Hepatitis B virus vaccine in lymphoproliferative disorders: a prospective randomized study evaluating the efficacy of granulocyte-macrophage colony stimulating factor as a vaccine adjuvant.

OBJECTIVES: Hepatitis B virus (HBV) infection is effectively preventable by immunization with the commercially available recombinant HBV vaccines (HBV(vac)) in approximately 95% of healthy people. Immunosuppressive diseases like hematological malignancies are a risk factor for non-response to HBV(vac). The aim of this study was to determine the efficacy and safety of granulocyte-macrophage colony-stimulating factor (GM-CSF) as a vaccine adjuvant in lymphoproliferative disorders (LPD). PATIENTS AND METHODS: One- hundred and two patients with LPD were randomized to receive either a single dose of 40 mug HBV(vac) intramuscularly or one course of 40 mug HBV(vac) after 5 mug/kg recombinant GM-CSF injection. RESULTS: Of the 94 patients that could be evaluated at 1 month, the seroprotection rate was higher in GM-CSF + HBV(vac) group (25.5% in GM-CSF + HBV(vac) group vs. 17% in HBV(vac) group). The median anti-HBs titer was also higher in GM-CSF + HBV(vac) group. However the difference did not reach to a significant level in terms of response rate and median antibody titers (P > 0.05). Univariate analysis identified age and time to vaccination from the last chemotherapy course as significant predictors of seroprotection. In multivariate analysis, age was the only predictor of achieving a seroprotective response. Patients who lost the seroprotective response during monitoring were boosted with a 20 microg HBV(vac) and they all achieved a seroprotective anti-HBs titer > 100 mIU/mL. CONCLUSION: In LPD, the response to HBV(vac) is impaired. GM-CSF enhance to HBV(vac) in terms of the rate of response and average of antibody titers at the dose and schedule given.

Cholestatic liver disease with ductopenia (vanishing bile duct syndrome) in Hodgkin's disease: report of a case.

Liver involvement is common in advanced stages of Hodgkin's disease. However, only a small percentage of patients with Hodgkin's disease develops jaundice due to several causes. Vanishing bile duct syndrome secondary to Hodgkin's disease is a rare cause of cholestasis in these patients. Only 20 cases, to our knowledge, have been reported so far in adults. We report a case of Hodgkin's disease presenting with obstructive jaundice without detectable liver involvement. Liver biopsies revealed intrahepatic cholestasis and ductopenia. Although the patient was given chemotherapy, he died of sepsis and disseminated intravascular coagulation after 24 weeks of admission to hospital.

Gastric emptying in patients with vitamin B(12) deficiency.

The clinical presentation of patients with vitamin B(12) deficiency varies in a spectrum ranging from haematological disorders to neuropsychiatric diseases. In rare cases, orthostatic hypotension, impotence, constipation and urinary retention have been attributed to autonomic nervous system dysfunction due to vitamin B(12) deficiency. The aim of this study was to evaluate the effect of vitamin B(12) deficiency on autonomic nervous system function by studying gastric emptying times ( T(1/2)). Twenty patients with newly diagnosed vitamin B(12) deficiency and 12 control patients with gastritis and normal vitamin B(12) levels were enrolled in this study. Gastroduodenoscopy, endoscopic biopsy, histopathological evaluation of the biopsy specimens and radionuclide gastric emptying studies were performed. After vitamin B(12) replacement therapy for 3 months, radionuclide gastric emptying studies were repeated. Mean gastric emptying T(1/2) in patients before and after treatment and in controls were 103.83+/-48.80 min, 90.00+/-17.29 min and 74.55+/-8.52 min, respectively. The difference in mean gastric emptying T(1/2) between patients before treatment and controls was statistically significant ( P<0.01). The statistically significant difference persisted after vitamin B(12) treatment ( P<0.05), though mean gastric emptying T(1/2) was somewhat shorter. There were no positive or negative correlations between gastric emptying T(1/2) and the following parameters: haemoglobin, vitamin B(12) level and Helicobacter pylori positivity. In conclusion, gastric emptying T(1/2) was prolonged in patients with vitamin B(12) deficiency and this prolongation was not corrected after vitamin B(12) replacement therapy. Although autonomic nervous system dysfunction due to vitamin B(12) deficiency rarely gives rise to clinical manifestations, latent dysfunction demonstrated by laboratory tests seems to be a frequent phenomenon. The level of vitamin B(12) does not correlate with the degree of autonomic nervous system dysfunction measured by radionuclide gastric emptying studies.

Solitary Plasmacytoma of Tibia in a 29-Year-Old Woman.

Solitary plasmacytoma of the bone is a plasma cell tumor characterized by a single bone lesion with no evidence of myeloma elsewhere, including fewer than 5% plasma cells in the bone marrow. Although median age is about 14 years younger than that of patients with multiple myeloma, both diseases are extremely uncommon under 30 years of age. Solitary plasmacytoma of bone seem to have a prediction to occur in the axial skeleton, particularly in a vertebra and long bones are rarely affected. Herein, we report a case of solitary plasmacytoma of bone involving the tibia in a 29-year-old woman.