Background Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare and highly aggressive lymphoma with a dismal prognosis and no established standard therapy. Its frequent expression of BCL-2 provides a rationale for targeting this anti-apoptotic protein. Methods We report the case of a 34-year-old female with refractory MEITL who failed prior lines of therapy, including CHOPE and gemcitabine/oxaliplatin (GemOx) combined with golidocitinib. Based on positive BCL-2 expression by immunohistochemistry, a salvage regimen combining venetoclax with Gemox was administered. Results The treatment induced a rapid and significant clinical improvement. A follow-up PET/CT scan confirmed complete metabolic remission. The main adverse event was grade 4 neutropenia and thrombocytopenia with febrile neutropenia, attributable primarily to the Gemox backbone, which resolved with supportive care. The off-label use was approved by the institutional committee, and informed consent was obtained. Conclusion To our knowledge, this is the first report of successful treatment of refractory MEITL with a venetoclax-containing regimen. This case validates BCL-2 as a actionable therapeutic target in MEITL. Future efforts should focus on optimizing combination partners for venetoclax to improve efficacy and tolerability. The rationale for exploring venetoclax as post-transplant maintenance therapy in MEITL is also discussed.

BACKGROUND Cefepime is a fourth-generation cephalosporin antibiotic widely used to treat a variety of serious bacterial infections, including febrile neutropenia, pneumonia, complicated intra-abdominal infections, urinary tract infections, and skin infections. It possesses broad-spectrum action against both gram-positive and gram-negative bacteria, with favorable pharmacokinetics and clinical efficacy, making it a cornerstone in the management of infections, especially in the hospital setting, where resistant organisms are prevalent. Well-known adverse effects include local reactions, gastrointestinal symptoms, and neurologic complications. However, instances of liver injury are rare. CASE SUMMARY We report the case of a 73-year-old male who presented to the emergency department (ED) with a 1-week history of productive cough, shortness of breath, and fatigue. Laboratory findings in the ED included leukocytosis, hyponatremia, and elevated procalcitonin. Computed tomography chest without contrast showed a new right-sided pleural effusion and worsening consolidative opacities in both lungs. He was admitted and started vancomycin and cefepime for infected bronchiectasis. Liver function tests subsequently worsened and improved with the discontinuation of cefepime. The patient ultimately died from acute hypoxic respiratory failure two weeks after hospitalization. CONCLUSION This case report highlights a rare adverse effect of a commonly used antimicrobial in the hospital setting for various bacterial infections. Prompt cessation of the medication is the primary treatment in cefepime-induced liver injury, and most cases resolve without complications.

Management of febrile neutropenia in previously healthy, presumed immunocompetent children varies. Unnecessary treatment impacts the patients, families, and the healthcare system. With guidance from a Canadian Paediatric Society Practice Point, most well-appearing children with a first episode of febrile neutropenia can be managed with reduced exposure to antibiotics and close outpatient follow-up. The aim of this initiative was to safely reduce antibiotic use in this low-risk population presenting to the emergency department (ED). A multidisciplinary team designed a quality improvement (QI) initiative. From July 2022 to July 2024, treatment with antibiotics was classified as indicated or non-indicated according to guidance from the Practice Point. Interventions involved guideline dissemination, provider education, and point-of-care tools to facilitate clinical decision-making and follow-up. Outcome measures included the proportion of children receiving antibiotics, hospital admission, and appropriate laboratory follow-up. Re-presentation to ED and missed serious bacterial infections were monitored as balancing measures. Analysis of the primary outcome was by statistical process control. Three hundred and ninety-eight (398) children with febrile neutropenia were included. The proportion of non-indicated antibiotics was 6.7% at baseline. Statistical process control analysis of the G-chart demonstrated special cause variation with 97 consecutive cases occurring without error (non-indicated antibiotics). Following the occurrence of special cause variation until the end of the study, only 1.6% of children received non-indicated antibiotics. There was no increase in re-presentations to ED (9% vs 8%; p = 0.65) nor missed serious bacterial infections (0% vs 0%). Quality improvement methodology can facilitate the timely adoption of best practices to align local clinical care with new national guidelines. Implementation of the national guideline allowed low-risk children with febrile neutropenia to avoid overtreatment.

