scholarly journals COVID-19 Coinfection with Mycobacterium abscessus in a Patient with Multiple Myeloma

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Jose A. Rodriguez ◽  
Charles Bonnano ◽  
Pratik Khatiwada ◽  
Alejandra A. Roa ◽  
Daniel Mayer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Chest Radiograph ◽  
Severe Pneumonia ◽  
Serum Lactate ◽  
Mycobacterium Abscessus ◽  
Serum Lactate Dehydrogenase ◽  
Reactive Protein ◽  
Lower Lung ◽  
Repeat Chest ◽  
The One

Background. Coronavirus disease (COVID-19) is a worldwide pandemic causing multiple fatalities and morbidities worldwide. We report a case of severe pneumonia causing acute respiratory distress syndrome due to a coinfection with SARS-CoV-2 and Mycobacterium abscessus in an elderly patient with multiple myeloma in Florida, USA. Case Presentation. An 84-year-old male with a medical history significant for multiple myeloma not in remission was sent to the emergency department to rule out COVID-19 infection prior to continuing his chemotherapy sessions. At presentation, he had nonspecific mild symptoms and an unremarkable physical examination. He had significant blood test findings including serum lactate dehydrogenase 373 U/L, high sensitive C-reactive protein 17.40 mg/l, and ferritin 415 ng/ml. Xpert-SARS-CoV-2 was positive. Chest radiograph revealed patchy areas of interstitial infiltrates in mid to lower lung zones. During his hospitalization course, his oxygenation deteriorated, requiring mechanical intubation. Repeat chest radiograph showed worsening bilateral infiltrates. He was started on broad-spectrum antibiotics and eventually weaned off mechanical intubation and extubated. On the 11th day of admission, he was found to be bradycardic and in shock, and he was reintubated. His labs showed worsening inflammatory markers along with kidney dysfunction to the point of requiring renal replacement therapy. He received both convalescent plasma and remdesivir for treatment of COVID-19 pneumonia. Eventually, repeat blood cultures came back positive for the growth of acid-fast beaded bacilli. While awaiting final culture and sensitivity reports, his antibiotics were upgraded to cover possible nocardia infection. Repeat blood and sputum cultures resulted in growth of AFB bacilli Mycobacterium abscessus 1 week after. Conclusions. This case report highlights the importance of keeping a broad differential and considering multiple coinfections, including atypical ones during this COVID-19 pandemic, such as the one that was discussed above, Mycobacterium abscessus, in order to provide goal-directed therapy.

scholarly journals The incremental value of computed tomography of COVID-19 pneumonia in predicting ICU admission

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maurizio Bartolucci ◽  
Matteo Benelli ◽  
Margherita Betti ◽  
Sara Bicchi ◽  
Luca Fedeli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Confidence Interval ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Receiver Operating Characteristic Curves ◽  
Icu Admission ◽  
Reactive Protein ◽  
Incremental Value ◽  
Validation Set ◽  
Radiological Model

AbstractTriage is crucial for patient’s management and estimation of the required intensive care unit (ICU) beds is fundamental for health systems during the COVID-19 pandemic. We assessed whether chest computed tomography (CT) of COVID-19 pneumonia has an incremental role in predicting patient’s admission to ICU. We performed volumetric and texture analysis of the areas of the affected lung in CT of 115 outpatients with COVID-19 infection presenting to the emergency room with dyspnea and unresponsive hypoxyemia. Admission blood laboratory including lymphocyte count, serum lactate dehydrogenase, D-dimer and C-reactive protein and the ratio between the arterial partial pressure of oxygen and inspired oxygen were collected. By calculating the areas under the receiver-operating characteristic curves (AUC), we compared the performance of blood laboratory-arterial gas analyses features alone and combined with the CT features in two hybrid models (Hybrid radiological and Hybrid radiomics)for predicting ICU admission. Following a machine learning approach, 63 patients were allocated to the training and 52 to the validation set. Twenty-nine (25%) of patients were admitted to ICU. The Hybrid radiological model comprising the lung %consolidation performed significantly (p = 0.04) better in predicting ICU admission in the validation (AUC = 0.82; 95% confidence interval 0.73–0.97) set than the blood laboratory-arterial gas analyses features alone (AUC = 0.71; 95% confidence interval 0.56–0.86). A risk calculator for ICU admission was derived and is available at: https://github.com/cgplab/covidapp. The volume of the consolidated lung in CT of patients with COVID-19 pneumonia has a mild but significant incremental value in predicting ICU admission.

