The association between COX-2 expression and survival in myeloma patients.

BACKGROUND: Increased cyclooxygenase-2 (COX-2) expression has been associated with poor prognosis in multiple myeloma (MM). AIM: This study examined the relationship between COX-2 expression in bone marrow and prognosis in MM patients. PATIENTS AND METHODS: Bone marrow biopsy samples of 67 newly diagnosed MM patients were examined immunohistochemically for COX-2 expression. Mean age of the patients was 52.69 years (52.69 ± 9.17) and median follow-up time was 99.5 months (range: 6-170 months). RESULTS: Of all patients, 30 (44.8%) were COX-2 positive and 37 (55.2%) were COX-2 negative. Median overall survival (OS) was 78 months (range: 54.07-101.92 months) among all patients, 75 months (range: 45.61-104.38 months) in COX-2-positive patients, and 98 months (range: 50.36-145.63 months) in COX-2-negative patients. Median progression-free survival (PFS) was 30 months (range: 3-134 months) in all, 29.5 months (range: 3-68 months) in COX-2-positive and 35 months (range: 3-134 months) in COX-2-negative patients. Statistically significant differences in OS and PFS between COX-2-positive and COX-2-negative patients were not observed (p = 0.84 and p = 0.22, respectively). Differences between the COX-2-positive and COX-2-negative patients in gender, hemoglobin, ß2-microglobulin (ß2M), creatinine, albumin, and disease stage were not statistically significant. CONCLUSIONS: COX-2 expression neither had a role in prognosis nor significantly affected OS and PFS. We conclude that stem cell transplantation might eliminate the detrimental effects of COX-2 positivity. Larger series of patients are needed to investigate this observation.

Rituximab therapy for life-threatining immune hemolytic anemia in a liver tranplant recipient: a case report.

Rituximab an anti-CD20 chimeric monoclonal antibody directed against the CD20 antigen on B lymphocytes, has been demonstrated to be highly effective for B-cell depletion. Because of its biological properties, it has become as a treatment option for a variety of autoimmune diseases. We report successful treatment of a 25-year-old male cadaveric liver retransplant recipient who displayed severe immune hemolytic anemia with rituximab, despite no previous response to corticosteroids plus intravenous immune globulin therapy.

Acute myeloblastic leukemia in pregnancy: a case report and review of the literature.

Leukemia is a rare event during pregnancy. The presence of leukemia during pregnancy raises several concerns about the effect of pregnancy on the prognosis of leukemia, the effect of the disease on pregnancy outcome and the teratogenic and mutagenic effect of chemotherapeutic agents on the fetus. We report a case of acute myeloblastic leukemia diagnosed during the third trimester of gestation and treated with chemotherapeutic agents before delivery. The duration of pregnancy was able to be prolonged for four weeks after clinical diagnosis of the disease and then terminated by cesarean section due to the presence of signs of fetal distress.

Activated protein C resistance in preeclampsia.

OBJECTIVE: Recently. hereditary and acquired diseases that lead to thromboembolic events by changing the hemostatic balance have attracted interest as a cause of preeclampsia. In this study the incidence of activated protein C resistance (APCR) in preeclamptic women was evaluated. METHODS: Activated protein C sensitivity ratio (APC-SR) was measured by the modified activated partial thromboplastin time (APTT) method in 19 preeclamptic and 12 healthy pregnant women and 26 normal women as the controls. Results below the levels of 2 were accepted as the presence of APCR. RESULTS: Median APC-SR values of 2.12 and 2.01 in preeclamptic and healthy pregnant women, respectively, were found significantly lower than the normal control values of 2.31 (p = 0.0005, p = 0.001). APCR was detected in 31% of preeclamptic patients, 16.6% of healthy pregnant women and 7.6% of normal controls. CONCLUSION: APCR was found significantly higher in preeclamptic women and it may play an important role in the pathogenesis of preeclampsia.

Acute leukemia in pregnancy with ovarian metastasis: a case report and review of the literature.

Acute leukemias tend to affect a younger population and are much more common in pregnant patients than chronic leukemias are. We report a case of acute lymphoblastic leukemia diagnosed during the third trimester presenting with organomegaly and thrombocytopenia. Delivery of the fetus by cesarean section was decided because of the fulminant nature of the acute leukemia within days of admission. Bone marrow biopsy revealed acute lymphocytic leukemia, French American-British L2 subtype B cell immunotype. A left ovarian mass was identified during the cesarean section which later proved to be lymphoblastic infiltration. The patient was started on induction chemotherapy consisting of vincristine, daunorubicin, prednisolone, and l-asparaginase immediately after the diagnosis. The patient died of Acinetobacter septicemia 18 days after the first admission.

