[Infections in non-transplanted oncohaematological patients]. / Infecciones en pacientes oncohematológicos no trasplantados.

Oncohaematological patients present a high incidence of infections, which are one of the principle causes of morbidity and mortality. There are different types of immunodepression related to the disease, the moment of its evolution and the treatment received. For practical purposes we will distinguish between patients with severe neutropenia, those with some alteration to humoral immunity and, finally, cellular immunodeficiencies. There are no immunodeficiencies associated to each disease, instead several immunitarian deficiencies can be associated in a single clinical entity. Neutropenic patients, generally with acute leukaemias and following intensive chemotherapy, have bacterial and fungal infections conditioned by the intensity and duration of the neutropenia. In the case of patients with humoral immunodeficiency (multiple myeloma, chronic lymphatic leukaemia, splenectomised) there are frequent infections by encapsulated germs. When there is cellular immunodepression (Hodgkin's disease, advanced chronic lymphoproliferative syndromes, treatment with glucocorticoids, analogues of the purines and treatment with monoclonal antibodies) the risk of infection by opportunist germs is conditioned by the reduction of the figure of CD4 lymphocytes. We review the different strategies of prophylaxis and treatment in each of the situations.

Nonhepatosplenic gamma delta T-cell lymphoma with initial testicular compromise.

We report here a case of nonhepatosplenic gammadelta T-cell lymphoma with undescribed initial localization in testis, without hepatosplenomegaly or adenopathies, and subsequent development in the maxillary sinus. The maxillar mass biopsy revealed a T-cell infiltration, and its immunologic characterization by flow cytometry showed a gammadelta T-cell phenotype (CD45+, CD3+, CD2+, TCR gammadelta+), without expression of CD7, CD5, CD1a, TdT, CD4, CD8, TCR alphabeta, or NK antigens (CD16, CD56, and CD57). Clonal gamma-chain gene rearrangement by polymerase chain reaction (PCR) was detected in testicular and maxillar biopsies. Epstein-Barr virus type 1 (EBV) sequences were detected by molecular biology in the biopsy material, suggesting that this oncogenic virus may play a role in the genesis of the clonal expansion of gammadelta T-cells. The patient was initially treated with standard chemotherapeutic protocols, with poor response and aggressive course.

Linfoma cutáneo de células T localizado en piel de mama, a cinco años de seguimiento / Cutaneous T-cell lymphoma localizad in breast skin, after a five years follow-up

Las manifestaciones cutáneas puras de linfome cutáneo a células T no micosis fungoide, sin compromiso sistémico, son infrecuentes; alrededor del 30 por ciento. Comunicamos un caso de linfoma cutáneo a células T en una mujer de 59 años de edad, localizado en piel de mama, hecho excepcionalmente mencionado en la bibliografía internacional. El interés de esta publicación radica en las dificultades diagnósticas, ya que la lesión de la paciente fue interpretada como eccema y recibió tratamiento con corticoides tópicos, durante varios años. Bajo la sospecha de linfoma cutáneo a células T, el examen histológico demostró un linfoma cutáneo de células pequeñas bien diferenciado, siendo su inmunomarcación PAN T (+) y CD 30 (-). Los estudios hematológicos no mostraron compromiso sistémico. Fue tratada con acelerador lineal (E/12 MeV), recibiendo una dosis total de 4500 cGy y lográndose remisión completa de la placa tumoral. Este caso corresponde a un estadio I A (T1NOMO) según la clasificación de Bunn y Lamberg, en 1979; modificada por Lamberg en 1984 y actualmente vigente. A cinco años de seguimiento, la paciente no presenta recaída local ni compromiso sistémico

Linfoma cutáneo de células T localizado en piel de mama, a cinco años de seguimiento / Cutaneous T-cell lymphoma localizad in breast skin, after a five years follow-up

