Classical meets malignant hematology: a case of acquired εγδß-thalassemia in clonal hematopoiesis.

Hemoglobinopathies including thalassemias are among the most frequent genetic disorders worldwide. Primarily, these entities result from germline variants in the globin gene clusters and their cis-acting regulatory elements, and thus the WHO classifies thalassemias as inherited diseases. Non-inherited disorders of globin chain synthesis mimicking the phenotype of thalassemias have also been described and are referred to as acquired thalassemias. These forms mainly affect the alpha-globin genes and are observed at much lower frequencies...

Primary leiomyosarcoma of the distal fibula: A case report and review of the literature.

We describe a primary leiomyosarcoma of bone located in the distal fibula in a 67- year-old man. Plain radiographs and computer tomography scan revealed a lytic destructive lesion in the distal metaepiphyseal region of the left fibula with little involvement of the surrounding soft tissues. The lesion was composed of proliferating spindle-shaped cells with very slim cytoplasm and narrow oval cigar shaped nuclei. Immunohistochemistry studies demonstrated a strong positivity for actin and desmin, and weak positivity for caldesmon.

Immunophenotyping of surface antigens in acute myeloid leukemia by flow cytometry after red blood cell lysis.

Immunophenotyping of acute leukemia using flow cytometry after density gradient separation (dg-sep) of mononuclear cells is the international gold standard. But destroying red cells by whole blood lysis (wb-lysis) after direct staining has found a broad usage. Both methods revealed congruent results in phenotyping of 26 cases of acute myeloid leukemias by testing CD4, CD7, CD11b, CD11c, CD13, CD14, CD15, CD33, CD34, CD65s, Glycophorin A and HLA-DR antigens. Mean values of these tested antigens were very similar. Only low antigen expression of CD2 was missed in the phenotype of two AML cases by the wb-lysis (23 and 29% positive cells by the dg-sep).

Once-daily oral levofloxacin monotherapy versus piperacillin/tazobactam three times a day: a randomized controlled multicenter trial in patients with febrile neutropenia.

A prospective, randomized, controlled multicenter trial was performed to evaluate the efficacy and safety of once-daily oral monotherapy with 500 mg levofloxacin in comparison with 4.5 g piperacillin/tazobactam 3 times a day in patients with low-risk febrile neutropenia. Low risk was defined by oral temperature > or = 38.5 degrees C on one occasion or > or = 38.0 degrees C twice within 24 hours and granulocytopenia < or = 500/microL for less than 10 days. The primary end point was defined as defervescence after 72 hours followed by at least 7 afebrile days. Secondary end points were overall response, time to defervescence, survival on day 30, and toxicity. Thirty-four episodes were included. Fever of unknown origin accounted for 26 (76.5%) of the episodes, microbiologically defined infection for 5 (14.7%) of the episodes, and clinically defined infection for 3 (8.8%) of the episodes. On an intent-to-treat basis, all episodes were evaluable for the primary end point. Levofloxacin and piperacillin/tazobactam were successful after 72 hours of treatment in 76.5% and 88.3% of the episodes. Overall response was achieved in 94.1% and 100% of the episodes, respectively. One inpatient in the oral treatment group died of septic shock without identification of a causative pathogen. A larger phase III trial is warranted to further evaluate the lack of inferiority of the oral monotherapy regimen versus standard intravenous therapy.

[Hydroxyurea-induced pneumonitis]. / Hydroxyurea-induzierte Pneumonitis.

BACKGROUND: Hydroxyurea (HU) is a good-controllable and well-tolerated cytostatic drug. CASE REPORT: Two patients with a myeloproliferative disease, who suffered from fever, lung symptoms and reticulonodular infiltrates on both sides after 4 and 10 weeks of HU medication, are introduced. One patient additionally presented with multiple, 1-cm diameter, pustulous (central abscess-like), elevated, livid skin lesions on his forearms and shins. After discontinuance of the HU administration, symptoms vanished within 1-2 days, but could be reinduced by HU reexposition within hours. CONCLUSION: Nine cases with a pneumonitis (alveolitis or interstitial lung disease) have been described so far. In all cases, including ours, HU medication was usually administered over a 3- to 12-week period, mostly for 4 weeks (five of eleven cases). All patients showed a uniform illness with fever (11/11), chills (6/11), reticular or nodular infiltrates on both sides (11/11), small pleural effusions (5/11), and lung symptoms (11/11) such as dyspnea (10/11) or cough (5/11). Due to the acute or subacute onset, all cases were first misinterpreted as bacterial pneumonia.

A phase II study of dose-dense docetaxel and mitoxantrone in the treatment of patients with high-risk metastatic breast cancer.

Doxetaxel (DCT) and mitoxantrone (MX) are highly active and potentially synergistic agents in the treatment of metastatic breast cancer (MBC). This pilot study evaluates the combination of dose-dense DCT and MX in patients with MBC to determine the efficacy and toxicity of this therapy. Thirty-six patients (56.1+/-1.7 years) were studied. The patients received DCT (35 mg/m(2) q1w) and MX (6 mg/m(2) q2w) for 6 weeks of an 8-week interval. Patients with tumor response or stable disease (SD) continued the treatment for a maximum of two additional periods. Hematologic and non-hematologic parameters were determined using the WHO common toxicity score. During this study 14 patients (40%) experienced partial response, 14 (40%) SD. In 20% of the cases the disease progressed on therapy. The treatment with DCT and MX was well tolerated. Seventeen patients (47%) experienced grade 3 leukopenia. Other hematologic and non-hematologic side effects did not exceed grade 2. One patient died during therapy because of a pulmonary embolism, which was unlikely related to active agents. Dose-dense DCT and MX combines both clinical activity and convenience for the patient. Therefore, we conclude that this regimen is a promising therapy in MBC, which warrants confirmation by large-scale clinical trials.