The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients

Abstract The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.

Silencing of augmenter of liver regeneration inhibited cell proliferation and triggered apoptosis in U266 human multiple myeloma cells

Augmenter of liver regeneration (ALR) is a thermostable cytokine that was originally identified to promote the growth of hepatocytes. This study was conducted to explore the expression and function of ALR in multiple myeloma (MM), a common hematologic malignancy. Real-time PCR and western blot analysis were performed to detect the expression of ALR in U266 human MM cells and healthy peripheral blood mononuclear cells (PBMCs). U266 MM cells were exposed to 20 or 40 μg/mL of recombinant ALR and tested for cell proliferation. Small interfering RNA-mediated silencing of ALR was done to investigate the role of ALR in cell proliferation, apoptosis, and cytokine production. Compared to PBMCs, U266 MM cells exhibited significantly higher levels of ALR at both the mRNA and protein levels. The addition of recombinant ALR protein significantly promoted the proliferation of U266 cells. In contrast, knockdown of ALR led to a significant decline in the viability and proliferation of U266 cells. Annexin-V/PI staining analysis demonstrated that ALR downregulation increased apoptosis in U266 MM cells, compared to control cells (20.1±1.1 vs 9.1±0.3%, P<0.05). Moreover, ALR depletion reduced the Bcl-2 mRNA level by 40% and raised the Bax mRNA level by 2-fold. Additionally, conditioned medium from ALR-depleted U266 cells had significantly lower concentrations of interleukin-6 than control cells (P<0.05). Taken together, ALR contributed to the proliferation and survival of U266 MM cells, and targeting ALR may have therapeutic potential in the treatment of MM.

Mieloma IgE: Dificultades de laboratorio para su tipificación

El mieloma múltiple de tipo IgE es una neoplasia de células plasmáticas muy poco frecuente pues representa el 0.01% de todas las discracias de células plasmáticas. Son generalmente de curso más agresivo y hasta el presente existen publicados no más de 50 casos en la literatura. Los estudios de laboratorio son, en estos casos, esenciales para la tipificación del componente monoclonal tanto en suero como en orina. El objetivo de esta presentación es informar sobre un paciente con diagnóstico de mieloma IgE señalando las dificultades de laboratorio que, en estos casos tan poco frecuentes, pueden conducir a un informe erróneo.

The IgE multiple myeloma is a rare neoplasm of plasma cell accounting for 0.01% of all plasma cell dyscrasias. They are generally of more aggressive development and to date there are no more than 50 cases published in current literature. Laboratory studies are, in these cases, essential for the classification of the monoclonal component in serum and urine. The aim of this presentation is to report a patient diagnosed with IgE myeloma and to point out that the laboratory difficulties noted in these rare cases can lead to an erroneous report.

Immunoglobulin heavy and light chain isotypes in multiple myeloma patients.

The frequency of expression of immunoglobulin (Ig) light and heavy chain isotypes was analyzed in myeloma proteins (M-proteins) from sera of 40 Indian patients with clinically established multiple myeloma. Patients samples were screened by a combination of electrophoresis, immunoelectrophoresis (IEP) and ELISA techniques in this study. We found that majority of the myeloma proteins (58%) were of the IgG isotype followed by IgA (24%) and biclonal gammopathy associated with IgG and IgA (5%). Both kappa and lambda light chains were associated with the heavy chain isotypes. We recommend the triangular combination for detection of M-proteins and biclonal gammopathy of cancerous plasma cells as biomarkers for diagnosis of myeloma.

Mieloma múltiple en Chile: características clínicas y sobrevida / Clinical features and survival of Chilean patients with multiple myeloma

Background: Mortality rate records are the only data available in Chile about the prognosis of patients with multiple myeloma (MM). Aim To characterize clinical features, survival rate and factors related to mortality in cases with MM treated in six large medical centers in Chile. Material and Method: Retrospective analysis of demographic data, clinical features and survival rate records of patients with MM, collected between 1998 and 2002. Survival curves were generated and a multivariate analysis of factors associated to early mortality was carried out. Results: Data from 245patients aged 38 to 95years (129 women) was collected. Fifty two percent had an IgG myeloma, 25 percent had and IgA and 6.1 percent had light chains myeloma. According to Durie and Salmon staging system, 8,2 percent were in Stage 112.6 percent in Stage II, 60.5 percent in Stage III and in 18.8 percent the information about staging was not available. Fifty percent had an hemoglobin level below 10 g/dL, 30 percent had a serum creatinine over 2 mg/dL and 28 percent had a serum calcium level over 10.5 mg/dL. Median survival was 33 months. Twenty percent of patients died within the first six months after diagnosis (early mortality). Predictive factors for early mortality were male sex, thrombocytopenia, anemia, renal failure, hypercalcemia, a beta2-microglobulin >5.5 mg/L and a serum albumin level <3.5 g/dL. There was a correlation between the number of bad prognosis factors present and the probability of early mortality. Conclusions: This group of Chilean patients with MM presented a short survival time, and 20 percent died within the first six months after diagnosis. More than a half of cases were diagnosed at an advanced stage (Durie and Salmon Stage III). Several factors were associated to early mortality, two of which (beta 2-microglobulin and serum albumin), are included in the new International Staging System for MM.

