RESUMO
A patient is reported who developed essential thrombocythemia after successful treatment for hairy cell leukemia. He was initially treated with interferon alfa and subsequently relapsed within one year of treatment. His diagnosis was reconfirmed and then treated with Pentostatin. Six years after treatment he had a progressive increase in the platelet count and was diagnosed as essential thrombocythemia. Second cancers including various types of hematological malignancy have been reported in patients with hairy cell leukemia treated with chemotherapy or interferon alfa. These malignancies may represent either a new clonal disorder or a complication of drug treatment. This is the first report of a chronic myeloproliferative disorder following successful treatment of hairy cell leukemia.
Assuntos
Antibióticos Antineoplásicos/uso terapêutico , Antineoplásicos/uso terapêutico , Interferon-alfa/uso terapêutico , Leucemia de Células Pilosas/complicações , Pentostatina/uso terapêutico , Trombocitose/etiologia , Idoso , Antineoplásicos/efeitos adversos , Biópsia , Células da Medula Óssea/patologia , Humanos , Interferon-alfa/efeitos adversos , Leucemia de Células Pilosas/tratamento farmacológico , Leucemia de Células Pilosas/patologia , Masculino , Recidiva , Trombocitose/induzido quimicamente , Trombocitose/patologiaRESUMO
There is a paucity of clinical data regarding radiation therapy in elderly patients. This is a retrospective study of all patients aged 80 years and older who underwent treatment with external beam irradiation at a single site. There were a total of 183 patients treated with 226 courses of therapy. The mean age was 84 years (range: 80-98 years). Fifty-eight percent of the patients were male. The treatment was deemed palliative in 51% and curative in 49%. The primary cancer diagnoses were: prostate 36, lung 28, breast 25, head and neck 23, gastrointestinal 21, hematologic 12, gynecologic 11, skin 11, genitourinary 9, unknown primary 6, central nervous system 1. The patients were able to complete the prescribed therapy in 173 of 226 courses (77%). Treatment breaks during the radiation courses were required in 81 (36%) of the courses. Radiation therapy can be safely administered to an elderly population with both curative and palliative intent with the expectation of completion in more than 80% of patients. The reasons for inability to complete therapy as prescribed are multifactorial, but careful patient selection and attention to comorbidity may optimize outcome. Further research is needed to better define these parameters.
Assuntos
Radioterapia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Comorbidade , Feminino , Humanos , Masculino , Neoplasias/radioterapia , Cuidados Paliativos , Seleção de Pacientes , Radioterapia/efeitos adversos , Estudos RetrospectivosAssuntos
Ligante de CD40/metabolismo , Leucemia Linfocítica Crônica de Células B/metabolismo , Leucemia Linfocítica Crônica de Células B/patologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Sobrevivência Celular/fisiologia , Humanos , Leucemia Linfocítica Crônica de Células B/terapiaAssuntos
Subpopulações de Linfócitos B/patologia , Leucemia Linfocítica Crônica de Células B/patologia , Células-Tronco Neoplásicas/patologia , ADP-Ribosil Ciclase , ADP-Ribosil Ciclase 1 , Antígenos CD/análise , Antígenos de Diferenciação/análise , Antígenos de Neoplasias/análise , Antígenos CD5/análise , Diferenciação Celular , Divisão Celular , Transformação Celular Neoplásica/patologia , Replicação do DNA , DNA de Neoplasias/genética , Células-Tronco de Carcinoma Embrionário , Rearranjo Gênico de Cadeia Pesada de Linfócito B , Genes de Imunoglobulinas , Centro Germinativo/patologia , Humanos , Cadeias Pesadas de Imunoglobulinas/genética , Região de Junção de Imunoglobulinas/genética , Região Variável de Imunoglobulina/genética , Ativação Linfocitária/imunologia , Glicoproteínas de Membrana , NAD+ Nucleosidase/análise , Telômero/ultraestruturaRESUMO
Acute transfusion-associated graft-versus-host disease (TA-GVHD) is rare but often fatal. Graft-versus-host disease that occurs as a complication of bone marrow transplantation is more common but has lower mortality. Features of TA-GVHD are nonspecific and can be confused with viral infections and drug reactions. We present a case of probable TA-GVHD in a patient with tuberous sclerosis who survived and was subsequently given irradiated blood without any further adverse events.
Assuntos
Transfusão de Eritrócitos/efeitos adversos , Doença Enxerto-Hospedeiro/etiologia , Imunocompetência , Esclerose Tuberosa , Adulto , Eritema/etiologia , Feminino , Doença Enxerto-Hospedeiro/diagnóstico , Humanos , Dermatopatias Papuloescamosas/etiologia , Esclerose Tuberosa/complicaçõesRESUMO
Cellular immunophenotypic studies were performed on a cohort of randomly selected IgM(+) B-chronic lymphocytic leukemia (B-CLL) cases for which Ig V(H) and V(L) gene sequences were available. The cases were categorized based on V gene mutation status and CD38 expression and analyzed for treatment history and survival. The B-CLL cases could be divided into 2 groups. Those patients with unmutated V genes displayed higher percentages of CD38(+) B-CLL cells (>/=30%) than those with mutated V genes that had lower percentages of CD38(+) cells (<30%). Patients in both the unmutated and the >/=30% CD38(+) groups responded poorly to continuous multiregimen chemotherapy (including fludarabine) and had shorter survival. In contrast, the mutated and the <30% CD38(+) groups required minimal or no chemotherapy and had prolonged survival. These observations were true also for those patients who stratified to the Rai intermediate risk category. In the mutated and the <30% CD38(+) groups, males and females were virtually equally distributed, whereas in the unmutated and the >/=30% CD38(+) groups, a marked male predominance was found. Thus, Ig V gene mutation status and the percentages of CD38(+) B-CLL cells appear to be accurate predictors of clinical outcome in B-CLL patients. These parameters, especially CD38 expression that can be analyzed conveniently in most clinical laboratories, should be valuable adjuncts to the present staging systems for predicting the clinical course in individual B-CLL cases. Future evaluations of new therapeutic strategies and drugs should take into account the different natural histories of patients categorized in these manners.