Search

Rituximab is a chimeric mouse-human antibody that targets the CD20 antigen, which is found in both normal and neoplastic B cells. In recent years, it has been increasingly used to treat cutaneous B-cell lymphoma and is now considered an alternative to classic treatment (radiotherapy and surgery) of 2 types of indolent lymphoma, namely, primary cutaneous follicle center lymphoma and primary cutaneous marginal zone B-cell lymphoma. Rituximab is also administered as an alternative to polychemotherapy in the treatment of primary cutaneous large B-cell lymphoma, leg type. Its use as an alternative drug led to it being administered intralesionally, with beneficial effects. In the present article, we review the literature published on the use of rituximab to treat primary cutaneous B-cell lymphoma.

Hepatic fibrin-ring granulomas and leishmania parasites were found in the liver biopsy specimens of 3 patients with prolonged fever and hepatosplenomegaly. It was recognition of the leishmanias in the liver biopsy specimen that prompted the diagnosis in all cases. There was no evidence of Q fever, Hodgkin's disease, cytomegalovirus hepatitis, or allopurinol treatment, which are the recognized causes of hepatic fibrin-ring granulomas. This report extends the range of etiologies of hepatic fibrinring granulomas. As a result, leishmaniasis should always be a consideration to the pathologist and the clinician in the differential diagnosis of fibrin-ring granulomas.

OBJECTIVE: To assess the relationship between plasma adrenomedullin (AM) levels and the presence of microvascular complications in type 1 diabetic patients. RESEARCH DESIGN AND METHODS: We measured plasma AM and cAMP levels in 103 type 1 diabetic patients (46 without complications, 24 with retinopathy only, 14 with microalbuminuria but normal kidney function, and 19 with renal insufficiency) and 41 matched healthy control subjects. RESULTS: Patients with renal insufficiency had higher levels of AM and cAMP than all other groups. Patients with only retinopathy showed a trend to have higher levels than patients without complications. There were no differences among all other groups. There was a significant correlation between AM and cAMP in the total diabetic group (rs = 0.36, P < 0.001) but not in the control group. In multiple regression analysis, plasma AM demonstrated significant relationships with creatinine clearance (beta = -0.31, P = 0.004) and duration of the disease (beta = 0.28, P = 0.008). CONCLUSIONS: Plasma AM and cAMP are increased in type 1 diabetic patients with renal insufficiency. Creatinine clearance (CrClc) and duration of the disease are related to plasma AM levels in these patients.

Seventy cases of follicular B-cell lymphomas were studied: 37 cases derived from the follicular centre [27 centroblastic-centrocytic (CB-CC) and 10 centroblastic (CB)] and 33 from the mantle zone [mantle-cell lymphoma (ML)]. Presenting features as well as response to therapy, time free of symptoms and survival were reviewed.All the cases were diagnosed and classified with routine and immunohistochemistry methods. In 61 cases tumores were studied with specific markers in a CAS-200 Image Analyser. Flow cytometry (FCM) was also done and correlated with proliferative-values and survival.A minor aggressive course of CB-CC and ML was demonstrated, with ML being the most benign form (lower proliferation rate and longest survival). Ploidy did not correlate with histological subtypes, survival or response to therapy. These results confirm the utility of biodynamic studies in lymphoid neoplasias.

Primary central nervous system lymphoma (PCNSL) is a rare malignancy with peculiar clinical and biologic features, aggressive course, and unsatisfactory outcome. To date, there is no standardized treatment of PCNSL. Concerns regarding neurocognitive toxicity of whole-brain radiotherapy (WBRT) have motivated development of alternative, dose-intensive chemotherapeutic strategies as consolidation, such as autologous stem-cell transplantation (ASCT). In the present study, we have evaluated the toxicity and efficacy of high-dose consolidation with ASCT after chemotherapy induction in patients with newly diagnosed PCNSL.

Primary central nervous system lymphoma (PCNSL) is a rare malignancy with peculiar clinical and biologic features, aggressive course, and unsatisfactory outcome. To date, there is no standardized treatment of PCNSL. Concerns regarding neurocognitive toxicity of whole-brain radiotherapy (WBRT) have motivated development of alternative, dose-intensive chemotherapeutic strategies as consolidation, such as autologous stem-cell transplantation (ASCT). In the present study, we have evaluated the toxicity and efficacy of high-dose consolidation with ASCT after chemotherapy induction in patients with newly diagnosed PCNSL.In 2008, the Spanish group GELTAMO developed a clinical protocol for first-line treatment of patients with PCNSL, consisting of an induction chemotherapy with 2 cycles of BAM (BCNU 100 mg/m2 day 1, Ara-C 3000 mg/m2 days 9, 25 and 41, and methotrexate 2000 mg/m2 days 8, 24 y 40). Patients who achieved at least partial response (PR) received an intensification with high-dose chemotherapy (BCNU 400 mg/m2 day -6, and thiotepa 5 mg/Kg days -5 and -4) followed by ASCT (day 0), whereas BAM refractory patients received WBRT (45 Gy), salvage therapy or palliative treatment. To date, 70 patients have been included in the protocol. We present the preliminary analysis of 57 patients (median age 55 years, range 29-74) treated between July 2008 and November 2012.BAM induction regimen was well tolerated, being the most common grade 3-4 toxicities: hematological (leucopenia in 32% of patients, thrombocytopenia in 15%), infectious (17%) and hepatic (5%). 33 out of 57 patients (58%) completed the 2 planned BAM cycles, achieving complete remission 19 patients (33,3%) and 8 (14%) PR. Reasons for not completing the 2 planned BAM courses were: lymphoma progression (n=21), and toxicity (n=3). 18 patients received WBRT, resulting in 5 and 9 patients achieving CR and PR, respectively. Regarding WBRT toxicity, 1 patient showed mild cognitive impairment, 3 leukoencephalopathy (2 mild, 1 severe), and 2 hydrocephalus. Finally, 24 patients (42%) underwent high-dose therapy and ASCT (18 after BAM and 6 after RT). Reasons for not performing the transplant were: progression of lymphoma (N=18), early death (N=2), comorbidities (N=3) or physician decision (N=10). After a median follow up of 22 months (4-49), 30 patients are alive (77% in CR), 26 patients have died (88% due to lymphoma progression, 8% due to infectious complications, and 4% due to other causes) and one patient have developed a secondary myelodysplastic syndrome (RAEB-2). Estimated 3-year progression-free survival and overall survival were 35% and 49%, respectively, for the whole series, and 65% and 85%, respectively, for transplanted patients.This preliminary analysis shows that BAM induction regimen followed by high-dose therapy and ASCT shows an adequate toxicity profile and leads to prolonged remissions in approximately a third of patients with PCNSL. More than 50% of patients do not reach the transplant, mainly due to disease progression, but results after ASCT seem to be good. New induction regimens are needed in order to decrease the rate of early progression.No relevant conflicts of interest to declare.