RESUMO
Bone marrow biopsy is recommended for staging of classical Hodgkin lymphoma. The aim of this study was to compare bone marrow evaluation by histology with that obtained by (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET). One hundred and three cases of Classical Hodgkin Lymphoma were reviewed. All patients were submitted to FDG-PET evaluation. Bone marrow biopsy results were compared with clinical data and FDG-PET results. Ninety-one cases had available bone marrow biopsies. Overall, there were 16 positive and one suspect case. In five cases, the FDG-PET scan was positive and biopsy was negative: 1/5 was found to correspond to a bone fracture, 3/5 showed marked reactive bone marrow changes and in 1/5 no explanation for the discrepancy was found. FDG-PET showed high sensitivity, supporting the idea that when it is negative, biopsy could be avoided. Care should be taken in patients with a positive FDG-PET, where confirmation by bone marrow biopsy should be recommended.
Assuntos
Medula Óssea/patologia , Fluordesoxiglucose F18 , Doença de Hodgkin/diagnóstico , Tomografia por Emissão de Pósitrons , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Feminino , Doença de Hodgkin/patologia , Doença de Hodgkin/terapia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVES: The aim of this retrospective study was to investigate the results of T-cell large granular lymphocytic leukemia treatment with fludarabine by assessing the complete hematologic response, the complete molecular response, progression-free survival, and overall survival. METHODS: We evaluated the records of six patients with T-cell large granular lymphocytic leukemia who were treated with fludarabine as a first-, second-, or third-line therapy, at a dose of 40 mg/m², for three to five days per month and 6 to 8 cycles. RESULTS: Of the six patients investigated with T-cell large granular lymphocytic leukemia who were treated with fludarabine, five (83.3%) were female, and their median age was 36.5 years (range 18 to 73). The median lymphocyte level was 3.4 x 10(9)/L (0.5 to 8.9). All patients exhibited a monoclonal T-cell receptor gamma gene rearrangement at diagnosis. Two (33.3%) patients received fludarabine as first-line treatment, two (33.3%) for refractory disease, one (16.6%) for relapsed disease after the suspension of methotrexate treatment due to liver toxicity, and one (16.6%) due to dyspepsia. A complete hematologic response was achieved in all cases, and a complete molecular response was achieved in five out six cases (83.3%). During a mean follow-up period of 12 months, both the progression-free survival and overall survival rates were 100%. CONCLUSION: T-cell large granular lymphocytic leukemia demonstrated a high rate of complete hematologic and molecular response to fludarabine, with excellent compliance and tolerability rates. To confirm our results in this rare disease, we believe that fludarabine should be tested in clinical trials as a first-line treatment for T-cell large granular lymphocytic leukemia.
Assuntos
Antineoplásicos/uso terapêutico , Leucemia Linfocítica Granular Grande/tratamento farmacológico , Vidarabina/análogos & derivados , Adolescente , Adulto , Idoso , Feminino , Humanos , Leucemia Linfocítica Granular Grande/genética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Vidarabina/uso terapêutico , Adulto JovemRESUMO
OBJECTIVES: The aim of this retrospective study was to investigate the results of T-cell large granular lymphocytic leukemia treatment with fludarabine by assessing the complete hematologic response, the complete molecular response, progression-free survival, and overall survival. METHODS: We evaluated the records of six patients with T-cell large granular lymphocytic leukemia who were treated with fludarabine as a first-, second-, or third-line therapy, at a dose of 40 mg/m², for three to five days per month and 6 to 8 cycles. RESULTS: Of the six patients investigated with T-cell large granular lymphocytic leukemia who were treated with fludarabine, five (83.3%) were female, and their median age was 36.5 years (range 18 to 73). The median lymphocyte level was 3.4x10(9)/L (0.5 to 8.9). All patients exhibited a monoclonal T-cell receptor gamma gene rearrangement at diagnosis. Two (33.3%) patients received fludarabine as first-line treatment, two (33.3%) for refractory disease, one (16.6%) for relapsed disease after the suspension of methotrexate treatment dueto liver toxicity, and one (16.6%) due to dyspesia. A complete hematologic response was achieved in all cases, and a complete molecular response was achieved in five out six cases (83.3%). During a mean follow-up period of 12 months, both the progression-free survival and overall survival rates were 100%. CONCLUSION: T-cell large granular lymphocytic leukemia demonstrated a high rate of complete hematologic and molecular response to fludarabine, with excellent compliance and tolerability rates. To confirm our results in this rare disease, we believe that fludarabine should be tested in clinical trials as a first-line treatment for T-cell large granular lymphocytic leukemia.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antineoplásicos/uso terapêutico , Leucemia Linfocítica Granular Grande/tratamento farmacológico , Vidarabina/análogos & derivados , Leucemia Linfocítica Granular Grande/genética , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Vidarabina/uso terapêuticoRESUMO
While chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML) are common diseases in the elderly, they rarely occur simultaneously in the same patient. Here we present the case of a 77-year-old patient diagnosed with CML in the chronic phase who showed an optimal response to 400 mg/day of imatinib. This patient progressed to Binet B-CLL with an 11q22.3 deletion and CD38 positivity in the 4th month of treatment. During the follow-up, his lymphocyte number doubled in <6 months. Based on previous reports, dasatinib was chosen instead of imatinib. After 6 months of treatment with 100 mg/day of dasatinib, the patient demonstrated a partial response, characterized by the regression of lymph node enlargement, a hemoglobin level of 10.7 g/dl, neutrophils of 1.7 × 10(9)/l, a 82% reduction in the lymphocyte number and an increase in cytotoxic CD8+ and large granular lymphocytes. This partial response has persisted to the present time. While little data have been published regarding the in vitro effect of dasatinib monotherapy for CLL, this case report provides some evidence of the clinical activity of dasatinib in CLL.
