Subject(s)
Encephalitis, Viral , Hematopoietic Stem Cell Transplantation , Herpesvirus 6, Human , Hyponatremia , Roseolovirus Infections , Humans , Hyponatremia/diagnosis , Hyponatremia/etiology , Transplantation, Homologous/adverse effects , Encephalitis, Viral/diagnosis , Encephalitis, Viral/etiology , Hematopoietic Stem Cell Transplantation/adverse effects , Roseolovirus Infections/diagnosis , DNA, ViralABSTRACT
We report a case of acute myeloid leukemia (AML) with two cytogenetically unrelated clones. The patient was a 45-year-old male who was diagnosed with acute monoblastic leukemia (AMoL). Initial G-band analysis showed 51,XY,+6,+8,inv(9)(p12q13)c,+11,+13,+19[12]/52,idem,+Y[8], but G-band analysis after induction therapy showed 45,XY,-7,inv(9)(p12q13)c[19]/46,XY,inv(9)(p12q13)c[1]. Retrospective FISH analysis revealed a cryptic monosomy 7 clone in the initial AML sample. The clone with multiple trisomies was eliminated after induction therapy and never recurred, but a clone with monosomy 7 was still detected in myelodysplastic marrow with a normal blast percentage. Both clones were successfully eliminated after related peripheral blood stem cell transplantation, but the patient died of relapsed AML with monosomy 7. We concluded that one clone was de novo AMoL with chromosome 6, 8, 11, 13, and 19 trisomy and that the other was acute myeloid leukemia with myelodysplasia-related changes(AML-MRC) with chromosome 7 monosomy showing different responses to chemotherapy. Simultaneous onset of cytogenetically unrelated hematological malignancies that each have a different disease status is a rare phenomenon but is important to diagnose for a correct understanding of the disease status and for establishing an appropriate treatment strategy.
ABSTRACT
CD4(+) T cell effectors are crucial for establishing antitumor immunity. Dendritic cell maturation by immune adjuvants appears to facilitate subset-specific CD4(+) T cell proliferation, but the adjuvant effect for CD4 T on induction of cytotoxic T lymphocytes (CTLs) is largely unknown. Self-antigenic determinants with low avidity are usually CD4 epitopes in mutated proteins with tumor-associated class I-antigens (TAAs). In this study, we made a chimeric version of survivin, a target of human CTLs. The chimeric survivin, where human survivin-2B containing a TAA was embedded in the mouse survivin frame (MmSVN2B), was used to immunize HLA-A-2402/K(b)-transgenic (HLA24(b)-Tg) mice. Subcutaneous administration of MmSVN2B or xenogeneic human survivin (control HsSNV2B) to HLA24(b)-Tg mice failed to induce an immune response without co-administration of an RNA adjuvant polyI:C, which was required for effector induction in vivo. Although HLA-A-2402/K(b) presented the survivin-2B peptide in C57BL/6 mice, 2B-specific tetramer assays showed that no CD8(+) T CTLs specific to survivin-2B proliferated above the detection limit in immunized mice, even with polyI:C treatment. However, the CD4(+) T cell response, as monitored by IFN-γ, was significantly increased in mice given polyI:C+MmSVN2B. The Th1 response and antibody production were enhanced in the mice with polyI:C. The CD4 epitope responsible for effector function was not Hs/MmSNV13-27, a nonconserved region between human and mouse survivin, but region 53-67, which was identical between human and mouse survivin. These results suggest that activated, self-reactive CD4(+) helper T cells proliferate in MmSVN2B+polyI:C immunization and contribute to Th1 polarization followed by antibody production, but hardly participate in CTL induction.
