CD8-positive mantle cell lymphoma: a report of two cases.

Two cases of mantle cell lymphoma with a unique CD8+ phenotype are reported. Both patients had disease that was resistant to therapy; one patient had the blastic variant of mantle cell lymphoma. Flow cytometric analysis of bone marrow and cerebrospinal fluid samples revealed a phenotype consistent with mantle cell lymphoma, with the additional finding of CD8 positivity in 40% or more of the tumor cells in both cases. This is the first description of such a finding, and CD8+ mantle cell lymphoma may represent a unique type of B-cell neoplasia. Our findings may be important in the prediction of therapeutic response or in the detection of residual disease after therapy.

High-dose cytarabine and recombinant human granulocyte colony-stimulating factor for the treatment of resistant acute myelogenous leukemia.

Few salvage treatments are successful for patients with relapsed acute myelogenous leukemia after a short first remission, multiple relapses, or for patients with disease refractory to initial induction chemotherapy. To improve the results of salvage therapy we studied the efficacy and toxicity of a combination of G-CSF (5 mu tg/kg IV q day) used as a priming agent followed by continued exposure to G-CSF and high-dose cyatarabine (2 gm/m(2) IV q 12 hours x 12 doses) in fifteen adult patients with relapsed or refractory acute myelogenous leukemia. Nine of fourteen (64%; 95% confidence interval 35 to 87%) achieved complete remission, four failed to enter remission and one died of multiorgan system failure after progressive leukemia cutis despite chemotherapy-induced bone marrow aplasia. Median disease-free survival is 148 days and median survival from study entry for responding patient is 174 days. Three patients who achieved complete remission subsequently relapsed with a median time to relapse of 147 days. Median time to granulocyte >0.5 x 10(9)/L was 22 days (19 to 34 days) and the median time to platelet recovery >20 x 10(9)/L was 30 days (23 to 214 days). Although gastrointestinal toxicity was common, no patient developed severe cardiac, hepatic, pulmonary, or neurologic complications. An elevation in the percent of bone marrow blasts in S-phase after 48 hours of treatment with G-CSF was identified in 7 of 12 evaluable patients. These results demonstrate that the combination of G-CSF and high-dose cytarabine may be used as an effective salvage treatment for patients with resistant acute myelogenous leukemia.

Pathogenesis of AIDS--related Kaposi's sarcoma.

The occurrence of Kaposi's sarcoma (KS) in patients with HIV infection is more than 7,000 times higher than in the non-HIV infected population. The reason for this association is unclear but may involve decreased immune surveillance as a result of the profound cellular immune deficiency caused by HIV, a sexually transmitted KS-inducing virus, whose KS-transforming capabilities may be enhanced by HIV, or a direct or indirect effect of HIV itself in susceptible individuals. Over the last few years, advances have been made in our understanding of the pathogenesis of this tumor, and several models have been proposed for its development in the setting of AIDS. Better characterization of the processes involved in the development of KS will ultimately lead to more effective methods of treating and preventing this unusual tumor.