying treatment when an active infection is present due to the concern that the pre-existing inflammatory response associated with infection may predispose patients to severe CRS. We describe two cases where tisagenlecleucel was successfully administered to patients in the setting of life-threatening infection. Patient 1 is a 23-year-old Caucasian male with refractory Philadelphia chromosome negative B-cell ALL who had received prior treatment with chemotherapy, blinatumomab, inotuzumab ozogamicin and a haploidentical stem cell transplant (SCT) followed by multiple Zalmoxis infusions. Five months following SCT he relapsed. At relapse, he underwent leukapheresis followed by bridging chemotherapy with ifosfamide and etoposide. He developed severe neutropenia and respiratory failure associated with a right lower lung consolidation. A biopsy demonstrated a mucormycosis infection and he required surgical debridement including resection of portions of the lung, diaphragm and liver. At this time, he had 92% blasts in the bone marrow. Eleven days after his surgery he received tisagenlecleucel despite being persistently febrile. Prior to the infusion, he received a modified lymphodepleting chemotherapy regimen including two days of fludarabine and cytarabine. Due to severe neutropenia, he was receiving granulocyte transfusions. These were discontinued prior to the infusion and resumed after 12 days. CRP and ferritin the day prior to infusion were 26.2 mg/dL and 18,419 ng/mL. He remained persistently febrile for 13 days post-infusion. He received a single dose of tociluzimab 7 days following his infusion due to high fevers. He did not require any treatment with corticosteroids for CRS. The absolute neutrophil count recovered to >500x103/µL at 31 days post infusion. A bone marrow aspirate done 26 days post-infusion did not show any evidence of leukemia by multicolor flow cytometry (MFC). He remains alive without evidence of disease 11 months after treatment with tisagenlecleucel. Patient 2 is a 4-year-old Hispanic female with refractory B-cell ALL found to have a TP53 deletion and t(1;19). She had received prior treatment with chemotherapy, blinatumomab and local radiation therapy to the site of extramedullary disease found in the left maxillary sinus at relapse. She underwent leukapheresis and received bridging chemotherapy with mercaptopurine and methotrexate. After 3 days of lymphodepleting chemotherapy she developed septic shock and E. Coli bacteremia. She became severely ill requiring continuous renal replacement therapy for 5 days and extracorporeal membrane oxygenation (ECMO) for 6 days. Shortly after ECMO decannulation she developed fever and was found to have multiple pulmonary opacities concerning for fungal infection. Blasts were noted in the peripheral blood. Sixteen days after presenting with septic shock and 11 days from ECMO she received tisagenlecleucel. CRP at the time of infusion was 22.9 mg/dL. She developed persistent fevers post-infusion for 17 days. She received two doses of tociluzimab 20- and 21-days post-infusion due to recurrence of high fever and reactive lymphadenopathy with third spacing and concern for renovascular compromise. She did not require any treatment with corticosteroids for CRS. Bone marrow aspirate done 32 days post-infusion did not show any evidence of leukemia by MFC. The absolute neutrophil count recovered to >500x103/µL at 59 days post infusion. The patient remained without evidence of disease for 7 months following treatment but died due to infectious complications with persistent pancytopenia. Tisagenlecleucel is a potentially life-saving treatment for relapsed and refractory B-cell acute lymphoblastic leukemia in children and young adults 24 years of age or younger. Tisagenlecleucel is an option for the treatment of patients with active infection and/or inflammation with progressive leukemia when no other therapeutic alternative exists. Disclosures August: Novartis Pharmaceuticals: Speakers Bureau. Myers:Novartis Pharmaceuticals: Consultancy, Speakers Bureau.

Port-A-Catheter Infection Rate and Associated Risk Factors in Children Diagnosed with Acute Lymphoblastic Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 987-987
Author(s):  
Beatriz Lasmar Portilho Junqueira ◽  
Bairbre Connolly ◽  
Oussama Abla ◽  
George A Tomlinson ◽  
Joao Guilherme Pires Vieira Amaral
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Acute Lymphoblastic Leukemia ◽  
Infection Rate ◽  
Lymphoblastic Leukemia ◽  
Catheter Insertion ◽  
Severe Neutropenia ◽  
Z Score ◽  
Post Procedure ◽  
Weight For Age

