Hematologic Neoplasms ; diagnosis ; therapy ; Humans

Dendritic Cells ; pathology ; Hematologic Neoplasms ; diagnosis ; therapy ; Humans

This study was aimed to analyze the clinical features, anti-fungal therapeutic efficacy and safety in hematological malignancy patients with invasive aspergillosis (IA) after hematopoietic stem cell transplantation (HSCT) or chemotherapy. The patients with hematological malignancies received chemotherapy or HSCT were analyzed retrospectively, then the clinical characteristics and diagnosis were analyzed according to the diagnostic criteria for IA. The efficacy and safety of anti- Aspergillus therapy, and the factors influencing therapeutic response were evaluated. The results showed that out of 30 cases with IA, 2 were proven, 19 were probable, 9 were possible, and 19 were diagnosed after HSCT, most in the late period after-HSCT (> 40 d). 8 cases received fluconazol only, 6 received caspofungin only, 7 received combined therapy. The efficacy and time interval from the first day of treatment to successful response (TTR) were 87.5%, 50% and 85.7% and 38, 20 and 36 days, respectively. Combined therapy is better than single drug treatment (p < 0.05) while the TTR was not significantly different between them. The factors influencing the therapeutic efficacy were as follows: age, HSCT, GVHD and CMV, previous IFI and so on (p < 0.05). All the anti- Aspergillus medicines resulted in some injury of hepatic and renal function. However, there were no significant difference between the drugs or between combination and single drug therapy (p > 0.05). It is concluded that IA is also the major and severe complication in the patients with hematological malignancies or received HSCT. Combined therapy for anti- aspergillus is better than single drug in efficacy and safety, without increasing the adverse drug reactions for hepatic and renal function. The efficacy of anti- aspergillus may be related to age, HSCT, GVHD and CMV, previous IFI and so on.
Adolescent ; Adult ; Antifungal Agents ; therapeutic use ; Aspergillosis ; complications ; diagnosis ; drug therapy ; Aspergillus ; Female ; Hematologic Neoplasms ; complications ; drug therapy ; microbiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

To investigate the clinical features and outcome of severe pneumonia after allogeneic hematopoietic stem cell transplantation for malignant hematological disease, the clinical features of severe pneumonia, including symptoms, signs, blood-gas analysis and thoracic X-ray change were observed, the clinical therapeutical outcome is also evaluated. The results showed that after treatment with antibiotics or antibiotics + antiviral drugs or antibiotics + antiviral drugs + glucocorticosteroids, as well as mechanical ventilation, pulmonary changes in 17 patients with sever pneumonia completely disappeared, 1 case died. In conclusion, early diagnosis and proper treatment for complicated pneumonia after allogeneic hematopoietic stem cell transplantation can decrease the mortality.
Adolescent ; Adult ; Female ; Hematologic Neoplasms ; therapy ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Male ; Middle Aged ; Pneumonia ; diagnosis ; etiology ; therapy ; Transplantation, Homologous

Primary mediastinal nonseminomatous germ cell tumor associated with Klinefelter's syndrome is a rare disorder. We experienced a case of recurred primary mediastinal nonseminomatous germ cell tumor developed in a 24-year-old patient with Klinefelter's syndrome. The patient had been treated with surgery and combination chemotherapy under the diagnosis of primary mediastinal nonseminomatous germ cell tumor before. A round mass was found on the right lower lung field in the chest X-ray during follow up. The patient was diagnosed as recurred primary nonseminomatous germ cell tumor and Klinefelter's syndrome through tumor markers, peripheral blood karyotyping, and other tests including hormonal assay and was treated with combination chemotherapy and surgery again. When the patient is diagnosed as primary mediastinal nonseminomatous germ cell tumor, Klinefelter's syndrome and hematologic malignancies should be considered to be associated diseases and vice versa.
Diagnosis ; Drug Therapy, Combination ; Follow-Up Studies ; Germ Cells* ; Hematologic Neoplasms ; Humans ; Karyotyping ; Klinefelter Syndrome* ; Lung ; Neoplasms, Germ Cell and Embryonal* ; Thorax ; Biomarkers, Tumor ; Young Adult

