RESUMO
A 73-year-old female with malaise, anorexia, and hydrodipsia was referred to our department. Peripheral blood tests revealed leukocytosis with 51% blast cells exhibiting flower-shaped nuclei. Flow-cytometry to detect tumor cells in peripheral blood indicated CD3+, CD4+, CD8-, and CD25- expression, but those in the lymph nodes expressed CD25+. Southern blots revealed clonal HTLV-1 provirus in the tumor cells, consistent with adult T-cell leukemia-lymphoma. Cytotoxic chemotherapy was ineffective, but eight cycles of mogamulizumab induced complete remission (CR). A relapse lesion appeared on the right breast but disappeared spontaneously. The patient has currently maintained CR for over five years.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Vírus Linfotrópico T Tipo 1 Humano , Leucemia-Linfoma de Células T do Adulto/tratamento farmacológico , Idoso , Feminino , Humanos , Indução de RemissãoRESUMO
Lymphomatosis cerebri (LC) is a rare variant of primary central nervous system lymphoma, and it is characterized by diffuse cerebral infiltration of malignant lymphoma cells without evidence of a mass lesion. Herein, we report a patient with systemic peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) who had central nervous system involvement mimicking LC. A 72-year-old immunocompetent male presented with rapidly progressive dementia. Fluor-deoxy-glucose (FDG) -positron emission tomography revealed increased FDG uptake in the bone and skin. Histopathological examination of the skin lesion revealed PTCL-NOS infiltration. A FLAIR MRI scan of the brain revealed diffuse hyperintense lesions in the cerebral white matter of both hemispheres. These lesions were not enhanced with gadolinium, and there was no perceptible mass effect. We performed a brain biopsy, and the histology results were consistent with PTCL-NOS. The patient was treated with corticosteroid and chemotherapy; however the disease progressed, and he died 4 months after the diagnosis. This was a rare case of systemic lymphoma accompanied with central nervous system involvement mimicking LC.
Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Linfoma de Células T Periférico/diagnóstico por imagem , Idoso , Neoplasias Encefálicas/patologia , Evolução Fatal , Humanos , Imageamento por Ressonância Magnética , Masculino , Imagem Multimodal , Tomografia por Emissão de PósitronsRESUMO
BACKGROUND: The treatment strategy for diffuse large B-cell lymphoma (DLBCL) in elderly patients is problematic. Although several researchers have reported the effectiveness of comprehensive geriatric assessment (CGA) and the futility of curative treatment in 'unfit' patients with DLBCL, these propositions are not firmly established. PATIENTS AND METHODS: We conducted a retrospective analysis using a database. Patients with DLBCL were eligible if ⧠60 yr old. CGA stratification was performed using medical records. RESULTS: One hundred and 35 patients were identified. Anthracycline-based chemotherapy with curative intent was performed in 115 (85%) patients. According to CGA, 82 (61%) patients were classified as 'fit'. Their 1-yr overall survival (OS) was significantly better than that of 'unfit' patients [91.3% vs. 53.8%, P < 0.001]. Patients classified as 'unfit' treated with curative intent had a significantly better 1-yr OS when compared with those receiving palliative measures [66.1% vs. 19.0%, P < 0.001]. CONCLUSIONS: CGA is an effective tool for predicting outcomes in older patients with DLBCL. The patients treated with curative intent had significantly better outcomes compared with those receiving palliation, irrespective of CGA stratification. Curative treatment should be considered even for 'unfit' patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Avaliação Geriátrica , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Feminino , Humanos , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Seleção de Pacientes , Prednisona/uso terapêutico , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Vincristina/uso terapêuticoRESUMO
Double-hit lymphomas are rare tumors that are defined by a chromosomal breakpoint affecting the MYC/8q24 locus in combination with another recurrent breakpoint, mainly a t(14; 18)(q32;q21)involving BCL2. We report a case of a 38-yearold woman with a 2-month history of abdominaldistention. 18F-FDG PET showed multiple positive systemic lymph nodes, positive peritoneum, and multiple positive intra-abdominal masses. Histopathology results of the cervical lymph node were compatible with double-hit follicular lymphoma(Grade 3A)because fluorescence in situ hybridization(FISH)demonstrated both MYC rearrangement and BCL2 gene fusion. She was initially started on R-CHOP(rituximab and doxorubicin, vincristine, cyclophosphamide, and prednisolone), but after one course the regimen was changed to dose-adjusted EPOCH-R(rituximab and doxorubicin, etoposide, vincristine, cyclophosphamide, and prednisolone). However, she showed no response to this chemotherapy regimen or haploidentical stem cell transplantation. The treatment strategy included salvage chemothera- py. An autologous and/or allogeneic hematopoietic transplantation is important for non-responders to DA-EPOCH-R.
