Hematology and cell therapy最新文献

A primary mucosa associated lymphoid tissue tumor (MALT) of the kidney in a 50-year-old man who suffered from on therapy resistant high blood pressure over 15 years period is presented. A mass in the right kidney (6x5x3 cm) during routine check up was discovered on ultrasonography and confirmed on CT scan and NMR. The patient was submitted to nephrectomy. A mass involving kidney, pyelon and upper part of the ureter was found. Histology showed low grade non-Hodgkin B-cell lymphoma of MALT type. The neoplastic cells were positive for monoclonal antibodies CD20, CD79alpha, surface and cytoplasmic and IgM immunoglobulins and showed light chain restriction (kappa+). After histology was available, a careful staging was performed. The disease was not found anywhere else. It was concluded that the patient belonged to the stage IE of primary kidney MALT lymphoma. Gastroscopy showed signs of chronic superficial gastritis. Urease test was positive and IgG antibodies against Helicobacter pylori in titer 421 were found as well. Except for Helicobacter pylori no additional therapy was given.

The evolution of the pattern of nucleolar organiser regions (AgNORs) in circulating lymphocytes during the stable phase and after chemotherapy in CLL was analysed. Peripheral blood smears were stained by the AgNOR technique at diagnosis, during observation follow-up in stable phase, or at the beginning and at the end of chemotherapy in patients with progressive disease. The changes in the AgNOR pattern were compared with those of TTM used as a tumour burden parameter. Among 52 cases that entered the study, 29 were in stable phase and 23 had progressive disease and received chemotherapy. During stable phase, the AgNORs as well as TTM remained constant. In treated patients, the relative reduction of tumour mass was correlated with a decrease in the percentage of lymphocytes containing one AgNOR cluster. The percentage of cells with one compact nucleolus before chemotherapy was inversely correlated with the relative amount of tumor reduction after treatment. We conclude that the AgNOR pattern in CLL describes the cell kinetic changes during the evolution of the disease and is a prognostic factor for tumor reduction after treatment.

CD(34+)-enriched peripheral blood stem cells (PBSC) are increasingly being used as an autograft in patients with multiple myeloma (MM). The rationale for the use of the CD34+-enriched fraction in MM is the ability to obtain a graft with a significant reduction of contamination by plasma cells. However, the effect of such a manipulation on the proliferating potential of the engrafted cells is not known. We wished to study, as part of a randomized trial comparing the outcome in MM patients transplanted with either CD(34+)-enriched cells or unfractionated PBSC, the primitive hematopoietic cell content of the autografts using long-term culture initiating cell (LTC-IC) assays in 7 MM patients. In 3 patients CD(34+)cell-enriched fraction was compared to unfractionated PBSC whereas in the remaining 4 patients the LTC-IC assay was performed on total PBSC. The mean percentage of CD34+ cells of the CD34+ selected fraction in three patients was 82% (range 71%-96%) whereas the same percentage in PBSC varied from 0.6% to 10% in 4 patients (mean: 4.2%). Out of three patients transplanted with CD34+ cell fraction, two patients were found to have a very similar LTC-IC generating potential in their CD34+ versus PBSC fractions as this was assessed by the clonogenic cell output at week+5 per 10(4) CD34+ cells initiating the culture (PBSC: 92 and 168 and CD34+ fraction: 102 and 16, respectively) whereas one patient had a slightly different values (PBSC: 51 and CD34+ fraction: 103). When the PBSC fraction was compared in all 7 patients, the LTC-IC generation potential was very heterogenous, varying from 1.4 to 168. To determine if the selection procedure influences the numbers of LTC-IC's in both fractions, we have performed limiting dilution assays to determine both the frequency of distribution of hematopoietic colonies and the frequency of LTC-IC's in two patients. The frequency of distribution of hematopoietic colonies was linear in both CD34+ and PBSC fractions as was the frequency of LTC-IC when the corrections were made with regard to the CD34+ cell-content of the cultures (1/20). Our results indicate that the CD34+ selection procedure used in all three patients (Ceprate) is not deleterious for the generation of LTC-IC's and these findings support the rationale for the use of this procedure in multiple for the purposes of tumor depletion.

