Didem S. Dede

Rituximab-related viral infections in lymphoma patients.

Recently, a human/mouse chimeric monoclonal antibody, rituximab, has been successfully used to treat cases of B-cell non-Hodgkins lymphoma and some autoimmune diseases. However, several viral infections related to rituximab have been reported in the literature, but were not well characterized. To further investigate this topic, relevant English language studies were identified through Medline. There were 64 previously reported cases of serious viral infection after rituximab treatment. The median age of the cases was 61 years (range: 21 – 79). The median time period from the start of rituximab treatment to viral infection diagnosis was 5.0 months (range: 1 – 20). The most frequently experienced viral infections were hepatitis B virus (HBV) (39.1%, n = 25), cytomegalovirus infection (CMV) (23.4%, n = 15), varicella-zoster virus (VZV) (9.4%, n = 6), and others (28.1%, n = 18). Of the patients with HBV infections, 13 (52.0%) died due to hepatic failure. Among the 39 cases that had viral infections other than HBV, 13 died due to these specific infections. In this study, about 50% of the rituximab-related HBV infections resulted in death, whereas this was the case in only 33% of the cases with other infections. Close monitoring for viral infection, particularly HBV and CMV, in patients treated with rituximab should be recommended.

Assessment of Endothelial Function in Alzheimer's Disease: Is Alzheimer's Disease a Vascular Disease?

OBJECTIVES: To compare endothelial function of people with Alzheimers disease (AD) with that of people without.

Rhabdomyolysis in a Patient Treated with Colchicine and Atorvastatin

Objective: To report a case of severe rhabdomyolysis that developed after administration of atorvastatin to a patient receiving regular colchicine treatment. Case Summary: A 45-year-old man with nephrotic syndrome and amyloidosis presented with dyspnea, altered mentation, and severe fatigue. He had been taking colchicine 1.5 mg/day for amyloidosis for 3 years without adverse effects. Atorvastatin 10 mg/day was prescribed for hypercholesterolemia one month prior to admission. After 2 weeks of atorvastatin treatment, he began to experience myalgia and reduced muscle strength. The creatinine and creatine kinase concentrations on admission were 8.1 mg/dL and 9035 U/L, respectively. The patient was diagnosed with rhabdomyolysis with the findings of myoglobinuric, oliguric acute renal failure, and more than 50–fold elevated creatine kinase concentration. His muscle strength improved after withdrawal of atorvastatin and colchicine. However, he died because of nosocomial pneumonia that developed during his hospital stay. The Naranjo probability scale indicated that atorvastatin and colchicine were probable causes of rhabdomyolysis. Discussion: Atorvastatin and colchicine have well-known myotoxic adverse effects. Despite atorvastatins proven safety, its use with certain drugs, such as colchicine, makes it a potential myotoxic drug. This might be because concomitant administration of P-glycoprotein substrates, such as statins, and colchicine, which is a P-glycoprotein inhibitor, modifies pharmacokinetics by increasing bioavailability and organ uptake of the substrates, leading to more adverse reactions and toxicities. Conclusions: We recommend checking the creatine kinase level one week after prescribing 2 or more potentially myotoxic drugs concomitantly, after dose increase of a myotoxic drug, or after prescribing a new drug to a patient already using other myotoxic agents.

Platelet size has diagnostic predictive value for bone marrow metastasis in patients with solid tumors

Though not very common, solid tumor involvement of the bone marrow (BM) may have serious consequences. Recent studies have shown that mean platelet volume (MPV) is a good indicator for BM disease in the differential diagnosis of thrombocytopenia. We investigated the significance of MPV in the diagnosis of BM metastasis in patients with solid tumors. Patients with histologically‐verified solid tumors for whom BM biopsy specimens were available (n = 121) and healthy controls (n = 62) were included in this retrospective study. A total of 183 individuals were analyzed. Of the patients, 61 had a diagnosis of BM metastasis (Group A), 60 did not have BM metastasis (Group B). Group B and C (healthy controls) constituted the control group without BM metastasis (n = 122). The mean MPV was 7.0 ± 0.8 fl in patients with BM metastasis and 8.4 fl in the control group (P < 0.001). A cut‐off point of <7.4 fl was found to have significant predictive value according to receiver‐operating characteristics curve analysis. This cut‐off point had 85% positive predictive value and 90% negative predictive value in the diagnosis of BM metastasis (odds ratio: 53; 95% confidence interval: 20–135), and a sensitivity of 82.7% and specificity of 89.6%. MPV can be used as a reliable marker to guide the clinician as to the likely presence or absence of BM metastasis in patients with solid tumors.

Characteristics of Breast Cancer Patients with Central Nervous System Metastases: A Single-Center Experience

The aim of this study was to assess the characteristics of breast cancer patients with central nervous system (CNS) metastases and factors associated with survival after development of CNS metastasis. One-hundred-forty-four patients with brain metastases were retrospectively analyzed. Median age at the time of brain metastasis diagnosis was 48.9. Median time between initial diagnosis and development of brain metastasis was 36 months. Fourteen cases had leptomeningeal involvement. Twenty-two patients (15.3%) had single metastasis. Ten percent of the patients had surgery, 94% had radiotherapy and 63% had chemotherapy. Median survival after development of brain metastasis was 7.4 months. Survival of patients with single metastasis was significantly longer than those with multiple metastases (33.5 vs. 6.5 months, p = 0.0006). Survival of patients who received chemotherapy was significantly longer than those who received radiotherapy alone (9.9 vs. 2 months, p < 0.0001). In multivariate Cox regression analyses, presence of single metastasis and application of chemotherapy were the only significant factors associated with better survival (p = 0.047 and p < 0.0001, respectively). Age at initial diagnosis or at the time of brain metastasis, time from initial diagnosis to development of brain metastasis, menopausal status, tumor stage, grade, hormone receptor or HER2 status individually were not associated with survival. In this study, survival after the diagnosis of CNS metastases appeared to be affected by patient characteristics rather than biologic characteristics of the tumor. This is probably secondary to the lack of effective treatment options in these patients and overall poor prognosis.