To evaluate the disproportionality, time to onset, reporting frequency, and outcomes of hematologic AEs associated with trastuzumab deruxtecan (T-DXd) using data from the Japanese Adverse Drug Event Report database (JADER). We analyzed data for the period from April 2004 to December 2024. Data on hematologic AEs were extracted, and the disproportionality of T-DXd-associated AEs was assessed by calculating reporting odds ratios. Among the 3,221,393 reports analyzed, 1561 were associated with T-DXd, including 433 hematologic AEs. Signals were detected for six AEs, including febrile neutropenia, anaemia, neutrophil count decreased, neutropenia, platelet count decreased, and myelosuppression. All had fatal cases, with particularly high fatality rates observed for febrile neutropenia and platelet count decreased. A histogram of median times to onset showed that febrile neutropenia and platelet count decreased typically occurred within 8 to 10.5days after administration. Weibull distribution analysis indicated that febrile neutropenia showed an early-onset tendency (early failure type), whereas platelet count decreased occurred in a dose-dependent manner (wear-out failure type). Some hematologic AEs associated with T-DXd can be fatal and may occur not only early in treatment but also later in the course. Continuous monitoring is essential for their timely detection and appropriate management.

Febrile neutropenia is a frequent complication of oncological treatment. Empirical antibiotic therapy should be started within the first hour after admission. Delays in its administration are associated with prolonged hospital stays and higher mortality rates. This study assessed the impact of Manchester Triage on time to antibiotic initiation in febrile neutropenia patients admitted to the Emergency Department (ED). This retrospective single-center study included adult cancer patients admitted to the ED in 2022 diagnosed with febrile neutropenia. Among 38 patients, 34% were assigned an orange code and 11% a white code (referred from outpatient consultation); all in these two groups were directed to Internal Medicine (IM). A yellow triage code was assigned to 55% of patients, who were then directed either to IM or General Medicine (GM), without a defined criterion. Among patients triaged to IM (74%), the median time from admission to initiation of antibiotics was 4h 27min compared with 7h 46min for those triaged to GM (p = 0.03). There was no statistically significant correlation between time to antibiotic initiation and length of hospital stay or mortality. Delays are significant and worsened when patients are assigned a yellow Manchester Triage code and are directed to GM. The study was underpowered to detect a statistically significant effect on mortality, but the observed mortality rate was double that reported in the literature. Proper triage of febrile oncological patients in the ED is crucial, and protocols with well-defined criteria should be implemented to ensure timely treatment.

Triplet therapy with darolutamide, androgen deprivation therapy, and docetaxel (DOC) has emerged as an intensified treatment option for metastatic castration-sensitive prostate cancer (mCSPC). This study evaluated real-world prostate specific antigen (PSA) responses and adverse events (AEs) associated with triplet therapy, with a focus on age-specific differences. We performed a retrospective cohort study across six academic institutions in Japan between February 2023 and February 2025. A total of 137 patients with mCSPC who received triplet therapy were analyzed. PSA responses and AEs were assessed, including subgroup analyses by age (<75 vs ≥75years). The median age was 71years, and 40 patients (29.2%) were aged ≥75years. Six cycles of DOC were completed at similar rates in patients aged <75years (66.0%) and≥75years (57.5%) (P=.435). The median baseline PSA was 298ng/ml, and 107 patients (78.1%) met the CHAARTED high-volume criteria. At three months, the median [interquartile range] PSA decline was 99.8% [99.0-99.9]; 113 patients (92.6%) achieved a PSA decline >90%, and 35 patients (28.7%) achieved a PSA <0.2ng/ml. During follow-up, the proportion achieving a PSA nadir <0.2ng/ml did not differ significantly between patients aged <75years (63.9%) and≥75years (55.0%) (P=.341). Grade≥3 AEs occurred in 56 patients (40.9%), including febrile neutropenia in 29 patients (21.2%). The incidence of AEs did not differ significantly by age. In this real-world cohort, triplet therapy showed substantial PSA declines and acceptable tolerability, with no significant differences in short-term efficacy or safety between patients aged <75 and≥75years. These findings suggest that chronological age alone should not preclude consideration of triplet therapy in appropriately selected patients.

