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1.
Article in Chinese | WPRIM | ID: wpr-934403

ABSTRACT

Objective:To detect the expression of receptor tyrosine kinase-like orphan receptor 1 (ROR1) antigen in chronic lymphocytic leukemia (CLL) and evaluate its diagnostic value and explore its correlation with the abnormalities of genetics and molecular biology.Methods:All of 209 newly diagnosed B-cell chronic lymphoproliferative disorders (B-CLPD) patients who were admitted to the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People′s Hospital) from November 2020 to November 2021 were collected retrospectively, including 70 cases of CLL with typical phenotype, 16 cases of CLL with atypical phenotype, 14 cases of MCL, and 109 cases of other types of B-CLPD. Multi-parameter flow cytometry (FCM) was used to detect the expression levels of ROR1 in tumor cells of 209 patients. And then the diagnostic value of ROR1 in CLL patients and its correlation with the genetic and molecular biological abnormalities were analyzed by c2 test and fourfold table assessment.Results:The positive expression rate of ROR1 in CLL patients was significantly higher than that in non-CLL patients (78%>11%, P<0.001); there was no significant difference of ROR1 expression between typical phenotype CLL and atypical phenotype CLL (81%>63%, P>0.05). The positive expression rate of ROR1 in atypical phenotype CLL was significantly higher than that in MCL (63%>21%, P<0.05). Additionally, there was significant difference in detection rate of chromosomal abnormalities between ROR1 +CLL group and ROR1 -CLL group. The detection rate of complex karyotype in ROR1 +CLL group was higher than that in ROR1 -CLL group (34%>14%, P<0.05). The CLL patients over 60 years old had higher ROR1 positive rate ( P<0.05). Conclusions:ROR1 can be helpful in the diagnosis of CLL, especially in the differential diagnosis of atypical phenotype CLL, MCL and other types of B-CLPD. Patients with ROR1 positive expression were older and more likely to detect complex chromosomal karyotypes.

2.
Iatreia ; 34(4): 370-374, oct.-dic. 2021. graf
Article in Spanish | LILACS | ID: biblio-1350837

ABSTRACT

RESUMEN Las alteraciones genéticas en el gen TP53 están presentes entre el 5 al 8 % de los pacientes de leucemia linfocítica crónica (LLC) en el momento del diagnóstico. Estos casos se relacionan con un mal pronóstico debido a su resistencia al tratamiento estándar. Presentamos el caso de un paciente masculino de 52 años diagnosticado con LLC, expresión del marcador CD38 y una deleción en el gen TP53 (17p13.1). Tras la evaluación posterior del tratamiento, se observó enfermedad mínima residual lo que llevó a un trasplante haploidéntico de progenitores hematopoyéticos. Debido al alto riesgo de recaída, su edad y la ausencia de comorbilidades, era la única opción curativa hasta la fecha para la LLC. El objetivo de este trabajo es realizar una revisión de la literatura que sirva como base para analizar el caso clínico presentado, en el marco de las implicaciones clínicas, pronóstico y respuesta al tratamiento en los individuos con LLC que presentan alteraciones en el gen TP53.


SUMMARY Genetic alterations in the TP53 gene are present in 5 to 8% of chronic lymphocytic leukemia (CLL) cases at the time of diagnosis. These cases are typically associated with poor prognosis due to their resistance against standard CLL treatment. In our report a 52-yearold male patient was diagnosed with CLL, CD38 expression and a deletion in the TP53 gene (17p13.1). Upon evaluation post-treatment, minimal residual disease (MDR) was observed, and a haploidentical stem cell transplant was performed. Because of the high risk of relapse, his age, and the absence of comorbidities it was the only curative option to date for CLL. The purpose of this article is to complete a literature review that will give a basis to analyze the clinical case presented, within the framework of the clinical implications, prognosis, and response to treatment in patients with CLL who present with aberrations of the TP53 gene.


