Klára Piukovics

Four cases of bacteraemia caused by Fusobacterium nucleatum in febrile, neutropenic patients

Although bacteraemia caused by obligate anaerobic bacteria is a rare event, this phenomenon will be an emerging problem among oncohaematological patients. We report four cases of bacteraemia caused by Fusobacterium nucleatum in febrile, neutropenic patients over a 10 month period. All patients had haematological malignancy and severe neutropenia, and three of them suffered from oral mucositis or oedema of the oral mucosal surfaces, which was the probable portal of entry. All isolated strains were susceptible to standard anti-anaerobic antibiotics.

Evaluation of Bloodstream Infections During Chemotherapy-Induced Febrile Neutropenia in Patients with Malignant Hematological Diseases: Single Center Experience.

From year to year, it is important to get an overview of the occurrence of causative agents in febrile neutropenic patients to determine the empiric treatment. Thus our aims were to evaluate a four-year period regarding the prevalence of bloodstream infections and the most important causative agents. During this period, 1,361 patients were treated in our hematology ward because of various hematological disorders. 812 febrile episodes were recorded in 469 patients. At that time, 3,714 blood culture (BC) bottles were sent for microbiological investigations, 759 of them gave positive signal. From the majority of positive blood culture bottles (67.1%), Gram-positive bacteria, mainly coagulase-negative staphylococci (CNS), were grown. Gram-negative bacteria were isolated from 32.9% of the positive blood culture bottles, in these cases the leading pathogen was Escherichia coli. The high prevalence of CNS was attributed to mainly contamination, while lower positivity rate for Gram-negative bacteria was associated with the use of broad-spectrum empiric antibiotic treatment.

Valós idejű polimeráz láncreakció alkalmazása cytomegalovirus-fertőzés és -reaktiváció nyomon követésére malignus hematológiai betegségek kemoterápiás kezelése során és autológ őssejt-transzplantációt követően

Absztrakt Bevezetes: A hematologiai betegek kemo-immun terapias kezelese es az őssejt-transzplantacio soran fellepő fertőzeses komplikaciok egyiket kepezi a cytomegalovirus-infekcio es -reaktivacio. Celkitűzes: A szerzők celja a cytomegalovirus-fertőzes es -reaktivacio kovetese kvantitativ valos idejű polimeraz lancreakcio modszerevel. Modszer: A szerzők intezeteben 2012–2014 kozott kezelt 96 beteg dokumentaciojat elemeztek retrospektiv vizsgalatban. A betegeket az alapbetegseg szerint csoportositottak (lymphoproliferativ betegsegek, akut leukaemiak), valamint megkulonboztettek aszerint, hogy tortent-e autolog őssejt-transzplantacio vagy sem. Eredmenyek: Lymphoproliferativ betegseg miatt kezeltek 83 beteget, kozuluk 63 (76%) reszesult autolog őssejt-transzplantacioban. A 604 plazmamintabol 46 mintaban (7,6%) igazolodott valos idejű polimeraz lancreakcioval cytomegalovirus-pozitivitas osszesen 25 betegből (6 nem transzplantalt [18%], 19 transzplantalt [30,2%]). A valos idejű polimeraz lancreakcioval cytome...

Autológ haemopoeticus őssejt-transzplantáció szerepe T-sejtes lymphomában. Magyar adatok

