Abnormal immunophenotype of the T-cell-receptor beta Chain in follicular-helper T cells of angioimmunoblastic T-cell lymphoma.

OBJECTIVE: Analysis for 24 variable regions of the T-cell-receptor beta chain by flow cytometry (Vbeta) is a new technique to detect clonal alpha-beta T lymphocytes and is characteristically performed on peripheral blood. Angioimmunoblastic T-cell lymphoma (AITL) has increased neoplastic follicular-helper T cells (FHT), which often express CD10; but nonneoplastic, CD10-positive T cells may be associated with reactive lymphadenopathy and with B-cell lymphomas. This study documents the utility of Vbeta analysis of FHT in specimens of AITL from blood, from marrow, and from lymph nodes. METHODS: The electronic medical record in the flow cytometry laboratory was searched for specimens that were analyzed by flow cytometry for Vbeta and that were involved by AITL. Flow cytometry was performed for the following antigens: T-cell-associated proteins, CD10, CD56, CD94, CD161, killer-cell immunoglobulin-like receptors, alpha-beta T-cell receptor, gamma-delta T-cell receptor, and Vbeta. RESULTS: Five patients had six specimens of blood (two), of bone marrow (one), or of lymph nodes (three). Immunophenotypic aberrances were detected for antigens: CD2 (2/6), CD3 (6/6), CD4 (1/6), CD5 (1/6), CD7 (5/6), and CD45 (2/6). All abnormal T-cell populations expressed CD4, and most expressed CD10 (5/6). Four specimens were clonally restricted for Vbeta. Two specimens lacked the alpha-beta T-cell receptor and Vbeta. CONCLUSIONS: Vbeta analysis by flow cytometry can be used to detect clonal alpha-beta FHT in AITL, which may be difficult to diagnose with early involvement. Abnormal Vbeta expression on CD10-positive T cells confirms that FHT are the neoplastic cells.

Transfusion indications for patients with cancer.

BACKGROUND: During the last few years, considerable focus has been given to the management of anemia and coagulopathies. This article provides current concepts of red blood cell (RBC) and plasma coagulation factor replacements. METHODS: The literature was reviewed for clinical studies relevant to RBC transfusion indications and outcomes as well as for the uses of coagulation factor replacement products for coagulopathies most likely encountered in patients with cancer. RESULTS: Most patients without complications can be treated with a hemoglobin level of 7 g/dL as an indication for RBC transfusion. However, the effects of disease among patients with cancer may cause fatigue, so transfusions at higher hemoglobin levels may be clinically helpful. Leukoreduced RBCs are recommended as standard therapy for all patients with cancer, most of whom do not develop coagulopathy. Transfusions to correct mild abnormalities are not indicated in this patient population. Data are inconclusive regarding the value of coagulation factor replacement for invasive procedures when the international normalized ratio is below 2. CONCLUSIONS: Indications for RBC transfusion have become more conservative as data and experience have shown that patients can be safely and effectively maintained at lower hemoglobin levels. Coagulation factor replacement is unnecessary for most modest coagulopathies.

Significance of GATA-3 expression in outcomes of patients with breast cancer who received systemic chemotherapy and/or hormonal therapy and clinicopathologic features of GATA-3-positive tumors.

GATA-3 and estrogen receptor (ER) are involved in a positive cross-regulatory loop and are frequently coexpressed in breast cancers. GATA-3 expression was shown to be an independent predictor of overall and disease-free survival in some studies, whereas others showed no difference. However, the studies used different cutoff values for determining GATA-3 positivity and analyzed outcomes in patients who received systemic therapy together with those who did not. We investigated GATA-3 expression and correlated clinicopathologic findings and outcomes in 516 women who received systemic chemotherapy and/or hormonal therapy. Nuclear staining of 1% or greater was considered positive for GATA-3, ER and progesterone receptor (PR). Of 516 cases, 436 (84.5%) were GATA-3+. GATA-3+ tumors were more likely to be grade 1 or 2, ER+, PR+, non-triple-negative phenotypes (all P < .0001), and higher stage (P = .01). ER-/GATA-3+ tumors, compared with ER-/GATA-3- tumors, had worse breast cancer survival (BCS) (P = .02) and a trend for worse overall survival (OS) (P = .05) in univariate analysis. However, there was no difference in OS and BCS between patients who received chemotherapy and/or hormonal therapy among GATA-3-positive and GATA-3-negative groups. GATA-3+ tumors are correlated with lower grade, ER+, PR+, and non-triple-negative phenotypes. Although there was no difference in OS and BCS between GATA-3-positive and GATA-3-negative groups, there was an adverse effect of GATA-3 expression in the ER-negative subgroup of patients who received systemic therapy.