Las manifestaciones cutáneas puras de linfome cutáneo a células T no micosis fungoide, sin compromiso sistémico, son infrecuentes; alrededor del 30 por ciento. Comunicamos un caso de linfoma cutáneo a células T en una mujer de 59 años de edad, localizado en piel de mama, hecho excepcionalmente mencionado en la bibliografía internacional. El interés de esta publicación radica en las dificultades diagnósticas, ya que la lesión de la paciente fue interpretada como eccema y recibió tratamiento con corticoides tópicos, durante varios años. Bajo la sospecha de linfoma cutáneo a células T, el examen histológico demostró un linfoma cutáneo de células pequeñas bien diferenciado, siendo su inmunomarcación PAN T (+) y CD 30 (-). Los estudios hematológicos no mostraron compromiso sistémico. Fue tratada con acelerador lineal (E/12 MeV), recibiendo una dosis total de 4500 cGy y lográndose remisión completa de la placa tumoral. Este caso corresponde a un estadio I A (T1NOMO) según la clasificación de Bunn y Lamberg, en 1979; modificada por Lamberg en 1984 y actualmente vigente. A cinco años de seguimiento, la paciente no presenta recaída local ni compromiso sistémico (AU)

Randomized trial of CVPP for three versus six cycles in favorable-prognosis and CVPP versus AOPE plus radiotherapy in intermediate-prognosis untreated Hodgkin's disease.

PURPOSE: To evaluate in a randomized trial the impact of three versus six cycles of cyclophosphamide, vinblastine, procarbazine, and prednisone (CVPP) chemotherapy in favorable-prognosis and CVPP versus doxorubicin, vincristine, prednisone, and etoposide (AOPE) plus involved-field radiotherapy (RT) in intermediate-prognosis previously untreated Hodgkin's disease. PATIENTS AND METHODS: Of 256 patients evaluated, 80 with a favorable prognosis according to a prognostic index designed by the Grupo Argentina de Tratamiento de Leucemia Aguda (GATLA) were randomized to three versus six cycles of CVPP without RT and 176 with intermediate risk to CVPP versus AOPE, both for six cycles with RT between the third and fourth cycles of 30 Gy to the involved areas at diagnosis. CVPP consisted of intravenous (I.V.) cyclophosphamide and vinblastine on days 1 and 8, and oral procarbazine and prednisone on days 1 to 14, every 28 days. AOPE consisted of I.V. doxorubicin and vincristine on day 1, oral prednisone on days 1 to 5, and I.V. etoposide on days 1 and 3, every 28 days. RESULTS: Complete remission was obtained in 39 of 41 (95%) patients treated with three cycles of CVPP and 36 of 39 (92%) treated with six cycles in the favorable-risk group (difference not significant [NS]). In the intermediate-risk group, 89 of 92 (97%) treated with CVPP plus RT versus 75 of 84 (89%) treated with AOPE plus RT achieved a complete remission (P = .05). At 60 months, the event-free survival (EFS) and overall survival rates in the favorable-risk group were 80% and 91% for CVPP x 3 and 84% and 97% for CVPP x 6, respectively (P = NS). In the intermediate-risk group, 60-month EFS rate for CVPP plus RT was 85%, compared with 66% for AOPE plus RT (P = .009). The overall survival rate was 95% versus 87% respectively (P = .157). CONCLUSION: Three cycles of CVPP without RT are equally effective as six cycles in the favorable-risk group. However, in the intermediate-group, CVPP plus RT is superior to AOPE plus RT, with significantly fewer events before and after induction (P = .009), without a difference in overall survival.

Recombinant Interferon Alpha-2b in Patients with Progressive and/or Recurrent Hodgkin's Disease.

Six patients were included in a trial involving the SC administration of rIFN{alfa)-2b (Schering Plough) at a dose of 5 {multi} 10(6) IU daily, 5 days a week and continued while a clinical response was observed. All patients had previously received between 3 to 5 salvage chemotherapy programs without a disease free interval prior to the administration of rIFN{ALFA}-2b. Two patients had extranodal disease (lung, bone) and all 6 patients had "B" symptoms. Five of the patients showed stable disease, for a period of 3 to 12 months. One patient with recurrent HD obtained partial remission which lasted 26 months, at which time he developed autoimmune hemolytic anemia. Toxicities observed were mild and consisted of a flulike syndrome, supraventricular tachycardia and mild increase in transaminases. The quality of life improved while on rIFN{ALFA}-2b therapy, contrasting with the toxicity of the aggressive chemotherapy regimens previously administered which required frequent hospitalizations. This preliminary experience suggests that the role of rIFN{ALFA}-2b in the treatment of HD requires more study.