AIMS: To evaluate antibody response to mRNA vaccine, identify subgroups with poor response and to determine long-term antibody durability in hematological patients. MATERIALS AND METHODS: We have vaccinated 292 patients with all hematological malignancies with a third dose of mRNA COMIRNATY vaccine with a 12-month follow-up period in our center in Ostrava, Czech Republic. RESULTS: Antibody response for the whole cohort exceeded 74% through the whole 12-month follow-up. Lowest seroconversion was observed in CLL cohort (20/41, 48.8%), patients who received anti-CD20 therapy < 6 months before vaccination (8/30, 26.7%) and BTK inhibitors (3/6, 50.0%). On the contrary, patients with chronic myeloproliferative neoplasms and acute leukemia performed comparably with healthy population (33/33; 100% and 12/13; 92.3%, respectively). We have seen better results if the time interval between anti-CD20 therapy and additional vaccine dose was longer than 6 months (5/8 patients achieved seroconversion on 4th booster dose after previous failure). Also, 36 patients received a 4th dose of vaccine as a booster with measurable increase in protective antibodies in 50% (18/36). CONCLUSIONS: Additional doses show promise for a well-timed revaccination even in poor responders. To our knowledge, no study comparable to our work in terms of follow-up length, vaccine consistency or variety of hematological malignancies and/or treatment has been reported yet. Our findings shed more light on long-term antibody response to mRNA vaccines against SARS-CoV-2 in patients with hematological cancer and bring important data for the evaluation of possible vaccine failure and scheduling of subsequent doses.
- MeSH
- časové faktory MeSH
- COVID-19 * prevence a kontrola imunologie MeSH
- dospělí MeSH
- hematologické nádory * imunologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mRNA vakcíny MeSH
- následné studie MeSH
- protilátky virové * krev imunologie MeSH
- SARS-CoV-2 * imunologie MeSH
- sekundární imunizace * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vakcíny proti COVID-19 * imunologie aplikace a dávkování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Patients with chronic lymphocytic leukemia (CLL) have a higher risk of developing other malignancies (OMs) compared to the general population. However, the impact of CLL-related risk factors and CLL-directed treatment is still unclear and represents the focus of this work. METHODS: We conducted a retrospective international multicenter study to assess the incidence of OMs and detect potential risk factors in 19,705 patients with CLL, small lymphocytic lymphoma, or high-count CLL-like monoclonal B-cell lymphocytosis, diagnosed between 2000 and 2016. Data collection took place between October 2020 and March 2022. FINDINGS: In 129,254 years of follow-up after CLL diagnosis, 3513 OMs were diagnosed (27.2 OMs/1000 person-years). The most common hematological OMs were Richter transformation, myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Non-melanoma skin (NMSC) and prostate cancers were the most common solid tumors (STs).The only predictor for MDS and AML development was treatment with fludarabine and cyclophosphamide with/without rituximab (FC ± R) (OR = 3.7; 95% CI = 2.79-4.91; p < 0.001). STs were more frequent in males and patients with unmutated immunoglobulin heavy variable genes (OR = 1.77; 95% CI = 1.49-2.11; p < 0.001/OR = 1.89; 95% CI = 1.6-2.24; p < 0.001).CLL-directed treatment was associated with non-melanoma skin and prostate cancers (OR = 1.8; 95% CI = 1.36-2.41; p < 0.001/OR = 2.11; 95% CI = 1.12-3.97; p = 0.021). In contrast, breast cancers were more frequent in untreated patients (OR = 0.17; 95% CI = 0.08-0.33; p < 0.001).Patients with CLL and an OM had inferior overall survival (OS) than those without. AML and MDS conferred the worst OS (p < 0.001). INTERPRETATION: OMs in CLL impact on OS. Treatment for CLL increased the risk for AML/MDS, prostate cancer, and NMSC. FCR was associated with increased risk for AML/MDS. FUNDING: AbbVie, and EU/EFPIAInnovative Medicines Initiative Joint Undertaking HARMONY grant n° 116026.