The objective of this study was to evaluate the etiological factors, diagnosis and therapy of pulmonary fungal infection in hematological malignancies, 14 cases of malignant hematological disease with pulmonary fungal infection were collected and analyzed. The results showed that 11 out of 14 cases had the respiratory manifestations, sputum was sticky and difficult to be expectorated in 7 cases, X rays in chests showed shadows with features of stigma and sheet in 11 cases, Candida albicans and aspergillus infection were observed in 10 and 2 cases respectively, the numbers of neutrophil were below 0.5 x 10(9)/L in 8 cases and below 1.0 x 10(9)/L in 3 cases respectively, fluconazole was used for 12 cases and clinical symptoms of 11 cases were improved within two weeks. In conclusion, the occurrence of pulmonary fungal infection in malignant hematological diseases is associated with intensive chemotherapy, decrease of neutrophil counts and using of broad-spectrum antibiotics, the diagnosis at early stage is difficult and clinicians should pay more attention to its clinical and laboratory examinations, and give them therapy in time.
Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Aspergillosis ; complications ; diagnosis ; drug therapy ; Candidiasis ; complications ; diagnosis ; drug therapy ; Female ; Fluconazole ; therapeutic use ; Hematologic Neoplasms ; drug therapy ; etiology ; pathology ; Humans ; Lung Diseases, Fungal ; complications ; diagnosis ; drug therapy ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVE: To analyze the clinical features of invasive fungal infection in patients with hematological malignancies and to compare the the therapeutic effect of fluconazole and intraconazole. METHODS: The clinical manifestations, mycological features, and the therapeutic results of 47 patients were retrospectively analyzed. Fluconazole was given to 17 paitents, intraconazole was given to 21 patients, and intraconazole to the other 9 patients after they had no effect with fluconazole. RESULTS: All patients had fever. The lung and the mouth cavity were the main locations of infection (53.2% and 21.3%, respectively). Fungi were found in 23 (48.9%) patients, in which the majority were Candida albicans and Aspergillus (56.5% and 26.1%, respectively). Intraconazole was more effective than fluconazole (63.3% vs. 34.6%, P<0.05) with no serious side effect. CONCLUSION The most common clinical features of IFI are fever, lung infection, and oral infection in patients with hematological malignancies. Candida albicans and Aspergillus infection are common. Intraconazole is safe and effective for invasive fungal infection.
Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Aspergillosis ; complications ; diagnosis ; drug therapy ; Candidiasis ; complications ; diagnosis ; drug therapy ; Female ; Fluconazole ; therapeutic use ; Hematologic Neoplasms ; microbiology ; Humans ; Itraconazole ; therapeutic use ; Lung Diseases, Fungal ; complications ; diagnosis ; drug therapy ; Male ; Middle Aged

Due to advances in the treatment and diagnosis of cancer, many women survive long after treatment, and therefore express concerns about the impact of estrogen deficiency on their quality of life. Cancer treatment can induce menopause through surgical removal of the ovaries, chemotherapy, or radiation. Women who undergo induced menopause usually experience more sudden and severe menopausal symptoms, including vasomotor symptoms, psychological symptoms, genitourinary symptoms, cardiovascular disease, and osteoporosis. Menopausal hormone therapy (MHT) is especially important in women younger than 40. In this review, we consider the role of MHT after the diagnosis of breast, gynecologic, colorectal, stomach, liver, lung, and hematologic cancers. MHT is advantageous in endometrial cancer type I, cervical squamous cell carcinoma, colorectal cancer, hepatocellular carcinoma, and hematologic malignancies. However, MHT is not recommended for use in breast cancer, endometrial stromal sarcoma, hormone receptor–positive gastric cancer, and lung cancer survivors because it is linked to an increased risk of cancer recurrence. Depending on the type of cancer, clinicians should recommend that cancer survivors receive appropriate MHT in order to reduce vasomotor symptoms and to benefit from its positive effects on the cardiovascular and skeletal systems.
Breast ; Breast Neoplasms ; Carcinoma, Hepatocellular ; Carcinoma, Squamous Cell ; Cardiovascular Diseases ; Colorectal Neoplasms ; Diagnosis ; Drug Therapy ; Endometrial Neoplasms ; Estrogens ; Female ; Hematologic Neoplasms ; Humans ; Liver ; Lung ; Lung Neoplasms ; Menopause ; Osteoporosis ; Ovary ; Quality of Life ; Recurrence ; Sarcoma, Endometrial Stromal ; Stomach ; Stomach Neoplasms ; Survivors

