ABSTRACT
Richter transformation (RT) is defined as development of aggressive lymphoma in patients (pts) with CLL. The incidence rates of RT among pts with CLL range from 2 to 10%. The aim of this analysis is to report the frequency, characteristics and outcomes of pts with RT enrolled in trials of the GCLLSG. A total of 2975 pts with advanced CLL were reviewed for incidence of RT. Clinical, laboratory, and genetic data were pooled. Time-to-event data, starting from time of CLL diagnosis, of first-line therapy or of RT diagnosis, were analyzed by Kaplan-Meier methodology. One hundred and three pts developed RT (3%): 95 pts diffuse large B-cell lymphoma (92%) and eight pts Hodgkin lymphoma (8%). Median observation time was 53 months (interquartile range 38.1-69.5). Median OS from initial CLL diagnosis for pts without RT was 167 months vs 71 months for pts with RT (HR 2.64, CI 2.09-3.33). Median OS after diagnosis of RT was 9 months. Forty-seven pts (46%) received CHOP-like regimens for RT treatment. Three pts subsequently underwent allogeneic and two pts autologous stem cell transplantation. Our findings show that within a large cohort of GCLLSG trial participants, 3% of the pts developed RT after receiving first-line chemo- or chemoimmunotherapy. This dataset confirms the ongoing poor prognosis and high mortality associated with RT.
Subject(s)
Cell Transformation, Neoplastic , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Lymphoma/pathology , Adult , Aged , Aged, 80 and over , Biopsy , Cell Transformation, Neoplastic/genetics , Disease Progression , Female , Genetic Variation , Germany , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/genetics , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Lymphoma/etiology , Lymphoma/mortality , Lymphoma/therapy , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Prognosis , Survival Analysis , Time Factors , Young AdultSubject(s)
Acute Chest Syndrome/therapy , Anemia, Sickle Cell/therapy , Extracorporeal Membrane Oxygenation/methods , Acute Chest Syndrome/etiology , Anemia, Sickle Cell/blood , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/drug therapy , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Combined Modality Therapy , Dobutamine/therapeutic use , Hemorrhage/prevention & control , Humans , Hydroxyurea/therapeutic use , Male , Multiple Organ Failure/etiology , Thrombosis/prevention & control , Young AdultABSTRACT
Raoultella planticola is a gram-negative, encapsulated, aerobic bacterium within the Enterobacteriaceae family. It has been primarily described as pathogen in cases with pneumonia and gastrointestinal infections. Here we describe a case of severe pelvic cellulitis in a patient with neutropenia following induction therapy for myeloid sarcoma. The patient experienced a septic shock and was treated successfully with antibiotic therapy. A literature review is provided to put this case in context with previous reports on R. planticola. This report highlights that awareness for uncommon pathogens is crucial in the clinical management of infections in neutropenic patients.
