Aspergilosis pulmonar invasiva en el paciente hematooncológico en las unidades de cuidados intensivos. Revisión de la literatura médica / Invasive pulmonary aspergillosis in a hematooncological patient in the intensive care units. A review of the literature

La aspergilosis invasiva es una entidad frecuente en los pacientes hematooncológicos. La sintomatología es sumamente inespecífica, por lo que es necesario conocer las herramientas diagnósticas para alcanzar diagnósticos precoces. Esta revisión intenta poner en claro la actual evidencia en los siguientes aspectos: la presentación clínica, los métodos de estudio y el tratamiento de esta entidad en pacientes hematooncológicos críticos (AU)

Invasive aspergillosis is a common condition in patients with hematologic malignancies. Symptoms are extremely non-specific, and therefore it is necessary to be familiar with the diagnostic tests for early diagnosis. This review has attempted to clarify the current evidence regarding the following areas: clinical presentation, methods of study and treatment of this condition in hemato-oncological critical patients (AU)

[Invasive pulmonary aspergillosis in a hematooncological patient in the intensive care units. A review of the literature]. / Aspergilosis pulmonar invasiva en el paciente hematooncológico en las unidades de cuidados intensivos. Revisión de la literatura médica.

Invasive aspergillosis is a common condition in patients with hematologic malignancies. Symptoms are extremely non-specific, and therefore it is necessary to be familiar with the diagnostic tests for early diagnosis. This review has attempted to clarify the current evidence regarding the following areas: clinical presentation, methods of study and treatment of this condition in hemato-oncological critical patients.

Simultaneous PML/RARalpha and AML1/ETO expression with t(15;17) at onset and relapse with only t(8;21) in an acute promyelocytic leukemia patient.

We report a patient with acute promyelocytic leukemia with the common translocation (15;17) and PML-RARAalpha fusion gene. In relapse, blasts showed typical FAB M2 morphologic features, and the karyotype was 45,X, -Y,t(8;21). A reexamination of the leukemic cells at diagnosis revealed that an AML1-ETO fusion gene was also present at that time without cytogenetic evidence of t(8;21). In relapse, only t(8;21) was detected. Two different clones were identified by cytogenetic standard techniques. The association of two common translocations supervening in the same time in the same cells could not be established.

Evaluation of hematopoietic progenitors in hematopoietic progenitor cell transplants. CD34+ dose effect in marrow recovery. Retrospective analysis in 38 patients.

Our main goal was to evaluate the CD34+ dose in patients undergoing haemotopoietic stem celltransplantation and its results in terms of recovery of neutrophile and platelet counts, transfusion requirements, days of fever, antibiotic requirements and length of hospital stay. We studied 38 consecutive patients with haematological malignancies transplanted at our Department, from Feb. 96 through Sept. 98. The CD34+ cell quantification technique was standardized, using a modification of the ISAGHE 96 protocol. Patients were sorted into three groups according to the CD34+ count administered: a) between 3 and 5 x 10(6) cells/kg; b) between 5 and 10 x 10(6) cells/kg; c) > 10 x 10(6) CD34+ cells/kg. As a secondary end point, results were assessed according to the number of aphereses required to arrive at the target count of CD34+, separating those patients that required only 1 or 2 aphereses versus those requiring 3 or more. Finally, an analysis was made of the results of transplantation comparing the different sources of stem cells (PBSC versus PBSC + B.M.). The best results were obtained in the group with cells between 3 and 5 x 10(6) CD34+. No statistically significant advantages were found in the group with cells over 5. The supra-optimal dose of more 10 x 10(6) would yield no additional beneficial results, while they can imply a greater infusion of residual tumor cells. The number of aphereses had no impact on engraftment. Results obtained with PBSC transplants were better than those with BM+PBSC in terms of neutrophile and platelet recovery. The number of CD34+ cells remains the main element in stem cell transplantation to evaluate the haematopoietic recovery after engraftment. Minimum and optimum yields remain unclear. Centers should establish their own optimal dose based on local methodologies and outcomes, maximizing costs and benefits.

