Francesca Romana Mauro

Enteral nutrition may cause false‐positive results of Aspergillus Galactomannan assay in absence of gastrointestinal diseases

Galactomannan (GM) detection using the Platelia Aspergillus enzyme immunoassay is widely used for diagnosing invasive aspergillosis (IA) in immunocompromised patients, particularly those affected by haematological diseases and ⁄ or those undergoing transplant procedures. A major problem with the detection of circulating GM by the Platelia Aspergillus immunoassay is the occurrence of false-positive results due to the cross-reactivity with antigens other than Aspergillus GM (Mennink-Kersten MA et al., Lancet Infect Dis 2004; 4: 349–57). We describe a patient with no evidence of IA and with false-positive GM assay while on enteral nutrition.

Practical management of ibrutinib in the real life: Focus on atrial fibrillation and bleeding

The Bruton tyrosine kinase inhibitor ibrutinib (IB) has attained an important role in the treatment of patients with chronic lymphocytic leukaemia, mantle cell lymphoma, and Waldenström macroglobulinemia, significantly improving clinical outcomes. However, IB therapy has been associated with an increased risk of atrial fibrillation (AF) and bleeding. We report on the expert opinion that a group of Italian haematologists, cardiologists, and pharmacologists jointly released to improve the practical management of patients at risk for AF and bleeding during treatment with IB. A proper pretreatment assessment to identify patients who are at a higher risk, careful choice of concomitant drugs, regular monitoring, and multispecialist approach were characterized as the main principles of clinical management of these patients. For patients developing AF, anticoagulant and antiarrhythmic therapy must be guided by considerations about efficacy, safety, and risk of pharmacokinetic interactions with IB. For patients experiencing bleeding or requiring procedures that increase the risk of bleeding, considerations about platelet turnover, IB‐related platelet dysfunctions, and bleeding worsening by concomitant anticoagulants or antiplatelet agents provide clues to manage bleeding. Overall, AF and bleeding are manageable clinical events in patients receiving IB, not requiring drug interruption in most cases. Preexisting AF should not represent an absolute contraindication to IB therapy. For each patient candidate for IB, strategies of risk assessment and mitigation may allow to exploit the life‐saving effects of in chronic lymphocytic leukaemia and mantle cell lymphoma.

Factors predicting survival in chronic lymphocytic leukemia patients developing Richter syndrome transformation into Hodgkin lymphoma

We hereby report the clinical and biologic features of 33 of 4680 (0.7%) patients with chronic lymphocytic leukemia (CLL), managed at 10 Italian centers, who developed Hodgkin lymphoma (HL), a rare variant of Richter syndrome. The median age at CLL and at HL diagnosis were 61 years (range 41‐80) and 70 years (range 46‐82), respectively, with a median interval from CLL to the diagnosis of HL of 90 months (range 0‐258). In 3 cases, CLL and HL were diagnosed simultaneously. Hl was characterized by advanced stage in 79% of cases, International Prognostic Score (IPS) ≥4 in 50%, extranodal involvement in 39%, B symptoms in 70%. Prior treatment for CLL had been received by 82% of patients and included fludarabine in 67%. Coexistence of CLL and HL was detected in the same bioptic tissue in 87% of cases. The most common administered treatment was the ABVD regimen given to 22 patients (66.6%). The complete response (CR) rate after ABVD was 68%, and was influenced by the IPS (Pu2009=u2009.03) and interval from the last CLL treatment (Pu2009=u2009.057). Survival from HL was also influenced by the IPS (Pu2009=u2009.006) and time from the last CLL treatment (Pu2009=u2009.047). The achievement of CR with ABVD was the only significant and independent factor predicting survival (Pu2009=u2009.037). Taken together, our results show that the IPS and the interval from the prior CLL treatment influence the likelihood of achieving CR after ABVD, which is the most important factor predicting survival of patients with CLL developing HL.

Refined karyotype-based prognostic stratification of chronic lymphocytic leukemia with a low- and very-low-risk genetic profile

Refined karyotype-based prognostic stratification of chronic lymphocytic leukemia with a low- and very-low-risk genetic profile