RESUMEN
We herein report the rare case of a 72-year-old female who presented with paraneoplastic pemphigus (PNP) and bronchiolitis obliterans (BO) associated with follicular lymphoma (FL), who was successfully treated with obinutuzumab (GA101; G) and bendamustine (B). The patient had severe erosive stomatitis and bilateral conjunctival hyperemia that persisted for more than 6 months. A huge mass was found in the abdominal cavity, and a biopsy revealed grade 1 FL (stage IV). Based on a lip biopsy result, the patient was diagnosed with PNP associated FL. The patient received bendamustine and obinutuzumab (BG) chemotherapy and FL and PNP responded very well, but BO was additionally associated during the course of BG. BO progressed without exacerbation as BG therapy progressed to a 2 year maintenance therapy with G, and combination of azithromycin, inhaled bronchodilator therapy, and corticosteroid. She was followed up at the outpatient department with no pulmonary function decline or FL and PNP recurrence. Our case suggests that BG could be a promising treatment option for PNP and BO.
Asunto(s)
Bronquiolitis Obliterante , Linfoma Folicular , Síndromes Paraneoplásicos , Pénfigo , Anciano , Anticuerpos Monoclonales Humanizados , Clorhidrato de Bendamustina/uso terapéutico , Bronquiolitis Obliterante/complicaciones , Bronquiolitis Obliterante/tratamiento farmacológico , Femenino , Humanos , Linfoma Folicular/complicaciones , Linfoma Folicular/diagnóstico , Linfoma Folicular/tratamiento farmacológico , Síndromes Paraneoplásicos/complicaciones , Síndromes Paraneoplásicos/etiología , Pénfigo/complicaciones , Pénfigo/tratamiento farmacológicoRESUMEN
This study reports a case of a 49-year-old woman having B-cell acute lymphoblastic leukemia with glycophorin A, a representative erythroid marker, expression. According to the WHO criteria for mixed phenotype acute leukemia (MPAL), erythroid lineage is not defined, and to the best of our knowledge, only one other case with erythroid/B-cell biphenotypic acute leukemia has been reported previously. To establish the disease entity and clarify the pathophysiology of erythroid/lymphoid MPAL, additional cases need to be analyzed.
Asunto(s)
Leucemia Bifenotípica Aguda , Leucemia-Linfoma Linfoblástico de Células Precursoras , Enfermedad Aguda , Linfocitos B , Femenino , Glicoforinas , Humanos , Inmunofenotipificación , Persona de Mediana EdadAsunto(s)
Antirreumáticos/efectos adversos , Cromonas/efectos adversos , Inmunosupresores/efectos adversos , Trastornos Linfoproliferativos/inducido químicamente , Metotrexato/efectos adversos , Sulfonamidas/efectos adversos , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Cromonas/uso terapéutico , Femenino , Humanos , Inmunosupresores/uso terapéutico , Metotrexato/uso terapéutico , Recurrencia , Sulfonamidas/uso terapéuticoRESUMEN
INTRODUCTION: Complications such as severe infection may occur during the chemotherapy of malignant lymphoma. Phlegmonous gastritis (PG) is a rare acute bacterial infection associated with high mortality, requiring early diagnosis, and prompt management. In addition, Guillain-Barré syndrome (GBS) occasionally requires early treatment and intensive care management due to the occurrence of severe neuropathy and respiratory failure. PATIENT CONCERNS: A 70-year-old male was diagnosed with primary gastric diffuse large B-cell lymphoma (DLBCL) after the detection of several polypoid tumors with ulcers. The patient underwent chemotherapy for DLBCL and exhibited adverse effects (i.e., fever, vomiting, epigastric pain, and neutropenia). Computed tomography indicated widespread thickening in the gastric wall. Furthermore, approximately 2 weeks later, the patient presented with gradual symmetric lower extremity weakness and respiratory failure due to paralysis of the respiratory muscle. DIAGNOSES: DLBCL was diagnosed through a gastric tumor biopsy. On the basis of the computed tomography findings, a culture of gastric juice, nerve conduction studies, and clinical symptoms, this case of gastric lymphoma was complicated with PG and GBS. INTERVENTIONS: The patient was treated with antimicrobial therapy and administration of granulocyte colony-stimulating factor for PG, and with intravenous immunoglobulin and intensive care management for GBS. OUTCOMES: Despite the aggressive progress of the condition, the patient improved without relapse of DLBCL. CONCLUSION: PG was regarded as a precedent infection of GBS. In this article, we present the first reported case of gastric lymphoma complicated with PG and GBS.
Asunto(s)
Gastritis/complicaciones , Síndrome de Guillain-Barré/complicaciones , Linfoma no Hodgkin/complicaciones , Infecciones por Pseudomonas/complicaciones , Neoplasias Gástricas/complicaciones , Anciano , Antibacterianos/uso terapéutico , Antineoplásicos/uso terapéutico , Gastritis/tratamiento farmacológico , Gastritis/microbiología , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/patología , Masculino , Conducción Nerviosa , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patologíaRESUMEN
Expression of intragenic exon rearrangements (IERs) has reportedly been detected in both normal and cancer cells. However, there have been few reports of occurrence of these rearrangements specific to neoplasms including malignant lymphoma. In this study, we detected IERs of ten genes (NBPF8, SOBP, AUTS2, RAB21, SPATA13, ABCC4, WDR7, PHLPP1, NFATC1 and MAGED1) in non-Hodgkin B cell lymphoma (B-NHL) cell line KPUM-UH1 using a high-resolution single nucleotide polymorphism array and reverse transcription polymerase chain reaction using reversely directed divergent primers within exons involved in genomic intragenic gains followed by sequencing analysis. Among them, the IERs involved in SOBP (6q21) exon 2 and 3 and AUTS2 (7q11.22) exon 2-4 were the molecular lesions specific to tumors and were frequently detected in B-NHL samples. These IERs constitute novel genetic alterations of B-NHL, which might be associated with tumorigenesis and be useful as genetic biological markers.
