Hematology, Transfusion and Cell Therapy最新文献

Objective

Polymyxins are bactericidal drugs that bind to lipopolysaccharides (LPS) and phospholipids in the outer cell membrane of gram-negative bacteria (1,2). The most important side effect of intravenous polymyxins is nephrotoxicity, neurotoxicity. Hypersensitivity reactions including rash, itching, urticaria, and fever have also been reported. It can also cause skin hyperpigmentation (3,4,5). We will present the rash thought to have developed due to polymyxin in an elderly patient diagnosed with AML.

Case report

A 77-year-old male patient diagnosed with AML was admitted to the hospital for a chemotherapy session. After the initial examination, he was hospitalized due to complaints of dyspnea, weakness, and cough. Polymyxin B was started upon recommendation to the patient, who was consulted with the department of chest diseases and infectious diseases regarding his current infection status.

Results: During the follow-up, petechial rashes and itching began to occur on both lower legs, starting from the ankle and spreading upwards, and it was noted that the rash and itching occurred after the use of polymyxin B. After the suspected drug was discontinued, the itching gradually decreased, and the rash was observed to become widespread and change color. The patient's rashes were photographed, and his follow-up continued and after comleting the treatment he was discharged.

Conclusion

In this multidrug-resistant Gram-negative bacteria era, the use of polymyxines has spread. Due to the use of these agents, adverse events such as pruritus, maculapapular rashes, and urticaria may occur (6). Patients should be observed for hypersensitivity reactions related to polymyxin B use, and the cause of these symptoms should be enlightened with the right anamnesis.

Case report

ABO-incompatible blood transfusions are potentially life-threatening. The common cause is skipping the final bedside check. Potential intensive and emergent transfusions have the risk of a blood component-patient matching hitch. A 58-year-old bleeding patient with anesthesia received the 4th RBC unit. Pretransfusion tests showed hemolysis in a mixed field. The returned empty bag confirmed the wrong blood group RBC transfusion. The blood bank and hemovigilance intervened; the incident was recorded

Objective

Cutaneous malignant melanoma of the breast is a rare tumor, accounting for less than 5% of all malignant melanomas, Surgical resection is the commonly adopted treatment method for malignant melanoma, supplemented by chemotherapy, radiotherapy, and immunotherapy treatments, resulting in a comprehensive treatment strategy. We aim to assess the efficacy of adjuvant radiotherapy in managing cutaneous malignant melanoma of the breast in long-term local and regional control.

Case report

A 65-year-old Libyan woman was diagnosed with stage III primary cutaneous malignant melanoma of the breast in 2021. She presented with a progressive painless mass of preexisting nevus, which is located on the skin of the upper inner quadrant of her left breast post-wide local excision without ipsilateral regional lymph node sampling. A month later, a regional ipsilateral axillary LN recurrence occurred. Modified radical mastectomy and axillary LN dissection were done.

Methodology

subsequently, six cycles of chemotherapy were received, followed by 40 GY in 15 fractions of adjuvant radiotherapy to the left chest wall, ipsilateral axilla, and supraclavicular LNs. In November 2022, lung metastasis was identified, and immunotherapy was advised, Subsequent imaging up to January 2024 indicated no local or regional recurrences and a complete disappearance of lung metastasis.

Results

The rarity of cutaneous malignant melanomas of the breast has made it difficult to evaluate a life-threatening disease in which local recurrence and regional or distant metastasis may develop after surgical removal of MM, which is common. Wide local excision and prophylactic lymphadenectomy, including radical mastectomy, gave the best long-term local and regional control. Internal mammary node Dissections are not indicated; radiotherapy decreases locoregional failure from 30-50 % to 10–20%.

Conclusion

Given the notable local, regional recurrence, and distal metastasis rate, local radiotherapy and immune checkpoint inhibitors monotherapy could serve as potent adjuvant treatment in metastatic cutaneous breast malignant melanoma.

Case report: Introduction

Secondary leukemias that occur after chemotherapy are mostly myelodysplastic syndrome and acute myeloid leukemias.With the recent increased use of immunomodulatory (IMID) drugs (pomalidomide, thalidomide and lenalidomide); It has been shown that secondary leukemias increase. Acute lymphoblastic leukemia (ALL) has frequently been described in association with IMID.

Here, we present our second ASCT experience in a case who underwent autologous stem cell transplantation (ASCT) with the diagnosis of multiple myeloma and developed B-ALL during the maintenance lenalidomide treatment.

Key words: Multipl myelom, B-ALL, autologous stem cell transplantation

Case report

A 62-year-old female patient was diagnosed with multiple myeloma (MM) in 2017.The patient was given 4 cycles of BED (bortezomide, cyclophosphamide, dexamethasone) treatment.The patient, who was in remission, underwent ASCT with Melphalan 200 mg/m2 preparation regimen in 2018.After ASCT, the patient was started on lenalidomide maintenance treatment. Approximately 4 years later, in 2022, during the course of lenalidomide treatment, CALLA+ B-ALL was diagnosed with a bone marrow biopsy.The patient was given hyper-CVAD Chemotherapy. The patient, who was in remission after the treatment, underwent ASCT again in 2023, for the second time with the TBI + endoxan protocol (3.8 × 106/kg cells) with peripheral blood stem cells collected during the previous MM disease period.

Discussion and conclusion

ALL can develop due to cytotoxic agents and immunomodulatory (IMID) drugs such as alkylating agents and topoisomerase inhibitors. Alkylating agents such as Melphalan can cause the development of AML or MDS, often through unbalanced chromosomal abnormalities from first use. The incidence of secondary ALL developing after primary malignancy is 2.3%. Secondary malignancies are a known, albeit rare, complication of long-term lenalidomide therapy. However, the incidence of secondary ALL due to lenalidomide is very low. Parrondo et al demonstrated a significant increase in the risk of secondary malignancies following lenalidomide maintenance following high-dose melphalan and autologous hematopoietic stem cell transplantation in patients with multiple myeloma (MM). 4-17% of these malignancies are hematological malignancies. After ASCT, maintenance lenalidomide has now become the standard treatment for multiple myeloma. Lenalidomide creates a basis for the development of hematological malignancy secondary to treatment in these patients. However, considering the use of melphalan in the chemotherapy regimen before ASCT, lenalidomide alone cannot be blamed for treatment-related ALL. However, as a result of our literature review, there is a stronger association between lenalidomide maintenance therapy and treatment-associated ALL in multiple myeloma patients.

Therefore, in case of susp