RESUMEN

Early intracranial hemorrhage (eICH) is a potentially fatal complication of acute leukemia. We analyzed risk factors for eICH in patients with de novo acute leukemia. Ninety-one de novo acute leukemia patients at our institution between September 2003 and June 2014 were included. Of the 91 patients, eight (8.8 %) and 83 were included in the eICH and non-eICH groups, respectively. Univariate analysis demonstrated that white blood cell (WBC) count (P = 0.018), fibrin-fibrinogen degradation product (FDP) level (P = 0.0075), co-occurrence of WBC ≥50,000/µl and FDP level >40 µg/ml (P < 0.001), and fever (P = 0.248) were all significant predictors of eICH at the 0.25 level. In a subsequent multivariate analysis involving these parameters, only the combination of hyperleukocytosis and elevated FDP levels was found to be significant at the 0.05 level. A significant difference in the duration of the overall survival (OS) period was detected between patients that did and did not exhibit the combination of hyperleukocytosis and elevated FDP levels (P < 0.001). Co-occurrence of hyperleukocytosis and elevated FDP levels is a significant risk factor for eICH in patients with de novo acute leukemia and has a significant adverse affect on OS.

Asunto(s)

Hemorragias Intracraneales/etiología , Leucemia/complicaciones , Leucocitosis , Enfermedad Aguda , Adulto , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Hemorragias Intracraneales/sangre , Hemorragias Intracraneales/diagnóstico , Leucemia/mortalidad , Recuento de Leucocitos , Persona de Mediana Edad , Factores de Riesgo , Tasa de Supervivencia

Asunto(s)

Deficiencia del Factor XI/terapia , Hematoma Subdural/cirugía , Atención Perioperativa , Plasma , Anciano de 80 o más Años , Deficiencia del Factor XI/complicaciones , Femenino , Hematoma Subdural/complicaciones , Humanos

RESUMEN

TAFRO syndrome is a systemic inflammatory disorder characterized by low platelet counts, anasarca, fever, reticulin fibrosis, renal dysfunction, and organomegaly. Patients with TAFRO syndrome occasionally have courses complicated by immunological diseases. Herein, we describe a case of TAFRO syndrome associated with autoimmune hemolytic anemia (AIHA). The patient was admitted because of menorrhagia. She had thrombocytopenia, pleural effusion and ascites, hepatomegaly, and multiple lymphadenopathies. Her symptoms worsened, especially fever, pleural effusion and ascites, and she developed AIHA. Steroid pulse therapy followed by 45 mg of prednisolone (PSL) improved not only the symptoms of TAFRO syndrome but also those of AIHA. There have been no reports, to our knowledge, of AIHA associated with TAFRO syndrome, and detailed studies on this syndrome are needed.

Asunto(s)

Anemia Hemolítica Autoinmune/etiología , Edema/complicaciones , Fiebre/complicaciones , Enfermedades Renales/complicaciones , Enfermedades Linfáticas/complicaciones , Trombocitopenia/complicaciones , Anemia Hemolítica Autoinmune/terapia , Femenino , Humanos , Persona de Mediana Edad , Resultado del Tratamiento