Subject(s)
Humans , Leukemia, Lymphocytic, Chronic, B-Cell , Genes, p53 , Research Report
3.
Journal of Leukemia & Lymphoma ; (12): 665-669, 2021.
Article in Chinese | WPRIM | ID: wpr-907232

ABSTRACT

Objective:To investigate the clinical efficacy and safety of ibrutinib in treatment of chronic lymphocytic leukemia (CLL).Methods:The clinical data of 68 patients with CLL in Fujian Medical University Union Hospital from May 1998 to October 2019 were retrospectively analyzed, including 39 cases receiving ibrutinib as the first therapy, 20 cases receiving ibrutinib as the second therapy, and 9 cases receiving ibrutinib as the second and above therapy. The clinical characteristics, IGHV gene mutation, the short-term therapeutic efficacy and survival of patients with stratified chromosomal karyotype were analyzed; the adverse events were also analyzed.Results:The median follow-up time was 53.2 months until May 2020. The objective remission rate (ORR) was 83.8% (57/68), including 8 cases (11.8%) of complete remission, 49 cases (72.1%) of partial remission, 5 cases (7.4%) of the stable disease, 6 cases (8.8%) of progression of the disease. The ORR of patients without IGHVmutation was higher than that of those with IGHV mutation [93.3% (28/30) vs. 76.3% (29/38), χ2=33.656, P<0.05]; the ORR of patients with low risk and low-moderate risk International Prognostic Index (IPI) score was higher than that of those with moderate-high risk and high risk [90.6% (29/32) vs. 77.8% (28/36), χ2=7.248, P = 0.007], and differences in the ORR of patients stratified by other factors were not statistically significant (all P > 0.05). Among 68 patients, 31 cases (45.6%) had adverse reactions and they insistently received the treatment; 26 cases (38.2%) had grade1-2 adverse reactions, 5 cases (7.4%) had grade 3 and above adverse reactions; 2 cases (2.9%) had drug withdrawal because of adverse reactions. The median progression-free survival (PFS) time and overall survival (OS) time of CLL patients treated with ibrutinib had not been reached. The 5-year PFS rate of patients with IGHV mutation was higher than that of patients with IGHV non-mutation (100.0% vs.72.1%, P = 0.020), the 5-year PFS rate of patients with normal chromosome karyotype was higher than that of those with abnormal chromosome karyotype (100.0% vs.74.3%, P = 0.019). Conclusion:Ibrutinib is effective and safe in treatment of CLL patients.

4.
Journal of Leukemia & Lymphoma ; (12): 380-384, 2021.
Article in Chinese | WPRIM | ID: wpr-907187

ABSTRACT

Chronic lymphocytic leukemia (CLL) is a heterogeneous, mature B-cell clonal malignancy that mainly affects the senior. The immunotherapies such as chimeric antigen receptor T cell therapy, bi/tri-specific cell binding agent, immune check point therapy, etc., pave several new avenues for CLL treatment, especially the combined applications of new and existing therapies have shown improved efficacy and safety. This article attempts to review the immunotherapies and their combinatorial applications in CLL.

5.
Journal of Leukemia & Lymphoma ; (12): 321-324, 2021.
Article in Chinese | WPRIM | ID: wpr-907176

ABSTRACT

Chronic lymphocytic leukemia (CLL) is a kind of B-cell chronic lymphoproliferative disease. At present, the common clinical treatment regimens (such as FCR, BR, ibrutinib, etc.) have showed good therapeutic effects, but recurrence and progression still occur in some patients. In order to further improve the efficacy, the new combination therapies for CLL are continuously emerging. This article summarizes the treatment progress of CLL in combination with the related reports at the 62nd American Society of Hematology Annual Meeting.

