ABSTRACT
A 70-year-old man was admitted to our hospital with fever, generalized lymphadenopathy and hypoxia in October 2009. Blood examination demonstrated leukocytosis, anemia, thrombocytopenia and hyper γ-globulinemia. Peripheral blood and bone marrow smear showed marked plasma cell proliferation mimicking plasma cell leukemia. However, flow cytometric analysis showed that plasma cells were of polyclonal origin and M-protein was not detected by immunofixation of serum protein. Elevations of soluble interleukin 2 receptor and serum IL-6 were observed. A heavy Epstein-Barr viral load was detected in serum by real-time PCR. Biopsy was obtained from the right inguinal lymph node. The pathological diagnosis was angioimmunoblastic T-cell lymphoma (AITL) and rearrangement of the T-cell receptor Cß1 gene was detected. The patient was treated with CHOP therapy, and all clinical manifestations, including fever, lymphadenopathy, anemia, thrombocytopenia, hyper γ-globulinemia, plasmacytosis and hypoxia, were improved. Only a few reported cases have demonstrated AITL with marked polyclonal plasmacytosis. Although pathological mechanisms of plasmacytosis in AITL patients have not been fully elucidated, it is suggested that IL-6 and IL-10 were involved in its pathogenesis in the present case.
Subject(s)
Bone Marrow/pathology , Immunoblastic Lymphadenopathy/blood , Immunoblastic Lymphadenopathy/pathology , Lymphoma, T-Cell/blood , Lymphoma, T-Cell/pathology , Plasma Cells/pathology , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Humans , Immunoblastic Lymphadenopathy/drug therapy , Immunoblastic Lymphadenopathy/etiology , Interleukin-10 , Interleukin-6 , Leukemia, Plasma Cell , Lymphoma, T-Cell/drug therapy , Lymphoma, T-Cell/etiology , Male , Prednisolone/administration & dosage , Treatment Outcome , Vincristine/administration & dosageABSTRACT
Factors that affect the response of multiple myeloma patients to thalidomide were evaluated in 40 patients who were not eligible for chemotherapy (untreated: 14, relapse/refractory: 26). The complete response (CR) rate was 2.5%; partial response (PR) 50.0%; minimal response (MR) 25.0%; no change (NC) 12.5%; and progressive disease 10.0%. The response to thalidomide could be evaluated after four weeks of treatment. Significantly higher responses were associated with untreated patients, patients with combined use of thalidomide plus dexamethasone, and patients with kappa light chain. Patients who responded well to thalidomide showed a significantly higher progression-free survival (PFS) rate. In patients with kappa light chain, PFS and overall survival rates were significantly higher than those with lambda light chain. Frequent adverse reactions were numbness (47.5%), constipation (32.5%), and eruption (30.0%). In patients previously treated with vincristine, numbness occurred in a significantly higher percentage of patients.
Subject(s)
Multiple Myeloma/drug therapy , Thalidomide/administration & dosage , Adult , Aged , Aged, 80 and over , Constipation/chemically induced , Dexamethasone/administration & dosage , Disease-Free Survival , Drug Eruptions/etiology , Drug Therapy, Combination , Female , Humans , Hypesthesia/chemically induced , Immunoglobulin kappa-Chains , Immunoglobulin lambda-Chains , Male , Middle Aged , Multiple Myeloma/mortality , Thalidomide/adverse effects , Treatment OutcomeABSTRACT
In adult T-cell leukemia/lymphoma (ATL), it is difficult to achieve remission and the reason for the resistance to chemotherapeutic agents may be linked to the presence of multidrug resistance (MDR) proteins. Lung resistance-related protein (LRP), multidrug resistance-associated protein and P-glycoprotein are three MDR proteins which we examined in ATL cells using multiparametric flow cytometry and real-time RT-PCR. LRP was highly expressed and suppressing LRP function increased doxorubicin accumulation in nuclei. This indicates LRP may be contributing to drug resistance in ATL patients, and the suppression of LRP function could be a new strategy for ATL treatment.
Subject(s)
ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism , Drug Resistance, Multiple , Gene Expression Regulation, Leukemic , Gene Expression Regulation, Neoplastic , Leukemia-Lymphoma, Adult T-Cell/metabolism , Multidrug Resistance-Associated Proteins/metabolism , Vault Ribonucleoprotein Particles/metabolism , ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics , Adult , Aged , Antibiotics, Antineoplastic/pharmacology , Doxorubicin/pharmacology , Drug Resistance, Neoplasm , Female , Flow Cytometry , Humans , Leukemia-Lymphoma, Adult T-Cell/genetics , Male , Middle Aged , Multidrug Resistance-Associated Proteins/genetics , RNA, Messenger/genetics , RNA, Messenger/metabolism , RNA, Neoplasm/genetics , RNA, Neoplasm/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Tumor Cells, Cultured , Vault Ribonucleoprotein Particles/geneticsABSTRACT
We report a 68-year-old woman with severe falciparum malaria contracted in Tanzania. She presented high parasitemia and was treated successfully with intravenous artesunate, a qinghaosu derivative, and aggressive supportive therapy. She developed hemolytic anemia and jaundice on day 11 and blood transfusion was required. This case illustrates that intravenous artesunate has excellent antimalarial activity with rapid efficacy and that no severe adverse effect but conventional aggressive supportive therapy is still important in the treatment of severe falciparum malaria.
