Leukocyte Transfusions: Function of Transfused Granulocytes from Donors with Chronic Myelocytic Leukemia

The in vivo function of chronic myelocytic leukemia (CML) leukocytes transfused into infected patients with severeneutropenia was evaluated and the results in four representative patients arereported. The intravascular survival, extravascular migration, and phagocyticcapacity of these cells appeared normalin two patients without preformed leukoagglutinins. In two other patients whohad only small transient increments incirculating granulocytes and severe transfusion reactions, preformed leukoagglutinins were found. The poor granulocyterecoveries in these patients with antibodycould probably be explained by splenicsequestration of the transfused cells.These studies provide evidence supporting the use of CML leukocyte transfusions in patients without preformedleukocyte antibodies.

Submitted on March 25, 1970 Revised on May 1, 1970 Accepted on May 8, 1970     

The successful management of two pregnancies with wild type metastatic gastrointestinal stromal tumors

Aim:   To discuss the management of the uncommon situation of metastatic gastrointestinal tumour coexisting with pregnancy.
Method:   We describe two cases of women with metastatic gastrointestinal stromal tumor (GIST) who successfully achieved a full-term pregnancy without complications and with the delivery of healthy infants. In both cases, treatment with imatinib mesylate was withheld during pregnancy because of its unknown effects and questionable safety for the developing fetus. The available data in the medical literature regarding the use and safety of imatinib and pregnancy are reviewed. We also examine whether the knowledge of the exon mutational status would have influenced treatment decisions.
Results:   Both women had wild type GIST, but with different tumor growth characteristics, treatment responses and outcomes. The first patient deferred imatinib therapy to fall pregnant and her disease progressed rapidly off treatment. The second patient had a more indolent GIST where active surgical management allowed her to experience a long durable clinical response. She potentially belongs to a pediatric subgroup which carries a better prognosis despite being off imatinib.
Conclusion:   While we have successfully managed two pregnant women with metastatic GIST, the issue of initiating imatinib therapy in treatment-naive women, and treatment interruption in women already on therapy, remain difficult areas. Patients and their partners need to make an informed choice regarding the associated risks and the potential long-term sequelae if pregnancies are contemplated. Further research into the natural history of wild type GIST and how to tailor subsequent treatment are needed.     

Spontaneous bacterial peritonitis following treatment for cervical carcinoma

Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection usually associated with ascites and cirrhosis or is a complication of peritoneal dialysis. There are very few case reports of cancer patients who developed this disease. Furthermore, there have been no published case reports of successfully treated gynecological cancer patients who later developed SBP. We present a case involving a 41-year-old woman who was treated for cervical carcinoma in 1992. She underwent radical surgery and adjuvant chemoradiation therapy. Two years later, the patient presented with streptococcal group B cellulitis associated with left leg lymphedema. She recovered following antibiotic treatment but had recurrent episodes of streptococcal cellulitis in her leg over the past 10 years. In 2003, the patient was admitted to the hospital because of sepsis, acute renal failure, and SBP. She was treated and recovered following treatment. SBP is usually associated with cirrhosis. Although SBP is rarely seen in successfully treated gynecological cancer patients, oncologists should be aware of this clinical entity. Timely treatment is essential to maximize chances of survival.