Explore the vast range of titles available.

Epstein-Barr virus (EBV) reactivation can occur following allogenic hematopoietic stem cell transplantation (allo-HSCT). However, the clinical characteristics and outcomes of EBV-viral load are not well known. Thus, we retrospectively analyzed the clinical features and prognostic impact of the EBV viral load in 121 allo-HSCT recipients from our hospital. EBV DNA quantification was performed in whole blood after transplantation. Patients were grouped based on whether EBV DNA quantification reached > 1000 copies/mL during follow-up (N = 50) or not (N = 71). Patients with EBV > 1000 EBV copies/mL were relatively more common in the groups with graft versus host disease (GVHD) prophylaxis including ATG, haploidentical donor type, peripheral blood as a donor source, and acute GVHD II–IV. The 20-month OS and DFS were not significantly different between patients with < 1000 EBV copies/mL and patients with > 1000 EBV copies/mL (20-month OS, 56.0% vs. 60.6%; p = 0.503, 20-month DFS, 50.0% vs. 57.7%; p = 0.179). Immunosuppressant (ISS) dose reduction was achieved after the maximum increase in EBV in 41/50 (82%) patients. Additionally, 30/50 (60%) patients achieved a 50% dose reduction or no restarting of ISS within 3 months of the maximum EBV increase. Among cases wherein EBV DNA quantification reached > 1000 copies/mL, those that achieved rapid dose reduction of ISS tended to have longer overall survival (“not reached” vs 5.4 months, p < 0.001) and disease-free survival (88.4 months vs 5.3 months, p < 0.001) than those in patients who did not. Our data highlight the importance of rapid ISS reduction in post-transplant EBV reactivation.

Background Rasburicase, a recombinant urate oxidase enzyme, has potent efficacy in controlling uric acid and is widely used to prevent tumor lysis syndrome in high-risk patients owing to its low toxicity profile. However, it has been associated with a risk of anaphylaxis, especially on re-exposure, owing to its immunogenic potential. Case presentation A 71-year-old Japanese female diagnosed with diffuse large B cell lymphoma with a large tumor burden experienced anaphylactic shock leading to death upon initial administration of rasburicase. The pre-and postmortem examination revealed that the cause of death was a cascade of events starting with anaphylaxis-induced distributive shock leading to obstructive shock due to the collapse of the heart, which was compressed by the post-mediastinal tumor. This was further compounded by massive bleeding from the tumor and tension hemothorax, resulting in circulatory collapse. Conclusions Although extremely rare, rasburicase can cause fatal anaphylaxis, even on first exposure.

Renal impairment is reported in 20%–50% of patients with newly diagnosed multiple myeloma and is known as a poor prognostic factor. Although several studies have demonstrated that treatment with novel antimyeloma agents improves renal impairment and myeloma itself, the time-dependent clinical course of recovery of renal function has not been extensively studied. We retrospectively collected the data of characteristics and outcomes in consecutive unselected patients diagnosed with and treated for symptomatic multiple myeloma between January 2015 and December 2022, and extracted and analyzed the cases with renal impairment. Among 234 patients with multiple myeloma, 67 (28.6%) had renal impairment (estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m 2 ) at the time of diagnosis. The median eGFR at diagnosis was 28 ml/min/1.73m 2 , and the eGFR significantly improved to 41.5 ml/min/1.73m 2 , which corresponds to a 42.9% increase, at 3 months after the initiation of treatment for myeloma ( p  < 0.0001). Further improvement in renal function was not observed at 6 months (eGFR 46 ml/min/1.73m 2 ) and 1 year (eGFR 43.5 ml/min/1.73m 2 ) after treatment initiation. The primary treatment was a bortezomib-containing regimen in approximately 90% of patients. A post hoc analysis revealed a positive correlation between the serum calcium concentration at diagnosis and improvement in renal function. In conclusion, renal function can partially recover through the treatment of multiple myeloma, and the treatment response during the first 3 months may predict the renal function prognosis. Further accumulation of cases is needed to identify the predictive factors for renal recovery.