RESUMO
A five-month-old male infant with familial hemophagocytic lymphohistiocytosis underwent cord blood transplantation using reduced-intensity conditioning. Methylprednisolone (mPSL) pulse administration was performed for marked pulmonary edema during the early phase of transplantation, followed by GVHD treatment with mPSL until day 100. CMV antigenemia was detected on days 27 and 55, but serum became negative with 2- to 3-week ganciclovir (GCV) treatment on both occasions. On day 120, ophthalmological findings included multiple bilateral white spots and a positive PCR study using anterior chamber fluid confirmed the diagnosis of CMV retinitis affecting both eyes, although CMV antigenemia was negative. Re-treatment with GCV had a minimal effect on the ophthalmological findings, while foscarnet administration markedly improved the retinitis and decreased the CMV-DNA level. Considering that a substantial proportion of patients develop CMV retinitis even when CMV antigenemia is not present, routine monitoring involving ophthalmological examinations should be conducted for hematopoietic transplant patients, especially infants, who cannot complain of ocular symptoms.
Assuntos
Infecções por Citomegalovirus/tratamento farmacológico , Retinite/tratamento farmacológico , Combinação de Medicamentos , Sangue Fetal/transplante , Humanos , Lactente , MasculinoRESUMO
The development of novel agents has markedly improved the prognosis of multiple myeloma(MM). However, salvage therapies for patients with MM that is refractory to novel agents and conventional chemotherapies have not been established. Herein, we describe successful treatments for such patients with the combination of clarithromycin, lenalidomide, and lowdose dexamethasone(BiRd)with or without melphalan and prednisolone(MP). Although its duration was relatively short, the remission is important in terms of the salvage strategy until the second generation of novel agents becomes available.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Idoso , Claritromicina/administração & dosagem , Dexametasona/administração & dosagem , Feminino , Humanos , Lenalidomida , Masculino , Melfalan/administração & dosagem , Prednisolona/administração & dosagem , Recidiva , Talidomida/administração & dosagem , Talidomida/análogos & derivadosRESUMO
Since the late 1990s, Stenotrophomonas maltophilia (S. maltophilia) has become one of the most common nonfermenting Gram-negative bacilli that cause opportunistic infection. Patients with hematologic diseases are the most risky candidate for S. maltophilia pneumonia or sepsis because of chemotherapy-induced neutropenia or immunodeficiency. Frequent exposure to broad-spectrum antibiotics and prolonged insertion of central venous catheter further enhance the risk of S. maltophilia infection. One of the most severe S. maltophilia infections is hemorrhagic pneumonia. This type of infection is mostly fatal because of pulmonary alveolar hemorrhage that leads to acute respiratory failure. Furthermore, S. maltophilia exhibits a high-level intrinsic resistance to conventional antibiotics such as ß-lactams and aminoglycosides and, more recently, the increasing acquired resistance to co-trimoxazole and quinolones. According to our experienced and previously reported cases, all of the patients with hemorrhagic pneumonia caused by S. maltophilia had a fatal course within a few days after the onset of the pneumonia. In this article, we perform a systematic review on a total 30 cases of hemorrhagic pneumonia induced by S. maltophilia from our institutions and the literature, and we describe its early diagnosis, prophylaxis, and recommended therapeutic strategy for the infection in the treatment of hematologic disease.