Assuntos
Linfoma Folicular/tratamento farmacológico , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-myc/genética , Translocação Genética , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Evolução Fatal , Feminino , Humanos , Linfoma Folicular/genéticaRESUMO
A 77-year-old-man was diagnosed with follicular lymphoma (FL), grade 3A. After six courses of R-THP-COP (rituximab, pirarubicin, cyclophosphamide, vincristine and prednisolone) therapy, he achieved complete remission (CR). He achieved a second CR after radiotherapy, a third CR after six courses of bendamustine /rituximab (BR) therapy, and a fourth CR after six courses of BR therapy. However 2 months after the last chemotherapy, his tumor progressed rapidly and he died. Autopsy results showed medium and large lymphoid cells with pleomorphic, irregular nuclei and prominent nucleoli infiltrated in multiple lymph nodes, the liver, the lung, and the spleen. The lymphoid cells were positive for CD3, CD8, granzymeB, TIA-1 and negative for CD4, CD20, CD79a, CD10, and CD56. Autopsy diagnosis was peripheral T-cell lymphoma, not otherwise specified. Occurrence of lymphoma in T-cell lineage should be considered, if the course of low-grade B-cell lymphomas, such as FL rapidly progresses.
Assuntos
Linfoma Folicular , Linfoma de Células T Periférico/diagnóstico , Idoso , Progressão da Doença , Evolução Fatal , Humanos , Linfoma de Células T Periférico/tratamento farmacológico , Masculino , Gradação de Tumores , RecidivaRESUMO
Cutaneous extramedullary hematopoiesis has been reported in a small number of patients with myelofibrosis. A 79-year-old male with JAK2V617F-positive myelodysplastic/myeloproliferative neoplasm, unclassifiable (MDS-MPN-U), presented with multiple skin lesions. The skin lesions were papulonodular, reddish brown, and elastic hard on palpation. Based on a lesion biopsy, cutaneous extramedullary hematopoiesis associated with MDS/MPN-U was diagnosed. He died four months later due to exacerbation of MDS/MPN-U. Cutaneous invasion might be associated with progressive disease and a poor prognosis for MDS/MPN-U, as it is for myelofibrosis.
Assuntos
Hematopoese Extramedular , Doenças Mieloproliferativas-Mielodisplásicas/complicações , Dermatopatias/patologia , Idoso , Biópsia , Medula Óssea/patologia , Humanos , Masculino , Invasividade Neoplásica , Dermatopatias/etiologiaRESUMO
A 77-year-old man was diagnosed with cold agglutinin disease in 2004. He had been treated with prednisolone with stabilization of hemoglobin in the 6- to 8-g/dl range. However, his hemolytic anemia worsened, and computed tomography showed systemic lymphadenopathy in May 2012. A pathological diagnosis of small lymphocytic lymphoma was made based on an inguinal lymph node biopsy. Treatment was started with rituximab. However, there was no response to 6 doses of rituximab monotherapy. He next received 6 courses of bendamustine in combination with rituximab. This resulted in stabilization of hemoglobin and independence from transfusion support. To the best of our knowledge, this is only the second case report describing bendamustine plus rituximab treatment for non-Hodgkin lymphoma complicated by cold agglutinin disease. Our results in this case suggest bendamustine to potentially be a useful therapeutic option in patients with cold agglutinin disease.
