Luca Facchini

Pre-chemotherapy risk factors for invasive fungal diseases: prospective analysis of 1,192 patients with newly diagnosed acute myeloid leukemia (SEIFEM 2010-a multicenter study)

Correct definition of the level of risk of invasive fungal infections is the first step in improving the targeting of preventive strategies. We investigated the potential relationship between pre-hospitalization exposure to sources of fungi and the development of invasive fungal infections in adult patients with newly diagnosed acute myeloid leukemia after their first course of chemotherapy. From January 2010 to April 2012, all consecutive acute myeloid leukemia patients in 33 Italian centers were prospectively registered. Upon first admission, information about possible pre-chemotherapy risk factors and environmental exposure was collected. We recorded data regarding comorbid conditions, employment, hygienic habits, working and living environment, personal habits, hobbies, and pets. All invasive fungal infections occurring within 30 days after the first course of chemotherapy were recorded. Of the 1,192 patients enrolled in this study, 881 received intensive chemotherapy and were included in the present analysis. Of these, 214 developed an invasive fungal infection, including 77 proven/probable cases (8.7%). Of these 77 cases, 54 were proven/probable invasive mold infections (6.1%) and 23 were proven yeast infections (2.6%). Upon univariate analysis, a significant association was found between invasive mold infections and age, performance status, diabetes, chronic obstructive pulmonary disease, smoking, cocaine use, job, hobbies, and a recent house renovation. Higher body weight resulted in a reduced risk of invasive mold infections. Multivariate analysis confirmed the role of performance status, job, body weight, chronic obstructive pulmonary disease, and house renovation. In conclusion, several hospital-independent variables could potentially influence the onset of invasive mold infections in patients with acute myeloid leukemia. Investigation of these factors upon first admission may help to define a patient’s risk category and improve targeted prophylactic strategies.

Leukaemic pulmonary infiltrates in adult acute myeloid leukaemia: a high-resolution computerized tomography study

Summary. Leukaemic infiltration of the lungs may occur in acute myeloid leukaemia (AML). Pulmonary infiltrates are usually microscopic and invariably associated with hyperleucocytosis. Four AML patients with respiratory symptoms and low leucocyte counts underwent standard chest radiography, bronchoscopy with bronchoalveolar lavage and high‐resolution computerized tomography (HRCT) of the lungs. HRCT scans showed pulmonary infiltrates with alveolar, interstitial, mixed and peribronchial/perivascular patterns in all patients, including one with negative standard radiographic findings. Infectious agents were excluded. Histology of the lung biopsy/autopsy specimens showed leukaemic infiltrates. Pulmonary leukaemia may be the cause of pulmonary infiltrates, even in non‐hyperleucocytosic AML patients with low blast counts.

A multicentre observational study for early diagnosis of Gaucher disease in patients with Splenomegaly and/or Thrombocytopenia.

Gaucher disease (GD) is the most common lysosomal disorder resulting from deficient activity of the β‐glucosidase enzyme that causes accumulation of glucosylceramide in the macrophage–monocyte system. Notably, because of non‐specific symptoms and a lack of awareness, patients with GD experience long diagnostic delays. The aim of this study was to apply a diagnostic algorithm to identify GD type 1 among adults subjects referred to Italian haematology outpatient units because of splenomegaly and/or thrombocytopenia and, eventually, to estimate the prevalence of GD in this selected population. One hundred and ninety‐six subjects (61 females, 135 males; mean age 47.8 ± 18.2 years) have been enrolled in the study and tested for β‐glucosidase enzyme activity on dried blood spot (DBS). Seven of 196 patients have been diagnosed with GD, (5 females and 2 males) with mean age 31.8 ± 8.2 years, with a prevalence of 3.6% (with a prevalence of 3.6% (I95% CI 1.4–7.2; 1/28 patients) in this population. These results show that the use of an appropriate diagnostic algorithm and a simple diagnostic method, such as DBS, are important tools to facilitate the diagnosis of a rare disease even for not disease‐expert physicians.

Risk of invasive fungal infection in patients affected by acute promyelocytic leukaemia. A report by the SEIFEM-D registry

Dr Mohanarasan Ratanam: wrote the paper. Professor Dr Visvaraja Subrayan: wrote up the case and proof read the manuscript. You Siang Ngim: contributed information from literature search. Assc. Prof. Nurliza Khalidin: performed literature research and proof read the manuscript. Mohanarasan Ratanam You Siang Ngim Nurliza Khalidin Visvaraja Subrayan Department of Ophthalmology, University of Malaya Medical Centre, Jalan University, Kuala Lumpur, and Department of Ophthalmology, Sultanah Fatimah Hospital, Muar, Johor, Malaysia. E-mail: mohanslayer@gmail.com

More on: Platelet count and the use of recombinant factor VIIa for the treatment of bleeding complications after hematopoietic stem cell transplantation.

In the last issue of JTH Pihusch et al. reported on the use of recombinant activated factor VII (rFVIIa) in treatment of bleeding complications following allogeneic and autologous hematopoietic stem cell transplantation [1]. The paper is certainly interesting as it explores, in a rigorous way, the hemostatic potentiality of rfVIIa in thrombocytopenic patients, so far reported just on a few case series. However, we think that additional data about the platelet levels on the study population would have been of some relevance. Although platelet transfusion policy was clearly stated, the only mention about this parameter was that nearly two-thirds of the patients had platelet counts 50.000 · 10L as a precondition for rFVIIa administration[3]. Relevant to this, we wonder if a subgroup analysis of the one-third of the patients with platelet counts >40.000 · 10L could show a greater efficacy of FVIIa treatment. Moreover, it has been demonstrated that anemia causes prolongation of the bleeding time, and that reduction of hematocrit significantly inhibits platelet adhesion and aggregation [4,5]. We think that a multivariate analysis of the study data including both of these variables could be usefully performed, as it could help hematologists to identify patients who are likely to be the most benefited by the use of rFVIIa.