Twocases of malignant lymphomacomplicated with capillary leak syndrome following super high-dose chemotherapy and administration ofgranulocyte colony-stimulating factor (G-CSF) are presented. Subsequent to the nadir of granulocytes, and at the stage of rapid increase of granulocytes, the symptoms of fever, hypotension, dyspnea, pleural eflusion and edema appeared, and laboratory data revealed hypoxia, hypocapnia and hypoalbuminemia. In addition, an abscesslike lesion was observed in the liver in one patient. After the administration of G-CSFwas ceased or decreased, and pulse therapy with methylprednisolone was initiated, these symptoms disappeared quickly.
ZAP-70 status of the patient, that is, o or X20% positive. Indeed, the CD38 þ CLL cells demonstrated equivalent ZAP-70 expression to their corresponding T cells in all the samples tested, even in samples categorized as ZAP-70 negative (o20% positive).We next physically cell sorted CD38 þ and CD38 À subclonal populations from the same patient (n ¼ 10), in order to establish whether these cells had a differential response to B-cell receptor stimulation. The CD38 þ CLL cells showed constitutively higher basal tyrosine phosphorylation when compared with their CD38 À counter parts. They also demonstrated a differential capacity to signal following stimulation with anti-IgM (Figure 2). Given that we have already established that CD38 þ CLL cells express higher levels of ZAP-70, a molecule known to enhance BCR signalling, 8 it seems likely that CD38 and ZAP-70 play complementary roles in the basal activation and signalling capacity of CLL cells. Importantly, our findings provide a biological rationale for the work of Ghia et al., 5 who demonstrated that CD38 expression, regardless of the size of the clone, confers poor prognosis in CLL.
Isolated extramedullary (EM) relapse of acute myelogenous leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. Predisposing factors include CD56 expression and the chromosomal abnormality t(8;21). We describe an AML patient showing the chromosomal abnormality t(8;21) and CD56 expression who experienced a unique EM relapse after allo-HSCT. Approximately 10 months after allo-HSCT, he experienced relapse involving the femur and lumbar vertebrae and, subsequently, an EM relapse of the stomach. Although we administered only local radiotherapy and not systemic chemotherapy, he showed no bone marrow relapse on long-term follow-up after achieving complete hematological remission. These findings suggest that the graft-versus-leukemia effect may preferentially maintain marrow remission rather than prevent EM relapse. In addition, our findings show that extended survival is possible after EM relapse following allo-HSCT in patients with marrow hematopoiesis of donor origin, and that augmentation of the graft-versus-leukemia effect may be useful.
We report on a 59-yr-old man with recurrent multiple myeloma. To reduce treatment-related mortality, while retaining the cytoreductive effects of high-dose chemotherapy, as well as graft vs. myeloma effect, we used a reduced-intensity conditioning umbilical cord blood (CB) transplantation following high-dose chemotherapy with autologous stem cell transplantation support. This patient was engrafted rapidly and extramedullary toxicities were acceptable. Although he had local recurrence in the right calf on day +130 after the CB transplantation, the tumor was successfully treated with radiation therapy, and he is alive and well at present (day +480).
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