Assuntos
Anemia Hemolítica Autoimune/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Compostos de Mostarda Nitrogenada/uso terapêutico , Idoso , Anticorpos Monoclonais Murinos/administração & dosagem , Cloridrato de Bendamustina , Humanos , Masculino , Compostos de Mostarda Nitrogenada/administração & dosagem , Rituximab , Resultado do TratamentoRESUMO
Patients with hyperleucocytic leukemia (WBC count>10×10(4) mL) are at high risk of early mortality owing to pulmonary or cerebral leukostasis. Several researchers have reported the efficacy of immediate leukapheresis. Here, we report of a patient with chronic myelogenous leukemia in blast crisis and with pulmonary failure due to leukostasis who recovered after a combination therapy of leukapheresis and imatinib treatment.
Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Leucostasia/terapia , Adulto , Antineoplásicos/uso terapêutico , Benzamidas/uso terapêutico , Feminino , Humanos , Mesilato de Imatinib , Leucaférese , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucostasia/etiologia , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Indução de RemissãoRESUMO
A 73-year-old woman was diagnosed with myelodysplastic syndrome(MDS). After 11 courses of treatment with azacitidine( AZA), her hemoglobin level and platelet count improved significantly, and she became transfusion independent. Therefore, treatment was discontinued and follow-ups were maintained. Three months later, her platelet count reduced again; we therefore treated her again with AZA. However, MDS transformed to acute myeloid leukemia in the 14th course, and she died 19 months after the initial diagnosis. AZA is an important drug for treating MDS, but premature withdrawal of treatment might cause rapid disease progression. In case treatment is discontinued, the patient needs to be carefully observed.
Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Azacitidina/uso terapêutico , Síndromes Mielodisplásicas/diagnóstico , Idoso , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Leucemia Mieloide Aguda/diagnóstico , Síndromes Mielodisplásicas/tratamento farmacológicoRESUMO
Eltrombopag, an oral thrombopoietin receptor agonist, is a novel drug that can be used in cases with previously-treated primary immune thrombocytopenia (ITP). In this study, we retrospectively analyzed 22 Japanese ITP patients treated in four hospitals. A responder was defined as a patient achieving a platelet count between 50,000/µl and 400,000/µl, at 75% or more of on-treatment assessments. Excluding 2 patients whose treatments were interrupted at their request, 13 of 20 patients (65%) were responders. Ten of the 13 responders had been taking more than 5 mg of a steroid preparation in the form of prednisolone or its equivalent. In 7 of these patients, the steroid dose could be tapered to 5 mg or less. Disappearance or amelioration of hemorrhagic symptoms was observed in 11 of 19 patients who had these symptoms prior to treatment (9 of 10 responders, 2 of 7 non-responders), and the improvement rate was greater in responders (p=0.018). No factors were identified as being related to efficacy. Reported adverse effects were fever (1), malaise (3), headache (2), and muscle pain (1). One severe adverse event, cerebral thromboembolism, was reported in 1 patient. Although eltrombopag is a useful therapeutic agent for refractory ITP, it is necessary to evaluate its position in the overall treatment strategy for ITP after assessing long-term complications as well as therapeutic effects.
Assuntos
Benzoatos/uso terapêutico , Hidrazinas/uso terapêutico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Pirazóis/uso terapêutico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Benzoatos/administração & dosagem , Benzoatos/efeitos adversos , Benzoatos/farmacologia , Feminino , Humanos , Hidrazinas/administração & dosagem , Hidrazinas/efeitos adversos , Hidrazinas/farmacologia , Japão , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/sangue , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Pirazóis/farmacologia , Receptores de Trombopoetina/agonistas , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The patient, a 44-year-old male, subjectively noticed edema in his lower legs in March, 2010. By June 2010, he could not walk, and was admitted to this hospital. Since multiple neuropathy, increased serum vascular endothelial growth factor-3, M-proteinemia, edema, pericardial effusions, papilledema, increased platelet count and skin lesions were detected in the complete examination, he was diagnosed with polyneuropathy, organomegaly, endocrinopathy, M-proteinemia and skin changes (POEMS) syndrome. Treatment with steroid and furosemide was initiated in September 2010. This markedly improved edema and brought about mild recovery of proximal lower-limb muscle strength. The patient, however, suffered prolonged difficulty in walking because his distal lower-limb muscle strength was not improved. In October 2010, he received treatment with high-dose cyclophosphamide, followed by peripheral blood stem cell sampling with granulocyte-colony stimulating factor. In November 2010, he underwent treatment with high-dose melphalan, followed by autologous peripheral blood stem cell transplantation. Recovery to neutrophils greater than 500 was achieved at 13 days after transplantation. He could walk without assistance in February 2011. M-protein was not identified by immunofixation electrophoresis in August 2011. Autologous peripheral blood stem cell transplantation is regarded as a useful treatment for POEMS syndrome.