RESUMEN

A 41-year-old man presented with the chief complaint of right hip pain that had persisted for 6 months. F18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging showed FDG accumulation in the right pubic bone. A bone biopsy specimen from the site revealed findings suggestive of a plasma cell tumor. Bone marrow examination and serum and urine immunofixation tests showed no abnormalities. Based on these findings, the patient was diagnosed as having non-secretory multiple myeloma. FDG accumulation in the right pubic bone diminished following four cycles of weekly bortezomib and concomitant dexamethasone therapy. Tandem autologous peripheral blood stem cell transplantation was performed, followed by monthly bortezomib/dexamethasone maintenance therapy. A further FDG-PET/CT scan 9 months after the start of therapy indicated that FDG accumulation in the right pubic bone had worsened. Consequently, the therapy was switched to twice-weekly bortezomib/dexamethasone as remission re-induction therapy. New FDG uptake in the right hip bone was noted after six cycles of the therapy, and plain X-ray examination revealed osteolytic changes. The patient was then administered eight cycles of combined lenalidomide-dexamethasone therapy, which resulted in a marked decrease of the FDG accumulation in the right pubic bone and disappearance of uptake in the right hip bone. There was radiographic evidence of bone formation at these sites. This is only the second reported case in which treatment with the immunomodulatory drug lenalidomide and concomitant dexamethasone has been found to induce bone formation.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Factores Inmunológicos/administración & dosificación , Mieloma Múltiple/tratamiento farmacológico , Osteogénesis/efectos de los fármacos , Adulto , Bortezomib/uso terapéutico , Dexametasona/administración & dosificación , Humanos , Lenalidomida , Masculino , Recurrencia Local de Neoplasia/tratamiento farmacológico , Trasplante de Células Madre de Sangre Periférica , Terapia Recuperativa/efectos adversos , Terapia Recuperativa/métodos , Talidomida/administración & dosificación , Talidomida/análogos & derivados

RESUMEN

Follicular lymphoma (FL) is the most common indolent lymphoma, and associated with the chromosomal translocation t(14;18)(q32;q21). While, FL harboring both BCL2 and MYC translocation at diagnosis is very rare. The evaluation of MYC expression in typical FL at presentation using southern blot, G-banded karyotyping or fluorescence in situ hybridization (FISH) analyses has been described so far. However, there are no reports about the use of immunohistochemistry (IHC) to evaluate MYC protein expression in FL at presentation. Here, we present a FL patient who transformed to a B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt's lymphoma, accompanied by concurrent BCL2, BCL6, and MYC translocations; i.e., triple-hit lymphoma. Paraffin-embedded tissue section-FISH analysis demonstrated that the FL was negative for MYC, but MYC protein expression was subsequently detected in the lymph node specimen obtained at the initial diagnosis using IHC. This case revealed aggressive clinical course and central nervous system involvement. In the literature concerning MYC positive FL five out of 8 patients were dead within 24 months. The detection of MYC protein expression in FL using IHC might be useful to predict more aggressive clinical course.

Asunto(s)

Biomarcadores de Tumor/análisis , Inmunohistoquímica , Linfoma de Células B/química , Linfoma Folicular/química , Proteínas Proto-Oncogénicas c-myc/análisis , Anciano de 80 o más Años , Biomarcadores de Tumor/genética , Proteínas de Unión al ADN/genética , Progresión de la Enfermedad , Resultado Fatal , Femenino , Predisposición Genética a la Enfermedad , Humanos , Hibridación Fluorescente in Situ , Linfoma de Células B/genética , Linfoma de Células B/patología , Linfoma Folicular/genética , Linfoma Folicular/patología , Clasificación del Tumor , Fenotipo , Valor Predictivo de las Pruebas , Proteínas Proto-Oncogénicas c-bcl-2/genética , Proteínas Proto-Oncogénicas c-bcl-6 , Proteínas Proto-Oncogénicas c-myc/genética , Factores de Tiempo , Translocación Genética

