Dealing with hypodysfibrinogenemia during pregnancy with a successful outcome

Background: Fibrinogen is a protein playing pleiotropic role in human body. It is engaged in maintaining hemostasis. Congenital fibrinogen disorders comprise quantitative and qualitative fibrinogen anomalies. The symptoms range from bleeding, thrombosis to asymptomatic at all what is the most common case. Hypodysfibrinogenemia with lower level of fibrinogen of reduced activity, is the least common of all congenital fibrinogen disorders. Case report: A 31-year-old woman was reported at the 21 weeks of gestation, suffered from genital tract bleeding and there was a history of stillbirth. Clinical examination with no pathology, however laboratory tests revealed coagulation abnormalities due to prolonged thrombin test, decreased protein S and lower fibrinogen level (70 mg/dl). Autoimmune diseases were excluded and the diagnosis was widened with rotational thromboelastometry and genetic test for hypodysfibrinogenemia. The patient was treated with fibrinogen substitution and prophylactic dose of heparin throughout pregnancy and 2 weeks following labour. At 39 week of gestation Caesarean section was done, with no complications. Results: Genetic test revealed heterozygous mutation in fibrinogen gamma gene confirming hypodysfibrinogenemia. Due to bleeding manifestation in this patient of congenital fibrinogen disorders, fibrinogen substitution was implemented with heparin as a paranticoagulant prophylaxis, what turned out to be successful and enabled the patient to maintain the pregnancy. Conclusions: As hypodysfibrinogenemia symptoms are diverse the management is difficult and each patient’s therapy should be planned separately. Pregnancy may be the first time when congenital fibrinogen disorders reveal and it is especially challenging to prevent from obstetrical complications.

Management of patient with immune thrombocytopenia with antiphospholipid syndrome and monoclonal gammopathy of undetermined significance

Immune thrombocytopenia with antiphospholipid syndrome and monoclonal gammopathy of undetermined significance poses therapeutic dilemmas – whether we should modify the immune thrombocytopenia treatment in antiphospholipid syndrome, what is the influence of monoclonal gammopathy of undetermined significance on the course of immune thrombocytopenia and whether we should and how to prevent the progression of monoclonal gammopathy of undetermined significance to multiple myeloma.

Abiraterone acetate – 10 clinically relevant facts

Prostate cancer is one of the most frequently diagnosed cancers in men. Number of newly diagnosed cases is increasing due to several factors and the most important ones seem to be: population ageing and more sensitive diagnostic procedures. Secondary – the higher efficacy of treatment with its influence on improving patients’ overall survival and the specific mechanism of action of drugs used in systemic therapy lead to growing population of men suffering from prostate cancer in general and, specifically – patients with castration resistance. It is hormone therapy to play the key role in systemic treatment of prostate cancer with increasing significance of novel drugs focused on inhibition of molecular signal transduction mediated by androgen receptor. Abiraterone acetate is the representative of this therapeutic class. The paper describes the most clinically relevant data regarding the drug.

Apalutamide – 10 clinically important facts

Apalutamide belongs to the ARTA group. This drug is a new generation selective androgen receptor inhibitor. Patients with prostate cancer develop resistance to castration testosterone levels over timeduring hormone therapy. Therefore, it is necessary to consider additional therapeutic options based on drugs from the ARTA group. Apalutamide is used in the treatment of patients with non-metastatic as well as metastatic prostate cancer. This article presents the most important clinical facts about apalutamide.

Epidemiological profile and distribution of prognostic factors in invasive breast cancer among Algerian women

Although the widespread of early screening and advanced medical therapies, the breast cancer incidence rate continues to rise among Algerian women. This retrospective study investigated mammary lesions’ epidemiological profile and histopathological characteristics and evaluated primary invasive breast cancer prognostic factors. We found that the incidence of breast cancer increases in middle- aged women between 40 and 60 years. Scarff Bloom Richardson grade II predominates in invasive breast cancer samples. In this study, molecular profiling shows that 82.1% of invasive tumours are hormone receptor-positive. A significant correlation is observed between the age of the patient and the SBR grade (p = 0.001) and with the hormone receptor expression (p = 0.001). In addition, the tumour grade is significantly correlated to oestrogen and progesterone receptor expression (p = 0.000; p = 0.000, respectively). Twenty-two per cent of cases were human epidermal growth factor receptor 2-positive. The Ki-67 proliferation index is expressed in 91% of breast cancer patients and was significantly associated with Scarff Bloom Richardson grade (p = 0.030), the progesterone receptor expression (p = 0.029) and with human epidermal growth factor receptor 2-positivity (p = 0.023). Primary breast cancer with a high grade is more frequent (31%) in young women under 40 years old, presenting 17% of our population. In summary, breast cancer patients in Algeria develop an unfavourable profile. Immunohistochemistry assay has played a pivotal role in assessing breast cancer predictive biomarkers improving the tumour behaviour and response to treatment.

