Hairy cell leukemia-variant

Hairy cell leukaemia variant is a very rare chronic lymphoproliferative disorder and is closely related to hairy cell leukemia. We hereby describe a case of hairy cell leukaemia variant for the first time in Saudi Arabia. An elderly Saudi man presented with pallor, massive splenomegaly, and moderate hepatomegaly. Hemoglobin was 7.7 g/dl, Platelets were 134 x109/l and white blood count was 140x10 9/l with 97% being abnormal lymphoid cells with cytoplasmic projections. The morphology, cytochemistry, and immunophenotype of the lymphoid cells were classical of hairy cell leukaemia variant. The bone marrow was easily aspirated and findings were consistent with hairy cell leukaemia variant.     

Fludarabine and cytarabine combined chemotherapy followed by transfusion of donor blood stem cells for treating relapse of acute leukaemia after allogeneic haematopoietic stem cell transplantation

Background Relapse remains an obstacle to successful allogeneic haematopoietic stem cell transplantation （allo-HSCT） for patients with acute leukaemia and no standard treatment is available. We assessed fludarabine and cytarabine with transfusion of donor haematopoietic stem cell in treating the relapse of acute leukaemia after allo-HSCT. Methods Seven patients, median age 34 years, with relapse of acute leukaemia after allo-HSCT received combination chemotherapy of fludarabine with cytarabine for 5 days. Five patients suffered from acute myeloid leukaemia （2 refractory） and 2 refractory acute lymphoblastic leukaemia. After the transplantation, the median relapse time was 110 days （range, 38-185 days）. Two days after chemotherapy, 5 patients received infusion of donor＇s peripheral blood stem cells, mobilized by granulocyte colony stimulating factor. No prophylactic agents of graft versus host diseases were administered, Results Six patients achieved haematopoietic reconstitution. DNA sequence analysis at day 30 after treatment identified all as full donor chimera type. The median observation time was 189 days. After the treatment, the median time for neutrophilic granulocyte value 〉0.5×10^9/L and for platelet value 〉20×10^9/L were 13 days （range, 10-18 days） and 15 days （range, 11-24 days）, respectively. Graft versus host disease occurred in 2 patients （acute） and 3 （chronic）. Five patients suffered from pulmonary fungal infection （2 died）, 3 haemorrhagic cystitis and 2 cytomegalovirus viraemia. The other patients died of leukaemia related deaths. Three patients with chronic graft versus host disease who had received donor peripheral blood stem cells reinfusion have survived for 375 days, 232 days and 195 days, respectively. Conclusions Fludarabine with cytarabine plus the donor haematopoietic stem cell should be considered as an effective therapeutic regimen for relapse of acute leukaemia after alIo-HSCT. The disease free state of patients may increase, though with high ri     

Pure red cell aplasia and thymoma associated with high levels of the suppressor/cytotoxic T lymphocyte subset

A 64 year old man admitted to hospital with increasing effort dyspnoea and lethargy was found to have a thymoma and pure red cell aplasia. Lymphocytes accounted for 20-30% of marrow cells, and numbers of T8 suppressor/cytotoxic cells in peripheral blood were greatly increased. He remained anaemic after removal of the thymoma despite blood transfusions, and immunosuppression with prednisolone 60 mg and cyclophosphamide 50 mg daily was started. The dose of prednisolone was reduced to 15 mg owing to steroid myopathy and the risk of opportunistic infection. He went into remission, and the dose was further decreased to 10 mg daily.     

Bilateral masculine mastoplasia associated with imatinib mesylate: A case report and literature review

1 CASE REPORT In June 2009, a 29-year-old Chinese male was diagnosed as having Philadelphia chromosome-positive chronic myeloid leukemia (chronic phase); other than a     