Assuntos
Síndrome POEMS/terapia , Transplante de Células-Tronco de Sangue Periférico , Adulto , Humanos , Masculino , Síndrome POEMS/tratamento farmacológico , Transplante AutólogoRESUMO
We investigated 8 cases of non-Hodgkin lymphoma(NHL)in human immunodeficiency virus(HIV)seropositive individuals who were diagnosed and treated at Osaka City General Hospital between April 2002 and October 2012. All patients were men, and the average age at the onset of NHL was 46 years(range: 30-61). Histological types were as follows: diffuse large B cell lymphoma in 4 patients, plasmablastic lymphoma in 2 patients, primary effusion lymphoma in 1 patient, and Burkitt lymphoma in 1 patient. In 3 cases, HIV infection was identified before the onset of NHL. Highly active anti-retroviral therapy (HAART)was initiated in 6 cases, and in 4 of these, we administered antineoplastic chemotherapy. Three patients who did not receive antineoplastic chemotherapy died within 1 month of diagnosis. Although 1 of the patients who received chemotherapy achieved complete remission, this patient died of BK virus nephritis. The remaining 3 patients achieved complete remission and are currently alive after 6 to 9 months. We believe that the combination of antineoplastic chemotherapy with HAART will lead to prognostic improvement in HIV-seropositive patients with NHL.
Assuntos
Infecções por HIV/complicações , Linfoma não Hodgkin/tratamento farmacológico , Adulto , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Humanos , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/etiologia , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
A 61-year-old man was referred to our hospital for leukocytosis and thrombocytopenia. Bone marrow examination showed hypercellular bone marrow accompanied by dysplasia, and the karyotype of his bone marrow cells was 46,XY, der(5;12)(q10;q10), +mar,inc[3]/46,XY[12]. A diagnosis of myelodysplastic syndrome, unclassifiable, was made. Analysis of major BCR/ABL1 chimeric RNA by real-time polymerase chain reaction method was positive, and then Ph chromosome was observed afterward. His Ph chromosome was seen in der(5;12)-negative cells analyzed by FISH, which suggested the late-appearing Ph chromosome evolved into another clone. Despite treatment containing imatinib, hydroxyurea, and cytosine arabinoside, he died due to respiratory dysfunction 5 months after the initial diagnosis. The autopsy revealed massive pulmonary infiltration by Ph-negative cells, suggesting MDS-derived clones. It has been reported that the late appearance of Ph chromosome associates with leukemic progression. Although the incidence of late-appearing Ph chromosome is estimated to be relatively low, further accumulation of cases is necessary for the evaluation of its impact on prognosis and disease progression.
Assuntos
Medula Óssea/patologia , Cromossomos Humanos Par 12/genética , Cromossomos Humanos Par 5/genética , Síndromes Mielodisplásicas/genética , Cromossomo Filadélfia , Aberrações Cromossômicas , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/diagnósticoRESUMO
We present three long-term survivors treated with high-dose melphalan with autologous peripheral blood stem cell transplantation(auto PBSCT)for primary AL amyloidosis. Because melphalan toxicity is dose-related, patient age and the extent of organ involvement are very important factors for the success of high-dose melphalan treatment with PBSCT. The patients were therefore given high-dose melphalan using the risk-adapted approach to melphalan dosing. They received 3 courses of a vincristine, doxorubicin and dexamethasone(VAD)regimen, along with high-dose melphalan(100-200mg/m2)with auto PBSCT. There were no serious complications or transplantation-related mortalities. Patients survived for an average of 68 months(22-100 months)in partial response. A risk-adapted approach to melphalan dosing with PBSCT is an effective treatment in patients with primary AL amyloidosis.
