Clinical and histological response to combination nivolumab and ipilimumab in metastatic renal cell carcinoma.

Patients with renal cell carcinoma (RCC) often remain asymptomatic until the disease is advanced, with about 25% presenting at an advanced stage. We present a case of metastatic RCC treated with combination ipilimumab and nivolumab with complete radiological and pathological response. Currently, combination nivolumab and ipilimumab is a preferred option for intermediate- and poor-risk patients with clear cell stage IV RCC.

Acquired Amegakaryocytic Thrombocytopenia Misdiagnosed as Immune Thrombocytopenia: A Case Report.

INTRODUCTION: Acquired amegakaryocytic thrombocytopenia (AATP) is a rare bleeding disorder that causes severe thrombocytopenia with preserved hematopoiesis of other cell lineages. Many cases are misdiagnosed and treated as immune thrombocytopenia. CASE PRESENTATION: We report a case of AATP, in a 50-year-old man, that was treated as immune thrombocytopenia for years with no clinical response. The disorder later was diagnosed as AATP after bone marrow biopsy and was successfully treated with cyclosporine. DISCUSSION: The exact mechanism of AATP remains unclear; it is suspected to be an immune-mediated process. Patients with AATP present with severe bleeding and thrombocytopenia, which is usually unresponsive to high-dose corticosteroids. There are no standard treatment guidelines for AATP. Cyclosporine and antithymocyte globulin are found to be effective in some cases. The prompt diagnosis of AATP is vital because it carries high mortality because of excessive bleeding, and it can progress into aplastic anemia or myelodysplastic syndrome.

A castrate-resistant metastatic prostate cancer patient with severe pancytopenia, successfully treated with docetaxel chemotherapy.

INTRODUCTION: Prognosis of metastatic castrate-resistant prostate cancer is poor with a median survival of 12 to 36 months. Bone metastasis is common, and bone marrow metastasis occurs later in the disease course. The median survival in these patients after bone marrow involvement is less than six months. We report a case of castrate-resistant prostate cancer patient presented with severe pancytopenia due to bone marrow involvement of prostate cancer, treated successfully with docetaxel chemotherapy. Post chemotherapy, the patient became transfusion independent and prostate-specific antigen improved to 0.1 ng/ml from 1051 ng/ml. CASE REPORT: A 70-year-old gentleman with a history of metastatic prostate cancer on androgen deprivation therapy and polycythemia vera presented to emergency room with dizziness and melena. Workup revealed severe pancytopenia with platelet count of 12k and hemoglobin of 4.5 gm/dl. Bone marrow biopsy confirmed diffuse involvement of bone marrow with prostate cancer. Prostate-specific antigen was 1051 gm/dl. Management and outcome: The patient received 14 units of packed red blood cell, 10 units of platelet transfusion within one week. Docetaxel chemotherapy was started along with thrombopoietin agonist romiplostim and pegylated filgrastim. He received five cycles of docetaxel treatment. Post chemotherapy, the patient became transfusion independent and prostate-specific antigen improved to 1.17 ng/ml from 1051 ng/ml. The patient is still alive one year after the presentation with good quality of life and the prostate-specific antigen further improved to 0.1 ng/dl. CONCLUSION: This case suggests that selected patients with severe pancytopenia, due to bone marrow infiltration of prostate cancer, can be treated with docetaxel chemotherapy and romiplostim support with significant response. Docetaxel treatment may be beneficial to unpack the marrow and for quicker response in patients with good performance status.

Castleman Disease.

An understanding of the disease pathogenesis has led to the discovery of therapuetic agents that target human herpesvirus-8 replication, CD20, and IL-6 and IL-6R antibodies.

Multiple Myeloma: Updates on Diagnosis and Management.

Two- and 3-drug treatment regimens and autologous stem cell transplants provide opportunities for longer term disease remission, though most patients will still develop relapsed multiple myeloma.

Updates on Cancer Survivorship Care Planning.

Cancer organizations have developed guides and tools to help build cancer survivorship programs and survivorship care plans.

Evaluation of the incidence of carboplatin hypersensitivity reactions in cancer patients.

OBJECTIVES: Although the reported incidence of carboplatin hypersensitivity is low, its occurrence is important to characterize because of potential fatal complications. The purpose of this study was to determine the current incidence of carboplatin hypersensitivity in the ovarian cancer patients compared to other oncology patients and identify potential risk factors that may contribute to development of carboplatin hypersensitivity reactions. METHODS: This was a retrospective chart review analyzing all hospital records at an academic tertiary oncology center between July 2002 and September 2003. Data collected included patient demographics, past medical histories, and detailed carboplatin administration information. Patients that had received carboplatin were identified from pharmacy dispensing records. Positive carboplatin hypersensitivity reactions were identified from the documentation provided in the patient medical record. RESULTS: The incidence of carboplatin hypersensitivity for all cancer patients compared to ovarian cancer patients receiving carboplatin at our institution was 2.6% and 7.9%, respectively. Statistically significant risk factors (P < 0.05) included prior carboplatin exposure and history of drug allergies. There was also a trend to suggest premedication with histamine1 (H1) and histamine(2) (H2) blocker decreases the risk of developing carboplatin hypersensitivity reactions. CONCLUSION: This study confirmed a similar incidence of carboplatin hypersensitivity reactions to previous reports. However, we found that the higher incidence associated with ovarian cancer patients can be attributed to the prolonged carboplatin exposure or history of drug allergies. This is the first study to observe that the administration of H1 and H2 antagonists is associated with a decrease risk of carboplatin hypersensitivity reaction.

Renal parenchymal tumors and lymphoma in the same patient: case series and review of the literature.

We reviewed the incidence of diagnosis of renal cell carcinoma and lymphoma in the same patient and analyzed the characteristics of this association. Nine patients in 4 years had the diagnosis of renal cell carcinoma (RCC) and lymphoma, including 2 with Hodgkin disease, 1 with chronic lymphocytic leukemia (CLL), and 3 each with low-grade follicular and intermediate-grade non-Hodgkin lymphoma (NHL). In SEER data, the observed/expected (O/E) ratio of NHL and RCC is 1.86 to 2.07. In our series, 2 patients were diagnosed with NHL after the diagnosis of RCC, 1 was diagnosed concurrently, and in the other 6, lymphoma preceded diagnosis of RCC. In reviews of second malignancies following treatment of Hodgkin disease, RCC is less common (O/E 1.5, with 1/3 being transitional cell carcinoma and 2/3 being adenocarcinoma). We report 2 cases with Hodgkin disease preceding RCC, and in both, Hodgkin disease occurred as an adult. There is a male predominance for patients with both diagnoses, which is greater than the male predominance for either RCC or NHL alone (2.2 vs. 2.0 vs. 1.2). There is an increased likelihood of the lymphoma being extranodal. There is an increased association of RCC and NHL more often among male patients, and often with extranodal lymphoma. Potential common etiological factors include prior treatment for malignancy, genetic predisposition, environmental factors, including a search for viral sequences, and possible immune dysregulation generating the lymphoma and subsequently leading to solid tumors such as RCC or melanoma.