FP+艾迪注射液联合125I粒子植入治疗中晚期原发性肝癌的临床研究

目的 观察5-氟尿嘧啶和顺铂(FP)联合艾迪注射液联合125I粒子植入治疗中晚期原发性肝癌的临床疗效.方法 以唐山市人民医院2012年2月至2015年7月收治的原发性肝癌患者95例作为研究对象,按随机数表法分为观察组(n=50)和对照组(n=45).对照组患者采取FP联合125I粒子植入治疗,观察组在对照组基础上联合艾迪注射液进行治疗,时间2个疗程.比较两组患者临床缓解率、治疗前后KPS评分、外周血白细胞计数、不良反应发生率,以及1年和2年生存率.结果 治疗后,观察组患者的临床缓解率为36.0%,明显高于对照组的17.8%,差异有统计学意义(P<0.05);观察组与对照组患者治疗前的KPS评分分别为(72.2±4.1)分、(72.4±4.4)分,外周血白细胞计数分别为(6.3±1.9)×109/L、(6.1±2.2)×109/L,组间比较差异均无统计学意义(P>0.05);治疗后,观察组与对照组患者的KPS评分分别升高至(85.3±5.0)分、(79.3±5.2)分,外周血白细胞计数分别减少至(5.0±1.6)×109/L、(3.1±1.3)×109/L,较治疗前均改善明显,且观察组治疗后的KPS评分、外周血白细胞计数均高于对照组,差异均有统计学意义(P<0.05).结论 FP+艾迪注射液联合125I粒子植入治疗中晚期原发性肝癌能明显提高临床缓解率与KPS评分,抑制白细胞减少,生存时间得以延长,值得临床推广应用.     

Anticoagulant induced leukoagglutination

Low leukocyte count secondary to leukocyte aggregation caused by an ethylene diamine tetra acetic acid (EDTA) occur in both benign and malignant disorders. We report a 71-year-old male patient who was admitted to the hospital with acute chest infection. Complete blood count (CBC) collected in EDTA tube and analyzed by sysmex instrument SE/9500 revealed low hemoglobin level of 9.4g/dl, white blood cell (WBC) count of 8.2x109/L and neutrophils of 4.8x109/L. Peripheral blood smear review shows multiple leukocytes aggregation one clump in each field. When we ask for another blood sample in citrate anticoagulant, the CBC showed WBC count of 11.8x109/L and neutrophils of 6.26 x 109/L. This is a case of low leukocyte count secondary to leukocyte aggregation induced by EDTA.     

Mycobacterium fortuitum catheter-related sepsis in acute leukaemia

We report Mycobacterium fortuitum (M. fortuitum) catheter-related sepsis in a five-year-old boy with acute lymphoblastic leukaemia (ALL). This is the first reported case of M. fortuitum infection seen in our paediatric oncology patients. The patient was in haematological remission and receiving maintenance chemotherapy via an indwelling central venous catheter (Port-a-Cath). He was febrile, toxic-looking and was in respiratory distress. Clinically, he had a right pleural effusion and gross hepatomegaly. The patient was lymphopaenic and had deranged liver function test. Repeat paired blood cultures were positive for M. fortuitum. The catheter was promptly removed and he was treated aggressively with intravenous amikacin, cefoxitin, ciprofloxacin, trimethoprim-sulfamethoxazole and oral clarithromycin, with good clinical response. The patient remained well without further complications while on chemotherapy. M. fortuitum is an uncommon cause of catheter-related infection in patients with malignancies. Removal of an infected catheter is necessary for complete control of atypical mycobacterial infection in an immunosuppressed patient.     

HAIRY CELL LEUKEMIA: CYTOMORPHOLOGY HISTOCHEMISTRY, ULTRASTRUCTURE, CELL SURFACE MARKERS AND PATHOLOGY REPORT OF 2 CASES

Both cases studied presented with typical hairy cells and splenomegaly, establishing hairy cell leukemia (HCL) diagnosis. When white cell count is high, hairy cell percentage is also high. Case l with unique leukocytosis, unimproved by splenectomy and prednisone plus vincristine, showed improvement on leukerancyclophospha- mide therapy. Hairy cells are probably lymphocyte-mo- nocyte hybrids, but both of our cases conform to B lymphocyte. Pseudosinuses in the spleen are helpful to HCL diagnosis. Ribosome lamellar complexes and tartarate resistant acid phosphatase reac- tion are also helpful to the diagnosis but neither is HCL specific.     

Allogeneic peripheral blood stem cell transplantation in the treatment of severe aplastic anemia and severe infection

Severeaplasticanemia (SAA)ischaracterizedbyafailureofbloodcellproductionresultinginseverepancytopeniawithamarkedlyhypocellularbonemarrow Bonemarrowtransplantation (BMT)isoneofthecurativeapproachesinpatientswithSAA Peripheralbloodstemcelltransplantation(PBSCT )hasbeenmainlyusedinthetreatmentofmalignanttumors Recently ,successfulsyngeneicandallogeneicPBSCTinpatientswithSAAwasreported ,1 3 　andsomewasasasalvagetreatmentinpatientswithSAAwhofailedtoBMT 4,5Wesuccessfullycompletedanallo…     

