Clinical evidence of a graft-versus-lymphoma effect against relapsed diffuse large B-cell lymphoma after allogeneic hematopoietic stem-cell transplantation.

BACKGROUND: A graft-versus-lymphoma effect against diffuse large B-cell lymphoma (DLBCL) is inferred by sustained relapse-free survival after allogeneic stem-cell transplantation; however, there are limited data on a direct graft-versus-lymphoma effect against DLBCL following immunotherapeutic intervention by either withdrawal of immunosuppression or donor lymphocyte infusion (DLI). MATERIALS AND METHODS: An analysis was carried out to determine whether a direct graft-versus-lymphoma effect exists against DLBCL. The analysis was restricted to patients with DLBCL, who were either not in complete remission at day +100 after allogeneic stem-cell transplantation or subsequently relapsed beyond this time point. RESULTS: Fifteen patients were identified as either not in complete remission (n = 13) at their day +100 evaluation or subsequently relapsed (n = 2) and were assessed for subsequent responses after withdrawal of immunosuppression or DLI. Eleven patients were treated with either withdrawal of immunosuppression (n = 10) or a DLI (n = 1) alone; four patients received chemotherapy with DLI to reduce tumor bulk. Nine (60%) patients subsequently responded (complete = 8, partial = 1). Six responses occurred after withdrawal of immunosuppression alone. Six patients are alive (range 42-83+ months) in complete remission without further treatment. CONCLUSION: The demonstration of sustained complete remission following immunotherapeutic intervention provides direct evidence of a graft-versus-lymphoma effect against DLBCL.

Antibody to hepatitis C virus increases with time on hemodialysis.

We studied whether chronic hemodialysis is associated with an increased risk of exposure to hepatitis C virus. Utilizing a first generation Elisa assay (C-100 Elisa, Ortho Diagnostic Systems, Raritan, NJ) and the Chiron RIBA HCV second generation assay (RIBA, Chiron, Emeryville, CA and Ortho Diagnostic Systems, Raritan, NJ), antibody to HCV was found in 31 of 87 hemodialysis patients (36%). Patients on hemodialysis less than 2 years had an antibody incidence of 15% (n = 46), as contrasted with a 59% incidence for patients on dialysis greater than or equal to 2 years (n = 41). We were unable to demonstrate a correlation of HCV-antibody positivity with history of blood transfusion. The overall incidence is higher than previously reported for hemodialysis patients in the United States. The very high incidence found in patients on dialysis greater than or equal to 2 years suggests that factors in the hemodialysis unit might contribute to the spread of virus.

Hepatitis C virus in the hemodialysis setting: detecting viral RNA from blood port caps by reverse transcription-polymerase chain reaction.

BACKGROUND: A widely observed increased risk of hepatitis C virus (HCV) infection in chronic hemodialysis patients has been previously attributed to violations of "Universal Precautions" for the control of blood-borne pathogens, as well as in part, to other risk factors, such as a history of blood transfusion or injection drug use. However, specific factors responsible for transmission have not been identified and the possibility that flaws in dialysis procedures, including sterilization, could increase the risk of transmission, has not been excluded. METHODS: We investigated reuse procedures for hemodialysis equipment and tested dialyzer blood port caps for detection of hepatitis C virus RNA (HCV RNA) by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Following artificial contamination of the blood port caps with blood or fluids from human HCV-positive patients, and overnight soaking in 1% Renalin, HCV RNA was detected on 4 of 20 caps contaminated with blood, 1 of 10 contaminated with serum and 8 of 24 contaminated with dialyzer blood compartment residue. HCV RNA was also detected on 1 of 111 pairs of blood port caps collected post dialysis from HCV positive patients, after soaking the caps overnight in 1% Renalin. CONCLUSION: The results suggest that HCV RNA might be detectable on reused dialysis equipment post sterilization procedures, if residual blood or serum is not entirely or almost entirely removed prior to sterilization. This may warrant evaluation of sterilization procedures to ensure that procedures are adequate and that protocols are rigorously followed. Further studies of sterilization procedures by sensitive techniques such as RT-PCR may be indicated.

Maximum surgical blood order schedule reduces hospital costs.

The maximum surgical blood order schedule (MSBOS) is a viable option for reducing unnecessary crossmatching and achieving significant cost savings in the blood bank. A MSBOS specifies, and thus limits, the amount of blood normally crossmatched for elective surgical procedures. During the first 10 months after introducing MSBOS at our hospital, there was a 33 per cent drop in the number of units of blood crossmatched for elective surgical procedures. The 712 crossmatches that were avoided saved the hospital blood bank more than $6000. Patient care was not adversely affected. Institution of MSBOS can be accomplished without difficulty by gaining input from surgeons and anesthesiologists. After implementation, follow-up is advisable to attain optimal blood use.

Lymphocyte subset changes in persons infected with human immunodeficiency virus.

The severe complications of the acquired immunodeficiency syndrome represent the final phase of a prolonged course of immune system destruction during the infection by human immunodeficiency virus (HIV). Many of these complications can be predicted by measuring the depletion of CD4 positive lymphocytes. The CD4 positive lymphocyte counts are now widely accepted as a surrogate marker to assess the stage of disease and to determine immune response in major clinical trials. Other lymphocyte subsets are candidate surrogate markers for antiretroviral therapy. Our laboratory has utilized flow cytometry to perform lymphocyte subset testing, including CD4, CD8, CD4/CD8 ratio, and others for more than three years on persons with suspected immune deficiency. Results from our laboratory are presented to illustrate the use of these procedures in an urban, predominantly inner city population. The role of flow cytometry in monitoring patients with HIV infection is discussed.

Fine needle aspiration cytology of chondroid syringoma. Report of a case.

A case of chondroid syringoma of skin was diagnosed by fine needle aspiration cytology and confirmed by histopathologic study. The most important feature in both smears and cell blocks prepared from the aspirate was the presence of two distinct components: an epithelial component and a contrasting stromal component with a chondroid appearance. The clinical and pathologic features of chondroid syringoma are reviewed and the differential diagnosis is discussed, especially for the benign and malignant variants of this lesion.

Cytomorphologic features of salivary duct carcinoma on fine needle aspiration biopsy. A case report.

Salivary duct carcinoma is an uncommon salivary gland malignancy resembling intraductal carcinoma of the breast. We report a case of salivary duct carcinoma in which fine needle aspiration biopsy was performed preoperatively. The cytologic features included tumor cells with abundant, finely granular cytoplasm and focal mucin positivity as well as sheets and tissue fragments demonstrating a distinctive cribriform pattern.

Anti-Jka autoimmune hemolytic anemia in an infant.

Anti-Jka was identified in the serum and on the red cells of an 8-month-old infant with anemia, splenomegaly, and symptoms of an upper respiratory infection. The anemia improved after transfusion and treatment with prednisone.