Análise imunofenotípica e avaliação nutricional na leucemia linfoblástica aguda da criança: [carta ao editor] / Immunophenotypic analysis and evaluation of nutritional status in childhood acute lymphoblastic leukemia: [letter to editor]

The cure rate for childhood acute lymphoblastic leukemia (ALL) differs between developed and developing countries. In developing countries there is a high prevalence of malnutrition thus it is important to evaluate the association between factors of nutritionand ALL prognosis, as well as to identify the prevalence of immunophenotypes and their association with nutritional status. Eighty-six children with acute lymphoblastic leukemia diagnosedin two universities in Rio de Janeiro were studied. The frequencies of each immunological subtype were: common ALL 57%, pre-B 9.3%; pro-B 8.1%; T-ALL 18% and biphenotypic ALL 7.0%. Itwas noticed that the typical incidence peak of common ALL is between 1 and 6 years old. The small number of malnourished children did not allow statistical analysis to compare data between the immunophenotype and nutritional status. For the same reason,a statistical approach comparing malnutrition status with complete remission and relapse rates was impaired. The relative incidence of each immunological subtype was similar to those found in developed countriess.

A relevância das células natural killer (NK) e killer immunoglobulin-like receptors (KIR) no transplante de células-tronco hematopoéticas (TCTH): [revisão] / The relevance of natural killer (NK) cells and killer immunoglobulin-like receptors (KIR) in hematopoietic stem cell transplantation (HSCT): [review]

As células natural killer (NK) foram identificadas há mais de 30 anos por sua capacidade de matar células tumorais e infectadas por vírus sem precisar de sensibilização prévia. No entanto, a forma como as células NK matam seus alvos ficou desconhecida por muito tempo. Na década de 90, a partir de várias observações, foi proposto que as células NK matariam células com a expressão diminuída de antígeno leucocitário humano (HLA), protegendo as células autólogas normais, o que ficou conhecido como hipótese do missing-self. Esta teoria foi confirmada através da descoberta de vários receptores, principalmente os da família killer immunoglobulin-like receptors (KIR), que reconhecem moléculas de HLA de classe I. Estes novos conceitos levaram à busca da importância dos receptores KIR no transplante de células-tronco hematopoéticas (TCTH). Foi sugerido que as disparidades de HLA entre o doador e o paciente poderiam ser reconhecidas por células NK levando à aloreatividade, o que ajudaria no efeito enxerto contra leucemia. No entanto, apesar de alguns resultados promissores, até hoje, os diferentes estudos sobre o assunto não chegaram a um consenso. Nesta revisão, será abordada a relevância das células NK e dos receptores KIR nos diferentes tipos de TCTH.

Natural killer (NK) cells were identified over 30 years ago by their ability to kill cancer and virally infected cells without prior sensitization. For years the recognition mechanisms of target cells were unknown, until the 1990s when the "missing-self" hypothesis was proposed. According to this theory, although tolerant to normal autologous cells, NK cells can recognize and attack cells that have down-regulated human leukocyte antigen (HLA) class I molecules. The discovery of killer immunoglobulin-like receptors (KIR) that specifically recognize HLA class I molecules corroborated this hypothesis. These new concepts point to the importance of studying KIR in hematopoietic stem cell transplantation (HSCT). HLA disparities between the donor and patient in HSCT may be distinguished by NK cells leading to alloreactivity. Even though there are some promising results, until now existing studies have not reached any consensus. Here, we will review the relevance of NK cells and KIR in the different types of HSC.

Hepatosplenic gammadelta T-cell lymphoma following seven malaria infections.

Hepatosplenic gammadelta T-cell lymphoma (HSTL) is a clinicopathological entity associated with an immunocompromised status in approximately 25% of patients. Herein is described a case of HSTL in a 53-year-old Brazilian man with seven previous malaria infections, initially misdiagnosed as a hyperreactive splenomegaly due to chronic malaria. A characteristic lymphoid infiltrate was observed in spleen, liver and bone marrow sinusoids/sinuses. Neoplastic cells had a CD45RO+, CD2+, CD7+, CD3+, CD5-, CD8+, CD56+, perforin+, FasL-negative, T-cell receptor (TCR)alphabeta-negative, TCRgammadelta+ profile. Analyses of gamma and delta TCR rearrangements confirmed diagnosis of gammadelta T-cell lymphoma by detecting VgammaI/Vdelta1-Jdelta1 clonal rearrangements. Sensitive polymerase chain reaction (PCR) for Plasmodium falciparum, Epstein-Barr virus and herpesvirus-8 failed to demonstrate infection. The disease progressed to a fatal outcome following cutaneous infiltration and leukemic proliferation. The authors also comment on the association of lymphoma and infection, focusing on PCR diagnosis of TCRgamma and delta clonal rearrangements and the presumed pathogenic events leading to HSTL in the context of chronic malaria infection. Initial lymphomagenic stages might not be direct consequences of antigenic stimulation of Vdelta1 T-cells, but might depend on interactions between gammadelta T and B cells during cooperative or regulatory responses to Plasmodium sp.