Assuntos
Leucemia Linfocítica Crônica de Células B/complicações , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Inibidores de Proteínas Quinases/administração & dosagem , Pirimidinas/administração & dosagem , Tiazóis/administração & dosagem , Idoso , Biópsia , Dasatinibe , Humanos , Leucemia Linfocítica Crônica de Células B/patologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Masculino , Resultado do TratamentoRESUMO
Paracoccidioides brasiliensis rarely shows bone marrow involvement and its response to treatment with itraconazole in children needs further assessment. We describe here a child with a juvenile disseminated form of paracoccidioidomycosis, which showed reticuloendothelial system involvement and the presence of Paracoccidioides brasiliensis in the bone marrow. The patient showed an effective and rapid response to itraconazole therapy.
Assuntos
Medula Óssea/microbiologia , Osteomielite/diagnóstico , Osteomielite/microbiologia , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/complicações , Antifúngicos/uso terapêutico , Biópsia , Medula Óssea/patologia , Criança , Feminino , Histocitoquímica , Humanos , Itraconazol/uso terapêutico , Linfonodos/patologia , Microscopia , Osteomielite/tratamento farmacológico , Osteomielite/patologia , Paracoccidioidomicose/tratamento farmacológico , Resultado do TratamentoRESUMO
Estudo retrospectivo que visa analisar a utilidade da biópsia de medula óssea (BMO) bilateral na infiltração de medula óssea (MO) por linfoma difuso de grandes células B (LDGCB). Nossos objetivos foram avaliar a incidência de infiltração unilateral de MO por LDGCB e comparar o comprimento dos fragmentos obtidos entre as amostras positivas e negativas para infiltração. Além disso, verificamos se houve diferença entre os casos com infiltração unilateral versus bilateral, correlacionando com desidrogenase láctica (DHL) e estadiamento tomográfico. Avaliamos 268 casos de LDGCB e observamos infiltração medular em 34 casos (13 por cento). Não foi possível a avaliação de seis casos, restando 28 casos para análise. Foram revisados no total 70 fragmentos de MO sobre presença ou ausência de infiltração e comprimento. A média do número de fragmentos por casos foi 2,5; a média do comprimento dos fragmentos foi 11,01 mm (± 5,12 mm), e a média do comprimento dos fragmentos por caso foi 27,53 mm. Foi observado que em seis casos (21,4 por cento) havia infiltração unilateral. Não foram evidenciadas diferenças nas médias do comprimento dos fragmentos em relação à presença versus ausência de infiltração 10,95 mm (± 5,1 mm) versus 11,57 mm (± 5,2 mm), p > 0,05, respectivamente. Não foram evidenciadas diferenças em 23 casos entre a comparação da infiltração medular unilateral versus bilateral com DHL e estadiamento tomográfico. Concluímos que a BMO bilateral foi superior à unilateral, pois pode aumentar a detecção de infiltração de MO em 21,4 por cento dos casos.
