Blog – Page 160

This stage IV lung cancer patient developed: persistent fever thrombocytopenia multiorgan dysfunction steroid-refractory course.

A high H-score led to the diagnosis: ICI-associated HLH. She improved rapidly with anakinra after failing steroids.

Takeaway: In immunotherapy patients, extreme hyperferritinaemia should trigger HLH evaluation early.

Would you have escalated to anakinra…or tried second-line steroids first?

Read more here.

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Immune checkpoint inhibitors (ICIs) are increasingly used in advanced malignancies but can cause rare, severe immune-related adverse events (irAEs). Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome infrequently reported with ICIs and often challenging to diagnose. We report a case of a woman in her 60s with stage IV lung adenocarcinoma treated with pembrolizumab-based chemoimmunotherapy who developed recurrent, steroid-refractory immune-related hepatitis and pneumonitis. Twenty-four weeks after starting pembrolizumab, she presented with persistent fever, thrombocytopenia, extreme hyperferritinaemia (ferritin >33,500 µg/L), and progressive multiorgan dysfunction. Despite overlap with other irAEs and infection, a high H-score prompted evaluation for HLH, confirmed on bone marrow biopsy with haemophagocytosis.

Objective: This study aims to develop a contrast-free, high-sensitivity ultrasound method, denoted as Radon transform-based flow measurement (R-Flow), for in vivo mapping of microvascular flow vectors and for establishing R-Flow-derived vector-field metrics to noninvasively quantify microcirculatory patterns in liver cirrhosis. Impact Statement: R-Flow enables robust, contrast-free imaging of microvascular dynamics and demonstrates translational feasibility in the human liver. Its direction-aware indices offer pilot in vivo quantification of flow redistribution and remodeling, providing unique insights into hepatic flow dynamics. Introduction: Microvascular dysfunction is a hallmark of many diseases, yet noninvasive visualization and quantitative assessment of abnormal microcirculation remain limited.

RCT: Among people with HIV who smoke, clinical pharmacist-delivered nicotine replacement with contingency management improved tobacco-related outcomes, providing evidence-based strategies for smoking reduction in HIV clinics.

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Question What are optimal clinical pharmacist–delivered treatment strategies for promoting cigarette smoking reduction among people with HIV?

Findings In this randomized clinical trial involving 323 participants, those receiving nicotine replacement therapy (NRT) with or without contingency management (CM) had similar reductions in cigarettes per day (CPD) at 12 weeks. Among participants who started with NRT alone and did not achieve week 12 abstinence, adding CM led to lower CPD than switching to oral medications. Participants who started with NRT and then added CM achieved lowest CPD at week 24.

Meaning Study findings, indicating that CM is an effective adjunct to clinical pharmacist–delivered NRT for improving tobacco-related outcomes, provide HIV clinics with guidance on strategies for addressing cigarette smoking reduction among people with HIV.

The author describes the scientific foundations of a study of rezatapopt, which targets a variant form of p53, to treat patients with solid tumors.