Assuntos
Amiloidose/tratamento farmacológico , Melfalan/uso terapêutico , Transplante de Células-Tronco de Sangue Periférico , Amiloidose/patologia , Amiloidose/cirurgia , Biópsia , Terapia Combinada , Feminino , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina , Masculino , Melfalan/administração & dosagem , Pessoa de Meia-IdadeRESUMO
We report the case of a 66-year-old man with primary diffuse large B-cell lymphoma of the prostate presenting with urinary retention and dyschezia as first manifestation. Although a colostomy was needed due to rectal obstruction, rituximab-combined chemotherapy resulted in complete remission. He underwent stoma closure safely and has remained in complete remission for over 3years. Primary prostatic lymphoma is extremely rare, presenting as 0.1% of newly diagnosed lymphomas, but rituximab-containing chemotherapy seems to be as effective as for nodal lymphoma.
Assuntos
Anticorpos Monoclonais Murinos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Constipação Intestinal/etiologia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Próstata/patologia , Neoplasias Retais/tratamento farmacológico , Retenção Urinária/etiologia , Idoso , Anticorpos Monoclonais Murinos/administração & dosagem , Terapia Combinada , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Prednisona/uso terapêutico , Neoplasias Retais/complicações , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Indução de Remissão , Rituximab , Vincristina/uso terapêuticoRESUMO
A 31-year-old female with acute myelocytic leukemia was admitted to our hospital in June 2004. She had complications of brain abscess at the WBC nadir after the second course of induction therapy. However,because the platelet count was low, neurosurgical procedures, including craniotomy/abscess resection, or abscess drainage, were not performed, and we could not detect bacteria or fungus as the cause of brain abscess. Combination therapy with meropenem trihydrate and fosfluconazole was effective. Thereafter, she underwent related peripheral blood stem cell transplantation, and has had no recurrence of brain abscess. Brain abscess during chemotherapy for patients with acute leukemia is commonly due to fungus,particularly Aspergillus, which has a very high fatality rate. Therefore, the treatment of brain abscess without the detection of bacteria and fungus requires combination therapy with antifungal agents and antibiotics. In this case, methionine-positron emission tomography was useful for the evaluation of therapeutic effectiveness for brain abscess.
Assuntos
Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Leucemia Mieloide Aguda/complicações , Transplante de Células-Tronco de Sangue Periférico , Adulto , Antifúngicos/administração & dosagem , Encéfalo/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Esquema de Medicação , Quimioterapia Combinada , Feminino , Fluconazol/administração & dosagem , Fluconazol/análogos & derivados , Humanos , Leucemia Mieloide Aguda/terapia , Meropeném , Organofosfatos/administração & dosagem , Tomografia por Emissão de Pósitrons , Tienamicinas/administração & dosagem , Tomografia Computadorizada por Raios XRESUMO
An 18-year-old female with myelodysplastic syndrome underwent an allogeneic cord blood transplantation in May 2005. The conditioning regimen consisted of total body irradiation, cytarabine and cyclophosphamide. The day of the cord stem cell transfusion was counted as Day 0. For acute GVHD prophylaxis, cyclosporine A (CsA) and methotrexate were used. Engraftment was achieved on Day 30, acute GVHD grade II developed on Day 45 and treatment with methylprednisolone for acute GVHD was started. On Day 68 the patient had generalized seizures accompanied by loss of consciousness, hypertension and left hemiparesis, and was intubated. A cranial CT scan showed a mass effect on the right basal ganglia, and high signal intensities on the T2-weighted and FLAIR images of a MR examination were detected in the bilateral basal ganglia and posterior lobes, the findings of which were compatible with a brain tumor or infectious disease. Since an increased level of apparent diffusion coefficient (ADC) values on the bilateral basal ganglia was noted, we suspected that vasogenic edema had caused the mass effect. She went into remission immediately after CsA treatment was discontinued. Therefore, this case was diagnosed as atypical reversible posterior leukoencephalopathy syndrome (RPLS) associated with CsA. CsA-induced encephalopathy presenting a mass effect in clinical imaging findings is very rare, and an ADC map may be useful for the diagnosis of RPLS.
