RESUMEN
Bendamustine (B) associated with rituximab (R) is widely described in literature for the management of patients with chronic lymphoid leukaemia (CLL) and indolent non-Hodgkin lymphoma. Safety data regarding late hematotoxicity such as late onset neutropenia (LON) are scarce. The aim of our study was to assess the incidence and to identify risk factors for LON in patients with indolent non-Hodgkin lymphoma and CLL treated with B and R (B-R). One hundred forty five patients were treated with B-R as first or second line. Patients with neutropenia prior induction treatment, treated beyond second line and relapsing within 3 months after the end of induction treatment, were excluded. Patients receiving at least 1 cycle of B-R and having LON during follow-up period were included and considered as eligible for toxicity assessment. A complete blood count was performed 4 weeks after the last cycle of induction treatment and thereafter every 3 months for 1 year. Thirty six patients were identified in our cohort (incidence of 25%), mostly affected by CLL (n = 11) and follicular lymphoma (FL) (n = 15). During follow-up, 84 events of LON were recorded, 61% and 39% were of grades 1/2 and 3/4, respectively. No episode of febrile neutropenia was documented. Amongst 13 of the 15 patients with FL undergoing R maintenance, 8 had treatment discontinuation because of LON. Median time for LON (grade > 2) and time to recovery (grade < 3) were of 11.2 and 17.3 weeks, respectively. One year after B-R induction, LON persisted in 4 patients. The risk of LON was increased both in patients with FL or CLL and performance status >1. The LON in B-R treated patients is clinically relevant. Close clinical and biological follow-up and treatment prophylaxis (eg, valaciclovir and cotrimoxazole) especially for FL patients undergoing maintenance with R monotherapy seems relevant.
Asunto(s)
Antineoplásicos Inmunológicos/uso terapéutico , Clorhidrato de Bendamustina/uso terapéutico , Linfoma/tratamiento farmacológico , Rituximab/uso terapéutico , Anciano , Anciano de 80 o más Años , Antineoplásicos Inmunológicos/farmacología , Clorhidrato de Bendamustina/farmacología , Femenino , Humanos , Linfoma/patología , Masculino , Persona de Mediana Edad , Neutropenia/inducido químicamente , Rituximab/farmacologíaRESUMEN
BACKGROUND: Blastic plasmacytoid dendritic cell neoplasm (BPDCN), formerly known as agranular CD4(+) /CD56(+) haematodermic neoplasm (CD4/CD56 HN), is a rare distinct form of lymphoma-like entity known of dermatologists because of its marked predilection for cutaneous involvement, and its aggressive behaviour. Moreover, the association or the evolution to an acute leukaemia entity that still expresses CD4 and CD56 markers is almost systematic. This new described entity of 'CD4(+) /CD56(+) leukaemia' or 'leukaemia of plasmacytoid dendritic cell lineage' has a poor prognostic and may lead to include haematopoietic stem cell transplantation in the treatment strategy as early as possible. REPORT OF CASES: We report here four cases presenting with skin lesions and haematological signs. One of the patients underwent allogeneic stem cell transplantation, with a relapse-free survival of 40 months. We discuss the diagnosis features as well as the treatment options. CONCLUSION: A collaborative work between dermatologists and onco-haematologists is essential to give patients the best chance of complete and long-term response.
Asunto(s)
Células Dendríticas , Neoplasias Hematológicas/patología , Neoplasias Cutáneas/patología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors report one case of AIDS-related-like Kaposi's sarcoma (KS) in a 59-year-old bisexual man without HIV-1 and HIV-2 infection. KS developed while the patient was receiving both androgen and steroid therapy for aplastic anemia, and regressed after their simultaneous interruption, despite the persistence of aplastic anemia. The authors discuss the etiology of KS in the patient, with a special regard to a putative role of the androgen therapy. The authors examine the arguments of the literature, probably underestimated, that may suggest a role of sex hormones in the pathogenesis of KS.