Leukemic meningitis in a patient with hairy cell leukemia. A case report.

We report a case of hairy cell leukemia with CNS involvement in a 66-year-old white male. This is an exceptionally rare complication in the evolution of this disease.

Differentiation ability of the CLL lymphocyte: an immature lymphocyte or an abnormal leukemic cell?

The present study is concerned with the patterns of cell differentiation in chronic lymphocytic leukemia. Most cases correspond to the proliferation of a B-cell clone. In contrast to the normal B-lymphocyte, the B-cell CLL lymphocyte is characterized by: (1) very low amounts of monoclonal surface Ig; (2) the presence of receptors for mouse red blood cells; (3) the presence in a high percentage of cases of dual B and T markers. T-cell CLL is a rare event and is defined by a peculiar clinical and hematological picture including the presence of receptors for sheep erythrocytes, the reactivity with anti-T sera, and negative or very low values of terminal transferase. Different studies have conflicted in their findings on the incidence of null-cell CLL; however, these cases appear to be rare. Perhaps more sensitive methods of study must be employed before concluding that the null-cell CLL exists and before establishing its incidence. Even though great progress has been made in the understanding of this disease, two main questions remain unresolved: 1. Does the proliferating clone correspond to an immature B-lymphocyte, or does it merely represent an abnormal leukemic cell? 2. What is the role of T cells in B-cell CLL?

Individual cell-by-cell quantitation of lymphocyte surface membrane Ig in normal and CLL lymphocyte and during ontogeny of mouse B lymphocytes by immunoperoxidase assay.

A new quantitative immunoperoxidase method is presented for determining absolute amounts of peroxidase and, consequently, surface antigen densities of individual cells in B lymphocytes from normal individuals, from subjects with CLL and prolymphocytic leukemia, and during ontogeny of B lympocytes in the mouse. The following results were observed: (1) The density of B antigenic sites were lower on CLL than on normal B lymphocytes. (2) The B antigens density of leukemic lymphocytes varied less from cell to cell, forming a homogeneous peak on histograms. (3) In a very rare case of CLL, the antigen density was measured at the time of initial diagnosis (22,500 sites or 647 U) and during the development of a blastic crisis (135,000 sites or 2576 U). The cell by cell distribution changed from a homogeneous peak with a low number of antigenic sites per cell to a heterogeneous peak with a high number of antigenic sites per cell. (4) In prolymphocytic leukemia, the density of B antigenic sites was greater than on normal B lymphocytes and much more heterogeneous than on CLL lymphocytes. (5) During ontogeny of B lymphocytes in the mouse, maturation is associated with the appearance of a population of cells of intermediate to high Smig density. The finding of a decrease in, and altered distribution of, surface markers in CLL is compared with these ontologic findings in the mouse, and the concept that a monoclonal B lymphocyte in CLL may be arrested at a particular stage in its differentiation is discussed.

Two new applications of the immunoperoxidase method: cell-by-cell quantitation of surface immunoglobulins and automated recognition of B-lymphocytes.

Two new applications of the immunoperoxidase method are reported. In the first one, cells after incubation with antibodies coupled with peroxidase washing and staining by carbazol are cytocentrifuged and individually analyzed for their content on surface immunoglobulin (Ig) in two photometric microscopes. The results included the following: 1. Maturation of mice B-lymphocytes during ontogeny is accompanied by the appearance of a population containing intermediate to high amounts of SIg. 2. The CLL B-lymphocyte pattern as compared with that of normal B-lymphocytes shows a decrease of SIg and a homogeneous distribution. In the second application, mice splenic lymphocytes are incubated with antimouse Ig coupled with peroxidase and analyzed through Hemalog D. B-lymphocytes are separated from T-lymphocytes in a distinct population since they become positive for peroxidase.