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Furlan A, Rossi MC, Gherlinzoni F, Scotton P. Prompt Hematological Recovery in Response to a Combination of Pegylated Interferon α-2a and Rituximab in a Profoundly Immuno-Suppressed Hairy Cell Leukemia Patient with a Mycobacterial Infection at Onset: Benefits and Drawbacks of Rapid Immune Reconstitution. Hematol Rep 2022; 14:135-142. [PMID: 35466184 PMCID: PMC9036287 DOI: 10.3390/hematolrep14020020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/11/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
The present paper reports, to the best of our knowledge for the first time, the efficacy and tolerability of the combination of interferon (IFN)α-2a in pegylated formulation and rituximab after a “priming” phase with IFN in the frontline treatment of hairy cell leukemia (HCL) in a profoundly immunosuppressed patient with a Mycobacterium abscessus infection at onset. This immunotherapy combination may represent a potential therapeutic option in patients with active severe infection and for whom the use of purine nucleoside analogues (PNA) is contraindicated. The benefits and drawbacks of remarkably rapid immune reconstitution in the context of opportunistic infections are highlighted as well, as the potentially paradoxical effects of immune recovery as a result of effective immunotherapy strategies, known as immune reconstitution inflammatory syndrome (IRIS), have to be taken into account when dealing with patients with opportunistic infections.
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Affiliation(s)
- Anna Furlan
- Hematology Unit, Azienda ULSS2 Marca Trevigiana, 31100 Treviso, Italy;
- Correspondence: ; Tel.: +39-0422-322921; Fax: +39-0422-322542
| | - Maria Cristina Rossi
- Infectious Disease Unit, Azienda ULSS2 Marca Trevigiana, 31100 Treviso, Italy; (M.C.R.); (P.S.)
| | | | - Piergiorgio Scotton
- Infectious Disease Unit, Azienda ULSS2 Marca Trevigiana, 31100 Treviso, Italy; (M.C.R.); (P.S.)
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Maniscalco GT, Annunziata M, Ranieri A, Alfieri G, Renna R, Iorio WD, Guarcello G, Cerillo I, Improta G, Florio C. Remission of early persistent cladribine-induced neutropenia after filgrastim therapy in a patient with Relapsing - Remitting Multiple Sclerosis. Mult Scler Relat Disord 2020; 43:102151. [PMID: 32417665 DOI: 10.1016/j.msard.2020.102151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cladribine tablets were recently approved for the treatment of Relapsing-Remitting Multiple Sclerosis (RRMS), reducing B cells and T cells, followed by reconstitution of the adaptive immune system, with transient and mild effects on the innate one. Cladribine is also the standard first-line and subsequent treatment for Hairy-Cell Leukemia (HCL), frequently complicated by neutropenic fever. Recombinant human Granulocyte Colony-Stimulating Factor (G-CSF; Filgrastim) has been proved to reduce neutropenia by increasing neutrophil count. CASE REPORT To the best of our knowledge, we report the first case of early and persistent high grade non febrile neutropenia after oral cladribine therapy in a 49-year-old RR-MS patient, successfully treated with Filgrastim. CONCLUSIONS This report suggests that in selected cases, cladribine requires early monitoring of blood sample as it may be responsible for early neutropenia, requiring specific treatment.
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Affiliation(s)
- Giorgia T Maniscalco
- Multiple Sclerosis Center "A. Cardarelli "Hospital, Naples, Italy; Neurological Clinic and Stroke Unit "A. Cardarelli "Hospital, Naples, Italy.
| | | | - Angelo Ranieri
- Neurological Clinic and Stroke Unit "A. Cardarelli "Hospital, Naples, Italy
| | - Gennaro Alfieri
- Neurological Clinic and Stroke Unit "A. Cardarelli "Hospital, Naples, Italy
| | - Rosaria Renna
- Neurological Clinic and Stroke Unit "A. Cardarelli "Hospital, Naples, Italy
| | - Walter Di Iorio
- Neurological Clinic and Stroke Unit "A. Cardarelli "Hospital, Naples, Italy
| | | | - Ilaria Cerillo
- Neurological Clinic and Stroke Unit "A. Cardarelli "Hospital, Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ciro Florio
- Multiple Sclerosis Center "A. Cardarelli "Hospital, Naples, Italy; Neurological Clinic and Stroke Unit "A. Cardarelli "Hospital, Naples, Italy
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Tadmor T, Levy I, Herishanu Y, Goldschmidt N, Bairey O, Yuklea M, Shvidel L, Fineman R, Aviv A, Ruchlemer R, Braester A, Dally N, Rouvio O, Shaulov A, Greenbaum U, Inbar M, Polliack A. Primary peg-filgrastim prophylaxis versus filgrastim given "on demand" for neutropenia during therapy with cladribine for hairy cell leukemia. Leuk Res 2019; 82:24-28. [PMID: 31152919 DOI: 10.1016/j.leukres.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major advances in the treatment of patients with hairy cell leukemia (HCL) have been made following the introduction of purine analogues. The major significant short-term toxicity of cladribine therapy are neutropenia and neutropenic fever (NF) which may be life-threatening. AIM In this retrospective study, we compared the incidence and duration of neutropenia and hospitalization in patients with HCL treated with cladribine followed by peg-filgrastim as primary prophylaxis versus daily filgrastim given "on demand" according to absolute neutrophil count (ANC). METHODS Medical records of patients with HCL diagnosed and followed in 12 medical centers in Israel during 1985-2015 were examined for details of disease at diagnosis. The efficacy of peg-filgrastim and filgrastim was assessed by evaluating the incidence of neutropenia (ANC < 1.0 × 10 [9]/L), number and length of hospitalizations, and number of days from the last day of therapy to recovery of ANC to >1.0 × 10 [9]/L. RESULTS The study population included 202 patients with HCL, 159 of whom (80.7%) were treated with cladribine; 78 patients (49%) required hospitalization for the administration of broad-spectrum antibiotics due to NF. Twenty-eight (19%) patients were treated with peg-filgrastim as primary prophylaxis, while 74 (64%) received filgrastim "on demand" due to neutropenia. Median length of hospitalization, and nadir duration were 8 and 18 days respectively (p = 0.71, p = 0.44). CONCLUSIONS Infectious complications post-cladribine treatment remain high. No difference was found in terms of incidence of NF, number of febrile days, and nadir duration in patients receiving primary peg-filgrastim prophylaxis compared to filgrastim given on demand. Both approaches are justifiable, and the choice remains at the physician's discretion.
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Affiliation(s)
- Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Ilana Levy
- Internal Medicine B, Bnai Zion Medical Center, Haifa, Israel
| | - Yair Herishanu
- Department of Hematology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
| | - Osnat Bairey
- Department of Hematology, Rabin Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv Petah-Tikvah, Israel
| | - Mona Yuklea
- Department of Hematology, Meir Medical Center, Kfar-Saba, Israel
| | - Lev Shvidel
- Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Riva Fineman
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ariel Aviv
- Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Rosa Ruchlemer
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Najib Dally
- Hematology Unit, Ziv Medical center, Safed, Israel
| | - Ory Rouvio
- Department of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Adir Shaulov
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
| | - Uri Greenbaum
- Department of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal Inbar
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
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