Assuntos
Infecções por Bactérias Gram-Negativas/microbiologia , Hemorragia/etiologia , Leucemia/complicações , Pneumopatias/etiologia , Infecções Oportunistas/microbiologia , Pneumonia Bacteriana/microbiologia , Stenotrophomonas maltophilia/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/microbiologia , Proteínas de Bactérias/fisiologia , Infecções Relacionadas a Cateter/microbiologia , Criança , Pré-Escolar , Infecção Hospitalar/complicações , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Neutropenia Febril/induzido quimicamente , Neutropenia Febril/complicações , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/mortalidade , Hemorragia/mortalidade , Humanos , Hospedeiro Imunocomprometido , Recém-Nascido , Japão/epidemiologia , Leucemia/tratamento farmacológico , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/mortalidade , Peptídeo Hidrolases/fisiologia , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/mortalidade , Radiografia , Estudos Retrospectivos , Stenotrophomonas maltophilia/efeitos dos fármacos , Stenotrophomonas maltophilia/enzimologiaRESUMO
A 68-year-old female was diagnosed with acute myeloid leukemia (AML-M2 without 8/21 translocation) in December 2006. Although a complete remission (CR) was obtained after induction chemotherapy, the first post-remission therapy was discontinued because of severe cardiovascular complications. She had a relapse of AML with CD33-positive myeloblasts which comprised 38.4 % of the bone marrow cells in November 2007. She received two courses of low-dose chemotherapy because of the previous complications. The amount of Wilm's tumor 1 (WT1) mRNA in the peripheral blood was 13,000 copies/µg RNA after the first course of the chemotherapy, and 4.8 % myeloblasts remained in the bone marrow after the second course. She was treated with a single course of gemtuzumab ozogamicin (GO), with a subsequent CR with 0.9 % marrow myeloblasts and fewer than 50 copies of WT-1 mRNA (normal level). Thereafter, she received five courses of GO monotherapy at each occasion of early AML relapse. Hematological remission has been sustained over a period of about 24 months with the GO monotherapy alone. This case suggests that GO monotherapy is a useful salvage therapy for early relapse of CD33-positive AML in situations in which standard chemotherapy is not indicated.
Assuntos
Aminoglicosídeos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/uso terapêutico , Leucemia Mieloide Aguda/tratamento farmacológico , Terapia de Salvação , Idoso , Aminoglicosídeos/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos/efeitos adversos , Feminino , Gemtuzumab , Humanos , Leucemia Mieloide Aguda/prevenção & controle , Indução de Remissão , Terapia de Salvação/efeitos adversos , Prevenção Secundária , Resultado do TratamentoRESUMO
The incidence of HHV-6 encephalitis during hematopoietic stem cell transplantation (HSCT) in children is thought to be less than that in adults and risk factors, prognosis and complications are virtually unknown. Herein, we report a pediatric case developing epileptic encephalopathy following HHV-6 encephalitis after a second cord blood transplantation (CBT). A 7-year-old boy with relapsed B-precursor acute lymphoblastic leukemia in second remission underwent CBT. However, he received a second CBT due to graft failure. On day 25 after the second CBT, he developed short-term memory defects and seizures. He was diagnosed with HHV-6 encephalitis because HHV-6 DNA was detected in his blood and cerebrospinal fluid and abnormal hippocampal signals were seen on cranial magnetic resonance imaging (MRI). After treatment with foscarnet, HHV-6 DNA levels and MRI findings improved; however, he developed epileptic encephalopathy five months after the onset of encephalitis. There are very few reports on pediatric epileptic encephalopathy associated with HHV-6 encephalitis after HSCT. Detailed studies are needed to analyze risk factors, prognosis, and complications.
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical , Encefalite Viral/complicações , Epilepsia/virologia , Herpesvirus Humano 6/fisiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Criança , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
We encountered a rare case of cytotoxic molecule-positive and Epstein-Barr virus (EBV)-associated peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), which was clinically preceded by polymyositis. A 50-year-old woman with a 4-year history of steroid-refractory polymyositis developed ulcerative skin swelling on her left arm. A diagnosis of cytotoxic molecule (TIA-1)-positive and EBV-associated PTCL-NOS was made on the basis of immunohistochemical and molecular examinations of the biopsied brachial muscle. Combination chemotherapies were ineffective, with a fatal outcome. Reassessment of the biopsy specimens of the muscle taken at the age of 46 years showed that the PTCL was already present, indicating that the polymyositis was likely a paraneoplastic manifestation.
