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Introduction: Hypomethylating agents have confirmed efficacy for myelodysplastic syndrome and acute myeloid leukemia and are widely used. Although arthralgia is common side effect associated with hypomethylating agents, arthritis has not been reported previously. Case Report: We present the first recorded patient with arthritis after azacitidine treatment. The patient we presented here had severe cytopenias requiring transfusion with erythrocyte and platelet suspensions, and a complete hematological response was obtained for myelodysplastic syndrome after three cycles of azacitidine (AZA) treatment. However, interestingly, after each AZA treatment cycle, the patient had recurrent attacks of arthritis. Management and outcomes: The episodes of arthritis were possibly acute flares of pre-existing crystal-induced arthritis, as exhibited with azacitidine treatments and were managed effectively with nonsteroidal anti-inflammatory drugs. Discussion: Because it is a rare condition, clinicians should not overlook AZA as a possible cause of arthritis exacerbations when arthritis of unknown etiology develops in patients treated with AZA. [ABSTRACT FROM AUTHOR]

The treatment process in acute myeloid leukemia (AML) often results in prolonged neutropenia, especially in the early period, and this requires antifungal prophylaxis. In the era of venetoclax (VEN), concomitant antifungal prophylaxis has been abandoned because azole antifungals inhibit cytochrome P450 3A4, the primary enzyme responsible for VEN metabolism. If azole antifungal prophylaxis is used with VEN, the dose of VEN needs to be reduced, but the clinical consequences in this situation are unknown. Limited clinical data exist on outcomes for patients treated with VEN, a hypomethylating agent (HMA), and posaconazole. We retrospectively evaluated our single-center experience on 46 patients, 20 treatment-naive and 26 relapsed/refractory (RR) AML patients. VEN was used after dose adjustment due to concomitant posaconazole use for antifungal prophylaxis. The median age was 65.5 years (range, 18-78). The median follow-up was 5.5 months (range, 1-25). The overall response rate (ORR) was 60.8%. The incidence of invasive fungal infection was 15.2%. The median OS from venetoclax initiation of all the patients and those with CR/CRi was 6 and 10 months, respectively. After VEN dose reduction due to concomitant posaconazole use, the observed ORR was comparable to the ORR previously reported in the literature without VEN dose reduction and antifungal prophylaxis. However, the OS obtained in our patients was shorter than previously reported in the literature. In addition, the incidence of invasive fungal infections in our patients was not less than that reported in the VEN and HMA studies without antifungal prophylaxis. [ABSTRACT FROM AUTHOR]

Despite recent therapeutic advances, the prognosis of patients with relapsed/refractory (RR) primary (PCNSL) and secondary central nervous system lymphoma (SCNSL) remains poor. Therefore, the need for new treatment options in CNSL continues. Ibrutinib has been used in clinical trials for CNSL in recent years. However, there is no real-life data on this subject yet. We retrospectively evaluated the efficacy of ibrutinib alone or in combination with various treatment options in 39 patients, 21 with PCNSL and 18 with SCNSL. The median age was 62 years and the overall response rate (ORR) was 59%. The median overall survival (OS) was four months for all patients and 13 months for responder patients (p< 0.001). Invasive aspergillosis occurred in 10.2% of the patients. Lactate dehy-drogenase activity, response to treatment, and the presence of the invasive fungal infection were prognostic factors affecting OS on the ibrutinib therapy (p= 0.04, p= 0.02, and p= 0.048, respectively). There was no significant difference in prognosis between the IBR monotherapy and IBR combination groups. Compared to early-phase clinical studies, lower ORR, shorter OS, and a higher incidence of invasive fungal infections were observed in this real-life study of ibrutinib which was used alone or in a combination regimen in patients with RR PCNSL and SCNSL. [ABSTRACT FROM AUTHOR]