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There is a large body of evidence showing a strong correlation between carcinogenesis of several types of human tumors, including chronic lymphocytic leukemia (CLL), and oxidative stress (OS). The mechanisms by which OS may promote cancer pathogenesis have not been completely deciphered yet and, in CLL, as in other neoplasms, whether OS is a primary cause or simply a downstream effect of the disease is still an open question. It has been demonstrated that, in CLL, OS concomitantly results from increased reactive oxygen species (ROS) production, mainly ascribable to CLL cells mitochondrial activity, and impaired antioxidant defenses. Interestingly, OS evaluation in CLL patients, at diagnosis, seems to have a prognostic significance, thus getting new insights in the biological comprehension of the disease with potential therapeutic implications. [ABSTRACT FROM AUTHOR]

Rituximab is an effective treatment for CD20+B-cell malignancies and autoimmune disorders. However, adverse drug reactions (ADRs) may occur after rituximab infusion, causing, in rare cases, its discontinuation. In this multicenter, retrospective study, among 374 patients treated with rituximab i.v., 23.5% experienced ADRs. Mean follow-up was 20.6 months (range 8–135). Overall, ADRs were significantly more frequent in non-Hodgkin lymphomas (NHL) and chronic lymphocytic leukemias (25–35.9%), than in autoimmune diseases (9.4–17.5%) (p<.0001). Grade 3–4 toxicity was observed in eight patients (2.1%), and in four of them (1% of all patients) definitive drug discontinuation was necessary. Interestingly, three groups of patients with different risk of developing ADR were identified, according to a predictive heat-map developed combining four parameters (splenomegaly, history of allergy, hemoglobin levels and gender) selected by multivariate analysis. This model may be useful in identifying patients at higher risk of ADRs, needing appropriate preventing therapies. [ABSTRACT FROM AUTHOR]

Microvescicles (MV) are shedding particles released by normal and neoplastic cells, whose levels in biological fluids highlight their potential role as disease biomarkers and therapeutic targets. By analyzing 131 newly diagnosed chronic lymphocytic leukemia (CLL), we found that the absolute number of serum CLL MV was significantly higher than in controls, in particular in advanced stages of disease. In addition, CD19 + and CD37+, B-cell derived MV, significantly correlated with high tumor burden. Absolute MV number cutoff selected by ROC analysis distinguished Rai stage 0 patients with shorter time to treatment (TTT) from those with more stable disease. Likewise, in the entire cohort, two groups of patients with different overall survival (OS) and different TTT were identified. At multivariate analysis, serum MV independently predicted for OS (along with Rai stage) and TTT (along with Rai stage, lymphocytes and CD38). In conclusion, circulating MV represent a new potential prognostic biomarker in CLL. [ABSTRACT FROM PUBLISHER]

Complementary and alternative medicine (CAM) is common in patients with cancer and its use is steadily increasing over time. We performed a multicenter survey in which the use of CAM in 442 Italian patients with chronic lymphocytic leukemia (CLL), the commonest form of leukemia in Western countries, was assessed. Data were collected by means of a face-to-face standardized questionnaire with several items. Mean age was 69 years; 258 patients (58%) were male and 184 (42%) female. Seventy-three patients (16.5%) were found to be CAM users. The most common CAM therapies were green tea, aloe formulations and high dose vitamins. Predictors of CAM use were female gender, younger age, higher education level, internet availability and newspaper reading. The reasons for CAM popularity among these patients are complex. Given the number of patients combining therapy with CAM and its possible drug interactions, doctor interest as well as patient education about CAM should be improved. [ABSTRACT FROM AUTHOR]

The incidence of non-Hodgkin lymphomas increases with age. Non-pegylated liposomal formulations of doxorubicin (Myocet®®) reduce systemic and cardiac toxicity especially in the elderly, who often have cardiac diseases. We treated 80 patients (mean age 70.9 years) with poor-risk diffuse large B-cell lymphoma with the R-COMP 21 regimen (Myocet®® 50 mg/m2, cyclophosphamide 750 mg/m2, vincristine 1.4 mg/m2, rituximab 375 mg/m2, prednisone 100 mg/day). In all, 82.5%% and 13.7%% patients showed complete and partial responses, respectively. Sixty-two of the 80 patients are alive and disease-free (77.5%%), while 3/80 are alive with active disease and 15 patients (18.7%%) have died (median follow-up: 31 months). The estimated probability of overall survival at 12/24 months from admission was 93.5/87.3%%, respectively. There were no therapy-related cardiac events and the ejection fraction improved (from 51.6 ±± 6.9%% to 54.2 ±± 3.9%%). Grade 3--4 neutropenia occurred in 22%% of patients. We concluded that Myocet®® shows both efficacy and tolerability, mainly at the cardiac level. [ABSTRACT FROM AUTHOR]