6.
Article in Spanish, English | LILACS-Express | LILACS | ID: biblio-1177979

ABSTRACT

Introducción. La identificación y el tratamiento de pacientes con hiperpotasemia son necesarios para prevenir el desarrollo de arritmias. La pseudohiperpotasemia se debe más comúnmente a la hemólisis de la muestra y a menudo es reconocida por los laboratoristas que posteriormente informan los resultados de las pruebas con advertencias de precaución. Los autores presentan un caso de pseudohiperpotasemia en un paciente con leucemia linfocítica crónica. Reporte de caso: los factores técnicos y el método de transporte son una causa potencial de pseudohiperpotasemia. La pseudohiperpotasemia se ha asociado también con hiperleucoctosis, en poblaciones de pacientes con cáncer, más comúnmente en Leucemia linfocítica crónica en adultos, pero también con leucemia linfoblástica aguda en niños. Esto pone al paciente en riesgo de tratamientos innecesarios y potencialmente peligrosos. Conclusión: Los médicos deben considerar la pseudohiperpotasemia como la causa subyacente de los niveles elevados de potasio en pacientes con leucocitosis maligna que no presentan signos o síntomas de hiperpotasemia sistémica.


Introduction. The identification and treatment of patients with hyperkalemia is necessary to prevent the development of arrhythmias. Pseudohyperkalemia is most commonly due to specimen haemolysis and is often recognised by laboratory scientists who subsequently report test results with cautionary warnings. The authors present a case of pseudohyperkalemia in a patient with chronic lymphocytic leukaemia. Report case: the technical factors and method of transport are a potential cause of pseudohyperkalemia. Pseudohyperkalemia has been associated with hyperleukoctosis, in cancer patient populations, more commonly in CLL in adults, but also acute lymphoblastics leukemia in children. This places the patient at risk of unnecessary and potentially dangerous treatments. Conclusion: Physicians should consider pseudohyperkalemia as the underlying cause of elevated potassium levels in patients with malignant leucocytosis who do not have signs or symptom of systemic hyperkalemia.

7.
An. bras. dermatol ; 95(3): 336-339, May-June 2020. graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1130869

ABSTRACT

Abstract Acquired reactive perforating collagenosis is a rare skin disorder characterized by the presence of umbilicated pruritic papules and nodules. Transepidermal elimination of altered and perforating bundles of basophilic collagen from the epidermis is a characteristic histologic feature of acquired reactive perforating collagenosis. Along with its well-known association with systemic diseases such as diabetes mellitus, chronic renal failure, and dermatomyositis, there are reports of acquired reactive perforating collagenosis being associated with malignancies. Herein, we present a case of acquired reactive perforating collagenosis associated with chronic lymphocytic leukemia, prostate adenocarcinoma, and Graves's disease. Clinicians are required to be more vigilant in evaluating patients with acquired reactive perforating collagenosis due to its unique association with malignancies and other systemic diseases.


Subject(s)
Humans , Male , Aged , Prostatic Neoplasms/complications , Skin Diseases/complications , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Adenocarcinoma/complications , Graves Disease/complications , Collagen Diseases/complications , Skin Diseases/pathology , Collagen , Collagen Diseases/pathology
8.
Chinese Journal of Hematology ; (12): 143-148, 2020.
Article in Chinese | WPRIM | ID: wpr-799583

