Tumor Flare Reaction in a Classic Hodgkin Lymphoma Patient Treated With Brentuximab Vedotin and Tislelizumab: A Case Report

BackgroundTumor flare reaction (TFR) is a clinical syndrome, which is mainly associated with painful and swollen lymph nodes or splenomegaly, slight fever, bone pain, and skin rash during treatment with immune-related drugs, causing difficulty in distinguishing TFR from disease progression. Brentuximab vedotin (BV) and programmed death 1 (PD-1) inhibitor are two ideal drugs used for the treatment of classic Hodgkin lymphoma, but few studies have reported their adverse effects in association with TFR. The efficacy and safety of monotherapy or combination therapy with these drugs needs to be further evaluated. It is essential to determine whether treated patients can develop TFR, thus enabling more accurate diagnosis and treatment.Case presentationA 26-year-old female patient, diagnosed with classic Hodgkin lymphoma, had received 2 + 3 cycles of ABVD chemotherapy (a combination of adriamycin, bleomycin, vinblastine, and dacarbazine) and 4 cycles of PD-1 inhibitor (tislelizumab) therapy but exhibited poor efficacy. Subsequently, she was given combination therapy of BV (100 mg) + tislelizumab (200 mg). However, a slight fever, painful and swollen axillary lymph nodes, multiple skin rashes with pruritus, joint pain, and fatigue with poor appetite appeared during the treatment. Ultrasound (US) scans revealed that multiple lymph nodes were significantly enlarged. After treatment with low-dose dexamethasone and cetirizine, the symptoms were alleviated. A biopsy of the left axillary lymph node revealed that lymphoid tissue exhibited proliferative changes, without tumor cell infiltration. These findings were consistent with the clinical and pathological manifestations of TFR.ConclusionCombination therapy with BV and PD-1 inhibitor was effective in the treatment of relapsed or refractory classic Hodgkin lymphoma. The results suggest that the combination therapy may cause TFR, and biopsy and also continuous imaging observation are important to determine the disease stage. This approach allows clinicians to decide whether to continue the current treatment plan, and alerts them to the occurrence of excessive activation of the immune system.

Non-immunological Contact Urticaria (NICU) due to Ethanol Containing Hand Sanitiser: A Case Report

Contact Urticaria (CU) is a wheal and flare reaction, occurring within few minutes to hours of contact to an external agent over skin or mucosa. Depending on underlying pathophysiology, CU is of two types: immunological CU and non-immunological CU. Use of hand sanitisers has increased multifold in this COVID-19 pandemic, due to increased awareness regarding maintaining a good hygiene to reduce the transmission of infection. This present case is a 24-year-old man, who overzealously added ethanol-based hand sanitiser to his bathing water on the advice of a general physician and after bathing developed redness, swelling and itching on various body parts. A diagnosis of Non-immunological CU (NICU) due to ethanol in sanitiser was made, based on history and clinical examination.

Pembrolizumab in Relapsed and Refractory Mycosis Fungoides and Sézary Syndrome: A Multicenter Phase II Study

PURPOSE To assess the efficacy of pembrolizumab in patients with advanced relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS). PATIENTS AND METHODS CITN-10 is a single-arm, multicenter phase II trial of 24 patients with advanced MF or SS. Patients were treated with pembrolizumab 2 mg/kg every 3 weeks for up to 24 months. The primary end point was overall response rate by consensus global response criteria. RESULTS Patients had advanced-stage disease (23 of 24 with stage IIB to IV MF/SS) and were heavily pretreated with a median of four prior systemic therapies. The overall response rate was 38% with two complete responses and seven partial responses. Of the nine responding patients, six had 90% or more improvement in skin disease by modified Severity Weighted Assessment Tool, and eight had ongoing responses at last follow-up. The median duration of response was not reached, with a median response follow-up time of 58 weeks. Immune-related adverse events led to treatment discontinuation in four patients. A transient worsening of erythroderma and pruritus occurred in 53% of patients with SS. This cutaneous flare reaction did not result in treatment discontinuation for any patient. The flare reaction correlated with high PD-1 expression on Sézary cells but did not associate with subsequent clinical responses or lack of response. Treatment responses did not correlate with expression of PD-L1, total mutation burden, or an interferon-γ gene expression signature. CONCLUSION Pembrolizumab demonstrated significant antitumor activity with durable responses and a favorable safety profile in patients with advanced MF/SS.

Efektifitas Bekam Basah Pada Pasien Hipertensi: Systematic Review

Bekam merupakan cara lain dalam diagnosa dan pengobatan (unclasified diagnostic and treatment methods). Bekam atau al-hijamah yaitu metode penyembuhan penyakit dengan membuang racun dalam tubuh melalui pengeluaran angina tau darah yang diambil dari permukaan kulit. Bekam dilakukan pada satu titik atau poin pada tubuh, kutis, subkutis, fasia, serta otot akan terjadi kerusakan dari mast cell, akibat dari kerusakan tersebut akan dilepaskan beberapa zat seperti serotonin, histamine, brandkinin, slow reacing substance, yang mana zat-zat tersebut dapat menyebabkan dilatasi kapiler dan arteriol serta flare reaction pada daerah yang dibekam. Dilatasi kapiler dapat terjadi di tempat yang jauh dari tempat pembekaman yang mana menyebabkan terjadinya perbaikan mikrosirkulasi pembuluh darah, akibatnya akan menimbulkan efek relaksasi otot-otot yang kaku serta menurunkan tekanan darah secara stabil. Tujuan penelitian ini untuk me-review bekam basah terhadap perubahan tekanan darah sistolik dan diastolik pada pasien hipertensi. Metode dalam studi ini adalah systematic review, dengan mencari artikel menggunakan database dari Ebsco dan Google Scholar. Kriteria inklusi yaitu penelitian dengan randomized controlled trial, quasy experiment, responden adalah pasien yang memiliki gejala hipertensi pada awal pengukuran dan tidak menggunakan obat yang dapat mempengaruhi tekanan darah, intervensi yang digunakan adalah tindakan terapi bekam basah, hasil yang diinginkan adalah adanya perubahan dalam hasil akhir pengukuran tekanan darah dan artikel studi primer yang digunakan antara tahun 2006 sampai 2017. Kriteria eksklusi adalah penelitian yang menggunakan hewan dalam intervensinya, pasien dengan ketergantungan obat. Berdasarkan pengumpulan data dari hasil penelitian ketiga penelitian primer didapatkan kesamaan hasil akhir pengukuran dan penilaian tekanan darah sistolik dan diastolik. Kesimpulannya terdapat kesamaan pada hasil yang signifikan dalam perubahan tekanan darah sistolik dan diastolic pada tiga penelitian yang didapatkan.