Factor XIII en transplante de médula ósea / Factor XIII in Bone Marrow Transplantation

La subunidad A del Factor XIII (FXIII), parte activa del FXIII, es sintetizada casi exclusivamente por megacariocitos y precursores de monocitos-macrófagos. Determinándose la actividad del FXIII en pacientes sometidos a transplante de médula ósea autólogo (TAMO) y alegeneico (TMO). En 52 pacientes, 30 TAMO y 22 TMO, la actividad del FXIII fue estudiada en días fijos (basal, mitad de régimen condicionante, día 0, día +7, día +15 y día +30). Un descenso del FXIII fue encontrado en todos los casos, cuando se comparó con los niveles basales, alcalzando el nadir de la actividad al día +7. La caída del FXIII fué significativamente más pronunciada en TMO que en TAMO. Se demostró correlación entre la actividad del FXIII y el tiempo de recuperación hematopoyética. Siete de los 52 ptes. (13, 4 porciento) tuvieron niveles de actividad del FXIII inferiores al 10 porciento, sólo 3 sufrieron sangrados asociados. En TMO, los niveles de PAI estaban significativamente aumentados en los días +7, +15 y +30. En conclusión, la actividad del FXIII está siempre desminuída post-trasplante y el restablecimiento de los niveles basales se relaciona directamente con la velocidad de reconstitución hematopoyética. Diferencias en los tiempos de "engraftment" podrían explicar las diferencias encontradas entre TAMO y TMO. Finalmente, la ausencia de sangrado en ptes. con actividad del FXIII por debajo de niveles hemostáticos(<10 porciento) podría deberse a hipofibrinolisis concominante asociada a aumento del PAI

Factor XIII en transplante de médula ósea / Factor XIII in Bone Marrow Transplantation

La subunidad A del Factor XIII (FXIII), parte activa del FXIII, es sintetizada casi exclusivamente por megacariocitos y precursores de monocitos-macrófagos. Determinándose la actividad del FXIII en pacientes sometidos a transplante de médula ósea autólogo (TAMO) y alegeneico (TMO). En 52 pacientes, 30 TAMO y 22 TMO, la actividad del FXIII fue estudiada en días fijos (basal, mitad de régimen condicionante, día 0, día +7, día +15 y día +30). Un descenso del FXIII fue encontrado en todos los casos, cuando se comparó con los niveles basales, alcalzando el nadir de la actividad al día +7. La caída del FXIII fué significativamente más pronunciada en TMO que en TAMO. Se demostró correlación entre la actividad del FXIII y el tiempo de recuperación hematopoyética. Siete de los 52 ptes. (13, 4 porciento) tuvieron niveles de actividad del FXIII inferiores al 10 porciento, sólo 3 sufrieron sangrados asociados. En TMO, los niveles de PAI estaban significativamente aumentados en los días +7, +15 y +30. En conclusión, la actividad del FXIII está siempre desminuída post-trasplante y el restablecimiento de los niveles basales se relaciona directamente con la velocidad de reconstitución hematopoyética. Diferencias en los tiempos de "engraftment" podrían explicar las diferencias encontradas entre TAMO y TMO. Finalmente, la ausencia de sangrado en ptes. con actividad del FXIII por debajo de niveles hemostáticos(<10 porciento) podría deberse a hipofibrinolisis concominante asociada a aumento del PAI (AU)

Fibroblastic colony-forming units and levels of tumor necrosis factor and prostaglandin E2 in bone marrow cultures from patients with advanced lung carcinoma.