RESUMEN

Transient elastography (TE) is a novel, non-invasive imaging technique for measuring liver stiffness (LS). It is considered to be useful for predicting the severity of fibrosis and the risk of cirrhosis or hepatocellular carcinoma. However, the association between the presence of diffuse regions of increased cell density in the liver and elevated LS values has not been assessed. We experienced a case in which a mature T-cell neoplasm had invaded the liver, but the infiltrating lesion was not detected by contrast-enhanced computed tomography (CT) or fluorodeoxyglucose positron emission tomography/CT scans. Instead, the tumor's presence was indicated by the change in the patient's TE-derived LS values after chemotherapy. At diagnosis liver dysfunction was detected in a biochemical examination, and mean LS value was as high as 25.4 kPa [interquartile range (IQR): 0.3, success rate (SR):100%]. After chemotherapy, the patient's mean LS value fell to 4.3 kPa (IQR: 0.8, SR:100%). A follow-up pathological investigation demonstrated that proliferating abnormal T-cells were no longer present in the patient's liver. This is the first report to describe the use of LS data to support a diagnosis of liver infiltration by tumor cells exhibiting a portal and sinusoidal distribution pattern rather than a focal pattern. Elevated TE-derived LS values should lead to hepatic tumor infiltration being considered during initial examinations or a suspicion of recurrence during follow-up examination of lymphoma patients who achieve complete remission, even when radiological investigations do not detect abnormalities in the liver.

Asunto(s)

Diagnóstico por Imagen de Elasticidad , Leucemia-Linfoma de Células T del Adulto/patología , Hígado/patología , Linfocitos T/patología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/metabolismo , Biopsia , Examen de la Médula Ósea , Proliferación Celular , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Elasticidad , Humanos , Inmunohistoquímica , Leucemia-Linfoma de Células T del Adulto/tratamiento farmacológico , Leucemia-Linfoma de Células T del Adulto/metabolismo , Hígado/efectos de los fármacos , Hígado/metabolismo , Pruebas de Función Hepática , Masculino , Invasividad Neoplásica , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Prednisolona/uso terapéutico , Inducción de Remisión , Linfocitos T/efectos de los fármacos , Linfocitos T/metabolismo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vincristina/uso terapéutico

RESUMEN

A 68-year-old man presented to us with pancytopenia, erythroderma, and multiple lymphadenopathies. Lymph node biopsy led to the diagnosis of peripheral T-Cell lymphoma-not otherwise specified (PTCL-NOS). Immunostaining of the lymph node biopsy specimens for cytokines revealed that the tumor cells were positive for plated-derived growth factor (PDGF), basic fibroblast growth factor (b-FGF), vascular endothelial growth factor (VEGF), tumor necrosis factor α (TNF-α), interferon-γ (IFN-γ), interleukin-1ß (IL-1ß), interleukin-2 (IL-2), and transforming growth factor-ß (TGF-ß). Bone marrow biopsy revealed infiltration by the PTCL-NOS and myelofibrosis (MF). Bone marrow blood was negative for JAK-2V617F. Bone marrow immunostaining for cytokines showed that the tumor cells were positive for PDGF, b-FGF, VEGF, TNF-α, IFN-γ, IL-1ß, IL-2, and TGF-ß. The patient was initiated on treatment, and after the first course of CHOP therapy, the bone marrow infiltration by the PTCL-NOS and MF improved. Repeat immunostaining of bone marrow biopsy specimens for cytokines showed that the tumor cells had become negative for PDGF, VEGF, TNF-α and TGF-ß. However, after the second course of CHOP therapy, the bone marrow infiltration by the PTCL-NOS and MF worsened. Immunostaining of bone marrow specimens for cytokines again revealed positive staining results of the tumor cells for PDGF, TNF-α, and TGF-ß. At the completion of the first course of treatment, the infiltration by the PTCL-NOS improved, but not the pancytopenia.

Asunto(s)

Médula Ósea , Ganglios Linfáticos , Linfoma de Células T Periférico , Mielofibrosis Primaria , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/sangre , Biopsia , Médula Ósea/efectos de los fármacos , Médula Ósea/inmunología , Médula Ósea/patología , Examen de la Médula Ósea , Ciclofosfamida/uso terapéutico , Citocinas/sangre , Doxorrubicina/uso terapéutico , Humanos , Inmunohistoquímica , Ganglios Linfáticos/efectos de los fármacos , Ganglios Linfáticos/inmunología , Ganglios Linfáticos/patología , Linfoma de Células T Periférico/sangre , Linfoma de Células T Periférico/tratamiento farmacológico , Linfoma de Células T Periférico/inmunología , Linfoma de Células T Periférico/patología , Masculino , Prednisolona/uso terapéutico , Mielofibrosis Primaria/sangre , Mielofibrosis Primaria/tratamiento farmacológico , Mielofibrosis Primaria/inmunología , Mielofibrosis Primaria/patología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vincristina/uso terapéutico

