Our objective was to evaluate the impact of using an imipenem de-escalation protocol for empiric febrile neutropenia on the development of carbapenem resistance. A pre-post intervention design was used. The intervention was adopting the imipenem de-escalation approach, which began on January 1, 2012. A retrospective chart review of cases of febrile neutropenia bacteremia was performed one year before and one year after the intervention. We compared the development of carbapenem resistance between the two study periods. Seventy-five episodes of febrile neutropenia bacteremia were included in the study. They had similar demographics, clinical features and outcomes. There were 78 and 12 pathogens in the primary and follow-up blood cultures, respectively. Approximately 61% and 66% of the primary and follow-up blood cultures, respectively, were gram-negative bacteria with similar carbapenem resistance profiles in the two study periods. In our study population, 57% of the gram-negative bacteria were ESBL pathogens. The resistance of the gram-negative bacteria to piperacillin/tazobactam (72% versus 53%, p=0.161), imipenem (16% versus 11%, p=0.684), and meropenem (8% versus 16%, p=0.638) did not significantly change after our policy change. In conclusion, the use of the carbapenem de-escalation approach for febrile neutropenia in our institution was not associated with an increase in carbepenem resistance. Future prospective multi-center studies are recommended to further confirm the current findings.

Dear Editor, Hodgkin's lymphoma accounts for approximately 30 % of all lymphomas. It is a highly curable condition with a 5-year survival above 85 %, which is even higher in patients with a limited stage disease [1]. Hodgkin's lymphoma (HL) that has relapsed after or is refractory to an autologous bone marrow transplant presents an ongoing treatment challenge [2]. Brentuximab vedotin (SGN-35) is an antibody-drug conjugate directed against the CD30 antigen expressed on HL. SGN-35 is usually well-tolerated but can cause various side effects, with some more likely to occur than others. A mild skin rash may occur during treatment. This may be treated with antihistamines and simple creams. Rarely, patients may develop a more serious skin reaction, as in our case, necessitating a dose reduction or discontinuation of treatment [3].A 51-year-old man with Hodgkin's lymphoma (HL) presented with severe pain, itching, and maculopapular rash on his hands and feet starting 2 days after a second cycle of brentuximab administered as a single agent. He had been previously treated for stage IV B HL with a standard chemotherapy regimen comprising doxorubicin, bleomycin, vinblastine, and dacarbazine for six cycles. Three years later, he relapsed and was treated with ifosfamide, carboplatin, and etoposide followed by autologous bone marrow transplantation. The treatment course was complicated with pulmonary embolism, treated with rivaroxaban. He relapsed 6 months after transplantation and was treated with brentuximab, a CD30 monoclonal antibody (mAb) used with promising results in relapsed or refractory HL. The patient developed a severe hand-foot syndrome. He has a maculopapular rash with cracking of the skin with a fissure formation below the ring and middle fingers ( Fig.

Purpose High-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) is used to treat patients with relapsed Hodgkin's lymphoma. In this retrospective study we report our experience with patients who underwent HDCT and ASCT. Methods All patients ≥15 years old with relapsed/refractory Hodgkin's lymphoma who underwent HDCT and ASCT between June 2001 and December 2013 were included. Results Fifty-four patients were identified. Median age at transplant was 22 years (range 15-49 years); 26 were men and 28 were women. Forty-eight patients (89%) underwent HDCT and ASCT after achieving a radiological response to salvage chemotherapy. The rate of radiological complete response to salvage chemotherapy was 13% and reached 50% within 3 months of ASCT in assessable patients. After a median follow-up of 25 months, 31 patients (57%) were still alive with no evidence of relapse or progression. Median event-free survival (EFS) was 24 months (95% CI 8.7-39.3) and 3-year EFS was 56%. Median overall survival (OS) was not reached and 3-year OS was 82.5%. Bulky mediastinal disease at relapse, hemoglobin level, and number of salvage regimens did not significantly impact EFS in univariate and multivariate analyses. After transplantation there was a trend towards longer EFS (30 vs. 24 months; p = 0.36) in patients with a longer time from the end of first-line treatment until relapse (≥12 vs. <12 months). The 100-day transplant-related mortality was 5.5%. Conclusions HDCT and ASCT for relapsed/refractory Hodgkin's lymphoma is safe. Our findings are consistent with published phase III results. Longer follow-up is warranted.