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The Chicago Medical Journal 1867
PubMed: 37412993
DOI: No ID Found -
The Hospital Apr 1890
PubMed: 29826825
DOI: No ID Found -
Blood Advances Jun 2023The POLARIX trial demonstrated the superiority of polatuzumab vedotin (Pola) over vincristine in the rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone... (Clinical Trial)
Clinical Trial
The POLARIX trial demonstrated the superiority of polatuzumab vedotin (Pola) over vincristine in the rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP) regimen for large B-cell lymphomas, but it is unknown whether Pola can be safely incorporated into intensified regimens (eg, dose-adjusted [DA]-EPOCH-R [etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab]) typically used for the highest risk histologies. This was a single-center, open-label, prospective clinical trial of 6 cycles of Pola-DA-EPCH-R (vincristine omitted) in aggressive large B-cell lymphomas. The primary end point was to estimate the safety of Pola-DA-EPCH-R as measured by the rate of dose-limiting toxicities (DLTs) in the first 2 cycles with prespecified suspension rules. Secondary and exploratory end points included efficacy and correlation with circulating tumor DNA (ctDNA) levels. We enrolled 18 patients on study, and with only 3 DLTs observed, the study met its primary end point for safety. There were 5 serious adverse events, including grade 3 febrile neutropenia (3, 17%), grade 3 colonic perforation in the setting of diverticulitis, and grade 5 sepsis/typhlitis. Among 17 evaluable patients, the best overall response rate was 100%, and the complete response rate was 76%. With a median follow-up of 12.9 months, 12-month event-free survival was 72%, and 12-month overall survival was 94%. No patient with undetectable ctDNA at the end of treatment has relapsed to date. Using Pola to replace vincristine in the DA-EPOCH-R regimen met its primary safety end point. These data support the further evaluation and use of this approach in histologies where the potential benefit of both an intensified regimen and Pola may be desired. This trial was registered at www.clinicaltrials.gov as #NCT04231877.
Topics: Humans; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Doxorubicin; Etoposide; Lymphoma, Large B-Cell, Diffuse; Prednisone; Prospective Studies; Rituximab; Vincristine
PubMed: 36521030
DOI: 10.1182/bloodadvances.2022009145 -
Mediterranean Journal of Hematology and... 2015Bacterial infections are major complications after Hematopoietic Stem Cell Transplant (HSCT). They consist mainly of bloodstream infections (BSI), followed by pneumonia... (Review)
Review
Bacterial infections are major complications after Hematopoietic Stem Cell Transplant (HSCT). They consist mainly of bloodstream infections (BSI), followed by pneumonia and gastrointestinal infections, including typhlitis and Clostridium difficile infection. Microbiological data come mostly from BSI. Coagulase negative staphylococci and Enterobacteriaceae are the most frequent pathogens causing approximately 25% of BSI each, followed by enterococci, P. aeruginosa and viridans streptococci. Bacterial pneumonia is frequent after HSCT, and Gram-negatives are predominant. Clostridium difficile infection affects approximately 15% of HSCT recipients, being more frequent in case of allogeneic than autologous HSCT. The epidemiology and the prevalence of resistant strains vary significantly between transplant centres. In some regions, multi-drug resistant (MDR) Gram-negative rods are increasingly frequent. In others, vancomycin-resistant enterococci are predominant. In the era of increasing resistance to antibiotics, the efficacy of fluoroquinolone prophylaxis and standard treatment of febrile neutropenia have been questioned. Therefore, a thorough evaluation of local epidemiology is mandatory to decide the need for prophylaxis and the choice of the best regimen for empirical treatment of febrile neutropenia. For the latter, individualised approach has been proposed, consisting of either escalation or de-escalation strategy. De-escalation strategy is recommended since resistant bacteria should be covered upfront, mainly in patients with severe clinical presentation and previous infection or colonisation with a resistant pathogen. Non-pharmacological interventions, such as screening for resistant bacteria, applying isolation and contact precautions should be put in place to limit the spread of MDR bacteria. Antimicrobial stewardship program should be implemented in transplant centres.
PubMed: 26185610
DOI: 10.4084/MJHID.2015.045 -
Cancer Jul 2005Typhlitis is increasingly recognized in children undergoing chemotherapy but is poorly characterized. The authors investigated the demographic, clinical, and imaging...
BACKGROUND
Typhlitis is increasingly recognized in children undergoing chemotherapy but is poorly characterized. The authors investigated the demographic, clinical, and imaging (ultrasonography and computed tomography [CT] scans) variables related to the diagnosis, risk, and outcome of typhlitis.