PERIPHERAL BLOOD CD34^＋ CELL MOBILIZATION IN 42 PATIENTS WITH SEVERE AUTOIMMUNE DISEASE

Objective To evaluate the feasibility and safety of peripheral CD34 cell mobilization in patients with severe autoimmune disease. Methods Forty-two patients underwent a total of 46 mobilizations by the regimen of cyclophosphamide 2-3 g/m2 recombinant human granulocyte colony stimulating factor (rhG-CSF) 5 μg·kg-1·d-1. The positive selection of CD34 cell was performed through the CliniMACS. Results In 8.1±2.3 days after administration of cyclophosphamide, the peripheral white blood cell and mononuclear cell (MNC) decreased to the lowest level. In 3.7±1.6 days after injection of rhG-CSF, the peripheral absolute MNC and CD34 cell counts were 0.95×109/L and 0.035×109/L, respectively. After 2.4±0.6 times of leukapheresis, there gained 4.46×108/kg of MNC and 5.26×106/kg of CD34 , respectively. After mobilization, the underlying diseases were ameliorated more or less. In systemic lupus erythematosus (SLE) patients, SLE Disease Activity Index (SLEDAI) decreased from a median of 17 to 3 (P<0.01). In rheumatic arthritis patients, an American College of Rheumatology criteria for 20%(ACR20) response was achieved in all five patients. Totally, 17.4% of patients whose absolute neutrophil count <0.5×109/L suffered infection, and 31.0% of patients had bone pain after the injection of rhG-CSF. Two patients suffered severe complications, one with acute renal failure and recovered by hemodialysis, the other died of thrombotic thrombocytopenic purpura. Failed mobilization occurred in three patients. Conclusions Sufficient CD34 cells can be mobilized by low dose of cyclophosphamide and rhG-CSF. CD34 cell mobilization for treatment of severe autoimmune disease not only is appropriate in both effectiveness and safety but ameliorates disease also.     

Acute myeloid leukaemia with chronic course

A 60 year old male presented with soreness and swelling of the oral cavity and throat for 2 weeks as well as fever and prostration. He was diagnosed as a case of acute myeloid leukaemia (AML) on the basis of blood and bone marrow morphology and immunophenotyping. Normal platelet count and normal bone marrow megakaryocytes were striking features as well as low total count of WBC and myeloblast. Being informed about the risk and benefit of the treatment with chemotherapy, he opted for taking palliative treatment rather than conventional chemotherapy for remission induction. Since then the patient was doing surprisingly well and he was alive for 38 months with few episodes of clinical deterioration which was successfully managed by palliative measures.     

河北省首例W135群脑膜炎奈瑟菌感染病例调查

目的调查河北省首例W135群脑膜炎奈瑟菌（Neisseriameningitidis,Nm）感染病例。方法查阅病例病案,进行流行病学调查,采集病例及密切接触者标本进行实验室检测。结果患者发热、间断性呕吐、伴有颈项强直,无惊厥、无皮肤瘀点瘀斑;血白细胞计数8．1×109个／L;脑脊液外观混浊、蛋白质2．63g／L、白细胞2．78X106个几。脑脊液培养得到可疑Nm菌株。初步诊断为流脑。最终脑脊液标本经荧光定量PCR基因检测确诊为W135群Nm感染病例。患者经抗菌药物治疗已痊愈出院。结论河北省存在W135群Nm流行可能性,应警惕W135群流脑疫情暴发。荧光定量PCR方法具有快速、微量、可靠等优点,在流脑诊断方面实用价值较高。     

自体外周血CD34+细胞移植治疗非霍奇金淋巴瘤

目的 采用CD34+细胞体外分选技术对非霍奇金淋巴瘤(NHL)患者进行自体外周血CD34+细胞移植,观察其临床疗效.方法 5例NHL患者,女3例,男2例;中位年龄29岁;T细胞NHL 3例,弥漫大B细胞NHL 1例,真性组织细胞型NHL 1例;临床分期ⅡA 2例,ⅣB 3例;移植前4例处首次完全缓解,1例为部分缓解.采用Clini MACS临床型磁性细胞分离器收集CD34+和CD34-细胞组分,患者于预处理后输注分选的CD34+细胞.结果 Clini MACS体外分选可去除3.3个对数级CD34-细胞;回输CD34+细胞中位数为2.0×106/kg;CD34+回收率为52%,CD34+细胞纯度为86%;移植后白细胞恢复至＞0.5×109/L和血小板＞20×109/L天数(中位数)分别为12 d和19 d.患者总体生存率和无病生存率均为4/5,1年生存率为4/5,估计5年生存率为75%.结论 NHL患者自体外周血CD34+细胞移植后可获得迅速稳定的造血重建,体外CD34+细胞纯化富集后移植可望提高NHL患者自体移植疗效.     