Plasma cell myeloma in a tertiary centre in Niger delta region of Nigeria: Clinicoimmunologic Analysis

To determine the incidence and pattern of presentation of patients with multiple myeloma [MM] in a tertiary health center in Edo state, Niger Delta region of Nigeria noted for its petrochemical industries and gas flare sites. A retrospective study of 30 cases of MM from 1992 to 2004. University of Benin Teaching Hospital, Nigeria. Clinicoimmunologic information in addition to autopsy findings was obtained from case-files. Diagnosis was established according to the standard definition and staged according to the Durie-Salmon clinical staging system. Advanced stages of the disease [II-III] and performance status scale of 2-4 with pathological fractures were the main form of presentation. Overall median survival was three months [P<0.0001] with 33.3% of the patients surviving at 12 months and 13.3% at 24 months. Bone pains and anaemia with pathological fractures were the commonest characteristic features with a short three months median survival rate

Multiple myeloma presenting as primary non-secretory plasma cell leukemia.

Primary plasma cell leukemia is a rare manifestation of multiple myeloma, whose neoplastic hierarchy in the classification of malignant hematological disorders is not yet very clearly defined. Morphological and immunological criteria indicate that the cells are at end stage of B cell maturation pathway. This unusual disorder is diagnosed by the presence of more than 2 x 10(9) plasma cells per liter of peripheral blood or more than 20% of the leucocytes being plasma cells on differential count. This occurs either denovo or as a terminal event in patients with long standing multiple myeloma. A case report of a young male patient with primary plasma cell leukemia is presented.

Sistema del complemento e inmunocomplejo en el mieloma múltiple / Complement system and circulating immune complexes in multiple myeloma

Se determinó la frecuencia de 29 antígenos HLA de los loci A y B en 20 pacientes con glaucoma primario de ángulo abierto diagnósticados en el Servicio de Oftalmología del Hospital General Docente ®Enrique Cabrera¼. Se utilizaron como controles 276 personas sanas. El antígeno HLA B35 mostró asociación positiva con un riesgo relativo (RR) de 5,3. Se obtuvo una frecuencia estadísticamente significativa con una p corregida (pc) <0,002 para el HLA B35 al compararla con controles normales no relacionados. El resto de los antígenos HLA estudiados no mostraron asociación

Analysis of immunoglobulin deficiency cases: a five year study.

A total of 734 serum specimens from various clinical disorders along with 100 control samples from healthy subjects were processed for estimation of serum IgG, IgA and IgM employing single radial immunodiffusion procedure. Immunoglobulin deficiency, either selective or combined was noted in 31 males and 24 females in all age groups. Of the 55 cases encountered it was secondary immunoglobulin deficiency which was seen on a larger scale and encountered in patients with Multiple myeloma (16 out of 32) followed by Leprosy (14 out of 250), Lymphoma (5 out of 43), Malaria (4 out of 137), Burns (4 out of 52), Rheumatoid arthritis (2 out of 69) and non lymphoreticular malignancies (1 out of 41) in decreasing order of frequency. Primary immunoglobulin deficiency was observed in nine cases comprising of six belonging to Idiopathic late onset immunoglobulin deficiency, two of dysgammaglobulineamia and a solitary case of Ataxia telangiectasia. Panimmunoglobulin deficiency was observed in six cases, 11 had a dual deficiency while 38 showed deficiency of an isolated class with selective IgA deficiency in 20 cases. Furthermore, one patient each had total absence of IgG or IgA while IgM was not detectable in seven patients. A high suspicion index along with a regular rapport between the clinician and the laboratory personnel is necessary in the diagnostic set up of immunoglobulin deficiency states.

Peripheral blood lymphocyte subsets after allogeneic bone marrow transplantation: reconstitution and correlation with the occurrence of acute graft-versus-host disease.

Peripheral blood lymphocyte subsets were enumerated at regular intervals during the first year after allogeneic bone marrow transplantation (BMT) in 21 Chinese patients. Eight of these patients had acute graft-versus-host disease (GVHD) while they were assessed at the time of engraftment. Our results show in patients receiving allogeneic BMT: (1) T and NK cells were the predominant lymphocyte subsets in the early reconstitution stage while B cells were severely depleted; (2) absolute numbers of the major lymphocyte subsets normalised in 4-5 months; (3) an increased percentage of T cells that expressed the activation antigen HLA-DR and a reversed CD4:CD8 ratio were observed throughout the first 12 months after BMT; (4) patients with acute GVHD had significantly higher white cell count and NK cell percentage than those not complicated by acute GVHD.

