Correspondence

retrieval techniques.5,6 Further attempts are warranted to improve the care and safety of patients by reducing the morbidity of open abdominal procedures and avoiding the use of power morcellators.

spread of an undetected uterine sarcoma. The optimization of techniques that allow this to occur, while minimizing surgical morbidity and mortality, is the shared goal.

FUNDING SUPPORT

No specific funding was disclosed.

FUNDING SUPPORT No specific funding was disclosed.

CONFLICT OF INTEREST DISCLOSURES CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

The authors made no disclosures.

REFERENCE REFERENCES 1. George S, Barysauskas C, Serrano C, et al. Retrospective cohort study evaluating the impact of intraperitoneal morcellation on outcomes of localized uterine leiomyosarcoma [published online ahead of print June 12, 2014]. Cancer. doi: 10.1002/cncr.28844. 2. US Food and Drug Administration. FDA Discourages Use of Laparoscopic Power Morcellation for Removal of Uterus or Uterine Fibroids. http://www.fda.gov/newsevents/newsroom/pressannouncements/ ucm393689.htm. Accessed June 14, 2014. 3. Kamp J. Johnson & Johnson suspends sale of device used in fibroid surgery: move involving power morcellators comes amid concerns over cancer risk. Wall Street Journal. April 29, 2014. online.wsj.com/ news/articles/SB10001424052702304893404579531961812995326. Accessed June 14, 2014. 4. Warren L, Ladapo JA, Borah BJ, Gunnarsson CL. Open abdominal versus laparoscopic and vaginal hysterectomy: analysis of a large United States payer measuring quality and cost of care. J Minim Invasive Gynecol. 2009;16:581-588. 5. Bogani G, Uccella S, Cromi A, et al. Electric motorized morcellator versus trans-vaginal extraction for myoma retrieval following laparoscopic myomectomy: a propensity-matched analysis [published online ahead of print April 26, 2014]. J Minim Invasive Gynecol. doi: 10.1016/j.jmig.2014.04.012. 6. Ghezzi F, Cromi A, Uccella S, Bogani G, Serati M, Bolis P. Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial. Am J Obstet Gynecol. 2012;207:112.e1-e6.

Giorgio Bogani, Maurizio Serati, Stefano Uccella, Fabio Ghezzi,

MD MD MD MD

Department of Obstetrics and Gynecology University of Insubria Del Ponte Hospital Varese, Italy

1. George S, Barysauskas C, Serrano C, et al. Retrospective cohort study evaluating the impact of intraperitoneal morcellation on outcomes of localized uterine leiomyosarcoma [published online ahead of print June 12, 2014]. Cancer. doi: 10.1002/cncr.28844.

Suzanne George, MD Center for Sarcoma and Bone Oncology Dana-Farber Cancer Institute Harvard Medical School Boston, Massachusetts Michael G. Muto, MD Division of Gynecologic Oncology Department of Obstetrics and Gynecology Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts DOI: 10.1002/cncr.28957, Published online August 7, 2014 in Wiley Online Library (wileyonlinelibrary.com)

Magnetic Resonance ImagingBased Diagnosis of Progressive Multifocal Leukoencephalopathy in a Patient With Non-Hodgkin Lymphoma After Therapy With Cyclophosphamide, Doxorubicin, Vincristine, Prednisone, and Rituximab

DOI: 10.1002/cncr.28959, Published online August 7, 2014 in Wiley Online Library (wileyonlinelibrary.com)

Reply to In-Bag Morcellation for Presumed Myoma Retrieval at Laparoscopy We appreciate the comments by Dr. Bogani and colleagues regarding our article,1 and agree that the issue at hand is the minimization of the risk of intraperitoneal Cancer

December 15, 2014

We read with great interest the article by Carson et al,1 in which they described 5 cases of progressive multifocal leukoencephalopathy (PML) associated with brentuximab vedotin therapy as part of the Southern Network on Adverse Reactions (SONAR) project. This condition was diagnosed among patients who received brentuximab vedotin-based chemotherapy for various lymphoid malignancies. This antibody-drug conjugate directed toward the protein CD30 was approved by the US Food and Drug Administration for the treatment of recurrent or refractory Hodgkin lymphoma and recurrent or refractory 4005

