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The incidence of venous thromboembolism (VTE) for non‐hospitalised patients with coronavirus disease‐2019 infection has not been very widely studied. 13 019 persons with a positive SARS‐CoV‐2 nucleic acid amplification test were identified. In total, 447 (0.2%) VTEs were identified in the study population, 293 (66%) of these were pulmonary embolisms. A positive SARS‐CoV‐2 test did not increase the risk for VTE in the univariate analysis (odds ratio (OR): 1.0, 95% confidence interval (CI): 0.69–1.4) or multivariable analysis (OR: 1.36, 95% CI: 0.93–1.97). [ABSTRACT FROM AUTHOR]

Objectives: AML‐2003 study sought to compare the long‐term efficacy and safety of IAT and IdAraC‐Ida in induction chemotherapy of acute myeloid leukemia (AML) and introduce the results of an integrated genetic and clinical risk classification guided treatment strategy. Methods: Patients were randomized to receive either IAT or IdAraC‐Ida as the first induction treatment. Intensified postremission strategies were employed based on measurable residual disease (MRD) and risk classification. Structured questionnaire forms were used to gather data prospectively. Results: A total of 356 AML patients with a median age of 53 years participated in the study. Long‐term overall survival (OS) and relapse‐free survival (RFS) were both 49% at 10 years. The median follow‐up was 114 months. No significant difference in remission rate, OS or RFS was observed between the two induction treatments. Risk classification according to the protocol, MRD after the first and the last consolidation treatment affected the OS and RFS significantly (p <.001). Conclusions: Intensified cytarabine dose in the first induction treatment was not better than IAT in patients with AML. Intensification of postremission treatment in patients with clinical risk factors or MRD seems reasonable, but randomized controlled studies are warranted in the future. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to identify the clinical characteristics, outcome, and antimicrobial susceptibility of healthcare‐associated bloodstream infections (BSIs) in hematological patients. Methods: This retrospectively collected laboratory‐based surveillance data include 3404 healthcare‐associated BSIs in 2296 patients with a hematological malignancy in hospitals participating in the Finnish Hospital Infection Program from January 1, 2006, to December 31, 2016. Results: The most common underlying diseases were acute myelogenous leukemia (35%) and non‐Hodgkin lymphoma (22%). Gram‐positive organisms accounted for 60%‐46% and gram‐negative organisms for 24%‐36% of BSIs in 2006‐2016. The most common causative organism was coagulase‐negative staphylococci (CoNS) (n = 731). The 7‐ and 28‐day case fatality rates were 5.2% and 11.4%, respectively, and was highest in BSIs caused by Candida species (10.8% and 30.8%). The median age of patients increased from 59 years in 2006‐2008 to 62 years in 2015‐2016 (P <.01). Five percent of S aureus isolates were resistant to methicillin and five percent of Pseudomonas aeruginosa isolates were multidrug‐resistant. Four percent of Klebsiella and seven percent of E coli isolates were resistant to ceftazidime. Conclusions: The proportion of gram‐positive bacteria decreased and gram‐negative bacteria increased over time. The case fatality rate was low and the median age of patients increased during the study. [ABSTRACT FROM AUTHOR]

Background: Heparin-induced thrombocytopenia (HIT) usually appears at 5 to 10 days after initiation of heparin. Autoimmune HIT can arise after discontinuation of heparin treatment (delayed-onset HIT) or without any preceding heparin exposure (spontaneous HIT syndrome).Case Report: This case presents a course of autoimmune HIT with delayed onset. The patient was hospitalized due to influenza pneumonia and received low-molecular-weight heparin thromboprophylaxis for 9 days. Seven days after discharge, she was readmitted because of a cerebral sinus vein thrombosis and severe thrombocytopenia. Intracranial bleeding and brain infarction caused her death.Discussion: Autoimmune HIT was confirmed by functional heparin-induced platelet (PLT) activation test. Intracranial bleeding prevented continuous and effective anticoagulation. PLT transfusions were given, although they are generally advised against in HIT patients due to potential risk of thromboembolic events.Conclusion: This case presents that testing PLT-activating antibodies both in the presence and in the absence of current heparin treatment helps to diagnose patients with autoimmune HIT. There is conflicting evidence to refuse PLT transfusion when HIT is complicated with life-threatening bleeding. [ABSTRACT FROM AUTHOR]