Características inmunohematológicas en 59 casos de mieloma múltiple Hospital Regional de Talca / Immunohematological characteristics in 59 cases of multiple myeloma regional Hospital of Talca

El mieloma múltiple, es la gammapatía monoclonal más frecuente. Se caracteriza por la proliferación de un clon neoplásico de células plasmáticas y como consecuencia presenta, entre otros trastornos, alteraciones inmunohematológicas. El objetivo del estudio fue conocer las características inmunohematológicas al momento del diagnóstico, en una serie clínica de 59 casos de mieloma múltiple, diagnosticados en el Hospital Regional de Talca, entre los años 1980 y 1992. Un 61,0 por ciento de los casos eran hombres y un 39,0 por ciento mujeres. Considerando ambos sexos, el promedio de edad fue de 63,4 +- 12,6 años. El componente monoclonal sérico fue clase IgG en 52,1 por ciento de los pacientes, IgA en un 22,9 por ciento e IgM en un 2,1 por ciento. Un 16,5 por ciento fue mieloma biclonal y un 6,2 por ciento no presentó componente monoclonal. La mayoría de los casos presentó IgG sérica << 3500 mg/dl o IgA sérica << 2000 mg/dl, criterio que por si sólo hace diagnóstico de mieloma múltiple (South Westh Oncology Group-SWOG). Entre las alteraciones hematológicas periféricas se encontró anemia (* 88,1 por ciento), leucopenia (34,3 por ciento) y bicitopenia (29,4 por ciento). Un 50 por ciento de los pacientes presentó una plasmocitosis superior a 30 por ciento en la médula ósea

Multiple myeloma complicated by Kaposi sarcoma

A fifty-one-year old female patient presented to Karama Teaching Hospital in May, 1986 with clinical picture of congestive heart failure due to severe anemia. She had some atypical features of multiple myeloma with genemlised lymphadenopathy. Her Investigations confirmed the presence of multiple myeloma complicated by Kaposi sarcoma. Three months after discharge from hospital, the patient died at home

Nephrotoxicity of human Bence Jones protein in rats: proteinuria and enzymuria profile

The effect of intravenous administration of 80 mg purified human Bence Jones protein twice weekly for 5 weeks was investigated in male Wistar rats (N = 7; 2 months old). A state of immunological tolerance was demonstrated by the absence of a B-cell response (plaque-forming cells and hemagglutination titers) and by the absence of detectable antigen or antibody deposition in glomeruli, as indicated by light and electron microscopy. No rise in blood urea level was detected (33.9 +/- 4.3 vs 32.8 +/- 1.3 mg per cent ). There was an increase in proteinuria (5.3 +/- 0.9 vs 32.8 +/- 4.0 mg/day), mainly due to Bence Jones protein excretion (0 vs 29.2 +/- 5.2 mg/day), with a slight but significant increase in albuminuria (0.2 +/- 0.1 vs 1.0 +/- 0.2 mg/day). There was a significant increase of lysosomal N-acetyl-beta-D-glucosaminidase in the urine (6.1 +/- 1.3 vs 72.7 +/- 18.8 mU/mg in creatinine). Lysosomal accumulation of Bence Jones protein in proximal tubular cells was evidenced by immunoelectronmicroscopy with protein A-gold. These results clearly showed proximal tubular dysfunction induced by chronic Bence Jones protein administration, without interference of autologous immune response as demonstrated by immunological state of tolerance

Biochemical abnormalities in multiple myeloma

Monoclonial gammopathies can either be benign or more commonly malignant. The commonest disease associated with it is multiple myeloma. Over the seven-year period 1984-1990, two hundred and thirty-four monoclonal gammopathies were seen at the University Hospital, Jamaica. Multiple myeloma was diagnosed in one hundred and fifty-six cases (84 males and 72 females). The diagnosis of most of the others were not known as the samples came from other institution. Of the patients with myeloma, the most common immunoglobulin type was IgG followed by IgA and then pure light chain disease. Only in about half of the cases where urine was analysed was Bence-Jones protien found. The majority of the cases had abnormal total serum protein, albumin and total globulin concentrations. Most of the cases also were in renal failure. Hypercalcaemia, hyperphoshataemia, elevated alkaline phosphate, gammaglutamyl transferase and aspartate aminotransferase occured in about one-third of them. These results were not much different from those reported in other countries

Amiloidose localizada da córnea: relato de 2 casos / Localized corneal amyloidosis: study of 2 cases

Os autores apresentaram dois casos clinicamente distintos, com diagnóstico histopatológico de amiloidose corneana localizada, sem que padräo familiar e patologias oculares ou sistêmicas associadas pudessem ser identificadas. De acordo com a literatura, os autores fazem o diagnóstico de amiloidose corneana secundária, na qual a provável patologia causal näo foi identificada, mas näo descartam a possibilidade de amiloidose primária localizada da córnea, patologia esta extremamente rara

Inhibidor heparinoide en un paciente con mieloma múltiple

Se describe una paciente con mieloma múltiple tipo IgA con un inhibidor de la coagulación de tipo heparinoide, no inmune ni relacionada con la paraproteina. Fue identificado por pruebas de neutralización con sulfato de protamina, con una concentración plasmatica menor de 0.3 U/mL. Se discute la naturaleza de este tipo de inhibidores y su relación con las neoplasias