Assuntos
Gânglios da Base/patologia , Edema Encefálico/induzido quimicamente , Edema Encefálico/patologia , Transplante de Células-Tronco de Sangue do Cordão Umbilical , Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Síndromes Mielodisplásicas/terapia , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/patologia , Doença Aguda , Adolescente , Edema Encefálico/diagnóstico , Ciclosporina/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Feminino , Doença Enxerto-Hospedeiro/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Síndromes Neurotóxicas/diagnóstico , SíndromeRESUMO
To evaluate the results of high-dose chemotherapy (HDT) and autologous hematopoietic stem cell transplantation (ASCT) in patients with diffuse B-cell aggressive non-Hodgkin's lymphoma(NHL). Between 1991 and 2004, 25 patients who did not achieve complete remission and 26 in complete remission from conventional chemotherapy received HDC-ASCT. Of 25 patients with refractory NHL,14 were chemotherapy-sensitive before HDT-ASCT and 11 were chemotherapy-resistant. CR was achieved after HDC-ASCT in 50% of 14 chemotherapy sensitive patients and in none of 11 chemotherapy-resistant patients. The 5-year probability of event-free survival for chemotherapy-sensitive and chemotherapy-resistant patients was 51.3% and 20.8%, respectively (p<0.05, log-rank test). Moreover, the 5-year probability of event-free survival for patients in the low-risk group with International Prognostic Index (IPI) and in the high-risk group with IPI was 75.0% and 16.3%, respectively (p<0.05, log-rank test). HDT-ASCT should be considered for patients with refractory aggressive NHL who are chemotherapy-sensitive rather than chemotherapy-resistant. Twenty-six patients in complete remission received consolidation therapy with HDT-ASCT. The 5-year probability of disease-free survival for patients in the low-risk group and in the high-risk group was 68.8% and 60.0%,respectively (p = 0.9 6). HDT-ASCT should be considered for patients at high risk who achieve complete remission after induction treatment. In future, HDT-ASCT combined with rituximab as induction therapy or as consolidation therapy is needed for patients with aggressive NHL in the high-risk group.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Linfoma de Células B/terapia , Linfoma Difuso de Grandes Células B/terapia , Transplante Autólogo , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Citarabina/administração & dosagem , Intervalo Livre de Doença , Esquema de Medicação , Etoposídeo/administração & dosagem , Feminino , Humanos , Linfoma de Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Compostos de Nitrosoureia/administração & dosagem , Indução de Remissão , Resultado do TratamentoRESUMO
Purulent pericarditis caused by Morganella morganii is extremely rare. We report herein a case of a 61-year-old man who presented with chest pain and dyspnea fourteen days after chemotherapy for multiple myeloma. Echocardiogram and computed tomography revealed a massive pericardial effusion and associated cardiac tamponade. Pericardiocentesis was performed. Pericardial fluid was found to be purulent, and Morganella morganii was isolated from the fluid. The patient was successfully treated with antibiotic therapy and surgical drainage of the fluid. Morganella morganii should be considered a possible pathogen when immunocompromised patients develop purulent pericarditis.
RESUMO
We report the case of a 17-year-old man with precursor B-lymphoblastic lymphoma involving an intracardiac mass and myocardial infiltration. Intensified chemotherapy followed by autologous peripheral blood stem cell transplantation resulted in long-term complete remission for over 5 years. As the most frequent sites of B-lymphoblastic lymphoma involvement are the skin, soft tissue, bone, and lymph nodes, reports of cases harboring cardiac involvement are relatively few. This is a rare case of B-lymphoblastic lymphoma displaying cardiac involvement, in which cardiac infiltration was one of the initial manifestations.