Search

The aim of this retrospective study was to evaluate and compare the incidence, timing and etiology of bloodstream infections (BSIs) in patients treated with liver-(LT) or hematopoietic stem cell transplantation (HSCT) in a single institution. We evaluated 280 consecutive transplantations over a period of 34 months. Our results demonstrated 84 episodes of BSIs (47 in LT patients and 37 in HSCT patients) at a median of 28 days post-transplantation. Relative incidence of 34.6 and 29.4 BSI episodes per 100 LT and HSCT patients, respectively, did not differ significantly between the two groups (p = 0.52). BSIs in HSCT patients occurred significantly earlier (p = 0.003) than in LT patients. The recently described reemergence of gram-negative (GN) pathogens as causative agents of BSIs in these patients was confirmed: GN bacilli were the predominant isolates in the LT group, responsible for 58.5% of BSIs and a very frequent (39%) cause of BSIs in the HSCT group. A higher incidence of resistant enterobacteriaceae producing extended spectrum beta-lactamases was found in isolates from LT patients compared to HSCT patients. In both groups, Pseudomonas aeruginosa was the most difficult to treat organism, with 57% of these isolates in LT patients and 44% in HSCT patients being resistant to carbapenems. To conclude, BSIs were confirmed to be important infectious complications of both LT and HSCT. Surveillance and analysis of bacteria causing bloodstream and other serious infections in transplanted patients remain the main prerequisites for planning interventions regarding prevention and treatment of infections in these patients.

Myeloid sarcoma is a rare extramedullary solid tumor consisting of immature myeloid cells and most commonly involving the bone, skin, lymph nodes, soft tissue, gastrointestinal tract and testis. Mediastinal myeloid sarcoma is very rare. There are two major types of myeloid sarcoma: granulocytic sarcoma and monoblastic sarcoma, according to immature cell type. Myeloid sarcoma is found in 2%-8% of patients with acute myeloid leukemia (AML). Myeloid sarcoma may develop before or concurrently with AML, or may be the initial manifestation of AML relapse in previously treated patients. Blast transformation of some form of myeloproliferative neoplasm or myelodysplastic syndrome may also manifest as myeloid sarcoma. A major differential diagnostic problem is isolated primary myeloid sarcoma without bone marrow and peripheral blood involvement, which may precede leukemic stage for months or years, and which is frequently misdiagnosed, mostly as malignant lymphoma. A case is presented of a 56-year-old female patient complaining of weakness, vertigo, dry cough and breathing difficulties. Clinical examination revealed enhanced vascular pattern on the right chest and right arm edema. Computed tomography (CT) of the thorax showed an expansive growth measuring 11 cm craniocaudally in the anterior mediastinum. Fine needle aspiration cytology of tumor mass yielded a scarcely cellular sample with individual atypical immature cells, fine chromatin structure and scarce cytoplasm with occasional granules and Auer rods. Considering the morphological, cytochemical and immunocytochemical characteristics of immature cells, the diagnosis of myeloid sarcoma was made and verified by histopathology of tumor biopsy sample. Immature cells were not found by analysis of bone marrow puncture sample, immunophenotyping of bone marrow cells and bone biopsy analysis. As immature cell proliferation was not detected in bone marrow and peripheral blood, while spread of the disease beyond the mediastinum was ruled out by imaging methods (CT, ultrasonography), it was decided to be a primary non-leukemic form of mediastinal myeloid sarcoma. Myeloid sarcoma should be taken in consideration on differential diagnosis of solid tumors because making an accurate diagnosis is necessary for timely initiation of appropriate therapy. Weakly expressed or lacking clear signs of myeloid differentiation may hamper morphological diagnosis. As isolated myeloid sarcoma is a very rare entity frequently resembling lymphoma in clinical presentation, it poses a major diagnostic challenge for both morphologists and clinicians.

Multiple myeloma is clonal malignancy of plasma cells with overproduction of monoclonal antibodies and destruction of bones. Hypercalcemia, anemia and renal disfunction are common manifestations of the disease. Billateral pleural effusion is rare multiple myeloma presentation with unfavorable prognosis so it is important to recognizze it for better diagnostic and therapy approach. 59-year old woman was admitted to Hematology Department with history of severe caugh, dyspnea and left chest pain. Physical examination and chest X-ray showed billateral pleural effusion while cytologic examination of pleural aspirate found plasma cells. Bone marrow examination and skeleton X-ray confirmed diagnosis of multiple myeloma. Serum and urine immunoelectrophoresis detected lambda Bence Jones protein. This case is rare manifestation of multiple myeloma.

