Adrenal Insufficiency as a Manifestation of Disseminated Non-Hodgkin's Lymphoma

Levy, N; Young, William F.; Habermann, Thomas M.; Strickler, John G.; Carney, J. Aidan; Stanson, Anthony W.

doi:10.4065/72.9.818

Cited by 23 publications

(9 citation statements)

References 17 publications

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“…Because we observed an increase in RNASE1 gene expression with ICs alone, PBMCs may respond to exposure to RNA containing ICs by increasing RNase expression. Increased expression of RNASE2 has been observed previously in expression arrays in SLE patient PBMCs (43,44) and also noted to be upregulated in inflammatory bowel disease and rheumatoid arthritis patient PBMCs (62,63). RNASE6 has 47% amino acid sequence similarity to RNASE2 (64) and is most highly expressed in pDCs, monocytes, neutrophils, and B cells (64)(65)(66).…”

Section: Discussionmentioning

confidence: 58%

Plasmacytoid Dendritic Cells and C1q Differentially Regulate Inflammatory Gene Induction by Lupus Immune Complexes

Santer

Wiedeman

Teal

et al. 2012

The Journal of Immunology

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Immune complexes (ICs) play a pivotal role in causing inflammation in systemic lupus erythematosus (SLE)3. Yet, it remains unclear what the dominant blood cell type(s) and inflammation related gene programs stimulated by lupus ICs are. To address these questions, we exposed normal human peripheral blood mononuclear cells (PBMCs) or CD14+ isolated monocytes to SLE ICs in the presence or absence of C1q and performed microarray analysis and other tests for cell activation. By microarray analysis, we identified genes and pathways regulated by SLE ICs that are both type I IFN dependent and independent. We also found that C1q containing ICs markedly reduced expression of the majority of IFN-response genes and also influenced the expression of multiple other genes induced by SLE ICs. Surprisingly, IC activation of isolated CD14+ monocytes did not upregulate CD40 and CD86 and only modestly stimulated inflammatory gene expression. However, when monocyte subsets were purified and analyzed separately, the low abundance CD14dim (‘patrolling’) subpopulation was more responsive to ICs. These observations demonstrate the importance of plasmacytoid dendritic cells (pDCs), CD14dim monocytes and C1q as key regulators of inflammatory properties of ICs and identify many pathways through which they act.

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Section: Discussionmentioning

confidence: 58%

Plasmacytoid Dendritic Cells and C1q Differentially Regulate Inflammatory Gene Induction by Lupus Immune Complexes

Santer

Wiedeman

Teal

et al. 2012

The Journal of Immunology

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“…Our data revealed a CR rate of 54.8% and PR rate was 32.3% after R-CHOP therapy, with 2-year estimates of OS and PFS at 68.3% and 51.1%, respectively. According to the previous reports, advanced age, larger size of tumor, presence of adrenal insufficiency, bilateral involvement of adrenal gland, and elevated LDH were related with poor prognosis in primary adrenal NHL [7,15,16]. Most patients with primary adrenal DLBCL accompanied by a number of these adverse features.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in primary diffuse large B-cell lymphoma of adrenal gland treated with rituximab-CHOP chemotherapy from the Consortium for Improving Survival of Lymphoma (CISL)

Kim

Min

et al. 2012

J Hematol Oncol

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BackgroundThe objective of this study was to identify prognostic factors for survival in patients with primary diffuse large B-cell lymphoma (DLBCL) of the adrenal gland.MethodsThirty one patients diagnosed with primary adrenal DLBCL from 14 Korean institutions and treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) were analyzed.ResultsComplete remission (CR) and overall response rate after R-CHOP chemotherapy were 54.8% and 87.0%. The 2-year estimates of overall survival (OS) and progression-free survival (PFS) were 68.3% and 51.1%. In patients achieving CR, significant prolongations of OS (P = 0.029) and PFS (P = 0.005) were observed. Ann Arbor stage had no influence on OS. There was no significant difference in OS between patients with unilateral involvement of adrenal gland and those with bilateral involvement. When staging was modified to include bilateral adrenal involvement as one extranodal site, early stage (I or II) significantly correlated with longer OS (P = 0.021) and PFS (P <0.001).ConclusionsContrary to prior reports, our data suggests that outcomes of primary adrenal DLBCL are encouraging using a regimen of R-CHOP, and that achieving CR after R-CHOP is predictive of survival. Likewise, our modified staging system may have prognostic value.

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“…Old age, initial presentation with PAI, huge tumor size, elevated serum LDH level, and involvement of other organs generally carry a poor prognosis [18,25,27]. Patients with widespread disease and recurrent PAI who were refractory to chemotherapy rarely survived longer than 1 year after diagnosis.…”

Section: Discussionmentioning

confidence: 98%

Adrenal insufficiency caused by primary aggressive non-Hodgkin's lymphoma of bilateral adrenal glands: report of a case and literature review

Hsu

Sheu

et al. 1999

Annals of Hematology

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A 64-year-old woman was hospitalized because of poor general condition, gastrointestinal upset, unexplained fever, electrolyte imbalances, and an incidental finding of bilateral huge adrenal masses on computerized tomography (CT) of the abdomen. Non-Hodgkin's lymphoma (NHL) of B-cell origin was proven by ultrasound-guided aspiration biopsy of the left adrenal gland. Meanwhile, primary adrenal insufficiency was confirmed by her low serum cortisol level, high ACTH level, and inadequate adrenal response to the rapid ACTH stimulation test. The diagnosis of primary adrenal NHL was supported by detailed physical examinations, bone marrow examination, and such imaging studies as CT scan and sonography. She received three courses of chemotherapy with cyclophosphamide, vincristine, and prednisolone and there was an initial transient response, but she died of sepsis and progression of NHL three and a half months later.

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Adrenal Insufficiency as a Manifestation of Disseminated Non-Hodgkin's Lymphoma

Cited by 23 publications

References 17 publications

Plasmacytoid Dendritic Cells and C1q Differentially Regulate Inflammatory Gene Induction by Lupus Immune Complexes

Plasmacytoid Dendritic Cells and C1q Differentially Regulate Inflammatory Gene Induction by Lupus Immune Complexes

Prognostic factors in primary diffuse large B-cell lymphoma of adrenal gland treated with rituximab-CHOP chemotherapy from the Consortium for Improving Survival of Lymphoma (CISL)

Adrenal insufficiency caused by primary aggressive non-Hodgkin's lymphoma of bilateral adrenal glands: report of a case and literature review

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