Primary nodal peripheral T-cell lymphomas: diagnosis and therapeutic considerations

Nodal peripheral T-cell lymphomas are a rare group of neoplasms derived from post-thymic and activated T lymphocytes. A review of scientific articles listed in PubMed, Lilacs, and the Cochrane Library databases was performed using the term "peripheral T-cell lymphomas". According to the World Health Organization classification of hematopoietic tissue tumors, this group of neoplasms consists of peripheral T-cell lymphoma not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma-anaplastic lymphoma kinase positive (ALCL-ALK+), and a provisional entity called anaplastic large cell lymphoma-anaplastic lymphoma kinase negative (ALCL-ALK-). Because the treatment and prognoses of these neoplasms involve different principles, it is essential to distinguish each one by its clinical, immunophenotypic, genetic, and molecular features. Except for anaplastic large cell lymphoma-anaplastic lymphoma kinase positive, which has no adverse international prognostic index, the prognosis of nodal peripheral T-cell lymphomas is worse than that of aggressive B-cell lymphomas. Chemotherapy based on anthracyclines provides poor outcomes because these neoplasms frequently have multidrug-resistant phenotypes. Based on this, the current tendency is to use intensified cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) regimens with the addition of new drugs, and autologous hematopoietic stem cell transplantation. This paper describes the clinical features and diagnostic methods, and proposes a therapeutic algorithm for nodal peripheral T-cell lymphoma patients...

Time-to-treatment of diffuse large B-cell lymphoma in São Paulo

OBJECTIVE: Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma, accounting for nearly 50% of the cases in the Hematology Department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and Instituto do Câncer do Estado de São Paulo. The treatment outcome is influenced by age, abnormal lactate dehydrogenase levels, extranodal infiltration, the disease stage and the patient's performance status. In this study, we sought to report the time-to-treatment of diffuse large B-cell lymphoma in São Paulo's public health system network and its impact on patient outcomes. METHODS: We prospectively followed a cohort of 42 consecutive patients with de novo diffuse large B-cell lymphoma between 2008 and 2012. RESULTS: Our patients had more advanced disease than that reported in the literature (61.9% vs. 46%). In São Paulo's public health system network, it took an average of 7.4 months for a diagnosis to be made and an additional 1.4 months to obtain an appointment with a specialist. Once at our Hematology Department, it took less than 20 days for staging, confirmation of the diagnosis and treatment initiation. An interval from signs or symptoms to treatment of more than 6 months was associated with inferior progression-free survival in 3 years (p = 0.049). CONCLUSION: A delay in the diagnosis of diffuse large B-cell lymphoma is a public health problem and may be associated with worse progression-free survival. .

Synthetic nanoemulsion resembling a protein-free model of 7-ketocholesterol containing low density lipoprotein: In vitro and in vivo studies

7-ketocholesterol (7-KC) differs from cholesterol by a functional ketone group at C7. It is an oxygenated cholesterol derivative (oxysterol), commonly present in oxidized low-density lipoprotein (LDL). Oxysterols are generated and participate in several physiologic and pathophysiologic processes. For instance, the cytotoxic effects of oxidized LDL have been widely attributed to bioactive compounds like oxysterols. The toxicity is in part due to 7-KC. Here we aimed to demonstrate the possibility of incorporating 7-KC into the synthetic nanoemulsion LDE, which resembles LDL in composition and behavior. This would provide a suitable artificial particle resembling LDL to study 7-KC metabolism. We were able to incorpórate 7-KC in several amounts into LDE. The incorporation was evaluated and confirmed by several methods, including gel filtration chromatography, using radiolabeled lipids. The incorporation did not change the main lipid composition characteristics of the new nanoparticle. Particle sizes were also evaluated and did not differ from LDE. In vivo studies were performed by injecting the nanoemulsion into mice. The plasma kinetics and the targeted organs were the same as described for LDE. Therefore, 7-KC-LDE maintains composition, size and some functional characteristics of LDE and could be used in experiments dealing with 7-ketocholesterol metabolism in lipoproteins.

Reversão do fenótipo de resistência a múltiplas drogas em células de sarcoma uterino humano: utilização de emusão lipídica como veículo de oligonucleotídeos antissenso / Reversion of the multiple drug resistance phenotype in a human sarcomacell line: lipid emulsion as antisense oligonucleotide vector

O objetivo deste trabalho foi estudar a utilização de uma nanoemulsão lipídica (LDE) como vetor de oligonucleotídeos antissenso (OAS). Foi observado que o OAS se liga à LDE, sendo a constante de ligação de 4,2 X 10-3M-1. O complexo OAS/LDE se liga ao receptor de LDL e através desta via é internalizado, pelas células de sarcoma uterino resistentes a doxorrubicina. Os OAS apresentaram após 24 horas distribuição citoplasmática e nuclear e após 48 horas, somente citoplasmática. Utilizando-se dois diferentes OAS, verificou-se que ambos foram capaz de inibir (70 por cento) a expressão do gene de resistência a múltiplas drogas após 48 horas de incubação, tornando as células mais susceptíveis à ação da doxorrubicina. Assim, o complexo OAS/LDE é um sistema potencialmente promissor para ser utilizado em terapia gênica.

The objective of this study was to evaluate the usefulness of a nanolipid emulsion (LDE) as a vector to carry antisense olligonucleotide (OAS). We have observed that LDE was able to bind to the OAS; the binding constant was 4,2 X 10-3M-1. The complex was shown to bind to LDL receptors and then been internalized into a human sarcoma cell line resistant to doxirrubicine. After 24 hours the complex have shown citoplasmatic and nuclear distribution, after 48 hours only citoplasmatic distribution was observed. Two OAS were used. Both OAS strongly inhibited (by 70 per cent) the cell MDR-1 gene expression after 48 hours of incubation and cells turned out to be more susceptible to doxorrubicine action. Therefore, OAS/LDE is promising complex to be used in gene therapy studies.