Subject(s)
CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/metabolism , Inhibitor of Apoptosis Proteins/immunology , Peptide Fragments/immunology , Poly I-C/immunology , Recombinant Fusion Proteins/immunology , Repressor Proteins/immunology , Amino Acid Sequence , Animals , Antibody Formation , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/metabolism , Epitopes, T-Lymphocyte/chemistry , Epitopes, T-Lymphocyte/genetics , Epitopes, T-Lymphocyte/immunology , Exons , Gene Expression , Gene Order , Genetic Loci , HLA-A24 Antigen/genetics , Humans , Inhibitor of Apoptosis Proteins/genetics , Mice , Mice, Transgenic , Molecular Sequence Data , Open Reading Frames , Peptide Fragments/genetics , Recombinant Fusion Proteins/chemistry , Recombinant Fusion Proteins/genetics , Repressor Proteins/genetics , SurvivinABSTRACT
A 22-year-old woman presented with high fever, chest tightness and cough in January 20XX. Since CT scans revealed an anterior mediastinal mass, percutaneous needle biopsies of the mass were performed and she was diagnosed with T-cell lymphoblastic lymphoma (T-LBL). After the immunophenotype of lymphocytes in her pleural effusion had been identified, she received CHOP therapy because her dyspnea worsened, and induction therapy for acute lymphoblastic leukemia was subsequently performed after confirmation of her diagnosis as T-LBL. During this induction therapy, she developed paralytic ileus. One week thereafter, she suddenly exhibited visual disturbance, headache and nausea. Her cerebrospinal fluid was normal. Magnetic resonance imaging showed symmetrical high signal intensities on T2-weighted and fluid-attenuated inversion recovery images, and low signal intensities on T1-weighted images in the cortical and subcortical white matter of the posterior parietal and occipital lobes. Based on these findings, she was diagnosed as having posterior reversible encephalopathy syndrome (PRES). During chemotherapy for hematologic malignancies, some patients with PRES reportedly develop paralytic ileus or tumor lysis syndrome. PRES should be considered in patients with neurological abnormalities following such complications during chemotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Intestinal Pseudo-Obstruction/chemically induced , Mediastinal Neoplasms/drug therapy , Posterior Leukoencephalopathy Syndrome/chemically induced , Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Vincristine/adverse effects , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Female , Humans , Induction Chemotherapy , Magnetic Resonance Imaging , Mediastinal Neoplasms/diagnosis , Posterior Leukoencephalopathy Syndrome/diagnosis , Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Prednisone/administration & dosage , Prednisone/adverse effects , Vincristine/administration & dosage , Young AdultSubject(s)
Acquired Immunodeficiency Syndrome/therapy , Brain Neoplasms/therapy , Leukoencephalopathy, Progressive Multifocal/pathology , Leukoencephalopathy, Progressive Multifocal/therapy , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/pathology , Brain Neoplasms/diagnosis , Brain Neoplasms/pathology , Central Nervous System/pathology , Diagnosis, Differential , Humans , Leukoencephalopathy, Progressive Multifocal/diagnosis , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnosis , Male , Middle AgedABSTRACT
A 56-year-old female was diagnosed with acute myeloid leukemia (FAB: AML-M1). G-banding karyotype of her bone marrow showed complete tetraploidy (92, XXXX [24/24]). Although she achieved complete remission (CR) after induction therapy and maintained CR during consolidation therapy, relapse occurred only 2 months after discharge. When the relapse occurred, bone marrow karyotypic analysis showed complete tetraploidy again. The patient received reduced-intensity cord blood transplantation (RI-CBT), which induced CR for the second time. The patient is currently alive 24 months after transplantation and there have not been any signs of recurrence to date. There have been a few reports of AML with near-tetraploidy, but cases of AML with complete tetraploidy are extremely rare. Tetraploid AML has been reported to have a poor prognosis and there have been very few cases maintaining CR over the long term after chemotherapy alone. This is the first case of complete tetraploid AML successfully treated by RI-CBT. The clinical course of this case suggests that hematopoietic stem cell transplantation during the first CR phase should be considered a treatment option for tetraploid AML.
Subject(s)
Cord Blood Stem Cell Transplantation , Leukemia, Myeloid, Acute/genetics , Leukemia, Myeloid, Acute/therapy , Tetraploidy , Transplantation Conditioning , Female , Humans , Middle Aged , Recurrence , Remission Induction , Treatment OutcomeABSTRACT
A 70-year-old male, who had undergone resection of gastric malignant lymphoma in 1992, presented with cervical lymph node swelling in January 2008. Pathological examination of the lymph node biopsy demonstrated recurrence of malignant lymphoma, and he was treated with the R-CHOP regimen. Although he did not develop fever during the first through third course of R-CHOP, from the fourth course, he repeatedly demonstrated fever over 38°C for about one week after each course of chemotherapy, despite the absence of neutropenia. Helicobacter cinaedi infection was confirmed by blood culture each time. Although it is difficult to diagnose Helicobacter cinaedi infection by the standard culture method, increased numbers of recent reports especially in immunocompromised patients have emphasized the importance of diagnosing Helicobacter cinaedi infection.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Helicobacter Infections/diagnosis , Immunocompromised Host , Lymphoma, Large B-Cell, Diffuse/drug therapy , Stomach Neoplasms/drug therapy , Aged , Anti-Bacterial Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cephalosporins/administration & dosage , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Helicobacter/isolation & purification , Helicobacter Infections/drug therapy , Helicobacter Infections/etiology , Helicobacter Infections/microbiology , Humans , Lymphoma, Large B-Cell, Diffuse/complications , Male , Neoplasm Recurrence, Local , Ofloxacin/administration & dosage , Prednisolone/administration & dosage , Remission Induction , Stomach Neoplasms/complications , Vincristine/administration & dosage , CefozopranABSTRACT
We report that granulocyte transfusion (GTX) was effective for prolonged pneumonia at allogeneic bone marrow transplantation. A 58-year-old man with MDS-RAEB-2 was admitted to our hospital for allogeneic bone marrow transplantation. He was complicated with pneumonia, which was not improved with G-CSF and antibiotics. We therefore decided to perform a GTX transplantation. During the period of neutropenia, pneumonia did not deteriorate. A combination of allogeneic stem cell transplantation and GTX is expected not only to improve transplantation results but also to expand the adaptation for transplantation. However, detailed investigation of the effect of GTX in allogeneic stem cell transplantation should be performed, and more cases should be accumulated.