RESUMEN
Light chain amyloidosis (AL) is a rare disease caused by the generalized deposition of misfolded free light chains. Patients with immunoglobulin M gammopathy (IgM) and indolent B-cell lymphoma such as marginal zone lymphoma (MZL) may in some instances develop AL amyloidosis. So far, CAR T cells for AL amyloidosis have only been reported utilizing the B cell maturation antigen as target, while CD19 has so far not been used in AL amyloidosis.We report the case of a 71-year-old male, diagnosed with systemic AL kappa amyloidosis and MZL, receiving third-generation CAR T cell therapy targeting CD19. Prior treatment included bendamustine/rituximab and cyclophosphamide/ dexamethasone with subsequent autologous stem cell transplantation. CAR T application was well tolerated despite heart and kidney amyloid manifestations, and only early low-grade procedure-specific toxicities were observed. A continuous decrease in IgM, kappa light chains and kappa-to-lambda light chain difference was observed in the patient from day + 30 on, resulting in a deep hematological response six months after treatment.In summary, we present a novel case of CAR T cell treatment with third generation CD19 directed infusion for AL amyloidosis with an underlying secretory active B cell lymphoma, showing that this is an effective treatment modality and can be applied to patients with subsequent AL amyloidosis.
RESUMEN
PURPOSE: We aimed to identify subsets of patients who benefit from emergency LA and to establish a therapeutic algorithm for AML patients with hyperleukocytosis. METHODS: In this single-center retrospective cohort study, a total of 20 consecutive patients underwent LA because of their clinical symptoms. Overall survival (OS) analysis was conducted using the Kaplan-Meier plot method. Univariate and multivariate analyses (using multiple logistic regression) were performed. At the time of diagnosis, all patients received a standard diagnostic workup for AML including FLT3-ITD mutational analysis. RESULTS: FLT3-ITD mut AML patients receiving LA had a median OS of 437 days (range 5-2379 days) with a corresponding 14-day survival of 92.3%, while FLT3 wt AML patients displayed a significantly lower median OS of only 5 days (range 1-203 days) with a corresponding 14-day survival of 14.3% (p = 0.0001). CONCLUSIONS: Among patients with clinical symptoms of leukostasis, the subset of FLT3-ITD mut AML patients showed a better outcome with lower early mortality after emergency LA. Based on these observations, we established a therapeutic algorithm for AML patients with hyperleukocytosis.
RESUMEN
Assessing the amount and subcellular distribution of protein expression is a key component in modern cell biological and medical research. We studied protein kinase Cδ (PKCδ) as a potential regulator of mitochondrial metabolism in astrocytes, and sought to evaluate mitochondrial translocation of PKCδ since this is an important determinant of its function. Apart from visualizing compartment specific localization of mobile proteins such as PKCδ, we also wanted to determine what amount of a cell's total content of a particular protein is located to a specific compartment, or translocated comparing control and experimental condition.We develop a semiquantitative parameter that indicates the relative protein distribution to two subcellular compartments, starting from standard two-channel fluorescence microscopy images. We studied the mitochondrial translocation of PKCδ in astrocytes using double immunofluorescence microscopy and object-oriented image analysis. In one channel, the protein of interest (PKCδ) is labeled, in the other the compartment or organelle of interest (mitochondria, using cytochrome oxidase IV). Both channels were binarized, turned into object populations, and the channel specific values for total area and integrated intensity extracted. From these values, the "intensity density ratio" (IDR) is calculated, a standardized parameter to easily compare distribution patterns in different cells or ROIs. IDR is highly sensitive to changes in localization pattern, and thus easily detects protein translocation in comparison between control and experimental condition. In our study, medium application of glutamate was found to result in partial PKCδ translocation to mitochondria, a statistically highly significant result based only on a limited number of acquired images.
