Multiple granulocytic sarcoma during complete hematologic remission of acute nonlymphoid leukemia

In this report we describe a case of granulocytic sarcoma (GS) developing in a patient after 66 months in complete remission of acute nonlymphoid leukemia. The granulocytic precursor cell proliferation arose simultaneously in two extramedullary sites (testis and small bowel), without evidence of bone marrow relapse. The intensive systemic chemotherapy with high-dose ARA-C allowed a clinical remission, lasting 8 months. GS eventually recurred as extramedullary multi-site disease (abdominal lymph nodes, central nervous system involvement), once again unassociated with blood and bone marrow relapse. Both, at onset and in relapse, special staining techniques on tissue sections (chloroacetate esterase) and immunohistochemical typing with monoclonal antibodies were necessary for a correct diagnosis. We discuss the relationship between systemic leukemia and the GS which showed a metastasizing tumor-like behavior.     

CA 125 levels in patients with non-Hodgkin lymphoma and other hematologic malignancies

Cancer antigen (CA 125) is a glycoprotein commonly used as a tumor marker. In this study, CA 125 levels were measured in 149 patients and 26 healthy control subjects. The study group included 69 non-Hodgkin lymphomas (NHL), 25 Hodgkin disease (HD), 20 acute myelocytic leukemia (AML), 14 chronic lymphocytic leukemia (CLL), 12 chronic myelocytic leukemia (CML), and nine multiple myeloma (MM) patients. CA 125 was elevated in 37 of the patients and in none of the control subjects. Average CA 125 level in NHL patients was significantly higher than the controls (56.2 +/- 9.2 U/ml, 7.99 +/- 1.05 U/ml respectively) (P < 0.05). CA 125 levels were significantly higher in NHL patients with abdominal involvement (113.6 +/- 23.4 U/ml), with B-symptoms (72.3 +/- 13.2 U/ml), higher stage of the disease (stages III and IV -75.3 +/- 14.9 U/ml), bulky disease (99.9 +/- 30.4 U/ml) and in those with serosal involvement (103.1 +/- 18.5 U/ml) (P < 0.05 for all). CA 125 levels were also elevated in seven patients with HD and in a patient with CLL with pleural effusion. In conclusion, for patients with NHL, high levels of CA 125 were associated with B-symptoms, advanced stage, bulky disease, abdominal, and serosal involvement. Therefore, CA 125 might be used as a marker to predict prognosis and to detect advanced disease in NHL.     

Clinical application of metabolic bone markers in hematologic malignancies

Hematologic malignancies such as multiple myeloma, adult T cell leukemia and malignant lymphoma are often complicated with bone lesions and/or hypercalcemia. The abnormal bone metabolism in these diseases are modified by co-existing cachexia, malnutrition, sex hormone deficiency and abnormal parathyroid function or by chemotherapy in a complex manner. Metabolic bone markers are not only clinically useful for evaluation and diagnosis of such bone abnormalities but may also be used to monitor the disease activity itself, particularly in multiple myeloma which almost inevitably involves bone destructive lesions.     

Iron overload and hematologic malignancies

Although iron is essential for cell replication and survival, an increase of body iron stores has been implicated in the development of cancer. However, while the association between iron overload and hepatocellular carcinoma is well documented, the relationship with nonhepatocellular malignancies remains ill-defined. In this review, we briefly report the present knowledge regarding the association between iron overload and hematologic malignancies.     

Clinical evaluation of Ftorafur (author's transl)]

The new soviet antimetabolite Ftorafur (N1-2'-Furanidyl-5-Fluorouracil, FFU) has been clinically evaluated in 18 selected patients with various solid tumours. Several of them had been treated before with other drugs. FFU was given to 8 patients as a monotherapy whereas 10 patients received the drug in combination with other therapeutic measures. A total response rate of 9/18 was seen. Three out of 8 patients treated with FFU alone have responded objectively. Due to its low toxicity FFU became a clinically interesting drug which is suitable for long-lasting administration. Its therapeutic activity is similar to that of 5-Fluorouracil. FFU is especially effective in carcinomas of the breast and the gastro-intestinal tract. It can be applied locally or safely be combined with other drugs or with irradiation.     

CA 125 levels in patients with non‐Hodgkin lymphoma and other hematologic malignancies

Cancer antigen (CA 125) is a glycoprotein commonly used as a tumor marker. In this study, CA 125 levels were measured in 149 patients and 26 healthy control subjects. The study group included 69 non‐Hodgkin lymphomas (NHL), 25 Hodgkin disease (HD), 20 acute myelocytic leukemia (AML), 14 chronic lymphocytic leukemia (CLL), 12 chronic myelocytic leukemia (CML), and nine multiple myeloma (MM) patients. CA 125 was elevated in 37 of the patients and in none of the control subjects. Average CA 125 level in NHL patients was significantly higher than the controls (56.2 ± 9.2 U/ml, 7.99 ± 1.05 U/ml respectively) (P < 0.05). CA 125 levels were significantly higher in NHL patients with abdominal involvement (113.6 ± 23.4 U/ml), with B‐symptoms (72.3 ± 13.2 U/ml), higher stage of the disease (stages III and IV ?75.3 ± 14.9 U/ml), bulky disease (99.9 ± 30.4 U/ml) and in those with serosal involvement (103.1 ± 18.5 U/ml) (P < 0.05 for all). CA 125 levels were also elevated in seven patients with HD and in a patient with CLL with pleural effusion. In conclusion, for patients with NHL, high levels of CA 125 were associated with B‐symptoms, advanced stage, bulky disease, abdominal, and serosal involvement. Therefore, CA 125 might be used as a marker to predict prognosis and to detect advanced disease in NHL.     

