ABSTRACT
Two cases of severe autoimmune hemolytic anemia (AIHA) that failed multiple treatment modalities obtained complete and long-lasting remissions with a combination of three one volume plasma exchange (PE) on succeeding days followed 6 hours later on the 3rd day by cyclophosphamide (cyc) 750 mg/m2 IV, and cyc/prednisone (pred) qd tapering to either no therapy or minimal therapy over a 6 month period. Both cases remain without evidence of AIHA after 43 and 19 months follow-up. Possible non-exclusive mechanisms that explain this favorable outcome are enhanced cytotoxic effect of cyc on proliferating lymphocytes participating in the antibody rebound phenomena, suppression of B lymphocytes with daily cyc/pred, and/or formation of anti-idiotype antibodies.
Subject(s)
Anemia, Hemolytic, Autoimmune/therapy , Anemia, Refractory/therapy , Cyclophosphamide/therapeutic use , Plasma Exchange , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Middle Aged , Remission Induction/methodsSubject(s)
Carcinoma, Squamous Cell/therapy , Head and Neck Neoplasms/therapy , Plasmapheresis , Carcinoma, Squamous Cell/immunology , Carcinoma, Squamous Cell/radiotherapy , Combined Modality Therapy , Head and Neck Neoplasms/immunology , Head and Neck Neoplasms/radiotherapy , Humans , Immunoglobulin A/metabolism , Immunoglobulin E/metabolism , Suppressor Factors, Immunologic/blood , Suppressor Factors, Immunologic/isolation & purificationABSTRACT
A major response to plasmapheresis is reported in a patient with advanced, recurrent squamous cell cancer of the oral cavity, similar to that previously reported in three of six comparable patients. Tumor regression followed temporary reduction of inhibition of normal lymphocyte response to phytohemagglutinin (PHA) by the patient's serum (from 99% to zero) and partial restoration of the patient's lymphocyte response (from 2% to 38% of control). The IgE level rose both overall and during some exchanges; this correlate of tumor response had been noted earlier. The tumor showed extensive necrosis, but the clinical effects were relatively short-lived and the patient died 11 weeks later. Biopsy specimens taken early in apheresis showed intense new infiltration of tumor by lymphocytes and monocytes; later biopsy specimens showed predominantly plasma cells with trapping and lysis of tumor cells. No other anti-cancer therapies had been used for 16 months before this trial, and no replacements were given other than saline and albumin.
Subject(s)
Carcinoma, Squamous Cell/therapy , Mouth Neoplasms/therapy , Neoplasm Recurrence, Local/therapy , Antigens, Surface/analysis , Carcinoma, Squamous Cell/immunology , Humans , Immune Tolerance , Immunoglobulins/analysis , Leukocyte Count , Leukocytes/classification , Lymphocyte Activation , Male , Middle Aged , Mouth Neoplasms/immunology , Neoplasm Recurrence, Local/immunology , Plasmapheresis , Tomography, X-Ray ComputedSubject(s)
Carcinoma, Squamous Cell/therapy , Head and Neck Neoplasms/therapy , Plasma Exchange , Plasmapheresis , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/immunology , Denture Design , Denture, Complete, Upper , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/immunology , Humans , Immunoglobulin A/analysis , Immunoglobulin E/analysis , Male , Middle Aged , Mouth Neoplasms/complications , Mouth Neoplasms/immunology , Mouth Neoplasms/therapy , Pilot Projects , Plasma Exchange/adverse effects , Plasmapheresis/adverse effects , Tongue Neoplasms/complications , Tongue Neoplasms/immunology , Tongue Neoplasms/therapyABSTRACT
Six patients with advanced squamous cell cancers of the head and neck, with serum IgA greater than or equal to 400 mg/dl and IgE less than or equal to 1000 IU/ml, underwent a trial of six 2-liter plasma exchanges over a 2-3-week period. Disease progressed in patients 1, 2, and 4, who died on days 44, 72, and 159. The tumor in patients 3 and 6 regressed significantly, repeatedly in patient 3 over each of four courses of apheresis. Tumor recurred in both patients after cessation of treatment, and they died at days 420 and 79. Patient 5, with inoperable disease, received full-dose radiotherapy immediately following the course of apheresis, and showed complete response in the primary lesion and a major response in the extensive lymph node metastases, dying on day 421 of apparently unrelated causes. Serum IgE in the three patients experiencing tumor regression rose paradoxically during plasmapheresis. Only patient 3 had an elevated level of soluble E-receptor suppressor factor prepheresis; the serum of patient 6 was lymphocytotoxic prepheresis but this activity decreased or disappeared during each of the exchanges studied. Controlled trials are now indicated.
Subject(s)
Carcinoma, Squamous Cell/therapy , Head and Neck Neoplasms/therapy , Plasma Exchange , Suppressor Factors, Immunologic , Aged , Humans , Immunoglobulin A/analysis , Immunoglobulin E/analysis , Lymphokines/analysis , Male , Middle Aged , PlasmapheresisSubject(s)
Blood Coagulation Factors , Factor VIII , Purpura, Thrombotic Thrombocytopenic/blood , von Willebrand Factor , Adult , Chronic Disease , Female , Humans , Immunoelectrophoresis, Two-Dimensional , Purpura, Thrombotic Thrombocytopenic/etiology , Purpura, Thrombotic Thrombocytopenic/therapy , RecurrenceABSTRACT
Transfusion of a misidentified and mislabeled unit of hepatitis B surface antigen (HBsAg)-positive blood was recognized 18 hours after the transfusion episode. Within 24 hours of transfusion the recipient became HBsAg-positive, and antibody to the hepatitis B core antigen (anti-HBc) was detected. Despite hepatitis B immune globulin (HBIG) administration of 28 hours after transfusion, the serologic markers persisted for at least one month. Clinically apparent hepatitis developed about two months after transfusion. At this time HBsAg could not be detected, but antibody to HBsAg (anti-HBs) was present and anti-HBc persisted. The recipient recovered and became a plasmapheresis donor for several hepatitis B research programs.