T-cell lymphoma is a poor prognostic hematological malignancy. The generally used - not sufficiently effective - induction chemotherapy should be improved with consolidative autologous hemopoetic stem cell transplantation. The authors describe the role, place and effectiveness of transplantation in this disorder. One hundred thirty three autologous stem cell transplantations were performed in the last 22 years in Hungary. Detailed results are available from the last 6 years. In this period 43 transplantations were carried out in 4 Hungarian centers. Carmustine-etoposide-cytosine arabinoside-melphalan (BEAM) conditioning regimen was used in 95%. The transplantation was done mainly in complete remission (84%), 1 year after transplantation 65% of patients were still in complete remission. Eleven patients died, 82% of them have progressive disease. Brentuximab vedotin has already proved the effectiveness, several other chemoterapeutics, monoclonal antibodies, kinase inhibitors are under investigation. In certain cases allogeneic stem cell transplantation has real indication among therapeutic options. Orv Hetil. 2017; 158(41): 1615-1619.Absztrakt: A T-sejtes lymphoma rossz prognozisu hematologiai malignitas. Az altalanossagban alkalmazott – nem kellően hatekony – indukcios kemoterapiat javitani lehet konszolidativ autolog haemopoeticus őssejt-transzplantacioval. A szerzők ismertetik az autolog atultetes szerepet, helyet, hatasossagat ebben a betegcsoportban. Az elmult 22 ev alatt Magyarorszagon 133 autolog atultetest vegeztek T-sejtes lymphomaban. Reszletesebb adatok hat ev transzplantacios eredmenyeiről allnak rendelkezesre. Ebben a periodusban 43 atultetes tortent a negy magyar centrumban kozel azonos esetszamokkal. Kondicionalo kezeleskent 95%-ban carmustin-etoposid-cytosin arabinosid-melphalan (BEAM) semat hasznaltak. Az esetek dontő tobbsegeben komplett remisszioban tortent az atultetes (84%), a beavatkozas utan egy evvel a betegek 65%-a volt komplett remisszioban. Tizenegy beteg halt meg a vizsgalt periodusban, 82%-uk alapbetegseg progressziojaban. Az uj szerek kozul a brentuximab vedotin mar bizonyitotta hatasossagat, szamos egyeb...

Nasalis típusú extranodalis natural killer T-sejtes lymphoma hazai előfordulása és kezelésével szerzett tapasztalatok

INTRODUCTION Extranodal natural killer/T (NK/T) cell lymphoma, nasal type (ENKTL) represents a rare subtype of T-cell lymphomas with aggressive clinical behavior according to WHO 2016 classification. AIM ENKTL has distinctive geographic distribution with higher incidence in Asia and Latin America (10% of all non-Hodgkin lymphoma cases), than in Europe and North America (<1%). ENKTL tipically origins from nasopharynx and upper aerodigestive tract. Anthracycline-based chemotherapy regimens are largely ineffective in the treatment of ENKTL. METHOD Our aims were to evaluate the incidence and treatment strategies of ENKTL patients in Hungarian Haematological Centres between 2003 and 2015. Altogether 20 patients with ENKTL were treated in the 4 haematological hospitals (male:female ratio 12:8, with median 49.5 years of age). RESULTS Ten patients had localized (stage I-II) disease at the time of the diagnosis. Seventeen patients were treated with chemotherapy (11/CHOP, CHOP-like, 2/HyperCVAD, 1/ProMACECytaBom, 1/SMILE, 2/others), which was completed with involved-field radiation therapy (IFRT) (40-46 Gy) in 6 cases were used. After first-line therapy 9 patients achieved complete remission (CR), 3 patients had partial remission (PR), 3 patients had progressive disease (PD), and 2 patients had stable disease (SD). Median follow-up was 32 (3-113) months. Five patients received second-line therapy for progressive or recurrent disease [2/DHAP, 1/VIM, 1/HyperCVAD, 1/ProMACECytaBom]. None of the patients achieved CR after second-line therapy. Two patients have undergone autologous hematopoietic stem cell transplantation (HSCT) after the first CR. CONCLUSION ENKTL treatment is more effective with nonanthracycline-containing regimens. L-asparaginase containing chemotherapy and concurrent or sequential chemo-radiotherapy improves survival and CR rates. Orv Hetil. 2017; 158(41): 1635-1641.Absztrakt: Bevezetes: Az extranodalis nasalis tipusu natural killer/T (NK/T) sejtes lymphoma (ENKTL) a T-sejtes lymphomak egyik ritka agressziv megjelenesű formaja, amely elsősorban sinonasalis es nasopharynx kiindulasu. Bar előfordulasa ritka a fejlett nyugati orszagokban, kezelese a hagyomanyos, agressziv lymphomakban alkalmazott antraciklintartalmu kemoterapiaval csekely hatekonysagu. Celkitűzes: ENKTL-esetek előfordulasa hazai hematologiai centrumok altal gondozott non-Hodgkin-lymphomas betegek kozott. Modszer: A szerzők negy magyarorszagi hematologiai centrumban 2003–2015 kozott kezelt 20 ENKTL-beteg klinikai adatait elemeztek. A betegek kozott 12 ferfi es 8 nő volt, median eletkor 49,5 ev (22–84 ev). Eredmenyek: Tiz esetben a betegseg lokalizalt (I–II. stadiumban) volt a diagnozis idejen. Kemoterapias kezelesben reszesult 17 beteg (11 CHOP, CHOP-szerű, kettő hyper-CVAD, egy ProMACECytaBom, egy SMILE, kettő egyeb), amelyet hat esetben erintett mezős besugarzassal (IFRT) egeszitettek ki (40–46 Gy). Az...