Asunto(s)

Antineoplásicos/uso terapéutico , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Terapia Combinada , Granulomatosis Linfomatoide/tratamiento farmacológico , Granulomatosis Linfomatoide/radioterapia , Adulto , Ciclofosfamida/uso terapéutico , Citarabina/uso terapéutico , Dexametasona/uso terapéutico , Etopósido/uso terapéutico , Femenino , Humanos , Rituximab/uso terapéutico

RESUMEN

A 61-year-old woman was diagnosed as having rheumatoid arthritis (RA) and began treatment with salazosulfapyridine (SASP) and methotrexate (MTX) in 2008; the administration of concomitant tacrolimus (TAC) was initiated in 2010. She subsequently developed concurrent multiple myeloma (MM), immunoglobulin G (IgG)-κ type, in 2012. A portion of the tumor cells tested positive for Epstein-Barr virus-encoded small RNA (EBER). MTX treatment was discontinued in 2014, and the exacerbation of MM ensued. The patient received two cycles of bortezomib plus dexamethasone (BD) therapy and attained a complete response (CR). She then underwent an autologous peripheral blood stem cell transplantation. The Epstein-Barr (EB) virus infection arising from the increased RA disease activity and immunosuppressant medication might have influenced the development of MM in this case. Most reported patients with EB virus-positive plasmacytoma are in a state of immunosuppression, and this condition may fall within the category of other iatrogenic immunodeficiency-associated lymphoproliferative disorders. No other reports of plasmacytoma occurring in a background of RA or after TAC or MTX therapy have been made, and the present case is the first such report.

Asunto(s)

Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Herpesvirus Humano 4/aislamiento & purificación , Inmunosupresores/efectos adversos , Metotrexato/efectos adversos , Mieloma Múltiple/patología , Antirreumáticos/uso terapéutico , Femenino , Humanos , Inmunosupresores/uso terapéutico , Metotrexato/uso terapéutico , Persona de Mediana Edad , Mieloma Múltiple/etiología , Mieloma Múltiple/virología

Asunto(s)

Anemia Hemolítica/inducido químicamente , Azacitidina/efectos adversos , Hemólisis/efectos de los fármacos , Síndromes Mielodisplásicos/tratamiento farmacológico , Anciano , Anemia Hemolítica/sangre , Antimetabolitos Antineoplásicos/efectos adversos , Antimetabolitos Antineoplásicos/uso terapéutico , Azacitidina/uso terapéutico , Haptoglobinas/metabolismo , Humanos , Recuento de Leucocitos , Masculino , Reticulocitos/patología