Assuntos
Infecções por Vírus Epstein-Barr/diagnóstico , Linfoma de Células T Periférico/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Polimiosite/diagnóstico , Testes Imunológicos de Citotoxicidade/métodos , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/imunologia , Feminino , Humanos , Linfoma de Células T Periférico/complicações , Linfoma de Células T Periférico/virologia , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/complicações , Síndromes Paraneoplásicas/virologia , Polimiosite/complicações , Polimiosite/virologiaRESUMO
OBJECTIVE: While unexplained liver dysfunction is common, it is sometimes difficult to identify its exact cause. One cause is viral infections. The identification of viruses other than hepatitis B and C that cause liver dysfunction is difficult because no methods to simultaneously identify these viruses have been established. The aim of this study was to quickly and simultaneously identify multiple virus species. METHODS: A total of 49 patients with unexplained liver dysfunction and undetermined inflammation were examined. The majority of patients had hematologic malignancies, and some had undergone bone marrow transplantation. Qualitative polymerase chain reactions (PCR) were performed to detect 12 species of DNA virus in whole blood. Quantitative real-time PCR was performed when a specific virus was amplified. In addition, 6 RNA hepatitis viruses were directly assayed by real-time PCR. These 2 PCR steps were completed within 1 hour. RESULTS: The most frequently detected virus in 37 patients with liver dysfunction, was transfusion transmitted virus (38%), which was followed by human herpes virus (HHV) type 6 (35%), Epstein-Barr virus (14%), cytomegalovirus (8%), and rarely hepatitis G virus and HHV-7 (3%). Similar viremia was observed in 12 patients with mild liver dysfunction. The results of the PCR assay were mostly consistent with those of routine virus serological tests. CONCLUSION: A multiplex viral PCR assay was a useful tool for quickly identifying viruses that possibly cause liver dysfunction. It was also important that liver dysfunction acted as a proband that led to the discovery of serious viremia.
Assuntos
DNA Viral/genética , Hepatopatias/diagnóstico , Hepatopatias/genética , Reação em Cadeia da Polimerase Multiplex/métodos , Viroses/diagnóstico , Viroses/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Hepatopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Viroses/epidemiologia , Adulto JovemRESUMO
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy with a poor prognosis. We encountered a unique case of BPDCN that was leukemic at presentation without skin lesion and expressed CD33 antigen. A 74-year-old man was admitted because of dyspnea. Physically, hepatosplenomegaly, but not skin lesions and superficial lymph node swelling, was noted. The white blood count was 33.6 × 10(9)/L with 19% giant abnormal cells. These cells were positive for CD4, CD86, CD123 (bright), BDCA-2, and HLA-DR, but negative for CD1a, CD3, CD11b, CD11c, CD13, CD14, CD19, CD64, and CD68. From these findings, a diagnosis of BPDCN was made. In terms of unusual expression, these tumor cells were positive for CD33 but negative for CD56. The karyotype was 47, XY, t(6;8) (p21;q24), + r. We performed combination chemotherapy (Ara-C + VP-16 + MIT), which resulted in a marked reduction of tumor cells and improvement of the dyspnea. On day 16, however, he died of sepsis due to Bacillus cereus. The clinical picture of this patient is unusual and may provide new information on the clinicopathology of BPDCN.
