[Diffuse large B-cell lymphoma with markedly improved chylothorax by lymphangiography].

Chylothorax is a rare clinical sign in patients with diffuse large B-cell lymphoma (DLBCL), which is often challenging to manage and has a poor prognosis. We report the case of a 59-year-old woman who presented with right pleural effusion at the time of DLBCL diagnosis. Lymphadenopathy rapidly improved in response to chemotherapy. However, the pleural effusion progressed and was identified as chylothorax by thoracentesis. Because attempts to manage the condition with fasting and central venous nutrition were unsuccessful, we performed ultrasound-guided intranodal lipiodol lymphangiography from the inguinal lymph node. Although leak sites were not detected, the pleural effusion markedly improved on the day after the examination and resolved after 2 months. Lymphangiography is a minimally invasive examination with few complications. It contributes not only to the identification of leak sites but also to the improvement and resolution of chylothorax. Therefore, lymphangiography should be considered for refractory chylothorax that is unresponsive to chemotherapy or nutritional management.

Prognostic factors and outcomes of unrelated bone marrow transplantation for Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ALL) pre-treated with tyrosine kinase inhibitors.

BACKGROUND: The treatment and prognosis of Acute Lymphoblastic Leukemia (ALL), including Philadelphia chromosome positive ALL (Ph+ALL), a poor prognostic factor, has changed with the introduction of tyrosine kinase inhibitors (TKIs). Nevertheless, allogeneic hematopoietic cell transplantation (allo-HCT) is still recommended as the first-line curative treatment. To date, no study has investigated the prognostic factors and outcomes of unrelated bone marrow transplantation (u-BMT) for Ph+ALL following pre-transplant treatment with a TKI-containing regimen. METHODS: We retrospectively evaluated 15 transplantations of 14 patients with Ph+ALL pre-treated with a TKI-containing regimen at our institute. The 14 patients comprised 11 males and 3 females, with a median age of 50 years (range: 19-64). We performed univariate and multivariate analyses of risk factors that contributed to overall survival (OS) or leukemia-free survival (LFS). RESULTS: Three-year OS of the patients with molecular complete remission (MCR) and with non-MCR at transplantation were 89% and 40% (p = 0.006), respectively, and three-year LFS rates were 79% and 0% (p = 0.001), respectively. Univariate analysis revealed that first hematological complete remission (HCR1) and MCR at transplant were significantly related to better OS and LFS. Multivariate analysis showed that MCR at transplant was significantly associated with better OS and LFS. CONCLUSIONS: In agreement with a previous study that included other stem cell sources, u-BMT was deemed feasible for the treatment of Ph+ALL. Analysis of a larger cohort is required to clarify the prognostic factors that affect transplant outcome in Ph+ALL since the introduction of TKIs.