The Netherlands journal of medicine
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Comparative Study
Chemotherapy-induced febrile neutropenia: primary G-CSF prophylaxis indicated during docetaxel cycles.
Chemotherapy-induced febrile neutropaenia (FN) is a common and life-threatening adverse event, which can be largely prevented by the use of granulocyte colony-stimulating factor (G-CSF); G-CSF, however is expensive and not without side effects. Although primary G-CSF prophylaxis is recommended when the risk of FN is ≥ 20%, it is unclear during which cycles it should be administered. This study assessed and compared the FN incidence in the neo-adjuvant or adjuvant administration of two chemotherapy regimens that are widely used in breast cancer care to provide clinically useful recommendations for G-CSF use. ⋯ In breast cancer treatment, compared to other frequently-used agents, monotherapy with docetaxel (100 mg/m2) renders a substantial risk of FN (20.9%), thereby justifying the use of primary G-CSF according to international guidelines.
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Infectious mononucleosis may mimic lymphoma, both clinically and histopathologically. We present a patient with neurological symptoms and lymphadenopathy, initially diagnosed as Epstein-Barr virus (EBV)-positive angioimmunoblastic T-cell lymphoma (AITL) with cerebrospinal fluid (CSF) localisation based on lymph node pathology and a 30-fold higher EBV load in the CSF compared with serum. However, the patient fully recovered spontaneously and EBV became negative in both CSF and serum, suggestive of a dramatic presentation of EBV meningoencephalitis.
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Case Reports
Exceptional response of brain metastases to short course nivolumab while on high-dose steroids.
In this manuscript, we describe a patient with an exceptional response of brain metastases from lung cancer to short course nivolumab while on high-dose steroids. This case shows that immunotherapy can cause delayed and enduring responses even in patients with poor predictive parameters for treatment success, such as low programmed death ligand-1 (PDL1) expression and long-term treatment with high-dose corticosteroids. Secondly, it underscores the importance of follow up after the administration of immunotherapy, even in cases with a deemed poor prognosis and few received cycles of immunotherapy.
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Acute withdrawal of calcium channel blockers can lead to the so-called calcium channel blocker withdrawal phenomenon, in particular, when high dosages are used. In the case presented, inadequate drug substitution led to this phenomenon which resulted in a serious course of events. Careful monitoring the process of drug substitution with respect to equal therapeutic dosages is therefore a necessity, especially in vulnerable patients.
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Monitoring low-molecular-weight heparins is generally not required. However, guidelines advise to monitor anti-Xa levels in patients with renal insufficiency or a BMI above 50, and in pregnancy. Measuring anti-Xa levels is a complex challenge since sampling should be performed three to five hours after subcutaneous injection and after steady state concentrations have been reached. Strict compliance is pivotal for justified dose adjustments. ⋯ Monitoring anti-Xa levels is a complex clinical challenge. This study showed that non-compliance with recommendations for anti-Xa monitoring was high, often resulting in unjustified dose adjustments.