Role of Serum Lactate Dehydrogenase (LDH) As a Prognostic Marker for Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3115-3115
Author(s):  
Krina Patel ◽  
Robert Z. Orlowski ◽  
Nina Shah ◽  
Qaiser Bashir ◽  
Simrit Parmar ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Stem Cell ◽  
Lactate Dehydrogenase ◽  
Hematopoietic Stem Cell Transplantation ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Hematopoietic Stem ◽  
The Impact

Abstract Abstract 3115 Background: The International Staging System (ISS), chromosomal abnormalities, and response to therapy are well recognized predictors of outcome in multiple myeloma (MM). However, the role of serum lactate dehydrogenase (LDH) as a prognostic marker for MM is not well established. Recently we showed that high LDH at diagnosis of MM is a predictor of shorter survival. Here we report the impact of the LDH level at the time of autologous hematopoietic stem cell transplantation (auto-HCT) on its outcome. Methods: We evaluated 1,658 patients with symptomatic myeloma who underwent auto-HCT from July 1988 to December 2010 at our institution. The primary objective was to determine the impact of high LDH (>1000 IU/L) level, obtained on the start day of the preparative regimen, on progression free survival (PFS) and overall survival (OS). Results: Patient characteristics according to LDH level at auto-HCT are summarized in Table 1. Patients in the 2 LDH groups (>1000 or ≤ 1000) were matched for age, gender, disease status, and response to prior therapy at the time of auto-HCT. Patients with LDH >1000 IU/L had a significantly higher beta-2 microglobulin (β2m) and bone marrow plasmacytosis at the time of auto-HCT. Median times to neutrophil (10 vs. 10 days: p=0.10) and platelet engraftment (11.3 vs.12.2 days: p=0.20) were not different in the 2 groups. Also, there was no significant difference in CR, VGPR, PR or overall response rates between the 2 groups. Median follow up was 35 months (1 to 244). Median OS in patients with LDH >1000 and ≤ 1000 were 49.2 and 68.0 months, respectively (p=0.03). Median PFS in patients with LDH >1000 and ≤ 1000 were 14.4 and 24.7 months, respectively (p=0.001). On univariate analyses, >10% plasma cells in bone marrow biopsy, relapsed disease, serum β2M ≥ 3.5 at auto-HCT, presence of any chromosomal abnormality, and < PR after auto-HCT were associated with significantly shorter PFS and OS. Conclusions: Having a serum LDH value of >1000 IU/L prior to auto-HCT is associated with shorter PFS and OS in patients with MM. These high risk patients may require aggressive post-transplant therapy, including consolidation, maintenance, tandem transplants or novel approaches like immunotherapy. Disclosures: Shah: Celgene: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Multiple Extramedullary-Bone Related and/or Extramedullary Extraosseous Are Independent Poor Prognostic Factors in Patients With Newly Diagnosed Multiple Myeloma

2021 ◽  
Vol 11 ◽  
Author(s):  
JingSong He ◽  
XiaoYan Yue ◽  
DongHua He ◽  
Yi Zhao ◽  
Yang Yang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Factors ◽  
Early Stage ◽  
Progression Free Survival ◽  
Staging System ◽  
Serum Lactate ◽  
Single Site ◽  
Serum Lactate Dehydrogenase ◽  
Newly Diagnosed ◽  
International Staging System

