The Incidence and Predisposing Factors of John Cunningham Virus-Induced Progressive Multifocal Leukoencephalopathy in Southern Finland: A Population-Based Study.

BACKGROUND: The aim of this study was to assess the prevalence, incidence rate (IR), predisposing factors, survival rate, and diagnostic delay of progressive multifocal leukoencephalopathy (PML) across medical specialties. Another objective was to survey how PML diagnosis was made in the studied cases. METHODS: This is a cross-sectional retrospective observational study of PML cases across different medical specialties during 2004-2016 in the Finnish Capital Region and Southern Finland. Data were obtained from clinical records, clinical microbiology, pathology and radiology department records, and human immunodeficiency virus (HIV) quality register medical records. RESULTS: A total of 31 patients were diagnosed with PML. The prevalence of PML was 1.56 per 100 000 people and the IR was 0.12 per 100 000 individuals per year during 2004-2016. Hematologic malignancies (n = 19) and HIV/acquired immune deficiency syndrome (n = 5) were the most common underlying diseases, and all patients who had malignant diseases had received cancer treatment. Before PML diagnosis, 21 (67.7%) patients were treated with chemotherapy, 14 (45.2%) patients with rituximab, and 1 patient (3.2%) with natalizumab. Two patients (6.5%) had no obvious immunocompromising disease or treatment. Neither gender, age, first symptoms, previous medication, nor underlying disease influenced the survival of PML patients significantly. The 5-year survival rate was poor, at less than 10%. CONCLUSIONS: The majority of PML patients in our study had a predisposing disease or had immunosuppressive or monoclonal antibody therapy. In the future, broader use of immunosuppressive and immunomodulatory medications may increase incidence of PML among patients with diseases unassociated with PML. Safety screening protocols for John Cunningham virus and PML are important to prevent new PML cases.

[Hypersensitivity reactions caused by intravenously administered anticancer drugs]. / Suoneen annosteltavien syöpälääkkeiden aiheuttamat yliherkkyysreaktiot ja niiden hoito.

Intravenously administered cytotoxic drugs and biological antibodies may cause infusion reactions, the majority of which are mild. Severe, even fatal reactions occur as well. Adrenaline is invariably the most important treatment of a severe reaction. When contemplating whether the patient should again be subjected to a drug having caused a reaction, aspects to be considered include the degree of severity of the reaction, pathogenetic mechanism, the patient's general condition and cancer stage as well as the possibility to change the anticancer drug that caused reaction to another drug having a similar action on the patient's disease.

Chemoradiotherapy in the treatment of inoperable high-grade osteosarcoma.

Radical surgery is not feasible for all osteosarcoma patients. Overall survival for non-extremity osteosarcoma, as well as for patients with metastatic disease at diagnosis remains poor. For such patients, radical radiotherapy combined with chemotherapy may present an effective treatment approach. This report describes the results of conservative treatment for osteosarcoma patients not suitable for surgery. Seven out of 71 consecutive osteosarcoma patients were treated non-surgically at the Helsinki University Central Hospital either due to the inoperability of the tumour or the patient's choice of therapy. Staging procedures and measurement of tumour size were performed using computed tomography and magnetic resonance imaging. Six patients were treated with chemo-radiotherapy, and one patient received radiotherapy alone. Five patients received computer-assisted dose-planned radiotherapy with curative intent (total dose 60-70.5 Gray), and two patients received radiotherapy as palliation. Radiotherapy relieved symptoms efficiently. Median time to local failure was 2.6 years (range 0.5-16.9+ years). Five year after treatment termination four patients were alive, and one of them remained disease-free. For selected patients not suitable for surgery, radiotherapy combined with chemotherapy provides an option to reduce symptoms caused by the primary tumour and improve quality of life. For some patients, this approach may (even) produce long-term remission.

[Allogenic stem cell transplantations in lymphoma patients]. / Lymfoomapotilaiden allogeeniset kantasolujensiirrot.

The disease recurs in a significant proportion of lymphoma patients after the first-line treatment. Intensive treatment supported by the patient's own cells (autologic stem cell transplantation) has long been utilized in selected cases, but restrictions of this form of therapy are well known. Allogenic transplantation with another person's stem cells provides a possibility to treat lymphoma having a poor prognosis even in cases where other methods of treatments have failed. Allogeneic stem cell transplantation is, however, associated with a significant risk of death.

Palliative radiotherapy in the treatment of skeletal metastases.

Two-third of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. Pathological fracture and spinal cord compression are additional complications caused by bone metastases. Radiotherapy is effective in treating bone pain not adequately controlled by analgesics. Seventy percent of patients benefit from radiotherapy. Single and multifraction regimens are equally effective in relieving pain. Retreatment is needed somewhat more often following single fraction therapy. Most patients benefit from retreatment irrespectively of previous fractionation schedule. Hemibody irradiation and radioisotopes, e.g., strontium-89 and samarium-153 are used in treating scattered painful bone metastases. Radiotherapy is used for preventing pathological fracture by treating osteolytic lesions especially in the weight-bearing bones such as the spinal column and long bones. Radiotherapy is the treatment of choice in spinal cord compression, which is the most serious complication caused by bone secondaries. Radiotherapy provides efficient, well-tolerated and cost-effective palliative care.