- Publikační typ
- časopisecké články MeSH
Immunotherapy is the new hope for longer survival for patients with small cell lung cancer. So far, it has only been given in trials, but 2022 has become a breakthrough year. In comprehensive cancer centers, these patients have a chance of receiving reimbursed treatment with durvalumab (with chemotherapy). Our case report focuses on the appropriateness of patient selection for this treatment, as long-term experience outside clinical trials is still limited.
Several years ago, a major change occurred in the treatment of chronic lymphocytic leukemia. New molecules - B-cell receptor inhibitors and inhibitors of antiapoptotic protein Bcl-2 - have entered common clinical practice. These oral agents are gradually replacing conventional immunochemotherapy. Venetoclax is currently the only approved Bcl-2 protein inhibitor in the Czech Republic. It can be administered in monotherapy in patients after treatment failure with B-cell receptor inhibitors or in combination with anti-CD20 monoclonal antibody in both primary and relapse treatment. A major advantage of venetoclax is the potential to achieve deep remission, including undetectable minimal residual disease.
- Klíčová slova
- venetoclax,
- MeSH
- chronická lymfatická leukemie * farmakoterapie genetika MeSH
- geny bcl-1 fyziologie účinky léků MeSH
- geny bcl-2 fyziologie účinky léků MeSH
- lidé MeSH
- protinádorové látky imunologicky aktivní MeSH
- protokoly protinádorové kombinované chemoterapie klasifikace MeSH
- rituximab farmakologie terapeutické užití MeSH
- senioři MeSH
- syndrom nádorového rozpadu MeSH
- úhrada zdravotního pojištění MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
Idelalisib (idela), a phosphatidylinositol 3-kinase inhibitor, and ibrutinib, a Bruton tyrosine kinase inhibitor, were the first oral targeted agents approved for relapsed/refractory (R/R) chronic lymphocytic leukaemia (CLL). However, no randomised trials of idelalisib plus rituximab (R-idela) versus ibrutinib have been conducted. Therefore, we performed a real-world retrospective analysis of patients with R/R CLL treated with R-idela (n = 171) or ibrutinib (n = 244). The median age was 70 versus 69 years, with a median of two previous lines. There was a trend towards higher tumour protein p53 (TP53) aberrations and complex karyotype in the R-idela group (53% vs. 44%, p = 0.093; 57% vs. 46%, p = 0.083). The median progression-free survival (PFS) was significantly longer with ibrutinib (40.5 vs. 22.0 months; p < 0.001); similarly to overall survival (OS; median 54.4 vs. 37.7 months, p = 0.04). In multivariate analysis, only PFS but not OS remained significantly different between the two agents. The most common reasons for treatment discontinuation included toxicity (R-idela, 39.8%; ibrutinib, 22.5%) and CLL progression (27.5% vs. 11.1%). In conclusion, our data show significantly better efficacy and tolerability of ibrutinib over R-idela in patients with R/R CLL treated in routine practice. The R-idela regimen may still be considered a reasonable option in highly selected patients without a suitable treatment alternative.
- MeSH
- chronická lymfatická leukemie * MeSH
- lidé MeSH
- recidiva MeSH
- registrace MeSH
- retrospektivní studie MeSH
- rituximab MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Patients with chronic lymphocytic leukemia (CLL) have a high risk of poor outcomes related to coronavirus disease 2019 (COVID-19). This multicenter cohort study evaluated the impact of COVID-19 infection on the population of CLL patients in the Czech Republic. Between March 2020 and May 2021, 341 patients (237 males) with CLL and COVID-19 disease were identified. The median age was 69 years (range 38-91). Out of the 214 (63%) patients with the history of therapy for CLL, 97 (45%) were receiving CLL-directed treatment at diagnosis of COVID-19: 29% Bruton tyrosine kinase inhibitor (BTKi), 16% chemoimmunotherapy (CIT), 11% Bcl-2 inhibitor, and 4% phosphoinositide 3-kinase inhibitor. Regarding the severity of COVID-19, 60% pts required admission to the hospital, 21% pts were admitted to the intensive care unit (ICU), and 12% received invasive mechanical ventilation. The overall case fatality rate was 28%. Major comorbidities, age over 72, male gender, CLL treatment in history, CLL-directed treatment at COVID-19 diagnosis were associated with increased risk of death. Of note, concurrent therapy with BTKi compared to CIT was not associated with better outcome of COVID-19.