Assuntos
Células Dendríticas/patologia , Neoplasias Hematológicas/patologia , Leucemia Monocítica Aguda/patologia , Idoso , Antígenos CD/imunologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Células Dendríticas/efeitos dos fármacos , Diagnóstico Diferencial , Dispneia/patologia , Evolução Fatal , Antígenos HLA/imunologia , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/genética , Hepatomegalia/patologia , Humanos , Leucemia Monocítica Aguda/diagnóstico , Masculino , Esplenomegalia/patologia , Translocação GenéticaRESUMO
A 68-year-old female with palmoplantar pustulosis was referred to our hospital in July, 2009 because of liver dysfunction, a positive test for HTLV-1, and circulating abnormal lymphocytes with irregularly shaped nuclei. A diagnosis of acute type adult T cell leukemia/lymphoma (ATLL) was made based on generalized lymph node swelling and high levels of serum LDH, in addition to the findings described above. The associated palmoplantar pustulosis responded to some extent to antibiotics, steroid ointment, and narrow band UBV light irradiation. For ATLL, she was serially treated with CHOP chemotherapy, an LSG 15 protocol, and CytaBOM protocol with consequent partial remission. These chemotherapies did not affect the palmoplantar pustulosis. For ATLL in partial remission, we performed allogeneic peripheral blood stem cell transplantation (allo-PBSCT) from a related donor (HTLV-1-negative) with a conditioning regimen consisting of fludarabine, melphalan, and total body irradiation with 3 Gy in February, 2010. After the engraftment of donor hematopoietic cells, ATLL cells disappeared and the patient currently (as of April, 2012) remains in complete remission (CR). The residual palmoplantar pustulosis was further improved soon after allo-PBSCT and disappeared on Day 84 after transplantation. This refractory skin disease has also been in CR to date.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Leucemia-Linfoma de Células T do Adulto/complicações , Leucemia-Linfoma de Células T do Adulto/terapia , Psoríase/etiologia , Psoríase/terapia , Idoso , Feminino , Humanos , Condicionamento Pré-Transplante , Transplante Homólogo , Resultado do TratamentoRESUMO
A 49-year-old man was diagnosed with pure red cell aplasia (PRCA) based on low reticulocyte count (0.1%) and near absence of erythroblasts in the bone marrow (BM). While a small number of CD20-positive large abnormal cells was observed in the BM, Multiplex PCR confirmed B cell monoclonality. Gallium scintigraphy showed abnormality only in the BM, and we made a diagnosis of PRCA secondary to BM-derived B-cell malignant lymphoma. He was treated with rituximab-combined CHOP therapy with subsequent resolution of both disorders. He was further treated with high dose chemotherapy with auto-PBSCT, sustaining complete remission of the PRCA and lymphoma.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma de Células B , Aplasia Pura de Série Vermelha/terapia , Transplante de Medula Óssea , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/terapia , Masculino , Pessoa de Meia-Idade , Aplasia Pura de Série Vermelha/complicações , Indução de Remissão , Transplante Homólogo , Resultado do TratamentoRESUMO
Blastic plasmacytoid dendritic cell neoplasm (BPDCN), currently considered to originate from immature plasmacytoid dendritic cells (DC), is a rare and aggressive CD4+CD56+ neoplasm that frequently involves the skin and bone marrow. We present a case of an 80-year-old man with a CD4+CD56+ BPDCN that affected the orbital cavity and bone marrow. Although BPDCN has not been reported to express any lineage-specific markers, the neoplastic cells strongly expressed the CD13 antigen. Therefore, in addition to pathological examination, we attempted to induce in vitro morphological and surface marker changes with IL-3 and CD40 ligand. After treatment with these cytokines, the tumor cells enlarged markedly, acquired many fine dendrites, similar to mature DC, and showed enhanced expression of antigens specific to DC or antigen-presenting cells, such as CD40, CD80, CD83 and CD86. To the best of our knowledge, this is the first report of BPDCN expressing a myeloid antigen, CD13, although CD33 expression has been described in some cases. The present patient received 2 courses of combination chemotherapy consisting of cytarabine and etoposide, which resulted in complete remission. Given that the cellular origin of plasmacytoid DC is still controversial, myeloid antigen expression involving CD13 may not exclude a diagnosis of BPDCN.