METHODS
The authors reviewed the records of patients who had typhlitis (bowel wall thickness > or = 0.3 cm plus clinical findings) during treatment at St. Jude Children's Research Hospital (Memphis, TN) between 1990 and 2001. They assessed whether duration of typhlitis was related to bowel wall thickness, extent of colonic involvement, ascites, demographics, primary diagnosis, symptoms of typhlitis, or duration of neutropenia. To identify risk factors for typhlitis, the authors compared the demographic data and previous drug therapy of 78 patients who had typhlitis and 1231 identically treated children who did not.
RESULTS
Of 3171 children, 83 (2.6%) developed typhlitis. Frequent symptoms were abdominal pain (91%), fever (84%), abdominal tenderness (82%), and diarrhea (72%). Twelve percent of the patients were not neutropenic. Duration of typhlitis was associated with bowel wall thickness measured by ultrasonography (n = 68; P = 0.05) but not CT scan (n = 48; P = 0.67) and was associated with duration of neutropenia (P = 0.02), fever (P = 0.01), and abdominal tenderness (P = 0.04). Age >16 years at cancer diagnosis was the only demographic factor associated with typhlitis (P = 0.03). Two patients died of typhlitis.
CONCLUSIONS
Ultrasonography was a useful imaging modality for children with suspected typhlitis. The classic triad of abdominal pain, fever, and neutropenia may be absent. The severity of typhlitis was related to the duration of neutropenia and the presence of fever or abdominal tenderness.
Topics: Adolescent; Adult; Age Factors; Antineoplastic Agents; Child; Child, Preschool; Enterocolitis, Necrotizing; Ethnicity; Female; Humans; Infant; Male; Neoplasms; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography
PubMed: 15952190
DOI: 10.1002/cncr.21134 -
JCO Clinical Cancer Informatics Sep 2022Adverse events (AEs) on Children's Oncology Group (COG) trials are manually ascertained using Common Terminology Criteria for Adverse Events. Despite significant effort,...
PURPOSE
Adverse events (AEs) on Children's Oncology Group (COG) trials are manually ascertained using Common Terminology Criteria for Adverse Events. Despite significant effort, we previously demonstrated that COG typhlitis reporting sensitivity was only 37% when compared with gold standard physician chart abstraction. This study tested an automated typhlitis identification algorithm using electronic health record data.
METHODS
Electronic health record data from children with leukemia age 0-22 years treated at a single institution from 2006 to 2019 were included. Patients were divided into derivation and validation cohorts. Rigorous chart abstraction of validation cohort patients established a gold standard AE data set. We created an automated algorithm to identify typhlitis matching Common Terminology Criteria for Adverse Events v5 that included antibiotics, neutropenia, and non-negated mention of typhlitis in a note. We iteratively refined the algorithm using the derivation cohort and then applied the algorithm to the validation cohort; performance was compared with the gold standard. For patients on trial AAML1031, COG AE report performance was compared with the gold standard.
RESULTS
The derivation cohort included 337 patients. The validation cohort included 270 patients (961 courses). Chart abstraction identified 16 courses with typhlitis. The algorithm identified 37 courses with typhlitis; 13 were true positives (sensitivity 81.3%, positive predictive value 35.1%). For patients on AAML1031, chart abstraction identified nine courses with typhlitis, and COG reporting correctly identified 4 (sensitivity 44.4%, positive predictive value 100.0%).
CONCLUSION
The automated algorithm identified true cases of typhlitis with higher sensitivity than COG reporting. The algorithm identified false positives but reduced the number of courses needing manual review by 96% (961 to 37) by detecting potential typhlitis. This algorithm could provide a useful screening tool to reduce manual effort required for typhlitis AE reporting.