RESUMEN

We retrospectively evaluated the clinical features, management, and survival of 12 patients (age 51-84 years) with localized primary testicular diffuse large B-cell lymphoma (PTL). All 12 PTL patients underwent orchiectomy. Seven of the 12 patients were treated with strategy A, which consisted of at least six cycles of rituximab (R) plus a CHOP-like regimen, central nervous system (CNS) prophylaxis involving intrathecal chemotherapy (IT) and/or high-dose intravenous methotrexate, and contralateral scrotal irradiation (cRT). The other five patients were treated with strategy B, which included three regimens: orchiectomy alone, orchiectomy plus cRT and IT, and orchiectomy plus 3-4 cycles of R-CHOP plus cRT with or without IT. The median follow-up period was 48 months (range 19-123 months). The 4-year progression-free survival (PFS) rate for the seven patients treated with strategy A was 85.7 %, whereas that for the five patients treated with strategy B was 20 %. The patients treated with strategy A exhibited a significantly higher 4-year PFS rate than those treated with strategy B (P = 0.017). These results confirmed that the administration of a sufficient number of cycles of an R-containing chemotherapy regimen plus cRT plus CNS prophylaxis should be considered as a treatment for localized PTL.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias del Sistema Nervioso Central , Linfoma de Células B Grandes Difuso , Neoplasias Testiculares , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales de Origen Murino/administración & dosificación , Neoplasias del Sistema Nervioso Central/mortalidad , Neoplasias del Sistema Nervioso Central/patología , Neoplasias del Sistema Nervioso Central/prevención & control , Neoplasias del Sistema Nervioso Central/secundario , Ciclofosfamida/administración & dosificación , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Estudios de Seguimiento , Humanos , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/terapia , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Radioterapia , Estudios Retrospectivos , Rituximab , Neoplasias Testiculares/mortalidad , Neoplasias Testiculares/patología , Neoplasias Testiculares/terapia , Vincristina/administración & dosificación

RESUMEN

A 39-year-old woman with a right frontal mass underwent a cranial bone tumor biopsy. Histopathologic examination of hematoxylin and eosin-stained slides showed spindle-shaped tumor cells in a storiform pattern, appearing somewhat like a sarcoma. However, the tumor cells were CD20-positive by immunohistochemical staining. Therefore, a diagnosis of spindle-shaped diffuse large B-cell lymphoma (Sp-DLBCL) was made. There have been at least 35 cases of Sp-DLBCL documented in the literature, and most were of the germinal center type, while the present case is the first report of a vimentin-positive primary Sp-DLBCL of the skull. The DLBCL in this case was immunohistochemically stained for six representative cytokines that might give rise to fibrosis, due to the evidence of fibroblastic proliferation. The DLBCL cells were positive for platelet-derived growth factor (PDGF), and some cells were also positive for tumor necrosis factor (TNF) α. Based on these findings, it was inferred that the PDGF and TNFα produced by DLBCL cells induced fibroblastic proliferation. The resultant conspicuous fibrosis caused interfibrous impingement on the DLBCL cells, which deformed them into a spindle shape. The present case is the first reported case of a PDGF-producing Sp-DLBCL.

Asunto(s)

Linfoma de Células B Grandes Difuso/patología , Factor de Crecimiento Derivado de Plaquetas/biosíntesis , Neoplasias Craneales/patología , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/análisis , Femenino , Fibrosis/patología , Humanos , Inmunohistoquímica , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/metabolismo , Neoplasias Craneales/metabolismo

RESUMEN

Plasmablastic lymphoma (PBL) is a rare B-cell neoplasm with an aggressive clinical behavior that predominantly occurs in the oral cavity of human immunodeficiency virus (HIV)-positive patients. HIV-negative PBL has not been extensively reported. A 65-year-old female presented with anemia, who was HIV-negative. Gastrointestinal fiberscope (GIF), and colon fiberscope (CF) were performed. However, we could not detect the bleeding sites. We detected the tumor by capsule endoscopy, and obtained the tumor cells from the duodenal and jejunal sites. The neoplastic cells were diffusely positive for CD56, epithelial membrane (EMA), CD4, λ, and EBV-encoded RNA1 (EBER1) and partially positive for CD138 and CD79a. This patient was diagnosed as PBL. The small intestine is a rare extra-oral site of involvement in PBL patients, and only four cases in HIV-negative patients have been reported.

