zithromax and Lymphoma--Large-B-Cell--Diffuse

The COVID-19 pandemic has dramatically challenged care for cancer patients, especially those with active treatment who represent a vulnerable population for SARS-CoV-2 infection. Aggressive lymphoid neoplasms, such as diffuse large B cell lymphoma and high-grade B cell lymphoma, need to be treated without delay in order to get the best disease outcome. Because of that, our clinical practice was changed to minimise the risk of SARS-CoV-2 infection while continuing haematological treatment. In this report, we analyse the management of front-line therapy in 18 patients during the COVID-19 outbreak, as well as the results of the implemented measures in their outcome.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Azithromycin; Bacterial Infections; COVID-19; COVID-19 Drug Treatment; COVID-19 Testing; Cyclophosphamide; Doxorubicin; Febrile Neutropenia; Female; Granulocyte Colony-Stimulating Factor; Humans; Hydroxychloroquine; Infection Control; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Pandemics; Plasmablastic Lymphoma; Prednisone; Rituximab; SARS-CoV-2; Spain; Superinfection; Vincristine

Using J774 macrophages, the intracellular activities of gentamicin, azithromycin, telithromycin, ciprofloxacin, moxifloxacin, and oritavancin (LY333328) against Staphylococcus aureus (strain ATCC 25923) have been quantitatively assessed in a 24-h model. S. aureus was positively localized in phagolysosomes by confocal and electron microscopy, and extracellular growth was prevented with 0.5 mg of gentamicin/liter (1x MIC) in controls. When tested at extracellular concentrations equivalent to their maximum concentrations in human serum, all antibiotics except azithromycin caused a significant reduction of the postphagocytosis inoculum within 24 h, albeit to markedly different extents (telithromycin [2 mg/liter], 0.60 log; ciprofloxacin [4.3 mg/liter], 0.81 log; gentamicin [18 mg/liter], 1.21 log; moxifloxacin [4 mg/liter], 1.51 log; oritavancin [25 mg/liter], 3.49 log). Intracellular activities were not systematically related to drug accumulation (apparent cellular-to-extracellular concentration ratios in infected cells: ciprofloxacin, 3.2; gentamicin, 6.8; telithromycin, 8.7; moxifloxacin, 13.4; azithromycin, 50; oritavancin, 348). Intracellular activity was not directly correlated to extracellular activity as measured in broth. Conditions of pH 5 (i.e., mimicking that of phagolysosomes) markedly reduced the activity of gentamicin, azithromycin, and telithromycin (>or=32 x) and fairly extensively reduced that of ciprofloxacin and moxifloxacin (>or=4 x) but did not affect oritavancin activity. We conclude that the cellular accumulation of antibiotics is not the only parameter to take into account for intracellular activity but that local environmental conditions (such as pH) and other factors can also prove critical.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Aza Compounds; Azithromycin; Ciprofloxacin; Fluoroquinolones; Gentamicins; Glycopeptides; Lipoglycopeptides; Lymphoma, Large B-Cell, Diffuse; Macrophages; Mice; Microbial Sensitivity Tests; Microscopy, Electron; Moxifloxacin; Quinolines; Staphylococcal Infections; Staphylococcus aureus; Tumor Cells, Cultured

We report two cases of cryptosporidiosis after CD34-selected PBSCT for lymphoma. While the first patient died of pulmonary cryptosporidiosis, treatment with paromomycin, azithromycin and subcutaneous low-dose rhIL-2 to improve numerical and functional T lymphocyte defects completely eliminated infection in the second patient. We conclude, that the removal of mature T lymphocytes by positive selection of CD34+ cells bears the risk of a delayed immune reconstitution resulting in an increased incidence of severe and sometimes fatal opportunistic infections. IL-2 might be useful in this situation by accelerating immune reconstitution and reducing the danger of opportunistic infections.

Topics: Adult; Antigens, CD34; Azithromycin; Cryptosporidiosis; Female; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cells; Hodgkin Disease; Humans; Immunosuppression Therapy; Interleukin-2; Lung Diseases, Parasitic; Lymphocyte Subsets; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Opportunistic Infections; Paromomycin; Recombinant Proteins; Transplantation, Autologous