BACKGROUND: Although alterations of the bone marrow (BM) fibroblast colony-forming cells are involved in the development of diverse hematologic disorders, these progenitors still have not been well characterized in patients with solid tumors. METHODS: The incidence of fibroblast colony-forming units (CFU-F) was evaluated in the cultures of unseparated and fractionated light density BM mononuclear cells (MC) from 25 consecutive untreated lung carcinoma patients (LCP) and 16 normal controls (NC). Unseparated MC also were cultured in the presence of indomethacin (10[-6] M). Finally, the authors evaluated the spontaneous production of prostaglandin E2 (PGE2) and tumor necrosis factor-alpha (TNF-alpha) in culture conditioned mediums of unseparated MC by radioimmunoassay and enzyme-linked immunoadsorbent assay methodology, respectively. RESULTS: A decreased number of CFU-F was observed in unseparated and fractionated (adherent and nonadherent) light density MC cultures from LCP compared with NC. When unseparated MC of LCP were treated with indomethacin, a slightly increase in the number of CFU-F was found. Adherent MC (stromal cells) achieved confluence only in 44% of LCP primary cultures compared with 100% of NC. Overproduction of PGE2 and TNF-alpha was found in the conditioned mediums of LCP compared with the mean values obtained in NC (P < 0.05 and P < 0.02, respectively). CONCLUSIONS: The lack of confluence and suppression of CFU-F in BM of LCP may be related to the increase production of PGE2 and TNF-alpha. Future investigation will allow the determination of how these modifications influence tumor cell growth and will prove if more alterations of the hematopoietic microenvironment imply a worse prognosis.

Collection efficiency on the Fenwal CS3000 when using filgrastim (recombinant methionyl human granulocyte colony-stimulating factor) as a peripheral blood stem cell mobilization agent.

The collection efficiency (CE) of the Fenwal CS3000 in collecting peripheral blood stem cells during post-chemotherapy recovery phase ranges from 58% to 73%. Recently filgrastim (recombinant methionyl human granulocyte colony-stimulating factor [G-CSF]) has also been shown to be effective as a mobilization agent although mobilization occurs during elevated and not low normal leukocyte counts. We compared the mononuclear cell (MNC) CE and the myeloid progenitor cell (CFU-GM) CE among 11 patients with G-CSF mobilization (33 procedures) and 19 patients during recovery following myelosuppression chemotherapy (93 procedures). Pre-apheresis leukocyte, neutrophil, MNC, and PB CFU-GM counts were significantly higher in the G-CSF group, while the granulocyte percentage in the apheresis products was similar in both groups. Both MNC CE (81.8 +/- 4.5% vs. 64 +/- 2.4%) and CFU-GM CE (79.5 +/- 10.5% vs. 55.8 +/- 3.5%) were higher in the G-CSF group. Only the pre-apheresis MNC count showed an independently significant correlation for both CE (P < .001). The higher CE in the G-CSF group can only be partly explained by a rise in MNC count during apheresis. These data suggest that the blood cell separator works better with leukocytosis, and especially with a higher MNC count. The improvement in CE is another benefit of G-CSF mobilization over chemotherapy mobilization.

Total lymphoid irradiation for treatment of drug resistant chronic GVHD.

We report our experience with total lymphoid irradiation (TLI) in three patients with GVHD which had failed to respond to standard drug treatment. The clinical manifestations of GVHD markedly improved with TLI treatment.

[Acute monoarthritis and laryngeal obstruction as extralymphatic manifestations of non-Hodgkin's lymphoma]. / Monoartritis aguda y obstrucción laríngea como manifestaciones extraganglionares de linfoma no Hodgkin.

Joints and larynx are uncommonly involved by non-Hodgkin's lymphoma (NHL). Synovial involvement has been reported in only 7 cases, mainly located in the knees. When this is the first location of NHL it is usually misdiagnosed. The treatment of choice is local radiotherapy followed by systemic chemotherapy. Laryngeal lymphoma can be either primary or forming part of multifocal disease. The prognosis of the primary form is usually good only with radiotherapy, whereas the prognosis of the laryngeal location of advanced disease is rather poor. The symptoms include dysphonia and slowly progressive dyspnea. A case of NHL is presented who showed initial arthritis of the knee, later evolving into severe laryngeal obstruction, an association not previously reported.