Assuntos
Anemia/etiologia , Neoplasias da Medula Óssea/metabolismo , Antígenos CD13/metabolismo , Células Dendríticas/patologia , Neoplasias de Plasmócitos/metabolismo , Neoplasias Orbitárias/metabolismo , Idoso de 80 Anos ou mais , Neoplasias da Medula Óssea/sangue , Neoplasias da Medula Óssea/patologia , Neoplasias da Medula Óssea/fisiopatologia , Humanos , Masculino , Neoplasias de Plasmócitos/sangue , Neoplasias de Plasmócitos/patologia , Neoplasias de Plasmócitos/fisiopatologia , Neoplasias Orbitárias/sangue , Neoplasias Orbitárias/patologia , Neoplasias Orbitárias/fisiopatologiaRESUMO
As the first step of UCB banking, UCB collection has an important role in banking procedures. The aim of this study was to reveal the current status of UCB collection and discuss the management of the UCB bank. We conducted a questionnaire survey at medical centers collecting UCB, followed by semi-structured interviews with some respondents. Out of 38 institutes, 11 respondents (28.9%) thought that collection of UCB in addition to their routine medical services puts a burden on physicians. The obstetricians involved in the UCB collection are generally willing to participate in the procedure under current circumstances at medical institutes.
Assuntos
Bancos de Sangue , Coleta de Dados , Sangue Fetal , Feminino , Humanos , Japão , MasculinoRESUMO
A 21-year-old man who was diagnosed with Diamond-Blackfan anemia at 2 years of age came to our hospital with the hope of undergoing bone marrow transplantation (BMT). He had been red cell transfusion-dependent for about 8 years; at presentation he had transfusion-induced hemochromatosis, a subsequent low left ventricular ejection fraction (LVEF) of 43%, and diabetes mellitus requiring insulin therapy. He received unrelated BMT with reduced intensity conditioning and sufficient GVHD prophylaxis. Regardless of the cardiac dysfunction, he had an uneventful course during pre- and post-grafting periods, and is currently doing well with an improved LVEF (55%), although he is still insulin dependent.
Assuntos
Anemia de Diamond-Blackfan/terapia , Transplante de Medula Óssea , Hemocromatose/complicações , Reação Transfusional , Disfunção Ventricular Esquerda/etiologia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/etiologia , Hemocromatose/etiologia , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Transplante Homólogo , Disfunção Ventricular Esquerda/diagnóstico , Adulto JovemRESUMO
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by the abnormal accumulation of alveolar surfactant protein in alveolar spaces. We report herein a rare case of myelodysplastic syndrome (MDS-RAEB) complicated by severe PAP, and successful allogeneic bone marrow transplantation (BMT) for both disorders. An unrelated BMT was planned for a 48-year-old male with advanced MDS-RAEB. Just before the initiation of the conditioning regimen for unrelated BMT in March 2007, he developed dyspnea. A diagnosis of PAP was made based on findings of chest X-ray, CT scanning, and the fluid obtained by bronchoalveolar lavage. To improve his dyspnea and improve BMT safety, whole lung lavage (WLL) was performed twice, with the partial improvement of PAP. Unrelated allogeneic BMT was performed in September 2007. We had to perform a third WLL because of the worsening of PAP on day 26 after BMT. Despite many infectious complications after BMT, GVHD was relatively mild. PAP had almost disappeared 6 months after BMT. He was well with favorable hematopoiesis 20 months after the BMT without any specific treatment. There has been no report of an MDS patient with PAP in whom 3 WLL procedures were performed before and after allogeneic BMT.
