RESUMEN
For sufficient collection of hemopoietic stem cells from peripheral blood for autologous peripheral blood stem cell transplantation (PBSCT), four patients with B-cell-type non-Hodgkin lymphoma (B-NHL) were examined for the appearance of circulating hemopoietic progenitors in blood (PSC) during the hemopoietic recovery phase following marrow ablative therapy in combination with or without administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF). Each patient received only chemotherapy in the first course, and rhG-CSF (1 microgram/kg/day) was administered for 14 consecutive days from the last day of the second chemotherapy. In the second chemotherapy course with rhG-CSF administration, white blood cell (WBC) counts demonstrated two peaks, and the appearance of granulocyte-macrophage precursor cells (CFU-GM) in blood at the maximum level was coincident with the second peak of WBC elevation. Erythroid precursor cells (BFU-E) were also detectable in blood after chemotherapy but the peak level was not enhanced by the use of rhG-CSF. To determine whether the minimal residual disease (MRD) cells were contaminated in PSC corrected from blood, kappa-lambda imaging (KLI) analysis was performed to detect the malignant B-cell population (mBp) before and after chemotherapy. No mBp was found in two of four patients in blood, although three of them were involved with mBp in bone marrow. The presence of mBp was detected in two patients both before and after chemotherapy, even though these cells were hardly detected morphologically, suggesting the necessity of judging for the incidence of contamination of MRD cells when collecting PSCs.
Asunto(s)
Transfusión de Sangre Autóloga , Trasplante de Células Madre Hematopoyéticas , Células Madre Hematopoyéticas/patología , Linfoma de Células B/cirugía , Adulto , Anticuerpos Monoclonales/inmunología , Linfocitos B/inmunología , Linfocitos B/patología , Eritrocitos/efectos de los fármacos , Eritrocitos/patología , Femenino , Técnica del Anticuerpo Fluorescente , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Granulocitos/efectos de los fármacos , Granulocitos/patología , Células Madre Hematopoyéticas/efectos de los fármacos , Humanos , Cadenas kappa de Inmunoglobulina/análisis , Cadenas kappa de Inmunoglobulina/inmunología , Cadenas lambda de Inmunoglobulina/análisis , Cadenas lambda de Inmunoglobulina/inmunología , Recuento de Leucocitos , Linfoma de Células B/sangre , Linfoma de Células B/tratamiento farmacológico , Macrófagos/efectos de los fármacos , Macrófagos/patología , Masculino , Persona de Mediana Edad , Proteínas Recombinantes/uso terapéutico , Factores de TiempoRESUMEN
We report 4 case histories in which an erosive arthritis was associated with the presence of a monoclonal gammopathy of uncertain significance. In all 4 cases, the appearance of paraprotein was noted either before or during the development of the arthritis. Two patients had a rather atypical oligoarthritis, while the others had a rheumatoid-like, symmetric polyarthritis. A synovial amyloid deposit was present in 2 patients, while mild mixed mononuclear infiltrates were the main pathologic finding in the others. In 2 patients, immunohistochemical investigation demonstrated deposits of immunoglobulin-derived material of the same isotype as the monoclonal component in the synovial tissue.
Asunto(s)
Artritis/complicaciones , Paraproteinemias/complicaciones , Anciano , Amiloide/análisis , Amiloide/metabolismo , Artritis/inmunología , Artritis/metabolismo , Femenino , Humanos , Cadenas kappa de Inmunoglobulina/análisis , Cadenas kappa de Inmunoglobulina/metabolismo , Cadenas lambda de Inmunoglobulina/análisis , Cadenas lambda de Inmunoglobulina/metabolismo , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Paraproteinemias/inmunología , Paraproteinemias/metabolismo , Paraproteínas/metabolismo , Proteína Amiloide A Sérica/análisis , Proteína Amiloide A Sérica/metabolismo , Membrana Sinovial/química , Membrana Sinovial/metabolismo , Microglobulina beta-2/análisis , Microglobulina beta-2/metabolismoRESUMEN
The simultaneous occurrence of two different lymphomas in a 57-year-old white woman is reported: mycosis fungoides and a leukemic lymphoplasmacytoid immunocytoma. The first was confirmed by histologic study and electron microscopy, and the latter by histologic study and immunoperoxidase staining. The lymphoid cells in the involved bone marrow and peripheral blood expressed the same surface immunoglobulin as was found in the cytoplasm of the immunocytoma cells, i.e., IgM-lambda. The clonal B-cell expansion was brought into a lasting remission by chlorambucil, but the cutaneous lymphoma proved to be refractory to therapy. The patient died 38 months after diagnosis.