ABSTRACT
OBJECTIVE: To determine the effect on the humoral immune system of long term treatment of patients with RA with etanercept. METHODS: 12 consecutive patients with seropositive RA treated with etanercept were studied and followed up for 9 months. Clinical efficacy of treatment was evaluated using the 28 joint count Disease Activity Score (DAS28). Serum samples were collected at baseline and after 9 months and serum immunoglobulin, RF isotypes, and anti-cyclic citrullinated peptide (aCCP), antinuclear, nucleosome, and dsDNA antibodies determined. For comparison 7 patients with seropositive RA treated with adalimumab were studied. RESULTS: DAS28 decreased significantly after the first month and then was constant for the whole study (5.7 (0.3) v 3.8 (0.2), p< or=0.000). Serum IgA-RF and IgG-RF increased significantly after 9 months' etanercept treatment (mean (SEM) IgA-RF rose from 19.5 (4.8) to 30.5 (5.9) IU/ml, p< or=0.01; IgG-RF from 20.6 (8.1) to 33.8 (11.5) IU/ml, p< or=0.04). Serum levels of total immunoglobulin and specific autoantibodies remained unchanged during the study. In patients treated with adalimumab, no significant changes in serum levels of RF isotypes and aCCP antibodies were seen. CONCLUSION: Etanercept, although effective in treating the clinical symptoms of RA, seems to have a pivotal effect on RF-producing B cells either directly or indirectly.
Subject(s)
Antirheumatic Agents/pharmacology , Arthritis, Rheumatoid/immunology , Autoantibodies/drug effects , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Aged , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Autoantibodies/blood , Etanercept , Female , Follow-Up Studies , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin G/pharmacology , Immunoglobulin G/therapeutic use , Male , Middle Aged , Receptors, Tumor Necrosis Factor/therapeutic use , Rheumatoid Factor/blood , Severity of Illness IndexABSTRACT
We retrospectively evaluated 107 fiberoptic bronchoscopies with and without transbronchial lung biopsy (TBLB) in 98 consecutive patients with haematologic malignancies and pulmonary infiltrates. Bronchoalveolar lavage (BAL) was performed in 45 and BAL plus TBLB in 62 procedures. There was no procedure-related severe haemorrhage, pneumothorax or death. Infectious aetiology was identified in 26 of 107 (24%), toxic pneumonitis in 17 of 107 (16%) and neoplastic infiltration in 9 of 107 (8.5%) episodes. Combined BAL and TBLB was significantly superior to BAL alone with respect to the diagnosis of neoplastic infiltrates (p=0.008) and toxic pneumonitis (p<0.001) and should therefore be included in the diagnostic work-up of this patient cohort.
Subject(s)
Biopsy , Hematologic Neoplasms/pathology , Lung/pathology , Adult , Aged , Antineoplastic Agents/adverse effects , Biopsy/adverse effects , Biopsy/methods , Biopsy/statistics & numerical data , Bronchoalveolar Lavage Fluid , Bronchoscopy , Cohort Studies , Disease Progression , Female , Fiber Optic Technology , Hematologic Neoplasms/complications , Hematologic Neoplasms/diagnosis , Hemorrhage/etiology , Hemorrhage/prevention & control , Humans , Leukemic Infiltration , Lung Diseases/diagnosis , Lung Diseases/etiology , Lung Diseases/pathology , Male , Middle Aged , Myelodysplastic Syndromes/complications , Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/pathology , Platelet Transfusion , Pneumonia/chemically induced , Pneumonia/diagnosis , Pneumonia/etiology , Pneumonia/pathology , Predictive Value of Tests , Retrospective StudiesABSTRACT
Two immunocompetent patients with cat-scratch disease due to infection with Bartonella henselae developed monoclonal and biclonal gammopathy. Neither patient had evidence of any other known cause of plasma cell dyscrasia, and antibiotic eradication of Bartonella henselae infection resulted in the prompt disappearance of the gammopathy. Hence, cat-scratch disease should be added to the list of possible underlying disorders in individuals presenting with monoclonal and biclonal gammopathy.
Subject(s)
Bartonella henselae , Cat-Scratch Disease/complications , Monoclonal Gammopathy of Undetermined Significance/etiology , Adult , Aged , Aged, 80 and over , Cat-Scratch Disease/microbiology , Humans , Immunocompetence , Male , Monoclonal Gammopathy of Undetermined Significance/microbiologyABSTRACT
It is yet undetermined whether patients with different hematological malignancies have different propensities to infectious complications after high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (HSCT). We retrospectively analyzed 136 cycles of HDC and autologous HSCT in 114 patients with acute myeloid leukemia (AML, 24 cycles), non-Hodgkin's lymphoma/Hodgkin's disease (NHL/HD, 55 cycles), and multiple myeloma (MM, 57 cycles) with respect to early infectious complications. Median duration of neutropenia was longer in patients with AML and NHL/HD than in patients with MM (11 days vs 8 days) and after conditioning including total body irradiation (TBI) compared with chemotherapy only preparative regimens (11 days vs 7 days). Fever requiring antimicrobial therapy was observed in 88 percent of cycles, with fever of unknown origin (FUO) accounting for 60 percent of febrile episodes. There was no proven fungal infection, but one case of probable invasive pulmonary aspergillosis. Microbiologically documented infections were seen in 29 percent and clinically documented infections in 11 percent. Response to first-line empirical antibiotic therapy was better for FUO than for documented infections (70 percent vs 40 percent). Patients with TBI as part of their conditioning regimen had more overall infections than patients without TBI (96 percent vs 82 percent). There were no differences with respect to the type or incidence of infections between patients with AML, NHL/HD, and MM. Patients with different hematological malignancies have similar rates of early infectious complications after HDC and autologous HSCT. TBI may be associated with an increased risk for infections in the early post-transplant period.