ABSTRACT

Objective@#To study the value of unmethylated cytosine guanine dinucleotide oligodeoxynucleotide (DSP30) and IL-2 in the conventional cytogenetic (CA) detection of the chromosomal aberrations in chronic lymphocytic leukemia (CLL) .@*Methods@#Bone marrow or peripheral blood cells of CLL patients were cultured with DSP30 plus IL-2 for 72 h, following which R-banding analysis was conducted. Fluorescence in situ hybridization (FISH) was performed in 85 patients. CA results were compared with data obtained by FISH.@*Results@#Among 89 CLL patients, the success rate of chromosome analysis was 94.38% (84/89) . Clonal aberrations were detected in 51 patients (51/84, 60.71%) . Of them, 27 (27/51, 52.94%) were complex karyotype. Among 85 CLL patients tested by FISH, chromosomal abnormalities were detected in 74 (74/85, 87.06%) patients, of which 2 (2/74) patients were complex karyotypes, accounting for 2.70%. Of the 85 CLL patients examined by FISH, 50 had abnormal karyotype analysis, 30 had normal karyotype, 5 failed to have chromosome analysis. Among them, 25 cases showed clonal aberrations by FISH assay but normal by CA, and 4 cases were normal by FISH but displayed aberrations in chromosome analysis, and totally 78 (91.76%) cases with abnormality detected by the combination of the two methods. The frequency of 13q- abnormality detected by FISH was significantly higher than that by CA analysis (69.41%vs 16.67%, P<0.001) , while the frequency of 11q-,+12 and 17p- detected by two methods showed no significant difference (P>0.05) . The detection rate of complex abnormalities in conventional karyotype analysis was higher than that in FISH (50.98%vs 2.70%) . In addition, 11 low-risk and 9 intermediate-risk patients according to FISH results showed complex karyotype by cytogenetics, and were classified into high-risk cytogenetic subgroup.@*Conclusion@#DSP30 and IL-2 are effective in improving the detection rate of CA in CLL patients (60.71%) and CA is more effective to detect complex karyotype. However, FISH had a higher overall abnormality detection rate (87.06%) than CA, especially for 13q-. The combination of CA and FISH not only enhanced the detection rate of clonal aberrations to 91.76%, but also provided more precise prognosis stratification for CLL patients, thus to provide more information for clinical implication.

9.
Article in Chinese | WPRIM | ID: wpr-799292

ABSTRACT

Objective@#To investigate the clinical features, diagnosis, occurrence sequence and clonal origin of chronic lymphocytic leukemia complicated with multiple myeloma.@*Methods@#The diagnosis and treatment of one patient with multiple myeloma and chronic lymphocytic leukemia who was admitted to the First Hospital of Jilin University in May 2018 was retrospectively analyzed, and the related literatures were reviewed.@*Results@#This patient began with lumbosacral pain, and he was diagnosed as chronic lymphocytic leukemia complicated with multiple myeloma after bone marrow aspiration, flow cytometry, and blood and urine immunofixation electrophoresis. It is recommended that Rd (lenalidomide + dexamethasone) or MPV (melphalan + prednisone + bortezomib) regimen, but the patient did not receive chemotherapy and died of infectious diarrhea 1 month later.@*Conclusions@#The occurrence of multiple myeloma and chronic lymphoblastic leukemia may originate from the same clone or different new clone. It is very rare that multiple myeloma and chronic lymphoblastic leukemia can co-occur. Therapeutic options tend to be more aggressive multiple myeloma-based regimen.

10.
Article in Chinese | WPRIM | ID: wpr-799282

ABSTRACT

Bendamustine, a bifunctionnal molecule with alkylating agent and antimetabolites properties, has shown a better efficacy in many pathological types of lymphomas. Many studies have shown the better efficacy of bendamustine with or without other agents in the treatment of lymphomas including indolent non-Hodgkin lymphoma, chronic lymphocytic leukemia, mantle cell lymphoma. In 2008, bendamustine was approved by Food and Drug Administration of the United States for the treatment of patients with rituximab-resistant indolent non-Hodgkin lymphoma and chronic lymphocytic leukemia. However, bendamustine was not approved for the treatment of lymphomas in China unitil 2018, and most physicians had little clinical experience on the use of this agent. Based on the results of clinical trials of bendamustine in China and the relevant domestic and foreign literatures, the Chinese hematologists and oncologists developed the Chinese expert consensus on bendamustine for the treatment of lymphomas (2020 version).

11.
Autops. Case Rep ; 9(3): e2019090, July-Sept. 2019. ilus, graf
Article in English | LILACS | ID: biblio-1020995

ABSTRACT

Richter transformation (RT), or Richter syndrome, is defined as the transformation of chronic lymphocytic leukemia (CLL) to an aggressive B-cell lymphoma. The vast majority, up to 99%, transform into diffuse large B-cell lymphoma (DLBCL), with a small subset (<1%) becoming classical Hodgkin lymphoma. Approximately half of RT cases progress through a pathway involving dysregulation of C-MYC. High-grade B-cell lymphoma (HGBL) is a recent diagnostic category of aggressive B-cell lymphomas set forth in the updated 2017 WHO Classification of Hematopoietic and Lymphoid Tissues. HGBL with MYC and BCL2 and/or BCL6 rearrangements, formerly "double-hit" and "triple-hit" lymphomas, comprise the majority of HGBL cases. Patients with HGBL have a worse prognosis than those with diffuse large B-cell lymphoma. We present a case of RT with rearrangements of MYC and BCL6. To our knowledge, there are no reported cases of RT with a "double-hit" lymphoma genotype.