Asunto(s)

Duodeno/patología , Neoplasias Intestinales/patología , Yeyuno/patología , Linfoma Inmunoblástico de Células Grandes/patología , Anciano , Femenino , Humanos , Inmunofenotipificación

RESUMEN

The patient, a 42-year-old man, was diagnosed as having an anterior mediastinal tumor. Examination of the resected tumor showed findings consistent with a primary thymic mucosa-associated lymphoid tissue lymphoma, stage IA. Postoperative (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography demonstrated fluorodeoxyglucose accumulation at the site of tumor excision. This accumulation was interpreted as representing a residual lesion, and the patient was treated with rituximab. The patient has since been in a state of complete remission for about 3 years. Sporadic mucosa-associated lymphoid tissue lymphoma cells that appeared to have a propensity for differentiating into plasma cells in this case were analyzed for IgG and IgG subclass expression by immunohistochemical staining. The mucosa-associated lymphoid tissue lymphoma cells that showed a propensity for differentiating into IgG-positive plasma cells were IgG3-positive and IgG1-, IgG2- and IgG4-negative. An increase in IgG3 or IgG1 expression in immune cells has been previously demonstrated in immune responses to continuous exposure to the same proteins or peptide antigens and most mucosa-associated lymphoid tissue lymphomas show increased IgG3 and/or IgG1 expression. It is consistent with the fact that inflammation due to stimulation by a pathogenic antigen is considered to be etiologically responsible for the development of mucosa-associated lymphoid tissue lymphoma.

Asunto(s)

Inmunoglobulina G/inmunología , Linfoma de Células B de la Zona Marginal/patología , Neoplasias del Timo/patología , Trisomía , Adulto , Cromosomas Humanos Par 18/genética , Cromosomas Humanos Par 3/genética , Humanos , Inmunohistoquímica , Linfoma de Células B de la Zona Marginal/inmunología , Masculino , Neoplasias del Mediastino/inmunología , Neoplasias del Mediastino/patología , Células Plasmáticas/inmunología , Células Plasmáticas/patología , Neoplasias del Timo/inmunología

RESUMEN

A 60-year-old man complained of nausea, vomiting, decreased appetite, and a feeling of abdominal fullness in August 2013. Based on biopsy findings from an upper gastrointestinal endoscopy examination, a diagnosis of non-Hodgkin's lymphoma (NHL), diffuse large B-cell lymphoma (DLBCL), non-GC type, was made. F18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed abnormal accumulations solely in the gastric wall (SUVmax = 14.5), the left adrenal gland (SUVmax = 14.3), and the right adrenal gland (SUVmax = 8.5). The clinical stage (Ann Arbor) was IVA, the serum LDH level was within the reference range, and the International Prognostic Index (IPI) was low-intermediate. The serum soluble IL-2 receptor level was within the reference range, and there was no evidence of HIV, EB virus, or autoimmune disease. After the completion of 4 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and 2 parallel cycles of prophylactic intrathecal (I.T.), an upper gastrointestinal endoscopy and a FDG-PET/CT examination showed complete remission (CR). The patient received 8 cycles of ritsuximab therapy, 6 cycles of CHOP, and 3 cycles of I.T. The patient has maintained a CR for about 14 months. A literature search revealed that malignant lymphoma with involvement confined to the adrenal gland and gastrointestinal tract is exceedingly rare, and only 3 cases of malignant lymphoma have been reported, with involvement of the stomach in 2 cases and the duodenum in 1 case. All of the cases were diagnosed as DLBCL. The case described herein represents the third case with involvement of the stomach.

Asunto(s)

Neoplasias de las Glándulas Suprarrenales/patología , Linfoma de Células B Grandes Difuso/patología , Neoplasias Gástricas/patología , Neoplasias de las Glándulas Suprarrenales/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Neoplasias Gástricas/tratamiento farmacológico

RESUMEN

Treatment of patients with multiple myeloma (MM) has drastically changed with the introduction of novel agents such as thalidomide, lenalidomide, and bortezomib, but treatment outcome of elderly patients has remained dismal mainly due to toxicities. We report an 82-year-old MM patient attaining stringent complete response (sCR) at 12 months with a daily dose of 100 mg of thalidomide monotherapy. She remains on thalidomide monotherapy and presently maintains a normalized serum free light chain ratio at 18 months. This is the first case of MM achieving sCR with thalidomide monotherapy, and shows that single-agent thalidomide can be effective and concomitant use of dexamethasone may not be necessary in frail elderly patients.