Autologous stem-cell transplantation is a fundamental therapy for multiple myeloma. Although inpatient chemo-based stem-cell mobilization (SCM) is standard care in Germany, outpatient approaches could ease healthcare constraints. We analyzed 109 myeloma patients undergoing SCM and collection at the University Medical Center Göttingen for safety. We then trained machine learning models to predict adverse events (AEs) requiring hospitalization and to forecast AE onset timing for optimized ward management. In our cohort, 97% achieved successful collection, but 69% experienced severe AEs necessitating hospitalization. Simulations suggest a risk-stratified outpatient protocol could cut bed usage by at least one third without compromising safety. Classification models accurately predicted some AE types (e.g., elevated creatinine, ROC-AUC 1.0), though neutropenic fever remained challenging (ROC-AUC 0.67). Regression models forecast AE onset with a mean error of just over one day. These results outline a data-driven roadmap for safely adopting outpatient SCM and optimizing resource allocation in clinical practice.

Sex-disparate safety profile of Obinutuzumab: a pharmacovigilance analysis using the FDA adverse event reporting system.

Triplet therapy, combining androgen deprivation therapy (ADT), darolutamide, and docetaxel has recently emerged as the standard first-line treatment for metastatic hormone-sensitive prostate cancer (mHSPC). Febrile neutropenia (FN) is a major clinical issue not only as a serious infection but also as a cause for early cessation or dose reduction of chemotherapy. However, little is known regarding the predictive factors for the development of FN in patients with mHSPC receiving triplet therapy. This study enrolled 60 patients diagnosed with mHSPC across multiple institutions from 2023 to 2025. We examined clinical characteristics, treatment schedules, adverse events, and oncological outcomes. We focused particularly on the development of FN and used logistic regression analysis to investigate the predictive factors. The median age was 72 years old, and 43 patients (73.3%) had high-volume disease at diagnosis. Nine patients (15%) developed FN. Multivariate logistic regression analysis identified older age [≥75, p=0.0161; hazard ratio (HR)=7.49], high-volume disease (p=0.0335), and shorter interval from ADT to docetaxel (<40 days) (p=0.0389; HR=7.86) as independent predictive factors of the development of FN. Notably, prolonged castration period prior to docetaxel (≥40 days) significantly reduced the risk of FN from 23.5% to 3.8% (p=0.0001). Patients who developed FN tended to have shorter castration-resistant prostate cancer progression-free survival (CRPC-PFS) compared to those who did not (p=0.0812; HR=3.2). Older age and high-volume disease were independent risk factors for FN in patients with mHSPC receiving triplet therapy. A longer interval from ADT initiation to docetaxel (≥40 days) was associated with a significantly lower risk of FN, suggesting that extending the pre-docetaxel castration period is a practical, adjustable scheduling strategy to improve treatment safety. These findings may support treatment selection and proactive prevention of FN.