Cerebral venous thrombosis (CVT) covers up to a third of all venous thromboses (VTs) detected in patients with acute lymphoblastic leukemia (ALL). It usually hampers patients' lives and may also endanger efficient leukemia treatment. Although many factors have been suggested to account for an elevated risk of VTs in patients with ALL, there still is a lack of studies focusing on CVTs and especially in the setting of adult ALL patients. We studied in our retrospective population-based cohort the occurrence, characteristics, as well as risk factors for VTs in 186 consecutively diagnosed Finnish adult ALL patients treated with a national pediatric-inspired treatment protocol ALL2000. In the risk factor analyses for VTs we found a distinction of the characteristics of the patients acquiring CVT from those with other kinds of VTs or without thrombosis. In contrast to previous studies we were also able to compare the effects of asparaginase in relation to CVT occurrence. Notably, more than half of the CVTs were diagnosed prior the administration of asparaginase which accentuates the role of other risk factors on the pathophysiology of CVT compared to truncal or central venous line (CVL) VTs in adult ALL patients. [ABSTRACT FROM AUTHOR]

Objective Infections and graft-versus-host disease (GVHD) are the main causes of transplant-related mortality (TRM) of patients undergoing allo- SCT. The role of iron overload ( IO) has been debated in this context. Studies, performed with non-specific surrogate markers of iron, suggest that IO predicts poor outcome after allo- SCT. Methods In this prospective study, we quantified pretransplant IO with MRI-based hepatic iron concentration ( HIC) measurement; the degree of IO was used to predict infections, GVHD, and mortality after allo- SCT. Logistic univariate, multivariate, and Cox's regression analyses were performed. Results Iron overload was present in 78% of the patients ( HIC>36 μmol/g). The median HIC was 98 μmol/g (range 5-348). There were no cases of cardiac iron excess. IO was significantly associated with severe infections during the early post-transplant period (for every 10 μmol/g increase OR: 1.15, 95% CI 1.05-1.26, P = 0.003). The odds for severe infections increased 6.5- (>125 μmol/g OR: 6.5, P = 0.013) to 14-fold (>269 μmol/g OR: 14.1, P = 0.040) with increasing HIC. IO was found to be associated with reduced risk of acute and chronic GVHD. Although TRM was due to infection-related deaths, IO was not associated with TRM or OS. Conclusion Pretransplant IO, measured with a direct MRI-based measurement, predicts severe infections in the early post-transplant period. [ABSTRACT FROM AUTHOR]

We investigated responses to vaccination against pneumococcal polysaccharide, Haemophilus influenzae b (Hib) conjugate and tetanus toxoid antigens in 31 patients with chronic lymphocytic leukaemia (CLL) and 25 controls. While in the control group all antibody responses against different antigens were highly significant, in the patient group clear evidence for responsiveness was detected only in the case of Hib polysaccharide antigen. Certain CLL patient subgroups showed low reactivity against tetanus toxoid antigen. In conclusion, plain polysaccharide vaccines seem to be ineffective in patients with CLL. Conjugate vaccines, in turn, are immunogenic and may offer protection against infections caused by encapsulated bacteria in these patients. Further studies concerning an optimal vaccination scheme and clinical efficiency are warranted. [ABSTRACT FROM AUTHOR]

We report a patient with incapacitating POEMS syndrome characterized by serum monoclonal protein, polyneuropathy, organomegaly, endocrinopathy, mesangiocapillary glomerulonephritis, massive ascites formation, and pulmonary hypertension. A dramatic improvement in the clinical condition occurred after administration of thalidomide, a drug with known anti-angiogenetic, anti-proliferative, and anti-cytokine properties., (Copyright 2004 Wiley-Liss, Inc.)