Subject(s)
Humans , Male , Middle Aged , Lymphoma, Large B-Cell, Diffuse/pathology , Lymphoma, Non-Hodgkin , Leukemia, Lymphocytic, Chronic, B-Cell , Cytogenetics
12.
Chinese Journal of Hematology ; (12): 388-392, 2019.
Article in Chinese | WPRIM | ID: wpr-810636

ABSTRACT

Objective@#To investigate whether high-dose methylprednisolone with Rituximab and fresh frozen plasma (HDMP+RTX+FFP) is an effective therapy for patients with B-cell chronic lymphoproliferative disorders (B-CLPD) with TP53 abnormalities.@*Methods@#Six B-CLPD patients with TP53 abnormalities from May 2008 to May 2012 were prospectively enrolled in the study. The patients were treated with HDMP+RTX+FFP for up to 6 cycles.@*Results@#Of the six B-CLPD patients, there were 4 cases of chronic B-cell lymphoproliferative disorders-unclassified (B-CLPD-U) , 1 B-cell prolymphocytic leukemia (B-PLL) and 1 mantle cell lymphoma (MCL) . After a median 3 courses of treatment, 4 patients achieved complete remission (CR) including 3 with undetectable minimal residual disease (MRD-) . One patient was evaluated as stable disease (SD) and another one patient was in disease progression (PD) . After a median follow-up of 30 (4-56) months, 2 non-responders progressed quickly and died. All of CR patients survived and no one succumbed to disease progression at the last follow-up. The hematopoietic function was significantly improved after the treatment whereas there was also significant decrease in serum IgA, IgG and IgM levels. All patients showed well tolerance to this regimen. The incidence of myelosuppression was low and adverse events (AE) were mainly neutropenia which did not exceed grade 3 and infection. All AE were controllable.@*Conclusion@#HDMP+RTX+FFP is an effective and relatively tolerable therapy for patients with B-CLPD accompanying with TP53 abnormalities.

13.
Chinese Journal of Hematology ; (12): 378-383, 2019.
Article in Chinese | WPRIM | ID: wpr-810634

ABSTRACT

Objective@#To analyze the survival and first-line immune-chemotherapy (CIT) of chronic lymphocytic leukemia (CLL) with abnormal TP53 gene in the era of traditional CIT.@*Methods@#The clinical data of 118 CLL patients diagnosed from January 2003 to August 2017 were collected. Survival was analyzed according to indicators including sex, age, Binet risk stratification, B symptoms, β2-microglobulin (β2-MG) , immunoglobulin heavy chain variable region gene (IGHV) mutation status, chromosome karyotype and TP53 gene deletion/mutation. The efficacy of first-line CIT of 101 CLL patients was further analyzed.@*Results@#Among 118 patients, median progression-free survival (PFS) was 12 (95%CI 10.148-13.852) months and median overall survival (OS) was 53 (95%CI 41.822-64.178) months, only 30.5% patients survived over 5 years. Low β2-MG<3.5 mg/L indicated longer PFS (P=0.027) , female and Binet A patients had longer OS (P=0.011 and 0.013, respectively) . Of 118 patients, 17 (14.4%) didn’t receive any therapy until follow-up time or the dead time. Among the 101 patients who received ≥1 CIT, median time to first treatment (TTFT) was 1 (0-62) months, patients in Binet A had longer TTFT (P<0.001) compared to the patients in Binet B/C. According to statistical needs, we divided those first-line CIT into four groups: there were 30 cases (29.7%) in mild chemotherapy group (mainly treated with nitrogen mustard phenylbutyrate or rituximab alone) , 32 cases (31.7%) in the fludarabine-containing group, 23 cases (22.8%) in high-dose methyprednisolone (HDMP) containing group and 16 cases (15.8%) in the other chemotherapy group. The first regimen contained HDMP can bring longer PFS (P<0.001) , however the OS between four groups had no statistical differences.@*Conclusion@#CLL patients with abnormal TP53 gene had poor response to immunotherapy, rapid clinical progressing, first-line immunotherapy containing HDMP can prolong PFS and will create an opportunity for patients to participate in clinical trials of novel drugs.

