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Neutropenic enterocolitis (NEC) is an abdominal infection reported primarily in patients with acute myeloid leukemia (AML) following chemotherapy, especially cytarabine, a notable efficacious cytotoxic agent for AML remission. Specific data regarding the impact of different cytarabine schedules and/or antibacterial regimens for NEC are sparse. The aim of the study was to identify the predictors of outcome within 30 days of NEC onset. NEC episodes were retrospectively pinpointed among 440 patients with newly diagnosed AML hospitalized in our Institution, over a 10‐year period, for receiving chemotherapy protocols with 100–6000 mg/m2 daily of cytarabine. Two subgroups, survivors versus nonsurvivors, were compared by using logistic regression analysis. NEC was documented in 100 of 420 (23.8%) analyzed patients: 42.5% had received high‐dose cytarabine, whereas 19% and 15% intermediate‐dose and standard‐dose cytarabine, respectively (P

Background The incidence of peripherally inserted central catheter (PICC)-related adverse events has been uncertain in the setting of acute myeloid leukemia (AML) compared with the incidence of centrally inserted central catheter (CICC) adverse events. Patients and Methods We conducted a monocentric, randomized trial of patients with previously untreated AML. Of the 93 patients, 46 had received a PICC and 47 had received a CICC as frontline intravascular device. Thereafter, all patients underwent intensive chemotherapy for hematologic remission induction. The primary endpoint was catheter-related (CR)-bloodstream infection (BSI) and venous thrombosis (VT) rate. The secondary endpoints catheter malfunction, catheter removal, and patient overall survival. Results The CR-BSI and CR-VT rate in the PICC and CICC groups was 13% and 49%, respectively, with a difference of 36 percentage points (relative risk for CR-BSI or CR-VT, 0.266; P = .0003). The CR-BSI incidence was 1.4 and 7.8 per 1000 catheters daily in the PICC and CICC groups, respectively. Among the CR thromboses, the symptomatic VT rate was 2.1% in the PICC group and 10.6% in the CICC group. In the CICC group, 16 of the 47 patients (34%) had the catheter removed for BSI (n = 5), septic thrombophlebitis (n = 4), VT (n = 2), or malfunction (n = 5) a median of 7 days after insertion. In the PICC group, only 6 of the 46 patients (13%) required catheter removal for VT (n = 2) or malfunction (n = 4). At a median follow-up of 30 days, 6 patients in the CICC group died of CR complications versus none of the patients in the PICC group (P = .012). Using PICCs, the reduction in BSI and symptomatic VT decreased mortality from CR infection and venous thromboembolism. In contrast, the CICC approach led to early catheter removal mostly for difficult-to-treat infectious pathogens. Conclusion Our data have confirmed that BSI and symptomatic VT are the major complications affecting frontline central intravascular device-related morbidity in the leukemia setting. The use of a PICC is safer than that of a CICC and maintains the effectiveness for patients with AML undergoing chemotherapy, with an approximate fourfold lower combined risk of infection or thrombosis at 30 days.

Background: Plasmacytoma is characterized by malignant proliferation of a single clone of plasma cells producing monoclonal immunoglobulins and presenting as multiple lesions, multiple myeloma (MM), or a single lesion, solitary plasmacytoma (SP). SP is a single lesion of monoclonal plasma cells inside or outside the skeletal system, in this later case it is named, extramedullary plasmacytoma (EMP). Patient affected by EMP are commonly younger than MM (55- 60); male/female ratio is 3:1. A non unusual presentation of EMP is in the upper airways, and the most common presenting symptoms of sinonasal EMP are unilateral nasal obstruction, epistaxis, rhinorrhea, facial swelling and pain. The diagnosis is based on biopsy of lesions, unilateral bone marrow aspirate, laboratory studies, CT, MRI, and PET/CT. Radiotherapy is the treatment of choice, whereas surgery is performed for diagnostic biopsy or excision of residual disease. Conversely, the role of chemotherapy is still debated. Aims: Adapting timing of control to the behaviour of the disease. Methods: We report 4 cases (3 M, 1 F; mean age:58, range 37-72) of EMP extended to sinonasal cavities complaining of unilateral nasal obstruction and epistaxis. Results: Nasal endoscopy showed a soft, friable, and bloody tumor mass occupying the nasal cavity in 1 case, extended to the right maxilla in 2 and to right ethmoid in the last one. All subjects underwent CT scan, MRI,biochemical tests and bone marrow histology. Nasal biopsies revealed a diffuse infiltration by CD138 positive plasma cells with Ig light chain restriction. Subjects received radiotherapy by linear acceleration , with dose ranging from 40 to 60 Gy over a 1-month period. At 5 years follow-up, 3 patients had signs of recurrence (2 after 5 years and 1 after 2 years) and underwent chemotherapy and autologous bone marrow transplantation with long term control of EMP with complete remission. Summary/Conclusion: Compared to other lymphoproliferative disorders, EMP shows higher probability of late relapse, hence prolonged periodical controls should be scheduled