Randomized trial of 8-week versus 12-week VNCOP-B plus G-CSF regimens as front-line treatment in elderly aggressive non-Hodgkin's lymphoma patients.

BACKGROUND: Among the third-generation chemotherapy regimens specifically adapted in the last decade for elderly aggressive non-Hodgkin's lymphoma (NHL) patients, we designed an 8-week cyclophosphamide, mitoxantrone, vincristine, etoposide, bleomycin and prednisone (VNCOP-B) plus granulocyte colony-stimulating factor (G-CSF) regimen which, in a national multicenter trial, induced good complete response (CR) and relapse-free survival rates with only moderate toxic effects. Here we report a prospective, multicenter, randomized trial comparing the efficacy and toxicity of 8- and 12-week regimens of VNCOP-B plus G-CSF. PATIENTS AND METHODS: From February 1996 to June 2001, 306 consecutive previously untreated stage II-IV aggressive NHL patients > or =60 years of age were enrolled from 12 Italian cooperative institutions. Of the 297 evaluable patients, 149 and 148 received 8- and 12-week regimens, respectively, of VNCOP-B. RESULTS: The CR rates were 63% and 56% in the 8- and 12-week groups; at a median of 32 months (range 3-62 months), relapse-free survival rates were 59% and 55%, respectively. Hematological and non-hematological toxicities were similar in both treatment groups. CONCLUSIONS: Our data show that extending induction treatment with the VNCOP-B plus G-CSF regimen from 8 to 12 weeks does not raise the CR rate or provide a more durable remission.     

Infiltrating dendritic/Langerhans cells in primary breast cancer

It is fully anticipated that dendritic cells (DCs) will become a mainstay for inclusion in biological therapies for patients with cancer including breast cancer. To elucidate the cellular composition of DCs infiltrating human breast cancers, we investigated the correlations between the density of infiltrating DCs and some clinicopathological factors of breast cancer patients, examined cytokine expression on cancer cells and finally, assessed the numbers of CD45RO⁺ tumor infiltrating lymphocytes (TIL). Tissues adjacent to cancer nests contained significantly more S-100 protein⁺ and S-100 protein⁺ CD1a^– DCs, but less CD1a⁺ DCs, than the nests. In invasive ductal carcinomas infiltration by S-100 protein⁺ DCs within and adjacent to nests, CDla⁺ DCs within nests and S-100 protein⁺ CD1a^– DCs adjacent to nests was denser than that in non-invasive carcinomas. With respect to the histological subtypes, there were fewer DCs in scirrhous carcinomas. Patients with stage IV disease had significantly fewer DCs of primary lesions than at other clinical stages. There were good correlations between infiltration by S-100 protein⁺ DCs and expression of the cytokines GM-CSF, IL-1 and TNF- on cancer cells and between GM-CSF expression and S-100 protein⁺ CD1a^– DCs. There was a close correlation between CD45RO⁺ TIL and S-100 protein⁺ DC densities both within and adjacent to the cancer nests and the S-100 protein⁺ CD1a^– DC density adjacent to the cancer nests. Despite extensive immunoelectron microscopic observation, CD1a⁺ DCs within cancer nests contained only few Birbeck's granule-like structure. These data indicate that cancer nests are infiltrated predominantly by CD1a⁺ DCs, whereas S-100 protein⁺ CD1a^– DCs predominate in surrounding tissues, and a infiltration by DCs may require cytokine expression on cancer cells and simultaneous lymphocyte infiltration. The findings of this clinicopathological study indicate the importance of evaluating simultaneously the types and localizations of infiltrating DCs in cancer tissues.     

单顺反子表达人GM-CSF和B7.1融合基因真核表达载体的构建和鉴定

目的　构建单顺反子表达人 GM- CSF和 B7.1融合基因真核表达载体。　方法　应用巨引物 PCR技术对 h GM- CSF基因 c DNA进行定点突变 ;应用 PCR重叠延伸法 ,将 h GM- CSF和 h B7.1基因的 c DNA编码序列通过一 linker序列拼接 ,构建 h GM- CSF与 h B7.1融合基因 h GM- B7.1,将其插入 pc DNA3真核表达载体 ,测定核苷酸序列。　结果　序列分析表明 :(1) h GM- CSF突变体基因 c DNA编码序列的 178位核苷酸由 C变为 A,其余核苷酸序列均未发生变化 ;(2 ) h GM- CSF、linker、h B7.1的连接顺序、方向及序列完全正确。　结论　构建 pc DNA3- h GM- B7.1融合基因真核表达载体成功     

rhG—CSF改变大鼠局灶性脑缺血预后的初步研究

目的　 研究重组人粒细胞集落刺激因子 (recombinanthumangranulocytecolony stimulatingfactor,rhG CSF)对大鼠局灶性脑缺血预后的影响以及与微管相关蛋白 (macrotubule associatedprotein 2 ,MAP 2 )mRNA表达的关系。 方法　 用线栓法建立大鼠大脑中动脉缺血再灌注模型 ,观察rhG CSF对死亡率和神经功能评分的影响。用半定量逆转录 聚合酶链式反应 (RT PCR)方法 ,测定rhG CSF用药组和非用药组的MAP 2mRNA表达水平的改变。 结果　 比较rhG CSF治疗组与非用药组 :治疗组大鼠 ,局灶性脑缺血再灌注后死亡率显著降低 ,神经功能评分明显改善。治疗组缺血侧脑组织的MAP 2mRNA表达明显提前恢复正常。结论　一定剂量的rhG CSF可以减轻脑缺血再灌注损伤 ,保护神经元 ,改善功能预后。     