Blood ABO groups and risk of breast cancer

To the editor ABO blood group has been previously found to be associated with the risk of gastrointestinal malignancies including gastric cancer and pancreas cancer [1, 2]. However, there is no data about the association of breast cancer with ABO blood groups. Thus, we aimed to investigate the relationship between ABO blood group and breast cancer risk by comparing the blood groups of breast cancer patients with healthy female donors in a cross-sectional model. Patients with breast cancer (n = 565) who were admitted to our clinic between 2004 and 2009 were retrospectively evaluated. The control group comprised healthy female blood-bank donors (n = 1853). The frequency of distributions of ABO blood groups and Rh types was nearly identical among the patients and the controls (Table 1). When the clinical and pathological characteristics of the patients with different blood groups were compared, again no significant difference was observed considering age at the time of diagnosis, menopausal state, disease stage, hormone receptor and HER2 expression, tumor size, lymph node involvement, lymphovascular/perineural invasion and tumor grade. In conclusion, there seems to be no association between ABO blood type and the risk of breast cancer or any specific clinical or pathological feature of breast cancer in our patient population.

Dasatinib may also inhibit c-Kit in triple negative breast cancer cell lines

In their interesting paper, Finn et al. [1] reported that dasatinib selectively inhibits growth of basal-type/’’triplenegative’’ breast cancer cell lines growing in vitro. Authors discussed that this activity may be happened through the inhibition of src and/or bcl kinase. Interestingly, by using a panel of 21 basal-like tumors, Nielsen et al. [2] showed that triple-negative breast cancer cell was typically immunohistochemically negative for estrogen receptor and HER2 but positive for basal cytokeratins, HER1, and/or c-KIT. In another study it was shown that dasatinib also inhibits c-Kit in addition to inhibition of src and bcl kinases [3]. Therefore, inhibitory activity of dasatinib on the growth of triple-negative breast cancer cell lines may also be attributed to inhibition of c-Kit in these cell lines.

Albumin-bound paclitaxel (ABI-007; Abraxane) in the management of basal-like breast carcinoma

We read with great interest the paper by Banerjee et al 1 regarding the clinical outcome and response to chemotherapy in basal-like carcinoma of the breast. After extensive discussion of chemotherapeutics used in the management of basal-like carcinoma, they concluded that new treatment options should be investigated for patients with this subtype of breast cancer. A recent study by Pinilla et al 2 showed that caveolin-1 (CAV1) expression is associated with a basal-like phenotype in sporadic and hereditary breast cancers. They …

Novel cardiovascular risk factors in the elderly and their correlation with the Framingham risk score

Objectives The aim of this study was to investigate the link between the risk of developing coronary heart disease as determined by Framingham risk score (FRS) and the novel cardiac risk factors including serum levels of ferritin, C reactive protein (CRP), homocysteine, creatinine, and uric acid. Methods A total of 1698 patients aged 65 years or more were examined. Plasma concentrations of lipids, CRP, ferritin, homocysteine, uric acid, and creatinine were measured in all the patients. The FRS was calculated for each patient who were divided into three groups according to their FRSs: score 0–9, score 10–19, and score 20 or more group. Results Levels of creatinine, uric acid, CRP, triglyceride, high-density lipoprotein, folate, ferritin, and homocysteine were significantly different between the three groups. Homocysteine, ferritin, triglyceride, uric acid, and creatinine significantly increased the risk of passing from score 0–9 group to 10–19 group. Triglyceride and creatinine also increased the risk of passing from score 10–19 group to 20 or more group. Conclusion An increase in homocysteine, uric acid, ferritin, creatinine, and triglyceride levels is associated with an increase in FRS in elderly people. The current findings support the use of these novel risk factors for diagnosis of coronary heart disease in elderly patients.

No alteration in the Pfa-100 in vitro bleeding time induced by the Ginkgo biloba special extract, Egb 761, in elderly patients with mild cognitive impairment

EGb 761 is widely used in the management of mild cognitive impairment in the elderly population. Elucidation of the effects of EGb 761 on primary haemostasis via PFA-100 could represent an important step for better understanding of the haemostatic safety of EGb 761. The purpose of this prospective study is to assess the effects of Ginkgo biloba special extract, EGb 761, on PFA-100 in vitro bleeding time in elderly patients with mild cognitive impairment. A total of 40 elderly patients aged 65–79 years who were referred for geriatric assessment and who were diagnosed as having mild cognitive impairment were included. Patients were started on 80 mg EGb-761 three times daily. The complete set of PFA-100 in vitro bleeding time and coagulation parameters including prothrombin time, activated partial thromboplastin time and International Normalized Ratio were assessed before and on the seventh day of treatment with EGb 761. There was no statistically significant prolongation in PFA-100 in vitro bleeding time or coagulation parameters in patients receiving EGb 761 after 7 days. The data about the safety of EGb 761 from the point of primary haemostasis in our elderly patient population with mild cognitive impairment casts hope for the future management of this ‘difficult-to-treat’ population with the promising Ginkgo extracts.