Abstract Abstract 987 Poster Board I-9 Background: Port-a-catheters are commonly used as vascular access device in children with Acute Lymphoblastic Leukemia (ALL) requiring long-term chemotherapy. Literature suggests that surgical procedures should not be performed in patients with very low neutrophil counts. Neutropenia, however, is very common in patients with ALL putting them at increased risk for infection and impaired wound healing. Objectives: 1) To determine if severe neutropenia, defined as neutrophil count < 500/mm3, on the day of port-a-catheter insertion is a risk factor for catheter-associated infection in children with ALL; 2) To evaluate the incidence of catheter-associated infection and wound dehiscence; 3) To assess other potential risk factors for infection, such as ALL risk category, dexamethasone use during induction therapy and nutritional status at the time of port-a-catheter insertion. Methods: This was a retrospective study conducted in children newly diagnosed with ALL (January 2005 to August 2008) who had a port-a-catheter inserted to assess catheter-associated infections and dehiscence. Demographic data, clinical characteristics, port-a-catheter insertion data and complications post-procedure were reviewed. The post-procedure complications were classified as early (≤ 30 days) or late (> 30 days). The end of catheter follow-up was March, 2009. The nutritional status was evaluated using albumin and total protein levels as well as the BMI-for-age z-score or weight-for-age z-score. Statistical analysis included descriptive and inferential statistics (Chi-squared test, Wilcoxon rank sum test and Kaplan-Meier survival curve). Results: 192 port-a-catheters were inserted in 179 patients with ALL in this 3.5 year time period. Most patients were started on chemotherapy 3 days prior to catheter insertion. A total of 43 catheter-associated infections (22.39%) were diagnosed and the infection rate was 0.35/1000 catheter-days. Children with severe neutropenia on the day of insertion (n=99) had a catheter-associated infection rate of 15.15%; whereas, non-severe neutropenic (≥ 500 cells/mm3) children (n=93) had a rate of 24.73%. This difference was not statistically significant (p=0.137). Out of 192 port-a-catheters, 12 (6.25%) had to be removed due to infection. The most common organisms to cause catheter removal were Coagulase Negative Staphylococcus and Staphylococcus aureus. Patients with high risk precursor B and T cell ALL had a statistically significant higher incidence of late catheter-associated infections (p=0.024) than standard risk ALL. Gender (p=0.863), use of dexamethasone during induction (p=0.201), low BMI-for-age z-score or weight-for-age z-score (p=0.659), low albumin (p=0.530), low total protein (p=0.759) and fever pre-procedure (p=0.339) were not risk factors for infection. Patients who had an early catheter-associated infection did not have a greater chance of having a late infection (p=0.813). Out of 9 wound dehiscences (4.68%), 5 presented also with a local infection. The catheter infection-free survival rate at 1 year was 88.6%, at 2 years was 86.7% and at 3 years was 83.9% (see Graph). Conclusion: This study shows that severe neutropenia on the day of port-a-catheter insertion does not increase the incidence of catheter-associated infection in children with ALL. In contrast, high risk ALL (precursor B and T cell) is a risk factor for late catheter-associated infections. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Severe neutropenia at time of port insertion is not a risk factor for catheter-associated infections in children with acute lymphoblastic leukemia

Cancer ◽  
2010 ◽  
Vol 116 (18) ◽  
pp. 4368-4375 ◽  
Author(s):  
Beatriz L. P. Junqueira ◽  
Bairbre Connolly ◽  
Oussama Abla ◽  
George Tomlinson ◽  
Joao G. Amaral
Keyword(s):  
Risk Factor ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Severe Neutropenia

scholarly journals Analysis of Emotional Support Intervention on Acute Lymphoblastic Leukemia Patient with Anxiety

2020 ◽  
Vol 4 (1) ◽  
pp. 4
Author(s):  
Nurlita Dwi Hikmatia ◽  
Denissa Faradita Aryani
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Emotional Support ◽  
Lymphoblastic Leukemia ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Support Intervention ◽  
Study Approach ◽  
Patient Reported ◽  
The Stability

<p><strong>Objective: </strong>This study aimed to describe nursing care provided for Acute Lymphoblastic Leukemia (ALL) patient who was affected by anxiety with case study approach which conducted for five consecutive days</p><p><strong>Methods: </strong>The emotional support intervention which was provided for 30-45 minutes in each of 5 days and evaluated by hemodynamic values monitoring, observation of patient's general condition, and the Hospital Anxiety and Depression Scale (HADS) revealed the effectiveness of the intervention. The monitoring of hemodynamic values was performed prior to and following the intervention.</p><p><strong>Results: </strong>The result suggested the stability of hemodynamic values within 5 days of intervention. There was no sign of bleeding, though the patient complained for cough and cold. The patient was still required to undergo blood transfusions due to low platelet counts. The patient reported that he felt more exuberant and seemed vigorous within those 5 days. The patient was also able to perform ADLs including eating, changing clothes, and praying independently on the bed, and seemed to be smiling all the time and remained a cheerful and sociable figure with his surroundings.</p><p><strong>Conclusion: </strong>Anxiety level score using HADS was decreased to 7 with normal category.</p><p><strong>Keywords: </strong>Acute Lymphoblastic Leukemia (ALL); anxiety; emotional support intervention.</p>

scholarly journals Rapid resolution of bone marrow necrosis mimicking relapse of pediatric acute lymphoblastic leukemia

2020 ◽  
Vol 55 (3) ◽  
pp. 184-187
Author(s):  
Jae Wook Lee ◽  
Seongkoo Kim ◽  
Pil-Sang Jang ◽  
Nack-Gyun Chung ◽  
Bin Cho ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Bone Marrow Necrosis ◽  
Pediatric Acute Lymphoblastic Leukemia ◽  
Rapid Resolution
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