Asunto(s)
Hormonas Esteroides Gonadales/efectos adversos , Sarcoma de Kaposi/etiología , Anemia Aplásica/complicaciones , Anemia Aplásica/terapia , Animales , Hormonas Esteroides Gonadales/fisiología , Humanos , Masculino , Persona de Mediana Edad , Sarcoma de Kaposi/inducido químicamenteRESUMEN
A case of fatal visceral leishmaniasis due to a dermotropic strain of Leishmania infantum (Zymodeme MON-24) is related in an AIDS patient in spite of a specific treatment.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Leishmaniasis Visceral/parasitología , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/clasificación , Examen de la Médula Ósea , Relación CD4-CD8 , Técnica del Anticuerpo Fluorescente , Humanos , Leishmaniasis Visceral/complicaciones , Leishmaniasis Visceral/diagnóstico , MasculinoRESUMEN
Fourteen Rhesus-positive patients with idiopathic thrombocytopenic purpura or thrombocytopenia associated with human immunodeficiency virus (HIV) infection were treated with intravenous Rhesus antibodies. The mean total dose was 6,800 micrograms administered over a 3 to 6 days' period. A significant rise in platelet count was observed in 13 of the 14 Rhesus-positive patients, but not in 3 Rhesus-negative patients used as controls. This rise was usually transient, lasting less than 3 weeks, but it persisted for more than 3 months in 2 cases. Treatment was well tolerated; transient signs of haemolysis appeared in 11 patients who did not require transfusion. Rhesus antibodies are quick-acting, the number of platelets being doubled as early as the second day of treatment. Interaction between antibody-coated red blood cells and macrophages is a possible mode of action and a feasible therapeutic approach in selected patients with autoimmune of HIV-mediated thrombocytopenia.
Asunto(s)
Seropositividad para VIH/complicaciones , Inmunoglobulina G/uso terapéutico , Púrpura Trombocitopénica/terapia , Sistema del Grupo Sanguíneo Rh-Hr/inmunología , Trombocitopenia/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Púrpura Trombocitopénica/etiología , Trombocitopenia/etiologíaRESUMEN
We report a case of large granular lymphocytosis, or chronic "natural killer" lymphocytosis, a newly described entity. We were able to demonstrate the proliferative character of the disease by the finding of karyotype abnormalities. This case was remarkable for the pre-existence, for at least three years, of severe hypogammaglobulinaemia, for the very slow course of the proliferative process and for the progressive and tumoral infiltration of the spleen and liver, then kidney.
Asunto(s)
Agammaglobulinemia/etiología , Leucemia Linfoide/complicaciones , Humanos , Neoplasias Renales/secundario , Células Asesinas Naturales/patología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Neoplasias del Bazo/secundario , Factores de TiempoRESUMEN
The case is reported of a 47 year old female patient admitted with asthenia, anorexia, nausea and constipation. The poor clinical features contrasted with the severe biological disturbances: 1 mmol.l-1 serum potassium, pH 7.26, 19 mmHg PaCO2, 8 mmol.l-1 bicarbonate, myoglobinaemia and myoglobinuria. The electrocardiogram showed a flattened T wave, an U wave, and a depressed ST segment. Potassium was given intravenously at a rate of 0.38 mmol.kg-1.h-1 during the first 24 h. Renal biopsy confirmed the diagnosis of distal renal tubular acidosis, but no aetiology could be found. This patient's excellent clinical tolerance of a severe hypokalemia suggested that the potassium pool could be replaced at slower rates than those suggested in the literature for patients with severe symptoms and signs.
Asunto(s)
Acidosis Tubular Renal/complicaciones , Hipopotasemia/etiología , Acidosis Tubular Renal/diagnóstico , Femenino , Humanos , Hipopotasemia/diagnóstico , Persona de Mediana EdadRESUMEN
The authors report the case of a 46-year old woman who, 7 years after bilateral implantation of a silicone breast prosthesis, presented with a seropositive rheumatoid arthritis involving the shoulders, wrists, metacarpophalangeal and interphalangeal joints of both hands, as well as the knees and ankles. Six months after the onset of the arthritis, she developed a Raynaud's syndrome and a lacrymal and salivary dry syndrome with unilateral axillary lymphadenopathy. No regression followed the removal of the breast prostheses, one of which was found broken.