Assuntos
Transplante de Medula Óssea , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/terapia , Proteinose Alveolar Pulmonar/complicações , Proteinose Alveolar Pulmonar/terapia , Lavagem Broncoalveolar , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Transplante HomólogoAssuntos
Neoplasias da Medula Óssea/terapia , Neoplasias de Cabeça e Pescoço/terapia , Leucemia Mieloide Aguda/terapia , Sarcoma Mieloide/terapia , Adolescente , Neoplasias da Medula Óssea/patologia , Neoplasias da Medula Óssea/secundário , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Leucemia Mieloide Aguda/patologia , Masculino , Neoplasia Residual , Sarcoma Mieloide/patologiaRESUMO
Most causative organisms of sepsis in immunocompromised patients are the same species as those that colonize their own nasopharynx or intestinal tract. To determine whether the strains recovered from blood originate mainly from patients' own flora, isolates from blood and throat and/or stool were investigated by genomic analyses. Surveillance cultures of throat and stool were taken prospectively from cancer patients being treated with intensive chemotherapy followed by haematopoietic stem-cell transplantation. In those cases of sepsis in which the isolate from blood was the same species as that from the throat and/or stool, the genomic profiles of the isolates were compared by PFGE. Ten cases of blood culture-positive sepsis were documented in six of 14 subjects during a 2 year period; isolates of Pseudomonas aeruginosa, Staphylococcus epidermidis, Enterococcus sp., viridans streptococci and Fusobacterium sp. were recovered from blood. In five of seven cases in which the blood isolate was the same species as that from the throat or stool, the genotypes of the isolates from both sites were identical. In the majority of immunocompromised patients, the causative organisms of bloodstream infections originated mainly from their own flora.
Assuntos
Bacteriemia/microbiologia , Bactérias/genética , Hospedeiro Imunocomprometido , Intestinos/microbiologia , Faringe/microbiologia , Adolescente , Bactérias/classificação , Bactérias/isolamento & purificação , Criança , Pré-Escolar , Eletroforese em Gel de Campo Pulsado , Fezes/microbiologia , Feminino , Genótipo , Humanos , Lactente , MasculinoRESUMO
It has been reported that autoimmunity might be sometimes transferred from a donor to a recipient following allogenic bone marrow transplantation (allo-BMT). We report a patient to whom Basedow disease was transferred from the donor through an allo-BMT. A 18-year-old man with acute lymphoblastic leukemia, received the allo-BMT from his HLA-identical sister. Two-years later, he developed symptoms of palpitations and general fatigue. He was diagnosed as having Basedow disease because of hyperthyroidism, and high levels of the anti-thyroid stimulating hormone receptor antibody and antithyroid antibody. When he received the allo-BMT, his donor had neither the clinical symptoms of Basedow disease, nor abnormal findings on examination to determine her eligibility as a the donor. We retrospectively assayed anti-thyroid antibodies from their cryopreserved sera, and found the donor's anti-thyroid antibody was positive, while her serum was negative before transplantation. It was apparent that the donor had subclinical Basedow disease. The patient has remained in complete remission without any signs of chronic graft-versus-host disease (GVHD) up till the time of writing. It is believed that an anti-thyroid tissue reactive B-cell clone was transferred from the donor to the patient and commenced to produce antibodies. It is suggested that thorough investigation of the donor's autoimmunity is needed before allo-BMT. If the recipient develops an autoimmune disease after allo-BMT, we should definitely investigate the donor's autoimmunity.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Doença de Graves/etiologia , Doadores Vivos , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Autoanticorpos , Autoimunidade , Linfócitos B/imunologia , Transplante de Medula Óssea/imunologia , Doença de Graves/imunologia , Humanos , Masculino , Receptores da Tireotropina/imunologia , Glândula Tireoide/imunologiaRESUMO
Neuroblastoma (NB), one of the most common solid tumors among children, is histologically classified by the degree of maturation. To elucidate the mechanisms underlying its maturational sequence, we analyzed gene-expression profiles of 14 NB tumors on cDNA microarrays consisting of 23,040 genes. Computational analysis identified 78 genes whose expression levels were significantly different between differentiating NB tumors and poorly differentiated NB tumors. This group included genes associated with cell maturation and apoptosis. Among them we identified 15 that were up-regulated in Stage IV NB tumors; these included genes encoding cell adhesion molecules and cytoskeleton proteins. The set of genes we report here should contribute to a better understanding of NB tumor maturation and could lead to development of new therapeutic strategies.