Asunto(s)
Proteínas Portadoras/genética , Proteínas del Citoesqueleto/genética , Exones/genética , Linfoma de Células B/genética , Linfoma no Hodgkin/genética , Proteínas Nucleares/genética , Factores de Transcripción/genética , Biomarcadores de Tumor/genética , Proteínas Portadoras/metabolismo , Línea Celular Tumoral , Proteínas del Citoesqueleto/metabolismo , Humanos , Leucocitos Mononucleares/metabolismo , Linfoma de Células B/patología , Linfoma no Hodgkin/patología , Proteínas de Neoplasias/genética , Proteínas Nucleares/metabolismo , Reacción en Cadena de la Polimerasa , Polimorfismo de Nucleótido Simple , Factores de Transcripción/metabolismoRESUMEN
Delayed platelet engraftment (DPE) is occasionally observed despite prompt neutrophil engraftment after autologous peripheral blood stem cell transplantation (auto-PBSCT). To identify risk factors for DPE and to develop a simple and clinically applicable system for predicting the time required for platelet recovery, we conducted a multi-institutional retrospective study in 144 patients with B-cell non-Hodgkin lymphoma who underwent auto-PBSCT. In a median observation period of 930 days (range: 25-5272 days), 139 patients successfully achieved platelet engraftment (≥50.0 × 109/L). The median duration for platelet engraftment was 19 days, and 130 patients had platelet engraftment within 40 days after auto-PBSCT; however, the other 14 patients failed to achieve platelet engraftment within 60 days. These 14 patients with DPE required a significantly greater number of apheresis procedures and had a lower pre-apheresis absolute lymphocyte count (PA-ALC) compared to those without DPE. Importantly, multivariate analysis revealed that the number of transplanted CD34+ cells (≤2.0 × 106/kg), number of required apheresis procedures (≥3 days), and PA-ALC (≤1.0 × 109/L) were independently associated with a longer time for platelet engraftment after auto-PBSCT. By incorporating these three independent factors as variables, we generated a new scoring system for prediction of the time and probability for platelet engraftment after auto-PBSCT.
Asunto(s)
Linfocitos B/patología , Plaquetas/citología , Trasplante de Células Madre Hematopoyéticas/métodos , Linfoma de Células B/terapia , Transfusión de Plaquetas/estadística & datos numéricos , Trombopoyesis , Adulto , Anciano , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Linfoma de Células B/sangre , Linfoma de Células B/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Acondicionamiento Pretrasplante , Trasplante AutólogoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Cromosomas Humanos Par 14/genética , Cromosomas Humanos Par 19/genética , Enfermedad Relacionada con Inmunoglobulina G4 , Linfoma de Células B Grandes Difuso , Tomografía de Emisión de Positrones , Translocación Genética , Anciano , Carboplatino/administración & dosificación , Dexametasona/administración & dosificación , Etopósido/administración & dosificación , Femenino , Humanos , Ifosfamida/administración & dosificación , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico por imagen , Enfermedad Relacionada con Inmunoglobulina G4/tratamiento farmacológico , Enfermedad Relacionada con Inmunoglobulina G4/genética , Enfermedad Relacionada con Inmunoglobulina G4/metabolismo , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/genética , Linfoma de Células B Grandes Difuso/metabolismo , Rituximab/administración & dosificación , Terapia RecuperativaRESUMEN
The patient, a 70-year-old woman with diffuse large B-cell lymphoma (DLBCL), developed haemorrhagic cystitis associated with the BK virus (BKV) and adenovirus type 11. Moreover, chest computed tomography showed ground-glass opacity (GGO) in the bilateral upper lobe, and we performed bronchoalveolar lavage (BAL). The BKV DNA load was elevated not only in blood but also in BAL fluid (BALF), leading to the diagnosis of BKV pneumonia. After administering cidofovir, the respiratory symptoms and GGO abated. Therefore, detection of BKV DNA in BALF is useful for diagnosing BKV pneumonia. The patient with DLBCL developed BKV pneumonia. We performed BAL, and BKV DNA load was elevated on BALF. The detection of BKV DNA in BALF is useful for diagnosing BKV pneumonia.
RESUMEN
Rabbit antithymocyte globulin (ATG) is an effective immunosuppressive therapy for patients with aplastic anemia (AA). However, Epstein-Barr virus-associated lymphoproliferative disorder (EBV-LPD) is a rare but serious complication of the therapy. An 81-year-old man was diagnosed with severe AA on the occasion of melena. Because cyclosporine monotherapy did not improve his condition, rabbit ATG was additionally administered. Thirty-one days after the administration of rabbit ATG, the patient presented with fever and general malaise. His liver and renal function tests showed rapid decline, and the patient went into shock. Although atypical lymphocytes in the peripheral blood, hepatosplenomegaly, and lymphadenopathy were not detected, the peripheral blood EBV-DNA load and serum ferritin levels were high, and his bone marrow aspiration specimen revealed hemophagocytic findings, leading to a diagnosis of EBV-LPD. He was treated with rituximab and recovered immediately. A total of 480 days have passed since the patient was administered the rabbit ATG, and he remains in AA remission without EBV-LPD relapse. This case suggests that rituximab is an effective therapy for EBV-LPD manifesting as EBV-associated hemophagocytic lymphohistiocytosis and indicates that monitoring the EBV-DNA load contributes to the diagnosis.