CD45 cell surface antigen is a transmembrane protein with tyrosine phosphatase activity, expressed by all nucleated cells of hematopoietic origin, except erythrocytes and platelets. Monoclonal antibodies directed against CD45 represent irreplaceable tool in differential diagnosis of hematologic and other, non-hematologic low differentiated malignancies, primarily in cases of: extranodal lymphomas, non-hematologic malignancies with nodal or bone marrow localization or their metastases in mentioned sites. As cell surface immunophenotype marker, CD45 is of great value in differentiation of lymphoproliferative diseases subtypes. By flow cytometry, based on CD45 expression, the malignant cell population is being identified and that fact is used in, not only diagnosis, but also in detection of minimal residual disease, especially in cases of CD45 negative acute leukemias. Incidence of childhood CD45 negative acute lymphoblastic leukemias (ALL) is about 10%. Children diagnosed with low CD45 expression ALL generally have better prognosis than those with high CD45 expression, especially when cut-off value for CD45 expression is set on 90%. We have analyzed CD45 expression by flow cytometry in 28 consecutive patients diagnosed with ALL in our institution during a 5-year period. Among these patients 7.1% were CD45 negative. A positive correlation between CD45 and CD20 expression was found, and a negative correlation between CD45 and CD34. In our group of patients, CD45 expression did not have any influence on survival.

Mantle cell lymphoma (MCL) is a B-cell neoplasm characterized by aggressive clinical course with an average 3- to 5-year patient survival. We present a patient whose illness turned from initial classical morphological variant to a more aggressive pleomorphic form of MCL in only a few months, but with unchanged long-term indolent clinical course. At the time when lymphoid cell pleomorphism was proven, the disease presented itself through recurrent peripheral lymphadenopathy without extranodal involvement or general symptoms. Other numerous abnormalities were found next to typical cytogenetic translocation t (11,14). Histopathology confirmed the diagnosis of MCL, pleomorphic type. After autologous stem cell transplantation, the disease remained morphologically the same, but the patient was in a good general condition for a long period of time. More than two years after the pleomorphic MCL had been diagnosed and one year after the transplantation, major lymphadenopathy occurred. Our case report points to a large spectrum of morphological and cytogenetic variability of MCL, which often does not correlate with the clinical course of the disease.

The aims of the study were to investigate the association between cytomorphology and immunophenotypic expression of CD34 cell surface antigen of blasts and their relationship with clinical and laboratory characteristics of patients with acute promyelocytic leukemia (APL). Sixteen consecutive patients (male 69% and female 31%) diagnosed with APL at Department of Hematology, Merkur University Hospital between August 1998 and December 2010 were included in the study. The mean age of patients was 43.9 (range: 18-78, SD 14.9). The patients' clinical and laboratory features, cytomorphological characteristics of APL-blasts and their immunophenotype determined by flow cytometry were analyzed. Patients were divided into two groups, CD34- and CD34+, and were then compared according to clinical and laboratory characteristics. There was no difference according to age, sex or white blood cell count between two groups. The mean value of hypogranular/agranular APL-blasts was markedly higher in CD34+ group than CD34- group (34%, range 9-60, SD 24.4 vs. 11.5%, range 0-38, SD 13.7), with borderline statistical significance (P=0.055). CD34- patients had significantly better overall survival than CD34+ ones (P=0.02). Patients without Auer rods detected in APL-blasts had higher CD34 expression (69.4% +/- 33.8) compared to patients with detected Auer rods (7.3% +/- 24.8), but statistical significance was not reached (p=0.053). Our results are consistent with the results of other published studies and point to the fact that higher CD34 expression and lower cytoplasmic granularity of APL-blasts are factors that seem to define a specific subgroup of APL patients. Together with other diagnostic tools currently available, they could be of value in planning treatment of APL patients.

Patients with relapsed or refractory Hodgkin's disease (HD) are routinely treated with intensive chemotherapy followed by autologous stem cell transplantation (ASCT). The objectives of the study were to evaluate ASCT in this subset of patients by assessing its toxicity in terms of transplant related mortality (TRM), hematopoietic recovery and need for transfusion support, and efficacy in terms of complete remission (CR) achieved as well as long-term efficacy expressed in patient overall survival (OS). From February 1995 until October 2006, a total of 53 patients with active HD (28 male and 25 female, aged 18-60, median 29) received BEAM myeloablative treatment followed by ASCT. All patients received heavy prior treatment with a median of 2 different lines of chemotherapy (range 1-6) and a median of 8 chemotherapeutic cycles (range 2-15). A mean of 9.12 (range 1.03-32.6, SD 9.5) x 10(6)/kg CD34+ cells was reinfused, followed by filgrastim (median 8 days, range 4-22 days). The median time to WBC recovery (> 1 x 10(9)/L) was 10 (range 2-26) days, while platelets recovered (> 20 x 10(9)/L) in a median of 10 (range 4-30) days. During the post-transplant period, a mean of 16.3 platelet doses (range 0-77, SD 15.5) and 345.6 mL of RBC concentrate (range 0-1990, SD 478.4) was administered. A median of 3 febrile days (range 0-20) was observed. Of all patients, 43 (81.1%) achieved CR and 9 (17.0%) achieved partial remission. One patient died during the pancytopenic period (TRM 1.9%). The projected overall survival is 66.3% at 3948 days. Accordingly, in this group of patients with active disease at the time of transplantation, ASCT toxicity could be considered acceptable. A very high remission rate was achieved (CR+PR 98.1%). We conclude that BEAM myeloablative chemotherapy followed by ASCT is a very efficacious treatment for patients with relapsed or refractory HD.