- MeSH
- chronická lymfatická leukemie * farmakoterapie epidemiologie MeSH
- COVID-19 * komplikace MeSH
- dospělí MeSH
- fosfatidylinositol-3-kinasy MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- testování na COVID-19 MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Česká republika MeSH
Rosai-Dorfmanova nemoc, známá jako sinusová histiocytóza s masivní lymfadenopatií, patří ke vzácným hematologickým onemocněním s prevalencí 1 : 200 000. Poprvé byla popsána v druhé polovině 20. století a byla pojmenována podle svých objevitelů Juana Rosaie a Ronalda Dorfmana.1 Nejčastěji se vyskytuje u dětí a mladých dospělých, především ve věku kolem 20 let. Vklinickém obrazu nemoci dominuje bilaterální nebolestivá krční lymfadenopatie, s nebo bez intermitentních horeček, nočních potů a úbytku hmotnosti. Diagnóza je založena na histologické verifikaci. Charakteristickým znakem jsou histiocyty s pozitivním proteinem S100, CD68, CD163. 3,7,8 V naší kazuistice předkládáme případ 65letého pacienta s generalizovanou lymfadenopatií, slabostí, horečkami a bolestmi hlavy. Diagnostický proces byl od počátku náročný, prvotní výsledky vedly diferenciální diagnostiku různými směry, zahrnujícími neuroinfekci, pneumonii či lymfom. Série nespecifických výsledků, zahrnujících i opakované biopsie, způsobily oddálení diagnózy a prodloužení hospitalizace. Po opakovaných důsledných revizích výsledků, konzultacích se specialisty a opakovaných čteních histologických preparátů jsme dospěli k raritní klinické entitě: Rosai-Dorfmanově nemoci.
Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, belongs to a group of rare haematological diseases with a prevalence of 1:200 000. It was first described in the second half of the 20th century by Juan Rosai and Ronald Dorfman. Children and young adults are the most frequently affected age group, especially around the 20th year of age. In the clinical aspect of the disease, painless lymphadenopathy of the neck dominates in alarge spectrum of clinical signs. Diagnosis isbased on histological verification. Trademark of the disease are histiocytes positive for protein S100, CD68, CD163. In our case report, we present a55-year-old patient with generalised lymphadenopathy, fever, malaise and headache. The diagnostic process was arduous from the start with findings leading differential diagnosis on various paths including neural infection, pneumonia, and lymphoma. Several inconclusive results, with numerous biopsies among them, were responsible for the prolonged diagnosis and hospital stay. After a careful review of acquired results, frequent consultations with specialists and repeated reviews of histological findings, we were able to diagnose our patient with a rare clinical entity: Rosai-Dorfman disease.
- MeSH
- bronchoalveolární laváž MeSH
- kladribin terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfadenopatie * diagnóza etiologie terapie MeSH
- prednison terapeutické užití MeSH
- rituximab terapeutické užití MeSH
- sinusová histiocytóza * diagnóza etiologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Vydání první 140 stran : barevné ilustrace ; 30 cm
Vysokoškolská učebnice, která se zaměřuje na hematologii a laboratorní diagnostiku.
- Konspekt
- Patologie. Klinická medicína
- Učební osnovy. Vyučovací předměty. Učebnice
- NLK Obory
- hematologie a transfuzní lékařství
- NLK Publikační typ
- učebnice vysokých škol
