Cellular composition of induced sputum in sarcoidosis

WSTĘP: Celem pracy była analiza składu komórkowego plwociny indukowanej (PI) u chorych na sarkoidozę i ocena, czy różnice we wzorze odsetkowym komórek pozwalają określić aktywność choroby. Oceniano także bezpieczeństwo procedury.MATERIAŁ I METODY: Indukcję plwociny przeprowadzano przez inhalację hipertonicznego roztworu chlorku sodu. Do analiz włączono 21 materiałów uzyskanych od osób zdrowych, 32 od chorych z aktywną i 33 od osób z nieaktywną sarkoidozą.WYNIKI: Odsetek limfocytów był istotnie wyższy w PI w aktywnej sarkoidozie niż w chorobie nieaktywnej i u osób zdrowych (9,7 v. 3,1 i 2,9%). Najwyższy był on w materiale od chorych z aktywną chorobą i zmianami miąższowymi w płucach (13,3%). Odsetek makrofagów był istotnie niższy w aktywnej chorobie niż u osób zdrowych (76,8 v. 83,4%). W PI od osób z aktywną chorobą w fazach II i III był on także niższy, niż w fazie I sarkoidozy, niezależnie od aktywności choroby. Nie było natomiast różnicy we wzorze odsetkowym komórek w PI pomiędzy całą grupą chorych na sarkoidozę a grupą kontrolną. We wszystkich badanych grupach procedura indukcji plwociny była dobrze tolerowana, przerwano ją tylko 4 razy, w tym dwukrotnie z powodu duszności lub spadku PEF. Objawy te szybko ustąpiły po podaniu dodatkowej dawki salbutamolu.WNIOSKI: Indukcja plwociny przez inhalację hipertonicznego roztworu chlorku sodu jest procedurą bezpieczną, ocena jej składu komórkowego nie przydaje się jednak w diagnostyce sarkoidozy. Może ona natomiast służyć ocenie aktywności choroby, zwłaszcza u osób ze zmianami w miąższu płuc.INTRODUCTION: The aim of this study was to evaluate the cellular composition of induced sputum (IS) in sarcoidosis and its role in assessing the disease activity. The safety of the procedure was also determined.MATERIAL AND METHODS: Sputum induction by inhalation of hypertonic saline was performed. Twenty-one samples from the healthy controls, 32 from patients with active disease, and 33 from subjects with inactive disease were analysed.RESULTS: The percentage of lymphocytes in IS was significantly higher in active sarcoidosis than in inactive disease and the control group (9.7% vs. 3.1% vs. 2.9%), and was the highest in the patients with parenchymal changes and active disease (13.3%). The percentage of macrophages was significantly lower in active sarcoidosis than in normal subjects (76.8% vs. 83.4%). It was also significantly lower in IS in active disease and stages II and III than in both subgroups with active and inactive stage I of sarcoidosis. There were no significant differences in the IS cell percentages between the whole sarcoidosis group and the controls. Sputum induction was well tolerated and stopped only four times, two of them because of dyspnoea or the decrease of PEF. The symptoms were well reversible after administering salbutamol.CONCLUSIONS: Sputum induction by inhalation of hypertonic saline is safe, but the evaluation of IS differential cell counts is not useful in sarcoidosis diagnosing. However, it could be used in assessing the activity of the disease, especially in patients with interstitial lung changes

The use of Yttrium-90 Ibritumomab Tiuxetan (^{90}Y-IT) as a consolidation therapy in high-risk patients with diffuse large B-cell lymphoma ineligible for autologous stem-cell transplantation

AIM OF THE STUDY: To evaluate the efficacy and safety of Yttrium-90 Ibritumomab Tiuxetan ((90)Y-IT) as a consolidation therapy in the management of DLBCL. MATERIAL AND METHODS: Patients with primary refractory or high-risk DLBCL (n = 18), ineligible for autologous stem-cell transplantation, were included in a retrospective study performed at three centers by the Polish Lymphoma Research Group (PLRG). All patients (mean age 61, range 35–82) either didn't achieve a complete response or didn't complete the scheduled therapy due to its complications. Response rates (CR, PR, SD, PD) according to Cheson criteria, overall survival (OS), progression-free survival (PFS) and adverse effects of radioimmunotherapy were analyzed. RESULTS: Consolidation radioimmunotherapy increased the CR rate from 38% (n = 7) to 82% (n = 15). One patient remained in PR, one patient remained in SD, while one patient remained in PD. During a median follow-up of five years, 11 patients (62%) were alive with no recurrence, 4 patients (22%) were alive with relapse while 3 patients (16%) died. There was no statistically significant difference in PFS between those in CR and those in PR before (90)Y-IT. CONCLUSIONS: Radioimmunotherapy is an effective consolidation therapy for high risk/refractory DLBCL patients and worthy of further investigation in prospective trials

Concomitant occurrence of Richter transformation and lung cancer in patient with chronic lymphotic leukemia

Pojawienie się objawów systemowych, takich jak chudnięcie, gorączka, lub miejscowych pod postacią szybko narastającej organomegalii u chorego z przewlekłą białaczką limfocytową (CLL) budzi podejrzenie transformacji w chłoniaka o wysokim stopniu złośliwości zwanej zespołem Richtera. Podobne objawy mogą pojawić się w przypadku drugiego nowotworu, którego ryzyko rozwoju u chorych z CLL jest o 10–20% wyższe niż w zdrowej populacji. W pracy przedstawiono przebieg kliniczny oraz trudności diagnostycznoterapeutyczne u 59-letniego chorego, u którego w 2 lata po rozpoznaniu CLL jednoczasowo rozpoznano transformację w chłoniaka Hodgkina oraz niedrobnokomórkowego raka płuca.Development of systemic symptoms such as losing weight, fever or local symptoms such as rapidly growing organomegaly in a patient with chronic lymphocytic leukemia (CLL) suggests transformation to high grade lymphoma known as Richter's syndrome. Similar symptoms can occur in case of second malignancy, which incidence in patients with CLL is 10–20% higher compared to normal population. Here we present a case of a 59-year-old patient who simultaneously developed transformation to Hodgkin's disease and non small cell lung cancer 2 years after CLL diagnosis. Clinical course, diagnostic and therapeutic difficulties in such case is discussed

Radioimmunotherapy in follicular lymphomas, a retrospective analysis of the Polish Lymphoma Research Group's (PLRG) experience

BACKGROUND: Ibritumomab is an 90Yttrium (90Y) labelled radioimmunoconjugate registered to treat follicular lymphoma relapsing or refractory after Rituximab therapy. Combining the specificity of anti CD20 monoclonal antibodies with the efficacy of radiotherapy, it is particularly effective in patients with advanced stages of disease with generalized lymphadenopathy. MATERIAL AND METHODS: Twenty-one patients with follicular lymphoma, after failing 2-5 lines of previous treatment, were subjected to radioimmunotherapy in three Polish Lymphoma Research Group (PLRG) centres. Ibritumomab infusion was followed by 2 doses of Rituximab (250 mg/m2 at day -7 and 0) to enhance its biodistribution. Radioimmunoconjugate was prepared in the Nuclear Medicine Departments of participating centres based on patient weight and full blood count results (14.8 MBq/kg, max 1200 MBq, reduced to 11.1 MBq/kg in cases with blood platelet 100 000-150 000 or leukocytes 1500-2000). 14.8 MBq/kg (0.4 mCi/kg) 100 thousand to 149 thousand/mm3 platelets 11.1 MBq/kg (0.3 mCi/kg) RESULTS: The primary endpoint of the study was the assessment of response rate and haematological toxicity. Objective responses were observed in all patients, with 10 partial and 12 complete regressions. Cytopenia, starting 3-4 weeks after radioimmunotherapy, reflected haematological toxicity - the only important side effect. Thrombocytopenia was more pronounced, with platelet counts of < 50,000/ul in every second patient. One patient developed myelodysplastic syndrome 21 months after the procedure. After the medium time of follow up over 2 years, 2 patients died. Median progression free survival (secondary study endpoint) was 15 months. CONCLUSIONS: Ibritumomab radioimmunotherapy is an efficient method of palliation treatment of heavily pre-treated follicular lymphoma patients, failing numerous previous treatment lines. Earlier application increases the number of complete responses and prolongs progression free survival

Autologous stem cell transplantation as consolidation therapy for patients with peripheral T cell lymphoma in first remission : long-term outcome and risk factors analysis

This report is a retrospective analysis of 65 patients with peripheral T cell lymphoma (PTCL), who underwent high-dose therapy and autologous hematopoietic stem cell transplantation (autoHCT) as a consolidation of first response achieved with either induction or salvage chemotherapy. We intended to determine the prognostic factors that influenced outcome after autoHCT and to define the predictive value of the scoring systems most often applied for transplant outcomes. Nineteen patients in either complete or partial remission underwent autoHCT after induction chemotherapy. Forty-six patients received second-line chemotherapy as a consolidation of partial response after induction chemotherapy (n = 34) or as a salvage therapy after primary induction failure (n = 12), and thereafter proceeded to autoHCT. Finally, the 36 patients were in complete remission, and 29 in partial remission at autoHCT. The median follow-up of survivors was 53 months (range 7–157 months). The 5-year overall survival and progression-free survival for all patients were 61.5 % (95 % CI 47.0–74.2 %) and 59.4 % (95 % CI 46.1–71.5 %), respectively. In multivariate analysis, bone marrow involvement at diagnosis and less than partial remission after induction chemotherapy were factors independently predictive for overall survival and progression-free survival. The prognostic index for PTCL could reliably stratify the prognosis of PTCL in this analysis

Analysis of ibrutinib efficacy in a subgroup of chronic lymphocytic leukemia patients with 17p deletion: observational study of the Polish Adult Leukemia Group (PALG)

BackgroundThe 17p deletion is regarded as the strongest poor prognostic factor in chronic lymphocytic leukemia (CLL). Results of recently performed clinical trials have suggested that ibrutinib significantly improves the outcome in this patient group.AimThe study aimed at analyzing the efficacy and adverse events profile of ibrutinib monotherapy in CLL patients with 17p deletion treated in routine clinical practice outside clinical trials.Materials and MethodsClinical response and adverse events profile of ibrutinib monotherapy were assessed in thirty-five CLL patients with 17p deletion treated within the ibrutinib named patients program in Poland.ResultsOverall response rate was 80% (28/35 patients) with median observation time of 24.2 months (range 0,1 – 30,9). Complete remission was observed in 5 patients (14.3%), partial remission in 11 (31.4%), partial remission with lymphocytosis in 13 (37.1%), whereas stable disease and progression was noted in 4 (11.4%) and 1 (2.9%) respectively. Response was not assessed in 1 patient. Median progression-free survival was 29.5 months, whereas median overall survival was not reached. Eleven patients died (7 because of infection, 1 of CLL progression, 1 of sudden cardiac death, 1 of disseminated breast cancer and 1 of unknown causes). In 13 patients (37.1%) at least one 3 or 4 grade adverse event occurred. In 11 patients (31.4%) the treatment was temporary withheld or the dose reduced due to adverse events.ConclusionIbrutinib is characterized by high clinical efficacy and acceptable toxicity in CLL patients with 17p deletion in daily clinical practice