Immune checkpoint inhibitor immunotherapy enhances T cell activity against cancer cells but often leads to the immune system targeting healthy cells, causing 'immune-related adverse events' (irAEs). We report the case of a man in his 70s with metastatic melanoma being treated with ipilimumab and nivolumab. He presented with febrile neutropenia after lacerating a thumb on his compost bin. The neutrophil count only recovered once oral prednisolone was commenced, indicating a haematological irAE. A restaging Positron Emission Tomography scan revealed intramuscular ring-enhancing collections throughout his body, one of which was aspirated and cultured the fungus Lomentospora prolificans He was treated with voriconazole plus terbinafine, both of which were later substituted with olorofim due to a voriconazole-induced rash. After 4 months, the collections had resolved on repeat imaging, and olorofim was ceased due to transaminitis. This case highlights neutropenia as a lesser-known adverse effect of immunotherapy and raises awareness about L. prolificans infection.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency impairs cellular redox balance through reduced NADPH production and is the most common enzymatic disorder-causing anemia. Venetoclax combined with azacitidine (Ven-Aza) targets leukemic stem cells by disrupting oxidative phosphorylation and inducing mitochondrial stress. This study hypothesized that G6PD deficiency may enhance the efficacy of Ven-Aza in acute myeloid leukemia (AML) by reducing leukemic cell metabolic resilience. The authors studied 73 consecutive patients with newly diagnosed (ND) AML treated with Ven-Aza. G6PD activity was systematically assessed at diagnosis in all patients and categorized as normal (n=47), borderline (n=11), or deficient (n=15). Composite complete remission rates were 93% in the G6PD deficient group versus 69% in the normal/borderline group (p=.03). Patients with G6PD deficiency had a significantly longer median overall survival (23.8 months; 95% confidence interval [CI], 8.9-38.7), as compared to 8.96 months (95% CI, 2.9-15.0) in the normal/borderline group (p=.034). In multivariate analysis, G6PD-deficiency was associated with improved survival as compared to patients with normal G6PD activity (hazard ratio, 0.417; 95% CI, 0.181-0.965, p=.043). No significant differences were observed across groups in rates of febrile neutropenia, pneumonia, sepsis, or grade 3-4 cytopenia. G6PD deficiency is associated with higher response rates and improved survival in patients with ND-AML treated with Ven-Aza. These findings support G6PD deficiency as a potential biomarker of therapeutic sensitivity to Ven-AZA and may uncover metabolic vulnerabilities in AML with potential therapeutic implications.

Safety and Tolerability of Tocilizumab in a Case Series of Heart Transplant Recipients With Chronic Antibody-Mediated Rejection.

Effect of Designing Nursing Protocol regarding Chemotherapy Induced Febrile Neutropenia: Nurses performance and Patients’ related Outcome

Feasibility of preparing whole blood-derived pooled buffy coat granulocyte concentrates for pediatric patients.

Not available.

ABSTRACTBackgroundPaediatric classical Hodgkin lymphoma (cHL) is the most common malignancy in adolescents, and despite excellent survival, a subset of patients experiences treatment failure or severe long‐term toxicity, underscoring the need for improved risk stratification. Early response assessment is particularly important, as it guides decisions on radiotherapy, where overtreatment can lead to substantial late effects.MethodsIn the context of a large‐scale systems‐level immunomonitoring initiative, we specifically examined paediatric cHL and profiled their systemic immunology alongside children with intra‐ and extracranial solid tumours and other lymphomas. Through longitudinal sampling before and after treatment, we aimed to identify diagnostic and prognostic biomarkers relating immune profiles to early treatment response and risk of developing neutropenic fever.ResultsPlasma CCL17 and MCP‐4 were markedly elevated in cHL compared with other paediatric lymphomas and other solid tumours, with distinct immune cell compositions, particularly between cHL and extracranial tumours. CCL17 and MCP‐4 negatively correlated with age in extracranial and intracranial tumours but not in cHL, indicating disease‐specific regulation. Chemotherapy induced consistent protein changes in cHL and eliminated CCL17 and MCP‐4 differences between cHL and other lymphomas. Lower baseline MCP‐4 and greater CCL17 reduction after chemotherapy were associated with favourable early response, while lower granzyme levels identified patients at higher neutropenic fever risk.ConclusionTogether, these exploratory findings highlight clinically relevant biomarkers in a paediatric oncology context, with the potential to enhance diagnostic precision, guide response‐adapted therapy and effectively allocate supportive care, thereby improving outcomes for children with cHL.Trial RegistrationThe authors have confirmed clinical trial registration is not needed for this submission

