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.     

RNA editing in human cancer: review

Notice of Retraction: ‘RNA editing in human cancer: review’ (APMIS 2009;117:551–7) The following article from APMIS, ‘RNA editing in human cancer: review’ by Jozef Skarda, Ninette Amariglio and Gideon Rechavi, published online (2 July 2009) in Wiley InterScience ( http://www.interscience.wiley.com ) and in Volume 117, Issue 8 (August 2009), has been retracted by agreement between the authors, the journal Editors‐in‐Chief E. Ralfkiær and B. Norrild and John Wiley & Sons A/S. The retraction has been agreed as a result of textual overlap with a paper published in the journal RNA Biology, ‘A‐to‐I RNA editing and cancer: from pathology to basic science’ by Angela Gallo and Silvia Galardi, published in Volume 5, Issue 3 (September 2008). Jozef Skarda takes full responsibility for the textual overlap.     

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.     

Effects of Sex Hormones on Some T and B Cell Functions,Evidenced by Differential Immune Expression Between Male and Female Mice and Cyclic Pattern of Immune Responsiveness During the Estrous Cycle in Female Mice*

ABSTRACT: The responses of spleen cells from male and female BALB/c mice were evaluated to determine if sex-related variations in immune expression could be found. The immunologic assays used included blastogenic responses to mitogens, and direct and indirect measurement of plaque-forming cells against particulate antigens. The results indicated that responses of spleen cells from young adult female mice were higher than those of males in all comparative tests. Newborn mice did not demonstrate the sex-associated immune differences; and among the weanling mice slight differences between male and female spleen cells responsiveness to mitogenic agents were observed. The blastogenic responsiveness of spleens from female BALB/c was greater at proestrus and metestrus, as compared to estrus and diestrus. The peaks of responsiveness corresponded to reported elevated levels of estrogen and pregnenolone during these phases of the cycle. Similar results were obtained with the IgM plaque-forming cell responses, which were also increased at proestrus and metestrus. This study supports a role of sex hormones in modulation of immune expression.     

A Bayesian Meta‐Analysis Comparing AngioJet® Thrombectomy to Percutaneous Coronary Intervention Alone in Acute Myocardial Infarction

Objective: The purpose of this meta‐analysis was to compare outcomes for AngioJet thrombectomy versus percutaneous coronary intervention (PCI) without thrombectomy in acute myocardial infarction (AMI) patients. Background: PCI is the preferred treatment for revascularizing the infarct‐related artery in patients with AMI. There is controversy about the benefits of thrombectomy as an adjunct to PCI. Methods: AMI studies published between January 1, 1999, and March 1, 2007, were used to compare AngioJet thrombectomy plus PCI to PCI alone. Bayesian meta‐analytic estimates were used to estimate the odds ratios (95% CI) for short‐term mortality, major adverse cardiac events (MACE), and final TIMI 3 flow. Results: The AngioJet data included 11 studies and 1,018 patients. The PCI data included 81 studies and 24,076 patients. The AngioJet group included more patients with large thrombus burden, rescue PCI after failed thrombolytic therapy, and longer symptom duration compared to the PCI group. Despite the higher risk profile of AngioJet patients, the groups had similar odds of short‐term mortality, 0.98 (0.53, 1.50), MACE, 1.25 (0.54, 2.40), and final TIMI 3 flow, 1.12 (0.70, 2.27). Conclusion: AngioJet thrombectomy results in clinical and angiographic outcomes that are similar to PCI in lower risk AMI patients. These observations suggest that AngioJet thrombectomy may reduce the additional risk associated with visible thrombus in the infarct‐related lesion.     

Response of Carney's triad‐related metastatic gastrointestinal stromal tumor to sunitinib

Background: Metastatic Carney's triad is a rare syndrome of gastrointestinal stromal tumour, paraganglioma and pulmonary chondroma associated with unique clinical behavior and relative resistance to imatinib Case: A 50‐year‐old woman was diagnosed with metastatic gastrointestinal stromal tumour, after having complete remission for almost three decades following gastrectomy for her original gastric tumour. She was c‐kit‐wild type and developed various paragangliomas and possible pulmonary chondromas during the course of her disease. Treatment with the tyrosine kinase inhibitor imatinib mesylate and subsequently the multikinase inhibitor sunitinib were associated with periods of radiological response and clinical benefit before the patient died of progressive disease. Conclusion: Identification of patients with Carney's triad tumours is important in clinical practice as they have distinct clinical behavior, mutational status and relative lack of responsiveness to the current available targeted therapy compared to the typical c‐kit positive gastrointestinal stromal tumours.     

Hypersensitivity reactions to oxaliplatin: Can patients be rechallenged?

Background: The use of oxaliplatin is increasing in colorectal cancer both in the metastatic and adjuvant setting. There is an increased recognition of hypersensitivity reactions (HSR) to oxaliplatin which is a potential barrier to the continued use of this drug in patients in whom benefits are observed. The aim of this retrospective review is to identify the incidence of HSR and the results of rechallenging patients with oxaliplatin. Methods and results: In 97 patients, we identified six patients with HSR (an incidence of 6.2%) There was a spectrum of reported symptoms with most occurring within minutes of infusion after a median of six doses of oxaliplatin. All these patients were rechallenged with oxaliplatin. Success was noted when oxaliplatin was administered over a prolonged rate of 6 h. The use of maximal premedications did not influence the outcome. Conclusions: Our experience confirms the need to be vigilant of HSR to oxaliplatin and to recognize idiosyncratic reactions. A feasible method to prevent the recurrence of HSR is to prolong the infusion rate without delaying or stopping effective treatment with oxaliplatin.