Asunto(s)

Mieloma Múltiple/tratamiento farmacológico , Talidomida/uso terapéutico , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Femenino , Humanos , Cadenas Ligeras de Inmunoglobulina/sangre , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/uso terapéutico , Mieloma Múltiple/inmunología , Talidomida/administración & dosificación , Resultado del Tratamiento

Asunto(s)

Antineoplásicos/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/metabolismo , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Anciano de 80 o más Años , Benzamidas , Resultado Fatal , Humanos , Mesilato de Imatinib , Masculino , Proteínas Proto-Oncogénicas c-kit

RESUMEN

Pleural effusion or ascites complicating plasmacytoma is rare and has a poor prognosis. A 70-year-old man was diagnosed as plasma cell leukemia and one course of ranimustine-vindesine, melphalan, and prednisolone followed by melphalan and prednisone (MP) maintained a very good partial response. After MP he was diagnosed to have pleural effusion and ascites as a complication of the plasmacytoma. Low-dose bortezomib caused disappearance of the malignant effusion. The malignant effusions recurred after the end of the second course of bortezomib. High-dose dexamethasone vincristine, doxorubicin, cyclophosphamide, and prednisone yielded no benefit, the patient died of Aspergillus pneumonia.

Asunto(s)

Antineoplásicos/administración & dosificación , Ascitis/tratamiento farmacológico , Ascitis/etiología , Ácidos Borónicos/administración & dosificación , Leucemia de Células Plasmáticas/complicaciones , Leucemia de Células Plasmáticas/tratamiento farmacológico , Derrame Pleural Maligno/tratamiento farmacológico , Derrame Pleural Maligno/etiología , Pirazinas/administración & dosificación , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Bortezomib , Resultado Fatal , Humanos , Masculino , Melfalán/administración & dosificación , Prednisona/administración & dosificación , Insuficiencia del Tratamiento

Asunto(s)

Neoplasias Encefálicas/patología , Linfocitos T CD4-Positivos/patología , Linfocitos T CD8-positivos/patología , Leucemia Linfocítica Granular Grande/patología , Linfocitos T/patología , Antineoplásicos/uso terapéutico , Resultado Fatal , Citometría de Flujo/métodos , Humanos , Leucemia Linfocítica Granular Grande/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad

RESUMEN

We developed a prediction model to distinguish between malignant and nonmalignant lymphadenopathies. We first analyzed clinical features of 222 patients with lymphadenopathy (161 malignant and 61 nonmalignant) in the derivation group. Through logistic regression analysis we identified 6 covariates that independently predict malignancy: age (X1), abdominal lymphadenopathy (X2), lymphadenopathy of the other sites (X3), number of enlarged lymph node regions (X4), absence of fever (X5), and largest lymph node size (X6). We determined the formula as follows: predictive score=-2.3+x1+2.8x2+1.3x3+1.6x4-2.2x5+1.8x6.A higher score correlated with increased likelihood of malignancy. With the cutoff value of 0.4, the sensitivity and specificity of the model were 91.9% and 77.0%, respectively. The validation study using 117 cases (82 malignant and 35 nonmalignant) yielded 90.2% sensitivity and 68.6% specificity. A maximum lymph node size of less than 2.0 cm on systemic computed tomography (CT) scanning indicated a low probability of malignant lymphadenopathy. In this model, 4 of the 6 covariates were obtained by CT scanning, which strongly indicates the usefulness of initial evaluation with systemic CT scanning in the detection of malignant lymphadenopathy.

Asunto(s)

Linfoma/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Algoritmos , Técnicas de Apoyo para la Decisión , Diagnóstico Diferencial , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad