Assuntos
Cromossomos Humanos Par 13/genética , Cromossomos Humanos Par 8/genética , Leucemia de Células T/genética , Linfoma de Células T Periférico/genética , Transtornos Mieloproliferativos/genética , Proteínas de Neoplasias/genética , Receptor Tipo 1 de Fator de Crescimento de Fibroblastos/genética , Translocação Genética , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cromossomos Humanos Par 13/ultraestrutura , Cromossomos Humanos Par 8/ultraestrutura , Terapia Combinada , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , Hibridização in Situ Fluorescente , Leucemia de Células T/tratamento farmacológico , Leucemia de Células T/patologia , Leucemia de Células T/cirurgia , Linfoma de Células T Periférico/tratamento farmacológico , Linfoma de Células T Periférico/patologia , Linfoma de Células T Periférico/cirurgia , Masculino , Transtornos Mieloproliferativos/tratamento farmacológico , Transtornos Mieloproliferativos/patologia , Transtornos Mieloproliferativos/cirurgia , Transplante de Células-Tronco de Sangue Periférico , Indução de Remissão , Transplante Homólogo , Vincristina/administração & dosagemRESUMO
A case of leukemia escape from an HLA-specific cytotoxic T lymphocyte (CTL) response in a recipient of bone marrow transplantation is presented. Only the expression of HLA-B51, which was a mismatched HLA locus in the graft-versus-host direction, was down-regulated in post-transplant leukemia blasts compared with that in pre-transplant blasts. All CTL clones, that were isolated from the recipient's blood when acute graft-versus-host disease developed, recognized the mismatched B(∗)51:01 molecule in a peptide-dependent manner. The pre-transplant leukemia blasts were lysed by CTL clones, whereas the post-transplant leukemia blasts were not lysed by any CTL clones. The IFN-γ ELISPOT assay revealed that B(∗)51:01-reactive T lymphocytes accounted for the majority of the total alloreactive T lymphocytes in the blood just before leukemia relapse. These data suggest that immune escape of leukemia blasts from CTL pressure toward a certain HLA molecule can lead to clinical relapse after bone marrow transplantation.
Assuntos
Transplante de Medula Óssea/imunologia , Antígenos HLA/imunologia , Leucemia de Células T/imunologia , Leucemia/imunologia , Linfócitos T Citotóxicos/imunologia , Sequência de Aminoácidos , Transplante de Medula Óssea/efeitos adversos , Células Cultivadas , Evolução Fatal , Loci Gênicos , Antígenos HLA/química , Antígenos HLA/genética , Humanos , Leucemia/cirurgia , Leucemia de Células T/cirurgia , Masculino , Transplante Homólogo , Adulto JovemRESUMO
Vitamin D insufficiency is a reemerging and common health problem for skeletal system. Pharmacological application of glucocorticoid inhibits intestinal calcium absorption and stimulates tubular calcium excretion, thus induces severely negative calcium balance. We report a patient presenting symptomatic hypocalcemia following high dose glucocorticoid administration. After a pulse-therapy with methylprednisolone, hypocalcemia with muscle cramp developed in association with hypercalciuria and secondary hyperparathyroidism in the absence of hypomagnesemia. Circulating level of 1,25-dihydroxyvitamin D was in a reference range, while that of 25-hydroxyvitamin D was insufficient. Treatment with alfacalcidol of 1 mug/day promptly improved serum calcium level within a couple of weeks. Vitamin D insufficiency could be a serious problem in patients with high dose glucocorticoid therapy.
Assuntos
Glucocorticoides/uso terapêutico , Hipocalcemia/induzido quimicamente , Deficiência de Vitamina D/tratamento farmacológico , Biomarcadores/sangue , Reabsorção Óssea/sangue , Cálcio/sangue , Transplante de Células-Tronco de Sangue do Cordão Umbilical , Feminino , Humanos , Leucemia de Células T/cirurgia , Linfoma/cirurgia , Pessoa de Meia-Idade , Osteogênese , Fosfatos/sangueAssuntos
Carcinoma/diagnóstico , Carcinoma/patologia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Leucemia de Células T/diagnóstico , Leucemia de Células T/patologia , Idoso , Antineoplásicos Fitogênicos/uso terapêutico , Carcinoma/cirurgia , Colectomia , Neoplasias do Colo/cirurgia , Diagnóstico Diferencial , Progressão da Doença , Etoposídeo/uso terapêutico , Humanos , Leucemia de Células T/cirurgia , MasculinoAssuntos
Quimera , Transfusão Feto-Materna , Leucemia de Células T/cirurgia , Transplante de Células-Tronco , Adolescente , Feminino , Efeito Enxerto vs Leucemia , Humanos , Tolerância Imunológica , Leucemia de Células T/imunologia , Masculino , Gravidez , Imunologia de Transplantes , Transplante IsogênicoRESUMO
Guillain-Barré syndrome is a rare complication in the setting of hematopoietic stem cell transplantation. We report three children with T cell lymphoma/leukemia in whom this syndrome developed soon after they received unrelated donor transplants. The rapid onset of symptoms raises the concern that the bone marrow transplant conditioning regimen (ie, total body irradiation, cyclophosphamide and cytosine arabinoside) might have precipitated the clinical syndrome of ascending polyneuropathy. Although central nervous system toxicity has been well described with high-dose cytosine arabinoside therapy, peripheral neuropathy of the Guillain-Barré type has been reported only infrequently. We review possible factors contributing to the development of this syndrome in these three patients.
Assuntos
Síndrome de Guillain-Barré/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Adolescente , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Citarabina/efeitos adversos , Citarabina/uso terapêutico , Evolução Fatal , Síndrome de Guillain-Barré/induzido quimicamente , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/virologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Leucemia de Células T/tratamento farmacológico , Leucemia de Células T/radioterapia , Leucemia de Células T/cirurgia , Leucemia de Células T/virologia , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/radioterapia , Linfoma de Células T/cirurgia , Masculino , Vírus da Parainfluenza 1 Humana/imunologia , Vírus da Parainfluenza 1 Humana/isolamento & purificação , Infecções por Respirovirus/complicações , Infecções por Respirovirus/diagnóstico , Infecções por Respirovirus/tratamento farmacológico , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/métodos , Transplante Homólogo , Irradiação Corporal Total/efeitos adversos , Irradiação Corporal Total/métodosRESUMO
A 24 year old female with a 4 year history of anemia and absolute lymphocytosis was evaluated and found to have T cell large granular lymphocyte (T-LGL) leukemia associated with autoimmune hemolytic anemia, neutropenia, mild thrombocytopenia and splenomegaly. In an effort to ameliorate her symptomatic cytopenias, she was treated with prednisone and subsequently methotrexate without success. In February 1993, she underwent splenectomy for symptomatic anemia. Splenectomy resulted in an increased hemoglobin concentration to normal levels, resolution of all laboratory evidence of hemolysis, and disappearance of thrombocytopenia. This response has been durable despite persistence of the abnormal LGL clone. We suggest that splenectomy may be an effective treatment for autoimmune hemolytic anemia and/or thrombocytopenia often associated with T-LGL leukemia. As this disease often exhibits a chronic clinical course with morbidity resulting from consequences of resultant cytopenias rather than visceral involvement with leukemic LGL, effective treatment of cytopenias despite persistence of the abnormal LGL clone is beneficial.
Assuntos
Anemia Hemolítica Autoimune/etiologia , Anemia Hemolítica Autoimune/cirurgia , Complexo CD3/análise , Leucemia Linfoide/cirurgia , Leucemia de Células T/cirurgia , Esplenectomia , Adulto , Anemia Hemolítica Autoimune/sangue , Feminino , Humanos , Leucemia Linfoide/sangue , Leucemia de Células T/sangueRESUMO
An immunomagnetic method was developed to purge human bone marrow of malignant T cells, for use in conjunction with autologous bone marrow transplantation in patients with acute lymphoblastic leukemia and lymphoma. Three monoclonal antibodies anti CD2 (BH1), CD5 (BB8) and CD7 (BF12) were used. In model experiments employing MOLT4 cells it was found that with 50-fold excess of immunobeads relative to antigen-positive cells, the use of each antibody alone resulted in a 3.3-3.6 log tumor cell depletion, as assessed in a sensitive and reproducible clonogenic soft agar assay. When all three antibodies were used in a mixture, a purging efficacy of 5 logs was achieved. Two treatment cycles improved these figures to about 4 logs and more than 5 logs. When MOLT4 cells were mixed 1:10 with fresh bone marrow cells the antibody mixture yielded 3.1 and more than 5 log tumor cell depletion with one and two treatment cycles, respectively. This procedure resulted in only an insignificant reduction of the number of CFU-GM and CFU-GEMM progenitor cells. In two patients autotransplanted with purged marrow, the loss of CFU-GM was 37% and 48%, and no tumor cells could be detected by immunocytochemistry after purging. Rapid and sustained engraftment was achieved and both patients remain in complete remission after more than 20 months.