BackgroundExtramedullary (EM) lesions are common in multiple myeloma (MM) and are often related to the poor prognosis of MM but are scarcely understood.MethodsIn this retrospective study, the baseline characteristics of 357 newly diagnosed patients with extramedullary multiple myeloma (EMM) and their impact on the prognosis were analyzed. All patients received first-line treatment with bortezomib-based regimen.ResultsThe overall incidence rate of EM was 22.4%, and the detection rate of PET/CT was significantly higher than other imaging methods (P = 0.015). The cohorts consisted of 10 cases of extramedullary extraosseous (EME) and 70 cases of extramedullary-bone related (EMB), including 53 cases with single site involvement (one case with EME) and 27 cases with multiple sites (&gt;1 site) involvement (nine cases with EME). EMM patients had high levels of hemoglobin (Hgb, ≥10 g/dl) and serum lactate dehydrogenase (LDH, &gt;245u/L) and are inclined to early-stage revised international staging system (R-ISS). Compared to patients without EM, those with EMM had worse progression-free survival (PFS) (P = 0.014) and overall survival (OS) (P = 0.032). In addition, patients without EM and those with a single site of EMB had similar PFS and OS, while patients with multiple sites of EMB or EME and multiple sites of EMB with EME had poor PFS and OS. Multivariate analysis confirmed that multiple sites of EMB and/or EME were independent prognostic predictors affecting PFS and OS in newly diagnosed MM patients.ConclusionsThis study suggested that among patients treated with bortezomib-based regimens, multiple sites of EMB and/or EME are independent poor prognostic factors for newly diagnosed MM patients, while a single site of EMB does not affect the survival of newly diagnosed MM patients. Thus, these findings could be used as a reference for the study of EMM patients in the new drug era, but prospective clinical studies are needed to provide evidence-based data for the diagnosis and treatment of EMM.

Orbital plasmacytoma as the presenting feature in multiple myeloma

2020 ◽  
pp. 112067212092995 ◽  
Author(s):  
Malavika Mani ◽  
Nirupama Kasturi ◽  
Rekha Sravya ◽  
Subashini Kaliaperumal ◽  
Debasis Gochhait
Keyword(s):  
Plasma Cells ◽  
Systemic Disease ◽  
Elevated Serum ◽  
Needle Aspiration ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Reactive Protein ◽  
Lytic Lesions ◽  
Needle Aspiration Cytology

A 50-year-old female patient presented with protrusion of the left eye for 1 month. Examination showed abaxial proptosis, restriction of extraocular movements, and elevated intraocular pressure. Computed tomography of the orbits showed soft tissue enhancing lesion in the superolateral aspect of the left orbit with lytic lesions in calvarium. Fine needle aspiration cytology of the lesion revealed a diagnosis of plasmacytoma with positive CD138 and CD38 immunohistochemical stains. Erythrocyte sedimentation rate, C-reactive protein and serum lactate dehydrogenase were elevated. Serum protein electrophoresis revealed hypergammaglobulinemia, and bone marrow biopsy revealed 6% plasma cells. The patient was started on chemotherapy with bortezomib, dexamethasone and lenalidomide by the medical oncologist. Significant improvement in proptosis and extraocular movements noted on follow-up. Orbital myeloma may be the first manifestation of systemic disease.

Prognostic value of serum lactate dehydrogenase in symptomatic multiple myeloma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8093-8093 ◽  
Author(s):  
Krina K. Patel ◽  
Robert Z. Orlowski ◽  
Donna M. Weber ◽  
Michael Wang ◽  
Sheeba K. Thomas ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Lactate Dehydrogenase ◽  
Prognostic Value ◽  
Intensive Therapy ◽  
Serum Lactate ◽  
Response To Therapy ◽  
Stage Iii ◽  
Serum Lactate Dehydrogenase ◽  
Survival Times ◽  
The Impact