LEUKOCYTOSIS AND RETINOIC ACID SYNDROME IN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA TREATED WITH ARSENIC TRIOXIDE

ALL-trans-retinoic acid ATRA),as the first-line drug,induces complete remission CR)in80%to90%of patients with acute promyelo-cytic leukemia APL)and significantly improves the out-come of the patients with APL.1Although ATRA is gener-ally well tolerated,40…     

Ⅰ类切口手术预防性抗生素的应用效果研究

目的：探讨Ⅰ类切口手术预防性应用抗生素的应用效果,为合理使用抗生素提供依据。方法选取1574例择期Ⅰ类切口手术患者为研究对象,根据是否预防性应用抗生素分为对照组（897例）和观察组（677例）。对照组不预防使用抗生素;观察组预防性使用抗生素。比较2组患者手术前,手术后1d、2d、3d、7d的体温变化。比较2组患者手术前后外周血白细胞计数。术后7d,比较2组患者切口甲级愈合率、感染率。结果手术前,2组患者体温比较差异无统计学意义。手术后2组患者均未见高热病例出现,且2组术后1d、2d、3d、7d体温比较差异无统计学意义。手术前,对照组外周血白细胞计数为（5.69±0.82）×109/L,观察组为（5.65±0.86）×109/L,2组比较差异无统计学意义。手术后,对照组外周血白细胞计数为（6.23±0.87）×109/L,观察组为（6.18±0.90）×109/L,组间比较差异无统计学意义。对照组切口甲级愈合率、感染率分别为92.20%、5.91%,观察组分别为93.35%、5.02%,观察组切口甲级愈合率和感染率与对照组比较,差异均无统计学意义。结论Ⅰ类切口手术患者预防性使用抗生素并不能有效降低切口感染发生率、提高其切口甲级愈合率,只要严格执行无菌操作,加强患者护理,可以不预防性应用抗生素。     

Successful peripheral blood stem-cell autograft with a near-critical dose of myeloid progenitor cells in acute non-lymphoblastic leukaemia in relapse

Rapid, complete and sustained haemopoietic reconstitution was achieved in a 69-year-old man with acute non-lymphoblastic leukaemia in relapse who received an autograft of peripheral blood cells that were collected during very early remission. The patient received 1.7 X 10(8) nucleated cells/kg bodyweight containing 63 X 10(4) myeloid progenitor cells (CFU-GM)/kg bodyweight. Trilineage engraftment was evident in the bone marrow seven days after the graft. Normal neutrophil and platelet counts were attained by day 17, on which day the patient was discharged from hospital. He remained in complete remission three months after the graft with normal blood counts and bone-marrow cellularity. The rapid and sustained haemopoietic activity in this patient, in conjunction with our previous experience of four other patients who received autografts with peripheral blood stem cells, supports the concept we have proposed that a minimum CFU-GM dose of 50 X 10(4)/kg bodyweight produces complete and sustained engraftment. The rapid recovery minimizes aplasia-related risks and suggests that such autografting can be carried out safely in first remission even in older patients. This technique should be considered as a new therapeutic option for patients with acute non-lymphoblastic leukaemia.     

鼠疟原虫引起血小板减少药物干预效果的观察

目的了解退烧药、抗生素及激素对感染鼠疟原虫引起的血小板减少是否具有恢复的效果。方法健康昆明小鼠腹腔接种感染伯氏鼠疟原虫,当感染鼠血小板明显低于正常值后,分别采用临床常用的大环内酯类、β内酰胺类和喹诺酮类抗生素、退烧药及激素类药物按照人体治疗量的10倍灌服或肌注方法给药3d,每12h采血1次做血小板计数观察。每5只小鼠为一个观察试验组,每种药物采用一组小鼠试验观察取平均数据,并设正常对照组。结果正常鼠血小板平均计数为256×109/L。健康鼠感染鼠疟原虫后第8d,各组感染鼠血小板计数平均降至90×109/L后,开始灌服各类抗生素和肌注氨基比林及地塞米松,除阿奇霉素观察组治疗3d后血小板计数平均恢复至201×109/L水平外,其它抗生素和退烧药及激素均对感染鼠疟原虫所引起的血小板明显减少恢复无影响。结论除阿奇霉素外,复方氨基比林、阿莫西林、左氧氟沙星、地塞米松对鼠疟原虫感染小鼠血小板减少无明显效果。     

Application of autologous peripheral blood stem cell transplantation in children with malignant tumor