Hemophagocytic syndrome after living-related liver transplantation.

Hemophagocytic syndrome (HPS) is a life-threatening hematological disorder in immunocompromised patients. Although the number of patients with HPS following liver transplantation is scarce the outcome is usually fatal. We report a patient who developed HPS following living-related liver transplantation (LRLT) and was treated successfully by a combination of intravenous (IV) immunoglobulin (Ig) and granulocyte colony-stimulating factor (GCSF).

Long Term Low Dose Maintenance Chemotherapy in the Treatment of Acute Myeloid Leukemia.

In this study the effect of low dose long-term maintenance chemotherapy in patients with acute myeloid leukemia (AML) was evaluated. Following a complete remission two consolidation courses were given with the same drugs. Thereafter patients received low dose maintenance chemotherapy in every four weeks until disease relapsed or for up to two years. A total of 68 patients were evaluated. The median duration of remission of 22.5 months in patients who received maintenance chemotherapy while it was only 7 months in those without maintenance chemotherapy after a median follow-up time of 71 months, which was significant. Overall survival (OS) was also significantly longer in patients with maintenance therapy. Similar results were also obtained in comparison of patients over 60. Thus, it was concluded that maintenance therapy might be beneficial for older AML patients with limited therapy choice.

Histopathologic and Immunophenotypic Features of Childhood and Adult Anaplastic Large-Cell Lymphomas.

The t (2;5) (p23; q35) translocation associated with CD30-positive anaplastic large-cell lymphoma (ALCL) creates a hybrid gene encoding the chimeric nucleolar protein nucleophosmin-anaplastic lymphoma kinase (NFMALK) protein, which can be demonstrated by immunostaining with ALK1 monoclonal antibody. In this study, 40 specimens of ALCL from 6 pediatric, 34 adult patients, were immunostained with monoclonal antibodies against CD30 (Ber-H2), EMA, CD45 (LCA), CD3, CD20 (L26), CD15, and ALK1 antigens, and results were correlated with histopathologic features. The mean age of the pediatric and adult patients was 10-years and 38-years, respectively. ALK1 was positive in 14 cases (35%) representing 83% of pediatric and 26% of adult patients, statistically significantly higher in the pediatric group (p= 0.01). Considering the better prognosis attributed to cases with t (2;5), it is interesting to note that the percentage of ALK1-positive cases is significantly higher in pediatric patients with coexpression of EMA, compared to adults.

Activated Protein C Resistance in Behçet's Disease.

We investigated activated protein C resistance (aPCR) using modified activated partial thromboplastin time (aPTT) in 32 patients with Behçet's disease (BD) and 9 healthy controls. None of the healthy controls were found to have aPCR. However, 11 out of 32 Behçet's patients (34.3%) were found to have aPCR. The frequency of aPCR was increased to 44.4% among 18 Behçet's patients having a history of venous thrombosis. In the subgroup of 14 patients without venous thrombosis, aPCR frequency was %22.2. Our findings show that, besides other factors, aPCR may also predispose patients to venous thrombosis in BD. The detection of aPCR, using modified aPTT may serve as a routine screening test to determine the necessity of prophylactic anticoagulation reatment in patients with BD.

Asecretory POEMS Syndrome with Widespread Osteosclerotic Lesions.

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes) is a rare disease and constitues 1-2% of plasma cell dyscrasia. Most of the patients have few sclerotic bone lesions and more than 90% of patients have serum and/or urinary M-protein. In this report, we present a patient with POEMS syndrome who had severe polyneuropathy and unusual widespread osteosclerotic lesions without M- rotein in serum and urine. According to our knowledge, this is the first case of asecretory POEMS syndrome with multipl sclerotic lesions and polyneuropathy. Our patient is still well and able to work actively 4 years after diagnosis with the treatment of 12 courses of VAD by reducing the vincristine dosage.

Two consecutive spontaneous regressions to chronic phase in a patient with blastic transformation of chronic myelogenous leukemia.

In this report, we present a patient with chronic myeloid leukemia (CML) in blastic phase who had two consecutive episodes of spontaneous regression back to chronic phase without chemotherapy. Although, spontaneous remission (SR) is well documented in acute leukemia, SR in CML blastic phase is extremely rare and to the best of our knowledge only one case has been reported in the world literature. The factors possibly related to this phenomenon are discussed.