Microbiologic Profile, Antimicrobial Resistance patterns, and Outcomes in Febrile Neutropenia in Eastern India: A Retrospective Analysis

Preventing the severity of side effects from anticancer therapy and reducing the number of hospitalizations due to severe chemotherapy complications remains a pressing and unresolved issue in oncology and healthcare. Complications from anticancer therapy lead to a decrease in patients’ quality of life, disrupt the interval between treatment courses, and negatively impact the overall effectiveness of treatment. Hospitalizations associated with the development of side effects from cytostatic incur additional costs for the healthcare system and increase mortality. Purpose of the study is: To identify opportunities to prevent the severity of side effects and initiate treatment early in order to prevent hospitalizations due to adverse events from anticancer therapy, improve treatment outcomes, and enhance the quality of life of cancer patients. Materials and methods. A literature review was conducted in open Russian and English-language sources, as well as in Russian and international databases (Cyberleninka, Pubmed). The search depth was 25 years. Database searches were conducted using the keywords «chemotherapy complications,» «side effects of cytostatics,» «hospitalization of patients with chemotherapy complications,» and «incidence of grade 3–4 chemotherapy complications.» The data obtained were systematized and divided into two sections: frequency of side effects and hospitalization rate. Results. The severity and type of side effects depend on the group of drugs used, the chosen treatment protocol, the stage of the disease, and the patient’s comorbidities. Toxicity is a common problem among cancer patients. The most common complications of chemotherapy are nausea, vomiting, diarrhea, and alopecia. The most severe complications, such as febrile neutropenia complicated by a systemic infection and cardiotoxicity (myocardial ischemia and cardiac arrhythmias), lead to hospitalization. Conclusions. Currently, the frequency and severity of side effects in patients receiving anticancer drug therapy, as well as the rate of hospitalizations associated with complications of anticancer drug therapy, have been insufficiently studied. Assessing the socioeconomic impact of side effects and developing effective strategies for their prevention are pressing issues. Knowledge and use of available risk assessment tools can reduce the number of unnecessary hospitalizations.

Background The prognosis for pediatric patients with relapsed or refractory sarcoma remains poor, and standard salvage therapies are lacking. This study evaluated the efficacy and toxicity of the gemcitabine and docetaxel (GEMDOX) combination in this patient population. Methods We retrospectively analyzed 36 pediatric patients treated with GEMDOX at our institution between 2015 and 2025. Patients received gemcitabine (1,000 mg/m 2 on days 1 and 8) and docetaxel (100 mg/m 2 on day 8) in 21-day cycles. Results The median age was 13.5 years, with osteosarcoma being the most common diagnosis (58.3%). GEMDOX was administered predominantly as a third-line regimen (58.3%). The objective response rate (ORR) at the final assessment was 5.8%, and the disease control rate (DCR) was 14.6%. The median progression-free survival (PFS) and overall survival (OS) were 5.72 months (95% CI, 3.95–7.48) and 12.33 months (95% CI, 8.97–15.66), respectively. The most common Grade 3–4 toxicities were neutropenia (22.2%) and febrile neutropenia (19.4%), both of which were manageable with G-CSF support. No treatment-related mortality occurred. Conclusions Although the objective response rate was modest in this heavily pretreated cohort, GEMDOX demonstrated a manageable safety profile. It represents a viable palliative option with a manageable toxicity profile for pediatric patients with relapsed/refractory sarcoma when curative options are limited. However, given its intensive nature, optimal efficacy may be better achieved when utilized earlier in the relapse setting rather than as a late-line rescue therapy.

75/m with febrile neutropenia during chemotherapy : Preparation for the medical specialist examination: part28