Objective To investigate if low dose total body irradiation (TBI, 6.0-9.0 Gy) combined with intensified chemotherapy followed by autologous peripheral blood stem cell transplantation results in better survival in children with refractory leukemia or solid tumors. Methods Twenty-one children with malignant tumors were included in this study.There w ere 14 males and 7 females aged 3.5-12 years.Underlying disease included high -risk acute lymphoblastic leukemia (ALL, CR(1) in 3 children and CR(2) in 5 ch ildren), acute myeloblastic leukemia (AML, 9 children), non-Hodgkin’s lymphoma stage Ⅳ ( 2 children), and neuroblastoma stage Ⅳ (2 children).The peripheral hematopoi etic stem cells were collected six to eleven months after complete response, mob ilized with high dose chemotherapy alone or combined with GM-CSF or G-CSF.Th e conditioning regimen consisted of chemotherapy with two to three combinations of the following drugs: cyclophosphamide, arabinosylcytosine, McNU, etopside, an d Idarubicin on the basis ofTBI (6.0-9.0 Gy).A mean of (1.8±0.5) ×10(8)/kg autologous mononuclear cells were transplanted.The patients were followed up after transplantation. Results Severe bone marrow suppression occurred in all patients around day +7.Peripher al white blood cell count decreased to 0 in all patients at day +4.8±2.9, and platelet count decreased to less than 20×10(9)/L at day +9.0±2.6.Succ essful engraftment was achieved in 21 patients, but four died of infection at da y +17, +20, +31 and +67, respectively.Recovery of white blood cell (WBC) to 10×10(9)/L, absolute neutrophil count to 0.5×10(9)/L, platelet count to 20 ×10(9)/L occurred on 21±12, 26±13, and 27±10 days, respectively.During the follow up period, three patients relapsed at +5 months, +1.5 years, and +2 yea rs 10 months, respectively.One patient died of intracranial hemorrhage at +8 m onths.Thirteen patients had event-free survival for 2-12 years, with a mean o f 6.7±3.4 years.Conclusion Our preliminary data suggest that myeloablative therapy with low dose TBI (6.0 -9.0 Gy) combined with intensified chemotherapy followed by autologous periphe ral blood stem cell transplantation might be associated with favorable results i n children with refractory leukemia or solid tumors.     

Lemierre syndrome caused by Arcanobacterium haemolyticum

A54-year-old male smoker was admitted to our hospital after undergoing the drainage of a left peritonsillar abscess.Ten days prior to admission (day 1),he complained of a "scratchy" throat with a fever of 38.5°C.He had an enlarged left tonsil with prominent exudate;white blood cell count (WCC) 8.8×109/L;platelet count (Pit) 103 × 109/L;chest X-ray was normal in a medical clinic.Then the patient received an intravenous injection of 4 million units of penicillin G every 6 hours and 500 mg of oral azithromycin once daily.But his condition worsened with a temperature of 41°C and laryngoscopy confirmed a marked left-sided peritonsillar abscess which was drained.On day 10,the patient was transferred to our hospital after developing persistent fever,rigors,left-sided neck pain,pain on swallowing and purulent bloody sputum.On examination,his temperature was 39.6°C,pulse 95 beats/min;respiratory rate 25 breaths/min and blood pressure 110/80 mmHg (1 mmHg=0.133 kPa).The left side of his neck was swollen and tender,anterior to the sternocleidomastoid muscle.     

儿童急性白血病合并呼吸道感染的危险因素及预防性护理措施分析

  目的  对儿童急性白血病(AL)合并呼吸道感染的危险因素进行分析,通过结果提出预防护理措施,为临床治疗提供参考。  方法  回顾性分析2018年2月—2021年2月温州医科大学附属第二医院收治的140例儿童AL患者,分为呼吸道感染组(72例)和非呼吸道感染组(68例)。收集患者的相关临床资料,分析影响儿童AL合并呼吸道感染的危险因素,并提出预防性护理措施。  结果  重度贫血、白细胞计数＞10×109/L或＜2×109/L、血小板＜20×109/L、低蛋白血症、住院时间延长、化疗方案、预防性应用抗生素是儿童白血病合并呼吸道感染的影响因素(均P＜0.05);多因素logistic回归分析显示重度贫血(OR=2.440, 95% CI:1.073~5.546)、血小板＜20×109/L(OR=1.972, 95% CI:1.061~3.663)、低蛋白血症(OR=2.959, 95% CI:1.115~7.853)、IA化疗方案(OR=3.799, 95% CI:1.207~11.957)是影响儿童AL合并呼吸道感染的独立危险因素。  结论  儿童AL合并呼吸道感染的危险因素包括重度贫血、血小板＜20×109/L、低蛋白血症、IA化疗方案,临床需针对上述危险因素采取预防性护理措施。