Four children with acute lymphoblastic leukaemia had autologous bone marrow (BM) or peripheral stem cell (PSC) transplantation with low dose of cyclosporine (CsA, 1 mg/kg/d i.v. during the first 28 d) to induce an autologous GVHD (auto‐GVHD). Two children did not have clinical auto‐GVHD and they relapsed 3 and 4 months after treatment. The 2 other children had clinical signs of auto‐GVHD (grade I and grade II): they both are in complete remission but after a first normal haematological recovery they had a prolonged period of aplasia until month 9 for 1 patient and still persistent at month 7 in the other case. We studied lymphocyte subsets reconstitution after transplantation in these patients. All patients had an important decrease in the CD4/CD8 ratio related both to a strong decrease in the CD4+ cells and a strong increase in the CD8+ cells. Most of the CD8+ cells were of the CD8bright+CD28‐ phenotype. These CD8bright+CD28‐ T‐cells represented from 33% to 68% of the total lymphocytes. We discuss the role of these cells after autologous transplantation with CsA, and wonder if these cells could mediate cytotoxicity. In conclusion, among 4 children who received autologous BM or PBC transplantation with low dose of CsA, we observed a complete remission after an auto‐GVHD and a prolonged period of aplasia in 2 patients and a relapse of leukaemia in 2 other patients. All these 4 patients had an increase in the CD8bright+CD28‐ T lymphocytes.
A 58-year-old woman underwent surgery for a pelvic mass. Palliative resection was performed despite the presence of multiple retroperitoneal lymph nodes. All pathology specimens exhibited an adenocarcinomatous component associated with carcinoid proliferation related to an appendicular tumor leading to the diagnosis of appendicular adenocarcinoid with ovarian, peritoneal, and nodal metastases. The patient's general status worsened rapidly with widespread nodal metastasis. Chemotherapy (Folfox 4 regimen) was given, and the patient improved within six weeks. Complete response was achieved after three months. Presently, more than three years after the end of the treatment, the patient is still alive and in complete remission. Appendicular adenocarcinoid is exceptional. These tumors exhibit two cellular components. Ovarian metastasis is frequent. Prognosis is intermediate between adenocarcinoma and malignant carcinoid. When given to patients with colonic carcinoma, the Folfox regimen used effectively here, is associated with a 50% objective response but complete response is very exceptional.
Gastroduodenal vasculopathy is a rare but well-known complication of upper gastrointestinal radiation treatment [1]. Although argon plasma coagulation (APC) has been shown to be effective and safe in the management of radiation-induced rectal bleeding [2] and watermelon stomach [3], the use of APC has not been reported for diffuse radiation vascular lesions located in the upper gastrointestinal tract.In 1999, an 80-year-old man was treated for a cholangiocarcinoma by endoscopic biliary metal stenting and external radiotherapy. At 6 months later he presented with repeated episodes of upper gastrointestinal bleeding related to gastric antral and duodenal radiation-induced mucosal vascular lesions, which had not been observed at the first endoscopy prior to radiotherapy. Iron supplementation and treatment with a proton pump inhibitor had little effect on the hemorrhage so that a total of 20 packed red blood cell units were transfused during a 5-month period. When he was admitted to our unit the endoscopic examination initially showed multiple telangiectasias bleeding spontaneously in the antrum and duodenum (Figure 1). He was treated on a monthly basis by endoscopic APC (55 W; 0.6 l/min) under general anesthesia. At the first three sessions an end-viewing endoscope was used. At the fourth session a side-viewing endoscope was used, in order to better visualize and treat the lesions of the second duodenum, in particular those close to the biliary stent. This final procedure showed that most of the initial lesions had been eradicated (Figure 2), and replaced in several areas by fibrotic scars. The need for transfusions decreased progressively during treatment. No transfusions were required during the following 12-month period and a hemoglobin concentration of 10 g/dl was sustained without any iron supplementation. The patient regained adequate independence and quality of life, and no immediate or delayed complications were observed.The development of new indications for upper gastrointestinal radiotherapy in digestive oncology, and more specifically in the treatment of cholangiocarcinoma, is likely to lead to an increased incidence of upper digestive bleeding caused by radiation-induced gastroduodenal vasculopathy. Different methods have been proposed to achieve hemostasis of radiationinduced mucosal lesions, including surgery (partial or total gastrectomy), endoscopy (Nd:YAG laser, bipolar electrocoagulation), and interventional radiology (embolization). To our knowledge, the efficacy of APC in this location has not been reported, except for a case of radiation-induced carditis after radiotherapy for lung cancer [4]. In our patient we found regression of the gastroduodenal lesions seen at endoscopy, a discontinuation of blood transfusions from the fourth session onwards and during a 12-month follow-up, and a return to normal activities. The presence of the metal biliary stent in the duodenal lumen did not hinder the therapeutic procedure, nor did it lead to any specific complication. Unlike the cases of rectal stric...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.