Aim: The aim of the study was to identify the clinical and laboratory (hematologic, biochemical and morphological) prognostic parameters of chronic leukemic lymphoproliferative diseases (CLLPD)., Methods: The study included 155 CLLPD patients. Analysis was performed in the overall CLLPD population and separately in a subgroup of patients with B chronic lymphocytic leukemia with variants (B-CLL+V) including typical B chronic lymphocytic leukemia (B-CLL), mixed chronic lymphocytic leukemia and prolymphocytic leukemia (CLL/PLL), and a variant of chronic lymphocytic leukemia with lymphoplasmocytoid differentiation (CLL/IMC). Kaplan-Meier method (Statistica 7.1) was used on survival analysis., Results: Male patients older than 62 (p=0.03991), female patients (p=0.02871), patients not receiving antitumor therapy on study entry (p=0.01902) and patients not treated for CLLPB upon study entry (p=0.04076) showed better survival rate. Older patient predominated in the group requiring no antitumor therapy (p=0.019247). Analyis of sex distribution yielded an equal male to female ratio in the overall CLLPD population and B-CLL+V subgroup. Mann-Whitney U-test was used to assess the clinical significance of quantitative parameters related to patient age and sex. The level of bilirubin, the size of cervical lymph nodes and doubling of peripheral blood lymphocytosis (DTL) were lower in the group of older patients (>60 years). Men had higher levels of hemoglobin, bilirubin, SGOT and creatinine, and larger spleen and liver. Statistically significant survival differences were recorded for 16 of 20 clinical parameters. Patients older than 60, female patients and patients receiving no antitumor therapy showed better survival. Lower clinical stage according to Rai and Binet and total tumor mass (TTM) lower than 9 indicated better prognosis, whereas patients with spleen enlargement and multiple regions involved with lymph node enlargement showed poorer survival. B-CLL+V patients and patients free from doubling of total tumor (DTM) or of absolute lymphocyte count (DTL) within 12 months had better survival than the overall CLLPD patient population. A statistically significant survival difference was recorded for 5 of 15 bone marrow (BM) parameters tested: normal and less cellular BM puncture specimen, >70% of all lymphatic cells, >16% of atypical lymphatic cells, and >18% of granulocytes in myelogram indicated better prognosis. Poorer disease outcome was associated with interstitial and nodular infiltration found on bone biopsy. Ten of 20 hematologic parameters were found to be statistically significant. Poorer prognosis was associated with red blood cell count <2.5 x 10(12)/L, leukocyte count >100 x 10(9)/L, reticulocyte count >5/10(3) E, hemoglobin <100 g/L and iron <15 mol/L. Better survival was associated with absolute count of total lymphatic cells <100 x 10(9)/L and absolute count of atypical lymphatic cells <5 x 10(9)/L in peripheral blood; <10% of all atypical lymphatic cells, >5.1% monocytes and >10.1% granulocytes in differential blood count. Statistically significant survival differences were found for 10 of 20 biochemical parameters tested. Poorer survival was recorded in patients with LDH >300 U/L, SGOT >24 U/L, calcium <2.3 mmol/L, total protein <66.1 g/L, albumin <40 g/L, alpha2 globulin<5.9 g/L, beta globulin <7.3 g/L, y globulin <9 g/L and IgG <10 g/L. Better prognosis was only indicated by lower levels of IgM (<0.91 g/L)., Conclusion: Careful clinical examination is an important step on assessing the extent and progression of the disease, and a major chain on tailoring individualized therapeutic approach, along with clinical stages according to Rai and Binet, CLLPD subtype and progression factors (DTM and DTL). Laboratory parameters (hematologic and biochemical) as objective quantitative parameters obtained by simple venipuncture, in contrast to the 'researcher-dependent' ones, increase the utilization of some of these parameters as risk factors in CLL.