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Immunocompromised patients in the hematology department are usually hospitalized in areas protected by the high-efficiency particulate air (HEPA) filtration system. Renovations may require moving these patients at risk for invasive fungal infection to areas without HEPA. Mobile air handling units may be a solution in these cases. For renovation purposes, we evaluated the efficiency of mobile air handling units called Plasmair® as well as their optimization, by comparing two generations of devices.Particle counts were performed to determine a particle cleanliness classification according to the ISO 14644–1 standard (high ISO classes correspond to a degraded particulate cleanliness). Mycological air samples were also taken to determine the percentage of positive samples and the median number of filamentous fungi colonies.Without air treatment, only 18 % (38/216) of particle counts were classified as ISO 6. With the use of mobile air treatment units, this proportion increased to 71 % (205/288). The positivity rate of mycological samples without air treatment was 86 % (31/36) with a median number of fungal colonies of 3 (1–5)/0.5m3. A significant decrease in fungal pressure was observed when using Plasmair®. Percentages of positive air samples and the median number of colonies found between the old generation Plasmair® (T2006) and the new generation Plasmair® (Guardian) were significantly different, respectively 55.6 % (20/36) versus 22.2 % (8/36) and 1(0–1) versus 0 (0–0).Finally, we confirm Plasmair® were effective in reducing airborne fungal pressure, the new generation especially. However, they were not effective enough to obtain negative mycological air samples as usually observed with the HEPA system, whatever the generation.

Background: This study aimed to determine whether implementing a rapid response system (RRS) is associated with improved short‐term outcomes in critically ill patients with haematological malignancies. Methods: Our monocentric pre‐ versus post‐intervention study was conducted between January 2012 and April 2020. RRS was activated at early signs of haemodynamic or respiratory failure. The primary outcome was the reduction in Sequential Organ Failure Assessment (SOFA) score on Day 3 after intensive care unit (ICU) admission. Secondary outcomes included time to ICU admission and mortality. Results: A total of 209 patients with a median age of 59 years were enrolled (108 in the pre‐intervention period and 101 in the post‐intervention period). 22% of them had received an allogeneic transplant. The post‐intervention period was associated with a shorter time to ICU admission (195 vs. 390 min, p <.001), a more frequent favourable trend in SOFA score (57% vs. 42%, adjusted odds ratio, 2.02, 95% confidence interval, 1.09 to 3.76), no significant changes in ICU (22% vs. 26%, p =.48) and 1‐year (62% vs. 58%, p =.62) mortality rates. Conclusion: Detection of early organ failure and activation of an RRS was associated with faster ICU admission and lower SOFA scores on Day 3 of admission in critically ill patients with haematological malignancies. [ABSTRACT FROM AUTHOR]

We investigated using a custom NGS panel of 149 genes the mutational landscape of 64 consecutive adult patients with tyrosine kinase fusion-negative hypereosinophilia (HE)/hypereosinophilic syndrome (HES) harboring features suggestive of myeloid neoplasm. At least one mutation was reported in 50/64 (78%) patients (compared to 8/44 (18%) patients with idiopathic HE/HES/HE US used as controls; p < .001). Thirty-five patients (54%) had at least one mutation involving the JAK-STAT pathway, including STAT5B (n = 18, among which the hotspot N642H, n = 13), JAK1 (indels in exon 13, n = 5; V658F/L, n = 2), and JAK2 (V617F, n = 6; indels in exon 13, n = 2). Other previously undescribed somatic mutations were also found in JAK2, JAK1, STAT5B, and STAT5A, including three patients who shared the same STAT5A V707fs mutation and features consistent with primary polycythemia. Nearly all JAK-STAT mutations were preceded by (or associated with) myelodysplasia-related gene mutations, especially in RNA-splicing genes or chromatin modifiers. In multivariate analysis, neurologic involvement (hazard ratio [HR] 4.95 [1.87-13.13]; p = .001), anemia (HR 5.50 [2.24-13.49]; p < .001), and the presence of a high-risk mutation (as per the molecular international prognosis scoring system: HR 6.87 [2.39-19.72]; p < .001) were independently associated with impaired overall survival. While corticosteroids were ineffective in all treated JAK-STAT-mutated patients, ruxolitinib showed positive hematological responses including in STAT5A-mutated patients. These findings emphasize the usefulness of NGS for the workup of tyrosine kinase fusion-negative HE/HES patients and support the use of JAK inhibitors in this setting. Updated classifications could consider patients with JAK-STAT mutations and eosinophilia as a new "gene mutated-entity" that could be differentiated from CEL, NOS, and idiopathic HES., (© 2024 Wiley Periodicals LLC.)