Correspondence

systemic anaplastic large cell lymphoma. As Carson et al reported the diagnosis of PML after therapy with a monoclonal antibody-based drug, herein our group also reports another case of PML in a patient with a lymphoid malignancy after combination chemotherapy with a similar drug, namely rituximab. A 52-year-old man was diagnosed with stage IVB diffuse large B-cell non-Hodgkin lymphoma. The patient received 6 cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP regimen), the standard of care for patients with advanced nonHodgkin lymphoma,2 but did not respond and the disease progressed. Rituximab was added, as suggested by Sehn et al for patients with therapy-refractory diffuse large B-cell nonHodgkin lymphoma.3 After the administration of rituximab, the patient presented with acute neurological symptoms that included photophobia, derailment, loss of speech, and dizziness, as well as convergent strabismus of the left eye, bradylalia, myoclonic movements of the upper limbs, marked hypotonia of the lower limbs, and fecal incontinence. The computed tomography scan showed no metastatic spread of the lymphoma and analysis of the cerebrospinal fluid demonstrated the absence of malignant infiltration of the central nervous system. Nevertheless, magnetic resonance imaging of the brain revealed multiple infiltrative lesions of the deep white matter, the periventricular area, the corpus callosum, and the thalamus. Subependymal extension was noted, along with perilesional edema. PML is a rare side effect of chemotherapy for nonHodgkin lymphoma,4,5 with severe consequences for the patient if not diagnosed early. Our report demonstrates the importance of a magnetic resonance imaging-based diagnosis of this disease after monoclonal antibody-based chemotherapy regimens for lymphoid malignancies, a key aspect in the clinical management of these patients because the immune reconstitution may lower their morbidity and mortality.

advanced non-Hodgkin’s lymphoma. N Engl J Med. 1993;328:10021006. 3. Sehn LH, Donaldson J, Chhanabhai M, et al. Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol. 2005;23:5027-5033. 4. Sikkema T, Schuiling WJ, Hoogendoorn M. Progressive multifocal leukoencephalopathy during treatment with rituximab and CHOP chemotherapy in a patient with a diffuse large B-cell lymphoma. BMJ Case Rep. 2013 Jan 25;2013. 5. Khoury S, Shapira S, Zilberman T, Mekori YA, Hershko AY. Progressive multifocal leukoencephalopathy in an HIV-negative patient following treatment with rituximab. Isr Med Assoc J. 2013;15:321322.

Delia Dima, MD Department of Hematology Ion Chiricuta Oncology Institute Cluj-Napoca, Romania

Ciprian Tomuleasa, MD, PhD Department of Hematology Ion Chiricuta Oncology Institute; Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

Alexandru Irimie, MD, PhD Department of Surgery Ion Chiricuta Oncology Institute; Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

Ioan-Stefan Florian, MD, PhD Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

Bobe Petrushev, MD Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

Ioana Berindan-Neagoe, PhD Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

Andrei Cucuianu, MD, PhD Department of Hematology Ion Chiricuta Oncology Institute; Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania DOI: 10.1002/cncr.28948, Published online August 13, 2014 in Wiley Online Library (wileyonlinelibrary.com)

REFERENCES

Reply to Magnetic Resonance Imaging-Based Diagnosis of Progressive Multifocal Leukoencephalopathy in a Patient With Non-Hodgkin Lymphoma After Therapy With Cyclophosphamide, Doxorubicin, Vincristine, Prednisone, and Rituximab

1. Carson KR, Newsome SD, Kim EJ, et al. Progressive multifocal leukoencephalopathy associated with brentuximab vedotin therapy: a report of 5 cases from the Southern Network on Adverse Reactions (SONAR) project. Cancer. 2014;120:2464-2471. 2. Fisher RI, Gaynor ER, Dahlberg S, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for

Disseminating timely information concerning serious adverse drug reactions is difficult. This is the mission of the Southern Network on Adverse Reactions (SONAR).

FUNDING SUPPORT No specific funding was disclosed. CONFLICT OF INTEREST DISCLOSURES The authors made no disclosures.

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Cancer

December 15, 2014

Magnetic resonance imaging-based diagnosis of progressive multifocal leukoencephalopathy in a patient with non-Hodgkin lymphoma after therapy with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab.

Magnetic resonance imaging-based diagnosis of progressive multifocal leukoencephalopathy in a patient with non-Hodgkin lymphoma after therapy with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab. - PDF Download Free
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