8093 Background: In patients with symptomatic multiple myeloma, the clinical features, responses to treatment, and survival times vary. Well established predictors of survival include the International Staging System (ISS), cytogenetic abnormalities, and response to therapy. Long recognized has been the association of high serum lactate dehydrogenase (LDH) with advanced disease and shorter survival. We focused here on the impact of high LDH on staging and prognosis in order to guide the role of recent advances in therapy. Methods: We evaluated 1,247 patients with newly diagnosed, symptomatic myeloma from 10/74 to 7/11. Our goal was to determine the prognostic value of high LDH (>300 IU/L) in relation to ISS stage. We also compared the frequencies of anemia, hypercalcemia, and response to therapy in patients with high LDH with those of patients with Stage III disease and normal LDH values. Results: All 1,139 patients with normal LDH lived significantly longer than the 108 patients with elevated values (47 vs. 16 months, p <.01). LDH was elevated in 9% of all patients, but in 2%, 6%, and 18% of patients with ISS-I, II, and III disease, respectively. Their survival times were also significantly shorter than those of comparable patients in each stage with normal LDH (table). Among the 108 patients with high LDH, the frequencies of hemoglobin <8.5 g/dl (54 vs. 41%, p=.03), and serum calcium>11.5 mg/dl (41 vs. 27%, p<.01) were significantly higher than those of 292 patients with Stage III disease and normal LDH, and the frequency of response to therapy was less (40 vs. 62%, p<.01). Conclusions: Serum lactate dehydrogenase provides a convenient and dependable prognostic indicator in patients with multiple myeloma. An elevated LDH value indicates a poor prognosis regardless of ISS stage, confirming the report by Gkotzamanidou, Terpos, and Dimopoulos et al, and should be included in the definition of stage III disease. Such patients require rapid control of disease with sequential combinations of effective drugs and intensive therapy in order to improve their outcome. [Table: see text]

scholarly journals Sex Differences in an Italian Pediatric Population Covid-19 Positive

2020 ◽  
Author(s):  
Elisabetta Straface ◽  
Isabella Tarissi De Jacobis ◽  
Rosa Vona ◽  
Camilla Cittadini ◽  
Alessandra Marchesi ◽  
...  
Keyword(s):  
Sex Differences ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
C Reactive Protein ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Males And Females ◽  
Multiple Drugs

Abstract Background: Since December 2019 coronavirus disease (COVID-19) emerged in Wuhan and spread rapidly worldwide. Despite the high number of people affected, data on clinical features and prognostic factors in children and adolescents are limited. We propose a retrospective study aimed to identify sex differences in a pediatric population with COVI-19.Methods: A pediatric population admitted with COVID-19 to Bambino Gesù Children's Hospital of Rome (Italy) in the period from March to May 2020 has been studied taking into account sex differences. Medical history, comorbidities, symptoms and laboratory findings were obtained from patients' electronic medical records. Results: In 37 patients (19 males and 18 females) we found that: i) fever and cough were the dominant symptoms, while gastrointestinal symptoms were rare; and ii) all ages of childhood were susceptible to COVID-19. Moreover, we found that females with COVID-19 were older than males (p < 0.01); required more days of hospitalization (p < 0.04); needed of treatment with multiple drugs; and had higher serum lactate dehydrogenase values (p < 0.04) than males. Conversely, males had, although not significant, higher values of C reactive protein and erythrocyte sedimentation rate than females.Conclusions: Based on the data listed above sex differences were detected in an Italian pediatric population. Compared to the adults we found that COVID-19 infection in children is a non-severe inflammatory disease in both males and females. In any case, many detailed studies should be conducted.

scholarly journals Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group

2015 ◽  
Vol 33 (26) ◽  
pp. 2863-2869 ◽  
Author(s):  
Antonio Palumbo ◽  
Hervé Avet-Loiseau ◽  
Stefania Oliva ◽  
Henk M. Lokhorst ◽  
Hartmut Goldschmidt ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Risk ◽  
Chromosomal Abnormalities ◽  
Laboratory Data ◽  
Staging System ◽  
Albumin Level ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Adaptive Partitioning ◽  
International Staging System

