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Objective:To identify clinical features,possible risk factors and treatment related to rituximab-associated interstitial pneumonia(RTX-IP). Methods:The clinicopathological characteristics,immune phenotype and treatment of six patients with diffuse large B-cell lymphoma(DLBCL)develped after receiving R-CDOP treatment were retrospectively analyzed. Results:Six patients had agranulocytosis or granulocytopenia within 1 week before RTX-IP diagnosis,and the median interval time was 3 courses of treatment.All six patients had double-expressor lymphoma(DEL)or triple-expressor lymphoma(TEL).Of the six patients,four had germinal-center B-cell-like lymphoma(GCB),and two had non-GCB.The expression of Ki-67 was＞70％,except for one patient with transformed lymphoma(TL).After treatment with methylprednisolone for about 1 week,all patients'chest CT showed inflammatory absorption.However,one patient developed pneumocystis carinii pneumonia during the process of hormone reduction,and recovered after 27 days of comprehensive treatment with hormones and anti-pneumocystosis therapy.All patients received CDOP regimen(a total of 8 courses)for the treatment of the primary disease,and the process was smooth. Conclusion:R-CDOP regimen may lead to a high incidence of RTX-IP in DLBCL patients(30.0％).The DLBCL patients with DEL or TEL,GCB subtype,TL and high Ki-67 expression were more liable to develop RTX-IP,and the recovery of agranulocytosis may be related to the pathogenesis of RTX-IP.High-resolution CT scan can provide valuable evidence for early diagnosis of RTX-IP.Metagenomic next-generation sequencing(mNGS)helps to distinguish IP from pathogen infections.High dose of glucocorticoids is effective treatment strategy.At the same time,it is necessary to strengthen the prevention and treatment of infection in the process of glucocorticoids application.
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<p><b>OBJECTIVE</b>To explore the feature of primary light chain amyloidosis patients treated with high-dose melphalan with auto peripheral blood stem cell transplantation (auto-PBSCT) and bortezomib plus dexamethasone (VD).</p><p><b>METHODS</b>Thirty-eight patients diagnosed from September 2004 to September 2012 were analyzed retrospectively, including 15 cases received auto-PBSCT, 23 cases exposed with VD.</p><p><b>RESULTS</b>The median follow-up duration for the patients was 34 months (range, 1-112 months), including auto-PBSCT group of 38 months (range, 5-112 months) and VD group of 31 months (range, 1-108 months). The organ response rate in all the patients was 39.5% (15/38), and the organ response rate between these two groups has no significant difference [33.3% (5/15) vs 43.5% (10/23), P=0.532]. However, the median time of organ response was significant difference [6 (3-10) months vs 3 (1-6) months, respectively (P=0.032)]. The 3-year overall survival (OS) rates in the two groups were 72.0% and 66.9%, and their average survival were 84.7 months and 75.9 months, respectively (P=0.683). In the patients with auto-PBSCT, the occurrence of III-IV grade of bone marrow suppression (P<0.001), fever (P<0.001), nausea and infection (P=0.006) were obviously higher than those with VD, but there was no statistically significant difference in pulmonary infection (P=0.069) and bloodstream infection (P=0.059).</p><p><b>CONCLUSIONS</b>The preliminary results have presented that primary light chain amyloidosis patients treated with auto-PBSCT or VD had similar organ response rate and survival. However, more adverse events occurred in the group of auto-PBSCT.</p>