ABSTRACT
Human parvovirus B19 [B19] exhibits a marked tropism to bone marrow, replicating exclusively in erythroid progenitor cells. Persistent B19 infection tends to occur in immunocompromised hosts and may manifest as pure red cell aplasia and chronic anemia. The aim of the present study was to assess the prevalence of B19 infection in patients with hematological malignancies receiving chemotherapy, and to highlight the relation between B19 infection and unexplained cytopenia[s]. The study included 30 adults and 18 children suffering from a variety of hematological malignancies and receiving chemotherapy. In addition, 10 healthy adults and 10 healthy children [age and sex matched as the studied patients] were included as controls. All patients had unexplained anemia, leukopenia, neutropenia and/or thrombocytopenia and had received a minimum of 4 courses of systemic chemotherapy. B19 infection was investigated both by serologic determination of specific IgG and detection of viral DNA in serum by nested PCR. IgG was detected in 24 [80%] adults and 11 [61.1%] children, while viral DNA was found in 16 [53.3%] adults and 5 [27.8%] children. Only one adult patient [3.3%] was positive for viral DNA and negative for IgG denoting an acute infection. Significant association was detected between unexplained anemia and IgG seropositivity in children. Meanwhile, unexplained thrombocytopenia was significantly associated with the presence of viral DNA in adults. In conclusion, patients with hematological malignancies receiving chemotherapy are at particular risk of persistent B19 infection. Moreover, it is important to consider B19 infection as a possible cause of unexplained cytopenia[s] in these patients. In such cases, administration of intravenous human immunoglobulin can reduce the viremia and correct the cytopenia[s]. Prospective studies are needed to define the serologic and clinical consequences of B19 infection in this group of patients
ABSTRACT
In the past, pseudomyxoma peritonei was considered an incurable disease and often no active treatment was given. With the advent of cyto-reductive surgery, including peritonectomy procedures and intra peritoneal chemotherapy, long-term survival of these patients became actually possible. To study the impact of the intraperitoneal hyperthermic chemotherapy [cisplatin], when locally administered in patients who presented with pseudomyxoma peritonei and were treated by extensive cyto-reductive surgery. Nine patients with and. peritoneal adenomucinosis or carcinomatosis arising from the appendix who presented with a clinical picture of pseudomyxoma peritonei were diagnosed, and treated by cyto-reductive surgery followed by 6 cycles of ultrasound-guided intraperitoneal hyperthermic cisplatin. Following aggressive surgical approach and intraperitoneal chemotherapy, 7 patients had 1 year disease free survival, achieved independent activity in daily living and had an improved quality of life. The other 2 patients developed recurrences at 8 and 10 months following the completion of treatment. No major [grade III] texicities were observed. Pseudomyxoma peritonei is a treatable condition that may result in long-term disease free survival. Successful management can be achieved by combining cyto-reductive surgery and intraperitoneal hyperthermic chemotherapy