OBJECTIVETo summarize the clinical experience and evaluate the efficacy of haploidentical HSCT.

METHODSThe survival rates of 156 patients receiving either haploidentical (83 cases) or HLA-identical (73 cases) transplantation for hematologic diseases were compared and risk factors related to overall survival (OS) were analyzed.

RESULTSHLA-identical and haploidentical cohorts were not statistically different in the hematopoietic reconstitution, incidence of acute and chronic graft-versus-host disease (GVHD), OS, disease-free survival (DFS), relapse and treatment-related mortality (TRM) after transplantation. Multivariate analysis showed that advanced disease status, relapse and grade III-IV acute GVHD were independent prognostic indictors for OS with relative risk (RR) of 4.8 (95% CI 2.2-10.1), 4.3 (95% CI 2.6-8.0) and 3.3 (95% CI 1.6-7.0), respectively (P<0.05).

CONCLUSIONHaploidentical transplantation with the present conditioning can achieve the therapeutic effects comparable to HLA-identical sibling transplantation. Disease status before transplantation and the presence or not of severe GVHD after transplantation have important significance for the long-term survival after transplantation.

Disease-Free Survival ; Graft vs Host Disease ; epidemiology ; Hematologic Neoplasms ; diagnosis ; therapy ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Prognosis ; Recurrence ; Risk Factors ; Siblings ; Survival Analysis ; Treatment Outcome

OBJECTIVETo analyze the impact of the time to hematopoietic reconstitution on the prognosis of hematological malignancies after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODS173 patients with hematological malignancies treated with allo-HSCT (excluding umbilical cord blood transplantation) at Peking University first Hospital between 2003 and 2011 were analyzed retrospectively. According to the median time to neutrophil and platelet engraftment, the patients were divided into tow groups. The 5-year overall survival (OS), transplant-related mortality (TRM), relapse rate (RR) and prognostic factors were analyzed.

RESULTSThe quicker neutrophil engraftment group with an estimated 5-year OS rate of 66.63%, 5-year TRM of 21.58% and 5-year RR of 18.65%. The slower neutrophil engraftment group with OS of 61.84%, TRM of 24.14% and RR of 23.57%. Univariate analysis demonstrated that no relationship was found between time to neutrophil engraftment and OS, TRM and RR (P = 0.462, P = 0.893, P = 0.545, respectively). There seems to be a trend toward increasing incidence of OS in quicker platelet engraftment group(OS were 69.44% and 54.31%, respectively), but no significant difference (P = 0.065). TRM were 19.13% and 25.45%, respectively (P = 0.424), RR were 17.36% and 24.71%, respectively (P = 0.251). Multivariate analyses showed that the time to neutrophil engraftment was not a significant risk factor for prognosis, the time to platelet engraftment was an independent risk factor for OS and TRM, but not a significant risk factor for RR. Pre-transplantation disease status was the only independent prognostic factor for RR.

CONCLUSIONSThe time to platelet engraftment was a significant predictor after allo-HSCT. Early platelet engraftment increased OS, which this may be due to decreasing TRM.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Hematologic Neoplasms ; diagnosis ; therapy ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Transplantation, Homologous ; Treatment Outcome ; Young Adult