This retrospective study aims to analyze the usefulness of bilateral bone marrow biopsy in bone marrow infiltration by diffuse large B-cell lymphoma (DLBCL). Our objectives were to assess the incidence of unilateral BM involvement by DLBCL and compare fragment length obtained from positive and negative samples for infiltration. Furthermore, we compared the differences between unilateral and bilateral infiltration correlating with lactic dehydrogenase (LDH) and computerized tomography (CT) staging. We evaluated 268 cases of DLBCL and observed medullary infiltration in 34 cases (13 percent). It was not possible to evaluate 6 out of 34 cases. 70 BM fragments were reviewed as to the presence or absence of infiltration and length. The mean number of fragments per case was 2.5; the mean BM fragment length was 11.01 mm (± 5.12 mm) and the mean BM fragment length per case was 27.53 mm. There was unilateral BM infiltration in six cases (21.4 percent). There were no differences in the mean fragment length as to the presence/absence of infiltration 10.95 mm (± 5.2 mm) versus 11.57 mm, p > 0.05, respectively. There were no differences in 23 cases between the comparison of unilateral medullary infiltration versus bilateral with lactic dehydrogenase and CT staging. We concluded that bilateral bone marrow biopsy was superior to unilateral because it may increase by 21.4 percent the detection of BM involvement by DLBCL.
Assuntos
Humanos , Masculino , Feminino , Biópsia , Invasividade Neoplásica/diagnóstico , Linfoma Difuso de Grandes Células B/patologia , Estadiamento de Neoplasias , Exame de Medula Óssea/métodos , Medula Óssea/patologia , Estudos RetrospectivosRESUMO
O Linfoma de Hodgkin (LH) clássico tem origem em Linfócito B do Centro Germinativo. Contudo, a célula neoplásica nem sempre expressa, em reações imunoistoquímicas, os antígenos de células 8. Há relatos conferindo a este imunofenótipo doença mais agressiva, enquanto outros mostram a mesma evolução clínica. Tem-se por objetivo relacionar as características clinicas, histológicas e evolutivas do LH clássico com imunofenótipo B. A determinação do imunofenótipo 8 foi feita pela pesquisa de CD20 e a detecção de infecção pelo vírus Epstein-8arr (E8V) pela pesquisa de LMP-1, ambas por métodos imunoistoquímicos. Foram analisados 238 pacientes, de 3 a 91 anos de idade, 58% do sexo masculino e 42% do sexo feminino, atendidos no Hospital do Câncer entre 1980 e 2000. O tipo esclerose nodular correspondeu a 49%; celularidade mista, 36%; depleção linfocitária, 2,5%; rico em linfócitos, 2% e 10,5% não foram classificados. O CD20 foi positivo em 13,8% dos casos, apresentando associação estatisticamente significativa com sexo (p=0,008), idade (p=0,043), celularidade mista (p=0,006) e E8V (p<0,001 ). Na análise multivariada somente a associação com o EBV foi fator independente associado à expressão de CD20 (p=0,034). A evolução clínica, medida pela sobrevida livre de doença (SLD) e pela sobrevida global (SG), foi semelhante nos dois grupos, exceto na faixa etária de 21 a 40 anos, onde a expressão de CD20 relacionou-se com e menor SG (p=0,018). O presente estudo permite inferir que a expressão imunoistoquímica de CD20 em LH clássico, quando comparado com os casos CD20 negativos, é mais comum em pacientes de sexo masculino, acima de 41 anos, do tipo histológico celularidade mista e em casos de LH associados com o EBV. Esta expressao nao teve influência na SLD e na SG, exceto em pacientes do grupo etário de 21 a 40 anos, onde a presença de CD20 nas células neoplásicas correlacionou-se a pior SG.
Classical Hodgkin Lymphoma {HL) originates in germinai center 8-cell. Nevertheless, the neoplastic cell does not always express B cell antigens in immunohistochemical reactions. There are reports showing a more aggressive disease on this immunophenotype, while others show the same clinicai course. The objective of this study isto associate, histological features and clinicai outcome of classical HL with immunophenotype B. lmmunophenotype B was determined by CD20 and Epstein-Barr virus {EBV) infection by LMP-1 expression, both by immunohistochemical methods. The study analyzed 238 patients ranging in age from 3 to 91, {58% male and 42% female), treated at the "Hospital do Câncer" between 1980 and 2000. The cases were further classified as nodular sclerosis 49%, mixed cellularity 36%, lymphocyte depletion 2.5%, rich in lymphocytes 2% and non-classified 10.5%. CD20 was positive in 13.8 % of cases, with statistically significant gender linkage (p=0.008), age (p=0.043), mixed cellularity subtype (p=0.006) and EBV positive {p<0.001). In the multivariate analysis only the association with EBV was an independent factor associated to expression of CD20 (p=0.034). Clinicai evolution, measured by failure-free survival of the disease (FFS) and by overall survival (OS), was similar in both groups, except in the 21-40 age group, in which the CD20 expression was related to a lower OS (p=0.018). This study allows us to inter that the CD20 immunohistochemical expression in classical HL when compared to negative CD20 cases, is more common in males over 41, of the mixed cellularity subtype and in cases linked to EBV. This expression did not affect FFS nor OS, except in the 21-40 year old group, in whom the presence of CD20 in neoplastic cells correlated with a worse OS.