Specificity of treatment is mandatory in very old patients with hairy cell leukemia.

INTRODUCTION: There are only a few available data about hairy cell leukemia (HCL) in very old patients. We presented three very different cases of HCL in very old patients diagnosed in a single center and discussed some epidemiological and therapeutical issues in such patients. CASE REPORT: The first patient, 89-year-old, had symptomatic cytopenia and achieved sustained complete remission after cladribine treatment. The second patient, 89-year-old, had asymptomatic disease with stable full blood counts during a 3-year follow-up period in which watch-and-wait policy was adopted. The third patient, 82 years old, had two malignancies (HCL and presumably metas- tatic colorectal carcinoma) and his only treatment were occasional red blood cell transfusions and symptomatic therapy. CONCLUSION: The presented illustrative examples confirm individualization of treatment is mandatory in very old patients with HCL.

Management of myelofibrosis during pregnancy: a case report.

INTRODUCTION: Primary myelofibrosis (PMF) is a clonal myeloproliferative neoplasm that occurs most commonly in the decade six of life and it is very rare in the young persons. CASE REPORT: We reported a 28-year-old female patient with primary myelofibrosis who had a normal pregnancy and delivery in the week 40 of pregnancy without any complications. Two years before the diagnosis of PMF she had normal pregnancy. The patient was treated with interferon-alpha and low dose aspirin during the whole pregnancy and with low-molecular-weight heparin a week before delivery and 6 weeks after. The patient had no complications during pregnancy. She delivered in term with healthy, normal baby weight. CONCLUSION: Decision about treatment strategy of pregnancy associated hematologic malignancies should be made for each patient individually.

BCL10 aberations and NF-kappa B activation involving p65 are absent or rare in primary gastric MALT lymphoma.

BACKGROUND/AIM: Mucosa-associated lymphoid tissue (MALT) lymphoma accounts for 5-17% non-Hodgkin lymphomas (NHL). The molecular pathogenesis of MALT lymphomas is not well-established. The aim of this study was to evaluate immunohistochemically determined nuclear coexpression of BCL10 and NF-kappaB (NF-kappaB) in tumor cells of gastric MALT lymphoma and its impact on the patogenesis and outcome of the disease. METHODS: Medical records of 35 patients with newly diagnosed gastric MALT lymphoma were analyzed and biopsy specimens were immunostained for BCL10 and NF-kappaB expression (p65 subunit). RESULTS: The median age of 35 patients diagnosed with gastric MALT lymphoma was 63.5 years (male/female = 21/14). Symptoms were present in 23/35 (65.7%) patients with the weight loss as the most common symptom. Gastric MALT lymphomas were usually localized in the stomach corpus and corpus and antrum (45.7% and 31.2%, respectively). H. pylon infection was confirmed in 20 out of 30 (66.7%) patients. Treatment options were as follows: immunochemotherapy in 10 (28.5%) patients, surgery in 9 (25.8%) patients, combined surgery and chemotherapy in 14 (40%) patients and supportive measures in 2 (5.7%) patients. Complete remission was achieved in 13 (37.10/) patients and partial remission in two (5.7%/) patients. Sixteen (45.7%/) patients had disease progression (p < 0.001). Cytoplasmatic expression of BCL10 in tumor cells was detected in 19 (54.3%) specimens. Nuclear expression was detected in no specimen. Cytoplasmic expression of NF-kappaB was present in 22 (65.7%) specimens, but nuclear expression was not detected in any specimens. CONCLUSION: Nuclear expressions (activation)of NF-kappaB p65 subunit and BCL10 were not detected in specimens of gastric MALT lymphoma. The correlation of nuclear coexpression of BCL10 and NF-kappaB in gastric MALT lymphoma was not established. These results indicate that other mechanisms and signal pathways are active in lymphogenesis of gastric MALT lymphoma, as that apoptotic inhibition is not the main, nor the only mechanism in tumorogenesis.

Comparison of prognostic impact of absolute lymphocyte count, absolute monocyte count, absolute lymphocyte count/absolute monocyte count prognostic score and ratio in patients with diffuse large B cell lymphoma.

BACKGROUND: The combination of absolute lymphocyte count (ALC) and absolute monocyte count (AMC) at diagnosis has prognostic relevance in patients with diffuse large B cell lymphoma (DLBCL). AIMS: The present study was designed to investigate the prognostic significance of ALC and AMC and to determine whether ALC/AMC ratio or ALC/AMC prognostic score is better predictor of outcome in DLBCL. METHODS: We retrospectively analyzed the prognostic significance of ALC and AMC, ALC/AMC ratio and ALC/AMC prognostic score at diagnosis in 222 DLBCL patients treated with R-CHOP. RESULTS: ROC analysis showed that optimal cut-off values of AMC and ALC/AMC ratio with the best sensitivity and specificity were 0.59×10(9)/L and 2.8, respectively. Cut-off of ALC was determined according to the literature data (1×10(9)/L). Low ALC, high AMC, low ALC/AMC ratio and high ALC/AMC prognostic score were in significant association with lower rate of therapy response and survival. In contrast, these parameters were not in significant correlation with relapse rate. The patients with low ALC, "high" AMC, low ALC/AMC ratio and high ALC/AMC prognostic score at diagnosis had significantly shorter EFS and OS. In multivariate analysis all tested parameters (ALC, AMC, ALC/AMC prognostic score and ALC/AMC ratio) are independent risk factors along with "bulky" disease and IPI. CONCLUSION: All tested parameters (ALC, AMC, ALC/AMC score and ALC/AMC ratio) may be useful prognostic factors in DLBCL patients. ALC/AMC score has a slight advantage as it allows the classification of patients into three prognostic groups. Further studies are needed to determine which of these parameters has the highest predictive value.

An unusual case of smoldering AML with prolonged indolent clinical course and spontaneous remission in the terminal phase.

An unusual case of acute myeloblastic leukemia (AML) with indolent clinical course and spontaneous remission in the terminal phase is described. A 63-year-old male has been diagnosed to suffer from AML, subtype M2. Chromosomal analysis showed 46,XY,del(6)(q21). Clinical course was slowly progressive ("smoldering" AML). The patient did not require cytoreductive drugs, and occasional supportive therapy was his only treatment. Five years from diagnosis patient exhibited spontaneous remission of the disease, accompanied with disappearance of del(6q) clone. Six months after, relapse occured and patient died from CNS bleeding. Additional curiosity in this case is the fact that patient's older brother died of acute lymphoblastic leukemia at the age of 71 years. Possible mechanisms of spontaneous remission of AML and genetic predisposition for human leukemia are discussed with a review of the literature.