Purpose The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM). Patients and Methods Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival. Results ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level < 3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively. Conclusion The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.

scholarly journals Effect of MAGE-C1 Gene Expression on Prognosis and Effectiveness of Bortezomib-Containing Courses in Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4327-4327
Author(s):  
Eleonora Makunina ◽  
Larisa Mendeleeva ◽  
Vadim L. Surin ◽  
Irina V. Galtseva ◽  
Julia O. Davidova ◽  
...  
Keyword(s):  
Gene Expression ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Cells ◽  
Conflicts Of Interest ◽  
Serum Lactate ◽  
High Serum ◽  
Serum Lactate Dehydrogenase ◽  
Cell Content ◽  
Antitumor Response

Abstract Introduction. The group of genes, encoding cancer-testis antigens is actively studied as a new markers of refractory in some diseases, including multiple myeloma (MM). It is suggested that the MAGE-C1 gene in MM may be considered as an additional marker predicting the effectiveness of therapy. Purpose. Determine of MAGE-C1 gene expression by quantitative real-time polymerase chain reaction (qRT-PCR) in MM patients and assess the correlation of expression with some laboratory parameters and response on bortezomib-containing therapy. Patients and methods. A prospective study from February 2019 to July 2021 included 76 MM patients (43 men and 33 women) aged 35 to 82 years (median 58). The level of MAGE-C1 gene expression by qPCR-PCR in bone marrow samples, enriched with CD138+ cells, was determined for all patients. Quantity of MAGE-C1 expression was calculated with 2ΔCt method relative to housekeeping gene expression. Plasma cell content ranged from 1 to 89% (median 26%), monoclonal paraprotein secretion vary from 2.1 to 82.1 g/l, Bence-Jones protein in urine (from trace values to 12.54 g/day) was determined in 50 patients. High - risk cytogenetic [t(4; 14)(p16; q32), del17p] was documented in 22 patients, bone plasmocytomas - in 36 patients, myeloma nephropathy - in 17. All patients recieved induction with bortezomib - containing courses. Median follow-up duration: 14 months (1-22 months). As a control, similar bone marrow cells of 7 healthy donors were investigated. Results. The average value of MAGE-C1 expression in donors was 0.01 ± 0.007, a range of values vary from 0.0003 to 0.06. Gene expression MAGE-C1 index &gt; 0.06 is accepted as increased expression. High serum lactate dehydrogenase (LDH) level (higher than the upper limit of reference values) was observed in patients with high MAGE-C1 gene expression [median - 0.35], normal LDH-level (≤ 260 U/L) was observed in patients with lower MAGE-C1 gene expression [median - 0.04]; p &lt; 0.0001 (Figure 1). Negative correlation was found between the content of hemoglobin (Hb) and level of MAGE-C1 expression: Hb ≥ 12.0 g/dl was observed in patients with increased MAGE-C1 expression [median - 0.27], and Hb 5.5-11.8 g/dl - in patients with lower expression indices [median 0.1]; p=0,034. Antitumor response was evaluated after induction therapy in 51 patients. In 100% of patients with MAGE-C1 expression of ≤ 0.06 ≥ partial response (PR) was achieved, while in patients with MAGE-C1 expression of 0.07-1.0 ≥ PR was achieved in 84.6% of cases, and in patients with MAGE-C1 expression of &gt; 1.0 - in 58%; p &gt; 0.05. Besides, patients with ≥ PR had a level of MAGE-C1 expression lower than patients with a refractory to bortezomib [median 0.17 vs 1.14]; p = 0.04 (Figure 2). Conclusions. High MAGE-C1 gene expression in MM patients is associated with an increase in LDH, which corresponds to stage III by R-ISS. Probability of achievement of the antitumor response ≥ PR on the bortezomib-containing induction is reliable above at patients with low MAGE-C1 expression while the hyperexpression of this gene is followed by a refractory to a bortezomib therapy. Further study of MAGE-C1 gene expression may promote a personalized approach in the choice of antitumor therapy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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