Therapy related acute myeloid leukemia occurs after exposure to various cytotoxic agents. Among typical chemotherapeutic agents are the alkylating agents and topoisomerase II inhibitors. This type of leukemia has been reported after the use of antimetabolites. We report here a patient who developed therapy related acute myeloid leukemia secondary to the use of 5-fluorouracil.

Comparison of apparatus for automatically spreading peripheral blood films (GENES) to manual wedge-pull technique has been performed, showing that the average size of optimal area for counting is twice larger in automated smears compared to manual ones. The variability of WBC repartition has been studied in doing differential count on manual and automated smears and both are compared to results obtain with an independent technique (Coulter STKS) for differential. The correlation coefficients for each WBC population show a closer relationship between automated smear preparations and reference instrument (STKS) than with manual spreading smears. Monocyte differential is particularly influenced by the variability of manual spreading procedures.

Manufacturing of cell therapy products has to follow several requirements to obtain sanitary security and quality of the product. Thus, at its conception, the cell therapy unit (CTU) of Nantes choose to integrate a quality assurance system: - The good manufacturing practices (GMP's) are a technical reference for the Unit. They are a quality criteria necessary to guarantee the security of products in term of staff, premises, material, matter and method; - The ISO 9001 standards are a model for quality assurance in design, development, production, installation and servicing. They established a quality system; - The creation, the running and the maintenance of premises are an essential aspect of the quality system and they are described in this paper. Thus, from October 1994 to June 1998, 450 cell processing (with or without cryopreservation and storage of cells) have been realised at the CTU of Nantes, leading to 160 injections without major undesirable effect and without microbiological contamination.

Polyploidy which is defined as an increase in chromosome number by an exact multiple of the haploid chromosome number is a typical characteristic of plant species but can also be found in almost all organisms from protists to humans. In the plant kingdom, since the reproduction can occur vegetatively, polyploid cells have time to settle down from the evolution point of view as a stable genetic system. So, 30 to 70% of angiosperms, including many important crop plants, are estimated to have polyploidy in their lineages. The success of polyploid species in plants has been attributed to their ability to colonise a wider range of habitats and to survive better in unstable climates compared with their diploid progenitors, presumably due to increased heterozygosity and flexibility provided by the presence of additional alleles.

A case of an inflammatory polyp-associated lesion extending through an extraction socket appearing as an intraoral nodular lesion and unilateral blindness secondary to leukemic optic nerve head infiltration is reported. The patient was a 28-year-old male whose his upper first molar had been extracted fifteen days previously. The lesion was an asymptomatic soft tissue mass, red in color and hot tender to palpation, involving the alveolar ridge in the maxillary molar area. Although this is apparently a rare occurrence, the nature of the lesion was suggested by the history, clinical appearance, and radiographic findings. Excision of the inflammatory lesion was followed by complete healing with closure of the lesion. Unfortunately, the blindness was irreversible. The patient is still under leukemia therapy. Review of the literature did not yield any other such cases. The role of oral lesions as a diagnostic indicator and the importance of dental surgeons in the diagnosis of leukemic patients are discussed. It is concluded that proper precautions and meticulous early diagnosis are required in these patients and that dental practitioners should be aware of the diagnostic features and possibilities of oral complications associated with leukemia.

Infections are the major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). Predisposition to infection in CLL is mediated through various abnormalities including both the immune defects inherent in the primary disease (impairment in humoral and cellular immunity) and in the further immunosuppression related to the management of CLL. Hypogammaglobulinemia is probably the most important immune defect in terms of risk of severe bacterial infections, its frequency and severity progressing with the duration of the disease. Newer antineoplastic agents such as purine analogues, especially when used in previously treated patients, may be associated with a new spectrum of pathogens (Listeria monocytogenes, Pneumocystis carinii, cytomegalovirus, herpes simplex virus, and mycobacteria) involving T-cell dysfunction. In this review we focus on the clinical characteristics of infections in CLL and on the risk factors involved in the pathogenesis of this complication. Furthermore, we describe the evolving patterns of infections associated with purine analogues and discuss the currently accepted approaches to prophylaxis and treatment.