14.
Article in Chinese | WPRIM | ID: wpr-753687

ABSTRACT

Chronic lymphocytic leukemia(CLL) is a heterogeneous mature B lymphocytic tumor.The apoptosis of mature lymphocyte is inhibited and clonal proliferation of mature lymphocyte aggregates in blood,bone marrow,spleen and lymph nodes,resulting in a class of inert hematological tumors.At present,the clinical pathogenesis is not completely clear,environmental and occupational factors do not occupy a major position. Studies have shown that long -term exposure to low-frequency electromagnetic fields may be associated with its incidence,but patients with primary and secondary relatives of lymphatic malignancies increased incidence. Many families still have patients whose age is earlier and the disease is more serious.In recent years,with the continuous improvement of medical level,a variety of treatment methods for chronic lymphoblastic leukemia have emerged,including a variety of new drugs.Ibutinib is the world's first marketed Bruton's tyrosine kinase(BTK) inhibitor,for more patients with chronic lymphoblastic leukemia has brought the gospel.This article reviews the clinical research progress of ibrutinib in treating CLL.

15.
Journal of Leukemia & Lymphoma ; (12): 434-437, 2019.
Article in Chinese | WPRIM | ID: wpr-751420

ABSTRACT

As a novel molecular targeted anti﹣tumor drug, it has been proved that ibrutinib has remarkable anti﹣tumor activity and is characterized by high efficiency and low toxicity. However, the risks of drug resistance, safety, and disease transformation are gradually concerned. This review focused on the research progress of ibrutinib′s drug resistance mechanism in various B﹣cell non﹣Hodgkin lymphomas.

16.
Article in Chinese | WPRIM | ID: wpr-802677

ABSTRACT

Chronic lymphocytic leukemia(CLL) is a heterogeneous mature B lymphocytic tumor.The apoptosis of mature lymphocyte is inhibited and clonal proliferation of mature lymphocyte aggregates in blood, bone marrow, spleen and lymph nodes, resulting in a class of inert hematological tumors.At present, the clinical pathogenesis is not completely clear, environmental and occupational factors do not occupy a major position.Studies have shown that long-term exposure to low-frequency electromagnetic fields may be associated with its incidence, but patients with primary and secondary relatives of lymphatic malignancies increased incidence.Many families still have patients whose age is earlier and the disease is more serious.In recent years, with the continuous improvement of medical level, a variety of treatment methods for chronic lymphoblastic leukemia have emerged, including a variety of new drugs.Ibutinib is the world's first marketed Bruton's tyrosine kinase(BTK) inhibitor, for more patients with chronic lymphoblastic leukemia has brought the gospel.This article reviews the clinical research progress of ibrutinib in treating CLL.

17.
Article in Chinese | WPRIM | ID: wpr-732675

ABSTRACT

Chronic lymphocytic leukemia (CLL) is one of the common lymphoid malignancies. Single agent ibrutinib has 74% progression-free survival (PFS) rate in RESONATE-2 trial, but ibrutinib-based therapy combined with obinutuzumab or rituximab in recent iLLUMINTE trial and ALLIANCE trail have 79% and 88% PFS rate respectively, which brings encouraging results. New inhibitors and chimeric antigen receptor T-cell (CAR-T) immunotherapy provide new treatment regimens for CLL patients who relapsed after receiving ibrutinib. The clinical trials have been done in phase Ⅰ/Ⅱ.