Immune and cell therapy of hematologic malignancies

Advances in molecular biology and immunology have identified means to activate the immune response against leukemia-associated antigens. Recent studies indicate that the stealth-like phenotype of leukemia cells can be reversed through transfer of genes encoding recombinant membrane-stabilized proteins of the tumor necrosis factor (TNF) imily, such as the one encoding CD154, the ligand for CD40. A phase I clinical trial using autologous CD154-transduced leukemia cells as a cellular vaccine has provided encouraging results. Treatment not only appears capable of inducing a cellular anti-leukemia immunity, but also may have a direct effect on leukemia cells by inducing latent sensitivity to Fas (CD95)-dependent leukemia-cell apoptosis. Phase II studies currently are underway using multiple injections of autologous leukemia cells made to express recombinant CD154 via gene transfer. Conceivably, we may be entering an era of effective gene therapy for hematologic malignancies.     

化疗联合HLA不全相合G-PBSC输注治疗恶性血液病的临床分析

目的初步探讨化疗联合HLA不全相合G-PBSC输注(微移植)治疗恶性血液病的临床应用。方法回顾性分析2015-05～2016-12接受微移植治疗的13例恶性血液病患者的临床及随访资料。根据病情,对13例患者行不同的预处理方案化疗后,计划给予微移植3～4次。观察微移植后患者的缓解情况,生存时间,血象恢复时间,急、慢性移植物抗宿主病(GVHD)及其他不良反应发生情况。结果随访至2017-04,中危组8例,其中存活6例,死亡2例;高危组5例,其中存活2例,死亡3例。中位生存期为9个月(4～24个月)。微移植治疗后,中性粒细胞和血小板平均恢复时间分别为8 d(5～14 d)和11 d(6～20 d)。所有患者在微移植过程中均未出现急、慢性GVHD及其他不良反应。结论微移植在供者选择上不受限制,移植后血小板及中性粒细胞恢复较快,且无急、慢性GVHD及其他不良反应发生;微移植在中高危恶性血液病的临床应用尚处于探索阶段,仍需多中心、大样本的临床研究来进一步验证。     

Management of thromboembolism in hematologic malignancies

Patients with hematologic malignancies have increased risks of thromboembolism or bleeding. The commonest thrombotic complication is venous thromboembolism (VTE). Other thrombotic conditions occur in association with specific disorders, such as thrombotic thrombocytopenic purpura in hematopoietic stem cell transplantation and disseminated intravascular coagulation in acute promyelocytic leukemia. Clinical trials show that unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are efficacious for VTE prophylaxis in cancer patients after major surgery or when hospitalized for acute medical illnesses. These findings in cancer patients are probably applicable to patients with hematologic malignancies, in whom there are very few studies. However, the effectiveness of anticoagulant VTE prophylaxis is not established in ambulatory patients with cancer except for multiple myeloma patients treated with thalidomide and chemotherapy. LMWH is widely used as initial treatment for VTE because it enables home therapy without laboratory monitoring, thereby improving the patient's quality of life. UFH is preferred in patients with high bleeding risks and renal impairment. In cancer patients, vitamin K antagonists for the long-term treatment of VTE are increasingly replaced by LMWH, which show superior efficacy. When prescribing anticoagulant prophylaxis or treatment to patients with hematologic malignancies, clinical benefits must be weighed carefully against the risks of bleeding.     

老年恶性血液病合并真菌感染20例临床分析

目的提高对老年恶性血液病患者合并真菌感染的认识,完善治疗措施,减少真菌感染率、死亡率,提高生存率。方法分析住院的老年恶性血液病合并真菌感染患者20例的一般临床资料、病原微生物学检查及治疗情况。结果老年血液肿瘤患者真菌感染的发病率不断增高,病原菌以念珠菌为主,20例患者应用抗真菌药物后总有效率为55％,死亡率为25％。结论真菌感染是老年恶性血液病患者化疗期间严重的并发症和主要的死亡原因之一,早期诊断、经验治疗,具有重要意义;对于高危患者,预防治疗尤为必要。     

Angiogenesis and antiangiogenic therapy in hematologic malignancies

Angiogenesis, the generation of new blood capillaries from preexisting blood vessels, is tightly regulated in the adult organism. Although many of the initial studies were performed on solid tumors, increasing evidence indicates that angiogenesis also plays an important role in hematologic malignancies. Overexpression of angiogenic factors in particular VEGF and bFGF in most hematologic malignancies may explain the increased angiogenesis found in these malignancies and correlate with poor prognosis as well as decreased overall survival. In this review, we focus on the current literature of angiogenesis and antiangiogenic therapy in hematologic malignancies, and finally describe advances and potential challenges in antiangiogenic treatment in hematologic malignancies.