Relabáló/refrakter Hodgkin-lymphoma brentuximab vedotin kezelése. Hazai tapasztalatok

Absztrakt: Bevezetes: A relabalo es refrakter Hodgkin-lymphoma kezelese tovabbra is nagy kihivast jelent. Hatalmas előrelepest jelentett a brentuximab vedotin alkalmazasa, amellyel jelenleg mar jelentős hazai tapasztalatok is vannak. Celkitűzes: A brentuximab vedotinnal kezelt magyar Hodgkin-lymphomas betegek adatainak, a kezeles hatekonysaganak elemzese. Modszer: Hat hazai hematologiai osztalyon 2013. januar 1. es 2016. december 31. kozott brentuximab vedotinnal kezelt Hodgkin-lymphomas betegek adatainak retrospektiv elemzese. Eredmenyek: Osszesen 86 beteg reszesult brentuximab vedotin kezelesben. A kezeles előtt a betegek egyharmada korai, ketharmada előrehaladott stadiumban volt. Autolog őssejt-transzplantacio előtt alkalmazva 54 betegnel a teljes valaszarany 66,6%, ebből komplett remissziot a betegek 42,6%-a ert el. Autolog őssejt-transzplantaciot kovetően 30 beteg kapta, a teljes valaszarany 46,67%, a komplett remisszio 30% volt. Harminchat beteg csak monoterapiaban kapta a keszitmenyt, mig 50 beteg ...INTRODUCTION The treatment of relapsed or refractory Hodgkin lymphoma is still a major therapeutic challenge. The use of brentuximab vedotin, an anti-CD30 antibody-drug conjugate, represents a promising approach for these patients, however clinical outcomes have not yet been evaluated in Hungary. AIM Our aim was to assess the efficacy, safety and outcome of brentuximab vedotin treatment in Hungarian Hodgkin lymphoma patients. METHOD In this retrospective case note review we enrolled patients at 6 clinical sites countrywide who were diagnosed with Hodgkin lymphoma and received brentuximab vedotin between 1 January 2013 and 31 December 2016. RESULTS A total of 86 patients were treated with brentuximab vedotin during the examined period. Before therapy initiation 66% of our patients had advanced-stage disease. Overall response rate to brentuximab vedotin, administered before autologous hematopoietic stem cell transplantation (n = 54) was 66.6%, complete remission rate was 42.6%. Thirty patients received brentuximab vedotin after AHSCT, 46.67% responded to treatment, 30% achieved complete remission. Thirty-six patients received the drug as a single-agent therapy, 50 patients were given brentuximab vedotin in combination, 39 of them with bendamustin. Toxicity was observed only in 13.95% of our patients, most common symptom was skin rash. Based on our analysis the estimated 5-year overall survival rate was 78.7%, the estimated progression free survival rate was 23.59 months (95% CI: 19.50-27.68). CONCLUSION Brentuximab vedotin carries a substantial improvement in the treatment of relapsed or refractory Hodgkin lymphoma. Our results underline prior observations published in the literature. The use of brentuximab vedotin in combination can be beneficial, however further investigation is needed on the subject. Orv Hetil. 2017; 158(41): 1630-1634.

