Invasive Pulmonary Aspergillosis and Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis - Sequelae of COVID-19 in a Liver Transplant Recipient

Gandotra, Akash; Mehtani, Rohit; Premkumar, Madhumita; Duseja, Ajay; De, Arka; Mallik, Nabhajit; Durgadevi, S.; Das, Ashim; Kalra, Naveen

doi:10.1016/j.jceh.2021.12.002

Cited by 10 publications

(4 citation statements)

References 14 publications

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“… 3 12 However, National Comprehensive Cancer Network guideline indicated that validated criterion to evaluate tumour response to molecular targeted therapies between the two criteria is needed. 13 Besides, several studies demonstrated that overall survival (OS) can be predicted more accurately by mRECIST than RECIST 1.1, since the latter is not capable of assessing therapy induced intratumoural necrosis. 14 15 On the contrary, another study observed both methods provided correlation with OS equally.…”

Section: Introductionmentioning

confidence: 99%

RECIST 1.1 versus mRECIST for assessment of tumour response to molecular targeted therapies and disease outcomes in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Bai

Xie

et al. 2022

BMJ Open

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ObjectivesResponse Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1) and modified RECIST (mRECIST) are commonly used to assess tumour response. Which one is better to evaluate efficacy after molecular targeted therapies in hepatocellular carcinoma (HCC) patients is still controversial. A systemic review was performed to compare the objective response rate (ORR) and disease control rate (DCR) and a meta-analysis was conducted to compare the correlation between objective response and overall survival (OS).DesignSystematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach.Data sourcesEMBASE, PubMed, Web of Science and Cochrane Library were searched through 31 December 2021.Eligibility criteriaWe included studies assessing the efficacy of molecular targeted therapy for HCC according to both RECIST 1.1 and mRECIST.Data extraction and synthesisTwo investigators extracted data independently. The consistency between RECIST 1.1 vs mRECIST is measured by the k coefficient. HRs with corresponding 95% CIs were used for meta-analysis.Results23 studies comprising 2574 patients were included in systematic review. The ORR according to mRECIST is higher than RECIST1.1 (15.9% vs 7.8%, p<0.001). The DCR is similar (68.4% vs 67.2%, p=0.5). The agreement of tumour response is moderate for objective response (k=0.499) and perfect for progressive disease (k=0.901), calculated from 8 studies including 372 patients. OS was significantly longer in response group than non-response group according to mRECIST (HR 0.56, 95% CI 0.41 to 0.78, p=0.0004) calculated from 7 studies including 566 patients, however, the RECIST1.1 could not distinguish the OS well (HR 0.68, 95% CI 0.44 to 1.05, p=0.08). Subgroup analusis by type of treatment was conducted.ConclusionsmRECIST may be more accurate than RECIST 1.1 in assessing ORR after molecular targeted therapies in HCC patients and can better assess the prognosis. However, the performance of both criteria in assessing disease progression is identical.PROSPERO registration numberCRD42020200895.Ethics approvalEthics approval is not required in this meta-analysis.

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Section: Introductionmentioning

confidence: 99%

RECIST 1.1 versus mRECIST for assessment of tumour response to molecular targeted therapies and disease outcomes in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Bai

Xie

et al. 2022

BMJ Open

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“…Based on our literature review, we encountered six cases of HLH secondary to aspergillosis with a mean age of ~47 years (Table 3) [8][9][10][11][12][13]. On her follow-up appointment after discharge, she was sent for HLH genetic analysis which tests for many genes involved in the pathogenesis of primary HLH, she did not have the test done (possibly due to the cost), and she did not follow up afterward.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Aspergillosis Complicated by Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review

Ali¹,

Sen²,

Tan³

2022

Cureus

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Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving excessive immune activation. It can be primary (familial) or secondary (triggered by infection, malignancy, or rheumatological disease). This is a case of a previously healthy 43-year-old African American woman who presented with fever and confusion. The patient was eventually diagnosed with pulmonary aspergillosis and responded well to antifungal therapy. She met the diagnostic criteria of HLH-2004 trial for hemophagocytic lymphohistiocytosis. She also fulfilled the 2019 classification criteria for systemic lupus erythematosus (SLE) without the classical signs and symptoms of SLE.HLH management includes supportive management, treatment of underlying condition, and immunosuppressive treatment. Etoposide and dexamethasone are commonly used treatments for HLH; however, underlying active infection can limit the treatment options. In our case, the patient was treated with steroids and hydroxychloroquine. Her condition gradually improved and she recovered without complications.Based on our literature review, we encountered six cases of HLH secondary to Aspergillosis with a mean age of approximately 47 years. The diagnosis of HLH is often delayed because of nonspecific presentation. Early identification and treatment are crucial to improve the survival rate.

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“…The patient was managed with intravenous immune globulin for HLH, liposomal Amphotericin B and ATT. 13…”

Section: Discussionmentioning

confidence: 99%

A systematic review of reactivation of tuberculosis due to use of corticosteroids for COVID-19 treatment between January 2020 to January 2022

Tewari

Yadav²

2022

Int J Basic Clin Pharmacol

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Coronavirus-19 disease became a matter of concern for the whole world and WHO declared it as pandemic on 11 March 2020. Soon a number of clinical trials started to check for the treatment modalities, to compare their efficacy and safety. Out of which corticosteroids in trials showed decrease in mortality in severe COVID-19 patients. However existing diseases such as tuberculosis still remains a leading killer and matter of concern. One out of four individuals are said to be having tuberculosis (mostly in inactive form or latent form) but there remains a threat of reactivation of tuberculosis in presence of risk factors such as corticosteroid administration as it causes immunosuppression. This is a retrospective observational study on reactivation of tuberculosis due to corticosteroids used in COVID-19 treatment. Most commonly given corticosteroid was found to be dexamethasone and the duration of corticosteroid therapy ranged between 5 to 12 days. Majority of patients (5 out of 6) showed reactivation of tuberculosis within 30 days of starting of corticosteroid therapy and most common co-morbidity associated was found to be diabetes mellitus followed by hypertension in such patients. Symptoms of 4 out of 6 patients resolved after starting of anti-tubercular therapy.

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Invasive Pulmonary Aspergillosis and Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis - Sequelae of COVID-19 in a Liver Transplant Recipient

Cited by 10 publications

References 14 publications

RECIST 1.1 versus mRECIST for assessment of tumour response to molecular targeted therapies and disease outcomes in patients with hepatocellular carcinoma: a systematic review and meta-analysis

RECIST 1.1 versus mRECIST for assessment of tumour response to molecular targeted therapies and disease outcomes in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Pulmonary Aspergillosis Complicated by Hemophagocytic Lymphohistiocytosis: A Case Report and Literature Review

A systematic review of reactivation of tuberculosis due to use of corticosteroids for COVID-19 treatment between January 2020 to January 2022

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