Topics: Adolescent; Adult; Algorithms; Anti-Bacterial Agents; Child; Child, Preschool; Electronic Health Records; Humans; Infant; Infant, Newborn; Predictive Value of Tests; Typhlitis; Young Adult
PubMed: 36198128
DOI: 10.1200/CCI.22.00081 -
Medicina (Kaunas, Lithuania) Jun 2021Neutropenic enterocolitis (NE), which in the past was also known as typhlitis or ileocecal syndrome for the segment of the gastrointestinal tract most affected, is a... (Review)
Review
Neutropenic enterocolitis (NE), which in the past was also known as typhlitis or ileocecal syndrome for the segment of the gastrointestinal tract most affected, is a nosological entity that is difficult to diagnose and whose pathogenesis is not fully known to date. Initially described in pediatric patients with leukemic diseases, it has been gradually reported in adults with hematological malignancies and non-hematological conditions, such as leukemia, lymphoma, multiple myeloma, aplastic anemia, and also myelodysplastic syndromes, as well as being associated with other immunosuppressive causes such as AIDS treatment, therapy for solid tumors, and organ transplantation. Therefore, it is associated with high mortality due to the rapid evolution in worse clinical pictures: rapid progression to ischemia, necrosis, hemorrhage, perforation, multisystem organ failure, and sepsis. : A case report is included to exemplify the clinical profile of patients with NE who develop sepsis. : To identify a specific profile of subjects affected by neutropenic enterocolitis and the entity of the clinical condition most frequently associated with septic evolution, a systematic review of the literature was conducted. The inclusion criteria were as follows: English language, full-text availability, human subjects, and adult subjects. Finally, the papers were selected after the evaluation of the title and abstract to evaluate their congruity with the subject of this manuscript. Following these procedures, 19 eligible empirical studies were included in the present review. : Despite the recent interest and the growing number of publications targeting sepsis and intending to identify biomarkers useful for its diagnosis, prognosis, and for the understanding of its pathogenesis, and especially for multi-organ dysfunction, and despite the extensive research period of the literature review, the number of publications on the topic "neutropenic enterocolitis and sepsis" appears to be very small. In any case, the extrapolated data allowed us to conclude that the integration of medical history, clinical and laboratory data, radiological imaging, and macroscopic and histological investigations can allow us to identify a specific pathological profile.
Topics: Adult; Child; Enterocolitis, Neutropenic; Humans; Lymphoma; Neoplasms; Prognosis; Sepsis
PubMed: 34203105
DOI: 10.3390/medicina57060638 -
Acta Medica Portuguesa Jan 1994Typhlitis, ileocecal syndrome and neutropenic enterocolitis are different terms, of what seems to be a localized infection in the cecal mucosa, caused by Clostridia...
Typhlitis, ileocecal syndrome and neutropenic enterocolitis are different terms, of what seems to be a localized infection in the cecal mucosa, caused by Clostridia species. Initially described in neutropenic patients, with leukaemias or after antineoplastic chemotherapy, typhlitis can also occur in HIV patients, as in the present case report. Their early diagnosis is not easy, becoming particularly difficult in immunodepressed patients, whom can be affected by multiple problems causing similar symptoms. Treatment, as well, can be problematic, and aggressive medical treatment should be pursued. If some patients may need surgery, others might be submitted to unnecessary surgical procedures. In the long range, medical control of this situation can be very difficult.
Topics: Enterocolitis; Humans; Male; Middle Aged
PubMed: 8184721
DOI: No ID Found -
The Hospital Mar 1891
PubMed: 29821410
DOI: No ID Found -
Revue Scientifique Et Technique... Aug 2000Fowl typhoid (FT) and pullorum disease (PD) are septicaemic diseases, primarily of chickens and turkeys, caused by Gram negative bacteria, Salmonella Gallinarum and S.... (Review)
Review
Fowl typhoid (FT) and pullorum disease (PD) are septicaemic diseases, primarily of chickens and turkeys, caused by Gram negative bacteria, Salmonella Gallinarum and S. Pullorum, respectively. Clinical signs in chicks and poults include anorexia, diarrhoea, dehydration, weakness and high mortality. In mature fowl, FT and PD are manifested by decreased egg production, fertility, hatchability and anorexia, and increased mortality. Gross and microscopic lesions due to FT and PD in chicks and poults include hepatitis, splenitis, typhlitis, omphalitis, myocarditis, ventriculitis, pneumonia, synovitis, peritonitis and ophthalmitis. In mature fowl, lesions include oophoritis, salpingitis, orchitis, peritonitis and perihepatitis. Transovarian infection resulting in infection of the egg and subsequently the chick or poult is one of the most important modes of transmission of these two diseases. Salmonella Gallinarum and S. Pullorum can be isolated by use of selective and non-selective media. Salmonella Pullorum produces rapid decarboxylation of ornithine whereas S. Gallinarum does not, an important biochemical difference between the two bacteria. Both FT and PD can be detected serologically by use of a macroscopic tube agglutination test, rapid serum test, stained antigen whole blood test or microagglutination test. Both diseases can be controlled and eradicated by use of serological testing and elimination of positive birds. Vaccines may be used to control the disease and antibiotics for the treatment of FT and PD. Although FT and PD are widely distributed throughout the world, the diseases have been eradicated from commercial poultry in developed countries such as the United States of America, Canada and most countries of Western Europe. Both S. Gallinarum and S. Pullorum are highly adapted to the host species, and therefore are of little public health significance.
Topics: Animals; Chickens; Poultry Diseases; Salmonella Infections, Animal; Turkeys
PubMed: 10935271
DOI: 10.20506/rst.19.2.1222