Cardiovascular complications during the treatment of castration-resistant prostate cancer with the use of modern antiandrogens: abiraterone acetate and enzalutamide

Modern antiandrogens: abiraterone acetate (inhibitor of CYP17 cytochrome) and enzalutamide (irreversible inhibitor of androgen receptor) are the drugs that are increasingly often administered in treatment of castration-resistant prostate cancer. Despite their clinical efficacy, especially in terms of prolonged survival and improved quality of life of patients, they pose of problem for a practicing oncologist such as possible cardiovascular complications (particularly arterial hypertension), which may lead to the cessation of this form of therapy. This article provides a brief overview of the mechanisms responsible for the above complications, including practical recommendations in the event such complications arise. A simple scheme of action for control of cardiovascular risk factors has been presented, which can improve the prognosis in this population of patients.

Prolongation of survival time and improvement of the quality of life after treatment with irinotecan liposomal in the patient with metastatic pancreatic adenocarcinoma

Pancreatic cancer is one of the malignant neoplasms with the worst prognosis. It is most often diagnosed at an advanced stage, which relates to unsatisfactory results of the therapy. Only about 15–20% of patients with pancreatic cancer qualify for surgery. The remaining patients are diagnosed with locally advanced disease or much more frequently in the generalized stage. Systemic treatment (chemotherapy) remains the mainstay of therapy in these patients, but both the response rate and progression-free time are unsatisfactory [1, 2]. This paper presents a case of a patient with metastatic pancreatic cancer, in whom three lines of systemic treatment were applied sequentially, which allowed to extend the survival time and improve the quality of life.

Quality of life patients treated with rituximab intravenous versus subcutaneous in B-cell lymphomas: results from outpatient Hematooncology Clinic in Lodz

Introduction: Nowadays, rituximab is available both as intravenous (IV) and subcutaneous (SC) formulations. The aim of this study is to compare quality of life (QOL) of patients treated in Hematooncology Clinic in Lodz with B-cell nonHodgkin lymphoma (B-NHL) treated with rituximab IV and SC. Material and Methods: In 50 adult patients with B-NHL diagnosis we assessed QOL by three different questionnaries (EORTC QLQ-C30, FACT/ GOG-NTx and EQ-5D). We compared it between patients treated with rituximab IV and SC. Results: In comparison of general condition in EQ-5D-3L and EORTC QLQ-C30 questionnaire patients treated with rituximab SC felt statistically better than with IV administration (p<0.01). In SC group general health was evaluated for 72 while in IV for only 58,1. According to FACT/GOG-NTx questionnaire SC group had significantly better physical well-being. In SC group we observed statistically more complete responses (CR) 21 (88%) versus 17 (65%) in IV group. Moreover, trend was observed in emotional well-being in favor of SC treatment. Discussion: In our study we observed for the first time in the literature statistical difference in frequency of vomiting, nausea, and lack of appetite mentioned from our patients in questionnarie. It is very important that this findings were not published in any other study comparing SC and IV route od administration. Also looking at economic side of SC administration, this type of dosing. As a result it should be preferred form for B-cell lymphoma patients.

On Becoming a Mother After Cancer Survival: A Comprehensive Literature Review

Problem identification: The desire for motherhood is one of the top priorities for most female young cancer survivors. The risk of infertility after cancer therapy is an important concern with several physical and emotional consequences. This comprehensive literature review aims to summarize and contextualize recent research that has been carried out on female fertility after cancer, suggesting future research and clinical directions. Literature search: Searches included the keywords “cancer”, “female”, “adults”, and “fertility”. Studies were selected if focused on infertility issues in female cancer survivors. Data synthesis: Eight themes were identified: the effects of anticancer treatments on fertility; fertility preservation methods; international recommendations regarding infertility risk; health professionals’ attitudes towards fertility preservation; patient’s concerns regarding the risk of infertility; patients' information needs; and the impact of the risk of infertility in patient’s quality of life. Conclusions: Psycho-oncologists should be integrated in the oncofertility teams to assess patients’ needs before cancer treatment initiation.

Patient with disseminated malignant tumor of the pancreas. Application of liposomal irinotecan as a new option of palliative treatment

In palliative treatment of pancreatic neoplasms, chemotherapy regimens with gemcitabine, nab-paclitaxel, oxaliplatin, irinotecan, 5-fluorouracil or combinations of these drugs are used. The registration of liposomal irinotecan in the treatment of stage IV disease in patients with progression after gemcitabine creates new options for the treatment choice. The described case concerns a relatively young patient in whom the use of liposomal irinotecan in the registration indication turned out to be a safe and well-tolerated treatment.