Fatal cases of disseminated nocardiosis: Challenges to physicians and clinical microbiologists - Case report

Despite the development in the identification of Nocardia spp., common challenges exist in the laboratory diagnosis and management of nocardiosis. We report two cases of disseminated nocardiosis in a patient with hematologic disorder and in a patient with systemic lupus erythematosus, where the cooperation between various specialists was essential to set up the adequate diagnosis of disseminated nocardiosis.

Refrakter sprue mint az enteropathia típusú T-sejtes lymphoma prekurzor laesiója – klinikopatológiai esetismertetés@@@Refractory sprue – precursor lesion of enteropathy type T-cell lymphoma – A clinicopathological case report

INTRODUCTION Refractory sprue is characterised by distinctive morphologic alterations and the emergence of clonal intraepithelial lymphocytes. AIM In this case report the authors emphasize the importance of histopathology in the diagnosis of refractory sprue. METHODS The sequential biopsies from this patient have been investigated with routine histology, immunohistochemistry and molecular genetics for T-cell clonality analysis. RESULTS The severely cachectic patient presenting with malabsorption syndrome has been diagnosed with celiac disease through a duodenal biopsy, and the CD8 negativity of the intraepithelial lymphocytes suggested the possible diagnosis of refractory sprue. Azathioprine and glucocorticoid therapy was administered due to the failed jejunal feeding and gluten-free diet, resulting in clinically complete, morphologically partial remission. Intestinal T-cell lymphoma developed in the ileocecal region within two years after the first clinical presentation. DISCUSSION Refractory sprue and the enteropathy-type T-cell lymphoma constitute a disease spectrum. The reported case shows how a simple method can provide crucial information in the diagnosis of refractory sprue.

[Refractory sprue--precursor lesion of enteropathy type T-cell lymphoma--a clinicopathological case report].

INTRODUCTION Refractory sprue is characterised by distinctive morphologic alterations and the emergence of clonal intraepithelial lymphocytes. AIM In this case report the authors emphasize the importance of histopathology in the diagnosis of refractory sprue. METHODS The sequential biopsies from this patient have been investigated with routine histology, immunohistochemistry and molecular genetics for T-cell clonality analysis. RESULTS The severely cachectic patient presenting with malabsorption syndrome has been diagnosed with celiac disease through a duodenal biopsy, and the CD8 negativity of the intraepithelial lymphocytes suggested the possible diagnosis of refractory sprue. Azathioprine and glucocorticoid therapy was administered due to the failed jejunal feeding and gluten-free diet, resulting in clinically complete, morphologically partial remission. Intestinal T-cell lymphoma developed in the ileocecal region within two years after the first clinical presentation. DISCUSSION Refractory sprue and the enteropathy-type T-cell lymphoma constitute a disease spectrum. The reported case shows how a simple method can provide crucial information in the diagnosis of refractory sprue.

Refrakter sprue mint az enteropathia típusú T-sejtes lymphoma prekurzor laesiója - Klinikopatológiai esetismertetés

INTRODUCTION Refractory sprue is characterised by distinctive morphologic alterations and the emergence of clonal intraepithelial lymphocytes. AIM In this case report the authors emphasize the importance of histopathology in the diagnosis of refractory sprue. METHODS The sequential biopsies from this patient have been investigated with routine histology, immunohistochemistry and molecular genetics for T-cell clonality analysis. RESULTS The severely cachectic patient presenting with malabsorption syndrome has been diagnosed with celiac disease through a duodenal biopsy, and the CD8 negativity of the intraepithelial lymphocytes suggested the possible diagnosis of refractory sprue. Azathioprine and glucocorticoid therapy was administered due to the failed jejunal feeding and gluten-free diet, resulting in clinically complete, morphologically partial remission. Intestinal T-cell lymphoma developed in the ileocecal region within two years after the first clinical presentation. DISCUSSION Refractory sprue and the enteropathy-type T-cell lymphoma constitute a disease spectrum. The reported case shows how a simple method can provide crucial information in the diagnosis of refractory sprue.