18.
Biomédica (Bogotá) ; 38(3): 298-302, jul.-set. 2018. graf
Article in Spanish | LILACS | ID: biblio-973982

ABSTRACT

RESUMEN El linfoma linfocítico de células pequeñas es una neoplasia de células B maduras con un amplio espectro de presentaciones clínicas. Las infecciones por gérmenes oportunistas no asociadas con el tratamiento, incluso en estadios avanzados de la enfermedad, tienen baja incidencia. Se han reportado muy pocos casos de pacientes con linfoma linfocítico de células pequeñas asociado a histoplasmosis diseminada que no habían recibido quimioterapia en el momento del diagnóstico. Se presenta el caso de una paciente de 82 años que fue hospitalizada por presentar tos seca intermitente, astenia y adinamia de un mes de evolución. Se le practicaron múltiples estudios para detectar infecciones o compromiso inmunológico o reumático, y se diagnosticó un síndrome adenopático extenso con compromiso cervical, torácico y retroperitoneal. En la citometría de flujo y en la biopsia de ganglio linfático cervical, se reportaron los fenotipos CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg y CD10neg, con restricción de la cadena ligera kappa, lo cual confirmó un linfoma linfocítico de células pequeñas. En la histopatología del ganglio, se observaron granulomas epitelioides sin necrosis, pero las coloraciones especiales no mostraron la presencia de microorganismos, en tanto que el cultivo del ganglio fue positivo para Histoplasma capsulatum. Se inició el tratamiento antifúngico con anfotericina B e itraconazol, y la paciente tuvo una adecuada evolución. Dado que no se cumplían los criterios para el tratamiento oncológico, se continuó con su observación mediante controles periódicos. Las infecciones oportunistas pueden ser la manifestación clínica inicial en pacientes con síndromes linfoproliferativos de bajo grado. Este caso demuestra que pueden desarrollarse, incluso, en ausencia de quimioterapia.


ABSTRACT The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis. A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed. A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma. Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a "watch and wait" basis. Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.


Subject(s)
Aged, 80 and over , Female , Humans , Opportunistic Infections/complications , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Histoplasmosis/complications , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Amphotericin B/therapeutic use , Itraconazole/therapeutic use , Diabetes Mellitus, Type 2/complications , Watchful Waiting , Alzheimer Disease/complications , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Hypertension/complications , Lymph Nodes/microbiology , Lymph Nodes/pathology , Lymph Nodes/diagnostic imaging , Antifungal Agents/therapeutic use
19.
Journal of Leukemia & Lymphoma ; (12): 573-576, 2018.
Article in Chinese | WPRIM | ID: wpr-691673

ABSTRACT

Autoimmune hemolytic anemia (AIHA) is a common complication of chronic lymphocytic leukemia (CLL) with a complicated pathogenesis. CLL tumor cells can trigger AIHA by directly secreting autoantibodies targeting red blood cells or by presenting erythrocyte antigens. According to the disease features of different patients, multiple treatment regimens, such as glucocorticoid, immunoglobulin, rituximab and chemotherapy containing rituximab and glucocorticoid, could be chosen. AIHA patients respond well to the treatment, but it is easy to relapse. Further studies are needed to optimize the treatment and improve the overall survival of the patients.

20.
Article in Chinese | WPRIM | ID: wpr-710114

ABSTRACT

To investigate the expression of microRNA-34a (miR-34a) in patients with chronic lymphocytic leukemia (CLL) in Xinjiang Uygur and Han nationalities and its prognostic significance. Our data showed that miR-34a expression in Uygur and Han CLL patients was significantly higher than that in their respective healthy controls, while miR-34a levels were similar between Uygur and Han patients. By comparing with known prognostic factors, receiver operating characteristic (ROC) curves showed that miR-34a was a good predictive factor for the prognosis of CLL (demarcation value was 3.567 6). Survival analysis was further performed according to miR-34a expression level, that low expression of miR-34a translated into poor prognosis.

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