Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

AbstractImmunocompromised patients are at high risk of invasive fungal infections (IFI), in particular those with haematological malignancies undergoing remission-induction chemotherapy for acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) and recipients of allogeneic haematopoietic stem cell transplants (HSCT). Despite the development of new treatment options in the past decades, IFI remains a concern due to substantial morbidity and mortality in these patient populations. In addition, the increasing use of new immune modulating drugs in cancer therapy has opened an entirely new spectrum of at risk periods. Since the last edition of antifungal prophylaxis recommendations of the German Society for Haematology and Medical Oncology in 2014, seven clinical trials regarding antifungal prophylaxis in patients with haematological malignancies have been published, comprising 1227 patients. This update assesses the impact of this additional evidence and effective revisions. Our key recommendations are the following: prophylaxis should be performed with posaconazole delayed release tablets during remission induction chemotherapy for AML and MDS (AI). Posaconazole iv can be used when the oral route is contraindicated or not feasible. Intravenous liposomal amphotericin B did not significantly decrease IFI rates in acute lymphoblastic leukaemia (ALL) patients during induction chemotherapy, and there is poor evidence to recommend it for prophylaxis in these patients (CI). De...
Source: Annals of Hematology - Category: Hematology Source Type: research

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CONCLUSION: This is the first case to our knowledge describing both such lesions in one patient and the first case describing the use of 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL)-PSMA PET/CT to detect IPAS. Furthermore we highlight the value of nuclear medicine diagnostic work up in complex cases. PMID: 30006647 [PubMed - as supplied by publisher]
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
CONCLUSION: Our results from this totally original study indicated that radioactive isotope 125I labeled to caerin peptide 1.9 may be used to treat breast cancer while at the same time the response to treatment may be monitored by simultaneous imaging. PMID: 30006645 [PubMed - as supplied by publisher]
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
CONCLUSION: A method of tumor size determination, using PHL on 18F-FDG PET/CT, showed more linear relationship and smaller size differences with pathology than MRI (average 0.6 vs. 1.9cm). It provides sufficient reliability and reproducibility for measuring tumor size in breast cancer. PMID: 30006644 [PubMed - as supplied by publisher]
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
Abstract Breast-conserving surgery (BCS) followed by radiation therapy is the current standard of care for early stage breast cancer. Successful BCS necessitates complete tumor resection with clear margins at the pathologic assessment of the specimen ("no ink on tumor"). The presence of positive margins warrants additional surgery to obtain negative final margins, which has significant physical, psychological, and financial implications for the patient. The challenge lies in developing accurate real-time intraoperative margin assessment techniques to minimize the presence of "ink on tumor" and ...
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: Surg Clin North Am Source Type: research
Management of the Axilla in the Patient with Breast Cancer. Surg Clin North Am. 2018 Aug;98(4):747-760 Authors: Park KU, Caudle A Abstract Evaluation of the axillary lymph nodes is critical in the management of breast cancer because it is a key predictor of survival outcome. Surgeons must not only be able to perform sentinel lymph node dissection with high accuracy but also understand the implications of the results. Management of clinically node-negative and node-positive cases can vary significantly, as described in this review. With emerging data, management of the axilla in breast cancer will...
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: Surg Clin North Am Source Type: research
Abstract Ductal carcinoma in situ has been stable in incidence for a decade and has an excellent prognosis. Breast conservation therapy is safe and effective for most patients. Adjuvant whole breast radiation therapy is recommended to reduce the risk of local recurrence. Accelerated partial breast irradiation is a promising alternative to decrease toxicity and improve cosmetic results. Adjuvant hormonal therapy can reduce local recurrence, but should be used cautiously. Future directions in management include developing predictive tools for guidance for use of adjuvant therapy and selecting low-risk patients ...
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: Surg Clin North Am Source Type: research
Abstract New emerging breast imaging techniques have shown great promise in breast cancer screening, evaluation of extent of disease, and response to neoadjuvant therapy. Tomosynthesis, allows 3-dimensional imaging of the breast, and increases breast cancer detection. Fast abbreviated MRI has reduced time and costs associated with traditional breast MRI while maintaining cancer detection. Diffusion-weighted imaging is a functional MRI technique that does not require contrast and has shown potential in screening, lesion characterization and also evaluation of treatment response. New image-guided preoperative locali...
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: Surg Clin North Am Source Type: research
Abstract The American Joint Committee on Cancer staging system has evolved in response to improved imaging, refined surgical techniques, enhanced pathologic evaluation, and greater understanding of tumor biology. The 8th edition has introduced clinical and pathologic prognostic stages for breast cancer that incorporate biologic variables (grade, estrogen/progesterone receptor status, HER2 status, multigene panels) with TNM categories that define the anatomic stage. The prognostic staging system facilitates more refined stratification than the anatomic stage with respect to survival and is an important advance that...
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: Surg Clin North Am Source Type: research
Abstract As more genetic information becomes available to inform breast cancer treatment, screening, and risk-reduction approaches, clinicians must become more knowledgeable about possible genetic testing and prevention strategies, including outcomes, benefits, risks, and limitations. The aim of this article is to define and distinguish high- and moderate-risk breast cancer predisposition genes, summarize the clinical recommendations that may be considered based on the identification of pathogenic variants (mutations) in these genes, and indications for risk-reducing and contralateral prophylactic mastectomy. ...
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: Surg Clin North Am Source Type: research
PMID: 30005782 [PubMed - in process]
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: Surg Clin North Am Source Type: research
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