Time dependent increase of differential monocyte count on the Sysmex NE-8000

During storage of whole blood samples the results of white blood cell counts on a Sysmex NE-8000 Hematology Analyser showed an apparent shift from the granulocytes towards monocytes. The effects of various storage conditions were investigated by incubating blood samples at different temperatures and time intervals. Granulocyte activation and degranulation during storage resulted in a false elevation of the automated monocyte differential counts. The phenomenon occurs at temperatures beyond ambient room temperature.     

Screening for induction of differentiation and toxicity to blast cells by chemotherapeutic compounds in human myeloid leukemia

Bone marrow cells from 9 patients with acute myeloid leukemia and 1 patient with a blast crisis of chronic myeloid leukemia were cultured to determine their ability to be induced to differentiate by different chemotherapeutic compounds. Five of these 10 patients showed differentiation to granulocytic and/or monocytic cells by culture with medium containing the myeloid cell differentiation-inducing protein MGI-2. Actinomycin D induced differentiation in cells from 2 of the patients who did not show differentiation with MGI-2 containing medium. In these 7 patients there was an increase in the ratio of differentiated myeloid cells to blasts. None of these 10 patients showed induction of differentiation by cytosine arabinoside, adriamycin, or daunomycin, but treatment with these compounds showed in some patients an increase in the ratio of differentiated myeloid cells to blasts. The results indicate that this ratio can be increased by differentiation and also in some patients by toxicity to blast cells. With dexamethasone or vinblastine there was no induction of differentiation and no increase in this ratio in any of the 10 patients tested. After in vivo chemotherapy with low dose cytosine arabinoside, cells from one patient showed a similar response in culture to actinomycin D as cells before chemotherapy, whereas in another patient the cells had acquired the ability to respond to actinomycin D. In contrast, after high-dose in vivo chemotherapy with cytosine arabinoside and daunomycin, cells from a third patient seemed to have lost the ability to differentiate in vitro by MGI-2 containing medium or actinomycin D. The results indicate that pre-screening for differentiation-inducing compounds and compounds that show toxicity to blast cells should be useful to select the appropriate compounds to be used for therapy, and that it is advisable to screen the cells both before and after initiation of therapy.     

The evaluation of neutropenia: the use of the granulocyte mobilization test

Summary. Ten individuals with idiopathic neutropenia and similar numbers of normal and abnormal controls were tested for mobilization of their marginal granulocyte pools and bone marrow reserve by using epinephrine and hydrocortisone intravenously. Individuals with ‘benign’ idiopathic neutropenia appeared to have a normal response while half the abnormal controls responded poorly. It is suggested that granulocyte mobilization tests are valuable in the assessment of individuals with neutropenia.     

Transfusion related acute lung injury: a pediatric perspective

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-associated mortality. TRALI occurs in children and adults, but the syndrome has not been reviewed from a pediatric perspective. We reviewed the literature on TRALI from a pediatric perspective. TRALI has been documented in pediatric patients, especially in the setting of hematologic malignancy. Additional TRALI cases have been reported in pediatric patients with a variety of diagnoses. TRALI is likely to be much more common than previously appreciated in the pediatric patient population. TRALI should be considered in the differential diagnosis of all pediatric patients who develop new acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) during or within six hours of a blood product transfusion. When a case of TRALI is suspected, a transfusion reaction report to the blood bank is important to initiate the investigation and identify the implicated donor.     

Complicated lichenoid drug eruption

We report a case of severe lichenoid drug eruption with multiple possible causative agents. A hepatitis C-positive male presented with a short history of painful erosions of the vermilion, lichenoid lesions on the buccal mucosa and glans penis, and erosions and lichenification of the scrotum. In addition, he had a pruritic polymorphic eruption over the scalp, trunk and limbs, comprising psoriasiform and eczematous lesions. He had received combination therapy of pegylated interferon-alpha-2a and ribavirin, along with granulocyte colony-stimulating factor for interferon-induced leucopenia, and propranolol for portal hypertension. The former three agents were ceased 3 weeks prior to presentation, but he remained on propranolol at the initial dermatology consultation. The polymorphous clinical picture was consistent with lichenoid drug eruption, which was confirmed on histology. The papulosquamous eruption responded quickly to 2 weeks of oral prednisone 25 mg daily, which was tapered to 1 mg over 3 months and then ceased. The mucosal lesions were slow to improve and required the addition of tacrolimus 0.03% solution t.d.s. for complete resolution.