Second primary nasopharyngeal carcinoma after high - dose chemotherapy and autologous bone marrow transplantation due to Hodgkin’s lymphoma: Сlinical case with literature overview

A second primary nasopharyngeal carcinoma diagnosed after Hodgkin’s Lymphoma is a rare disease. We present a 47-year old patient with nasopharyngeal carcinoma one year after high-dose chemotherapy and 8 months after autologous bone marrow transplantation due to Hodgkin’s Lymphoma with achieved clinical and hemopoetic remission. The diagnosis of the second primary neoplasm was made after nasopharyngoscopy with biopsy, MRI and PET/CT. The patient was positive for Epstein-Barr viral infection. Intensity-modulated radiotherapy combined with chemotherapy was performed using VMAT technique. In the primary nasopharyngeal tumor was achieved total dose of 70 Gy with 2.12 Gy per fraction while in the regional lymphatic basin (levels IB-V) with the retropharyngeal lymph nodes bilaterally is achieved a total dose of 59.4 Gy with 1.8 Gy per fraction. In the discussion the pathogenetic connection between the Epstein-Barr viral infection and the debut of nasopharyngeal carcinoma is focused on. The follow-up of patients who have undergone chemo- and/or radiotherapy due to Hodgkin’s Lymphoma is importance for the early diagnosis of a second malignant tumor and its proper treatment. Keywords: nasopharyngeal carcinoma; epstein-barr virus; hodgkin’s lymphoma; high-dose chemotherapy; radiotherapy.

Outcome of a HIV Positive Patient Infected with COVID-19 after an Autologous Bone Marrow Transplantation: A Case Report

Background: The World Health Organization (WHO) announced the SARS-COV-2 disease pandemic on March 9, 2020.With the advent of this disease, another health burden was added to about 37.9 million people in the world who are infected with HIV and are suffering from various diseases. These people may be at serious risk of covid-19. Information about the effects of Covid-19 on people living with HIV, is limited. Case presentation: We reported a 61-year-old man who was a known case of HIV from 6 years ago that was being treated with HAART (highly active antiretroviral therapy). He also had a history of Hodgkin’s lymphoma from 4 years ago who underwent autologous bone marrow transplantation (BMT) 2 weeks before given referral to our hospital. He complained of weakness, anorexia, and fever. RT-PCR for SARS-COV-2-RNA was positive in his nasopharyngeal and oropharyngeal swab. He was diagnosed with COVID-19 infection and treated with atazanavir. After one week, the patient discharged in a good general state. Conclusion: To the best of our knowledge, it is the first report of COVID-19 infection in an HIV positive patient after BMT in Iran. Despite his immunodeficiency, COVID-19 disease had mild manifestations and he had a good prognosis. We hope that our report and that of others can remain promising to doctors and HIV patients cross fingers for COVID-19 recovery.

Prognostic factors in multiple myeloma and the impact of the bone involvement

<p><strong>Background:</strong> Multiple myeloma is characterized by abnormal plasmocytes proliferation in the bone marrow, resulting in an immunoglobulin oversecretion, which can cause bone pain, anemia, kidney dysfunction, and infections. The present study evaluates prognostic factors and the bone involvement in patients who had a confirmed diagnosis of MM.</p><p><strong>Methods:</strong> A retrospective study was conducted in hospital universitário São Francisco of Bragança Paulista. Patient demographic data, laboratory parameters and treatment received were recorded. We also analyzed the variables related to diagnosis and the development of bone lesions in MM patients.</p><p><strong>Results:</strong> A total of 42 patients had a confirmed diagnosis of MM, out of which most (54.76%) were older than 65. Most patients (45.24%) had beta-2-microglobulin values greater than 5.5 mcg/dl, indicating an advanced stage of the disease and consequently a less favorable prognosis. The main clinical manifestation observed was anemia in 61.90% (26/42) and bone lesions 59.52% (25/42). The analysis of imaging exams showed that most patients presented bone alterations, such as osteopenia, lytic lesions and fractures. Interestingly, 11.90% patients were submitted to autologous bone marrow transplantation with further remission of the disease. Bone marrow transplantation increases overall survival and disease-free survival when compared to conventional treatment.</p><p><strong>Conclusions:</strong> Since MM prognostic factors are numerous and, therefore, the understanding and analysis of the clinical and laboratory features of MM can contribute to an early diagnosis of patients, a targeted therapeutic approach and better outcomes.</p>

Saprochaete clavata (Geotrichum clavatum) septicemia in a patient with multiple myeloma; An emerging case from Southeastern Turkey

Background and Purpose: Invasive fungal infections (IFI) are life-threatening and can be seen in immuno-compromised patients with malignancy, those who undergo chemotherapy, or transplant recipients. The Candida and Aspergillus species are the most common IFI agents; however, infections can also be caused by rare fungal species. This case report is about a bloodstream infection due to Saprochaete clavata (formerly known as Geotrichum clavatum) in a woman with multiple myeloma. Case report: A 59-years-old woman suffered from fever, widespread rashes, and diarrhea after an autologous bone marrow transplantation. Peripheral blood cultures were taken from the patient and sent to the microbiology laboratory. Cultures grew white to cream-colored cottony colonies. Moreover, septate and branched hyphae and arthroconidia were seen under a microscope by lactophenol blue staining. The fungi colonies were identified by Maldi Biotyper 3. 1. (manufactured by Bruker Daltonics, USA) as S. clavata (G. clavatum) with a reliable score. Antifungal susceptibility test was carried out by the concentration gradient strip Etest method. Minimal inhibitory concentrations of Amphotericin B, fluconazole, voriconazole, posaconazole, and anidulafungin were determined as 4, 3, 0.125, 0.125, and > 32 mg/dL, respectively. Despite amphotericin B treatment, the patient died three days after the identification of the fungi. Conclusion: The IFIs are serious conditions that have high mortality rates. In the current case report, we aimed to draw attention to S. clavata which is a rare fungal agent.

Phase II Trial of Maintenance Treatment With IL2 and Zoledronate in Multiple Myeloma After Bone Marrow Transplantation: Biological and Clinical Results

BackgroundMaintenance treatment after autologous bone marrow transplantation in multiple myeloma improves the outcome of patients. We designed a phase II clinical trial to evaluate the treatment with IL2 and zoledronate after autologous bone marrow transplantation in myeloma patients.MethodsPatients with a histologically proven diagnosis of multiple myeloma become eligible if achieved a very good partial remission in bone marrow samples after 3 months from autologous bone marrow transplantation. IL2 was administered from day 1 to 7. In the first cycle, the daily dose was 2 × 106 IU, whereas, in subsequent ones the IL2 dose was progressively escalated, with +25% increases at each cycle, until evidence of toxicity or up to 8 × 106 IU. Four mg of zoledronic acid were infused on day 2. Flow cytometry analysis of γδ-lymphocytes was performed at days 1 and 8 of treatment cycles.ResultsForty-four patients have been enrolled between 2013 and 2016. The median time to progression was 22.5 months (95% CI 9.7–35.2). A complete remission with a negative immunofixation was obtained in 18% of patients and correlated with a significantly longer time to progression (p = 0.015). Treatment was well tolerated without G3 or 4 toxicities. After a week of treatment with IL2 and zoledronate, γδ lymphocytes, Vγ9δ2, CD57+, effector, late effector, and memory γδ increased but in subsequent cycles, there was a progressive reduction of this expansion.ConclusionsThe maintenance treatment with IL2 and Zoledronate has a modest activity in myeloma patients after autologous bone marrow transplantation.EudraCT Number2013-001188-22.