Michele Baccarani

mdr-1 GENE AMPLIFICATION IN ACUTE LYMPHOBLASTIC LEUKAEMIA PRIOR TO ANTILEUKAEMIC TREATMENT

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Sinonasal risk factors for the development of invasive fungal sinusitis in hematological patients: Are they important?

Invasive fungal sinusitis (IFS) is a highly aggressive infection that can affect hematologic patients. The classically described general risk factors, however, do not fully explain the development of IFS in a small percentage of cases. This study examined the impact of anatomic sinonasal factors and environmental factors on the development of IFS in high-risk patients. Medical records and computed tomography (CT) scans of patients admitted to our institution who were at high risk of developing IFS were retrospectively reviewed. Twenty-seven patients of 797 fulfilled the inclusion criteria. Patients affected by IFS were compared with patients not affected to identify possible sinonasal and environmental risk factors of IFS. Seven patients were excluded because of the lack of adequate radiological images. Six of the 20 eligible patients were assigned to the study group of patients affected by IFS and the remaining 14 patients were assigned to the control group. All but one case developed the infection during the summer with a significantly higher mean environmental temperature (p = 0.002). Anatomic nasal alterations were found in all patients affected by IFS and were significantly more frequent than in the control group (p = 0.014). It would be advisable to have patients with hematologic risk factors of IFS, especially during the summer period, undergo endoscopic nasal assessment. Furthermore, a CT finding of anatomic nasal alterations, such as anterior nasal septum deviation causing nasal obstruction, should increase the suspicion of IFS in case of the occurrence of nasal symptoms.

Safety Profiles of First-Line TKIs and Managing Adverse Effects

The treatment armamentarium of chronic myeloid leukemia (CML) is based on at least five TKIs, employed either in first-line CP (imatinib, dasatinib, and nilotinib) and in second and third line (dasatinib, nilotinib, bosutinib, and ponatinib). These drugs share the same target of interest (BCR-ABL) but have profound different off-target effects. In turn, the general spectrum of adverse events experienced by the treated patients, either clinical symptoms, biochemical abnormalities, or severe AEs (or “complications”), varies considerably. SAEs are more frequent with second- and third-generation TKIs, and from this point of view, imatinib remains the safest drug. The early identification of CML patient candidates to experience more frequently SAEs with second (and third)-generation TKIs is of course part of the treatment decision process where the right balance between risk and benefit should be accomplished. Second-generation TKIs, nilotinib and dasatinib, are considered generally to be better tolerated than imatinib. However, two types of complications are described more frequently with nilotinib and ponatinib (cardiovascular, in general, and PAOD in particular) and with dasatinib (pleural effusions and pulmonary hypertension) if compared with imatinib. These two types of complications deserve a particular attention.