A prospective, multicenter, randomized trial comparing pamidronate administration (60--90 mg once a month for 1 year) versus simple observation in 177 patients with asymptomatic myeloma was performed to explore whether the administration of this drug reduces the rate of and/or the time to progression to overt, symptomatic disease. No relevant side effects were recorded in pamidronate-treated patients. With a minimum follow-up of 5 years for live patients, there were 56/89 (62.9%%) progressions in the pamidronate-treated group and 55/88 (62.5%%) within the controls ( p == NS). Median time to progression was 46 and 48 months, respectively ( p == NS). Overall survival was also similar between the two groups. Skeletal-related events at the time of progression were observed in 40/55 (72.7%%) controls, but only in 22/56 (39.2%%) pamidronate-treated patients ( p == 0.009). In conclusion, the administration of pamidronate in asymptomatic myeloma, while reducing bone involvement at progression, did not decrease the risk of transformation and the time to progression into overt myeloma. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the efficacy of romiplostim in the treatment of a 72-year-old patient diagnosed with chronic lymphocytic leukemia (CLL) associated with immune thrombocytopenia (IT).

A letter to the editor is presented in response to the article "Autoimmune hemolytic anemia during bendamustine plus rituximab treatment in CLL patients: multicenter experience" by Luca Laurenti and colleagues in the previous issue.

B-cell chronic lymphoproliferative disorders have been recognized as a heterogeneous group of neoplastic diseases affecting the lymphoid system. They are frequently characterized by leukemic manifestations with peripheral blood and/or bone marrow involvement. B-cell chronic lymphocytic leukemia (B-CLL), a disease which is now accepted as derived from immunologically competent antigen-activated B-cells, is the most common in the western countries. Although for several decades it was considered as a unique entity, a body of evidences is now emerging indicating the biological heterogeneity of B-CLL. Molecular and immunophenotypic data induce to consider two main subgroups of B-CLL exist at the cellular level: in fact, B-CLL cases can be divided into two categories according to IgV gene mutation status. One group develops from "memory" B-cells after antigenic stimulation in the germinal center of secondary follicles, displays mutated gene IgV and lacks CD38 expression; the second one derives from the so-called "naïve" antigen inexperienced B-cells, does not present IgV gene mutations and displays CD38 surface molecule. The two groups seem to be characterised by different clinical outcomes with the "mutated" group expected to have a more benign course than that arising from a "naïve" B-cell. Thus, the definition of the biological features of these different groups could be of help for clinicians in order to recognize patients needing more intensive therapeutic approaches. [ABSTRACT FROM AUTHOR]

Examines the immunophenotypic profile of AC133-positive cells in bone marrow, mobilized peripheral blood and umbilical cord blood. Restriction of human hematopoietic system; Antigenic features of stem cells; Identification and separation of early hematopoietic cells.

Reports on a single cohort of 41 patients suffering from poor-risk acute myeloid leukemia (AML) treated with a regimen containing cytarabine and fludarabine (F-ara-AMP) plus granulocyte-colony stimulating factor. Rates of complete remission; Patient characteristics; Improvement of therapeutic effectiveness by the addition of anthracycline[sup 21,24].

Describes a group of diseases called chronic lymphoproliferative disorders characterized by the expansion of mature B lymphocytes in peripheral blood, bone marrow and other lymphoid tissues. Chronic lymphocytic leukemia; Prolymphocytic leukemia; Hairy cell leukemia; Leukemic phase of low-grade non-Hodgkin's lymphomas; Mantle cell lymphoma.

The article presents case studies of two patients showing spontaneous remission (SR) to monoclonal B-lymphocytosis (MBL) after a diagnosis of early stage chronic lymphocytic leukemia (CLL) and the case of another patient with advanced CLL who experienced an unexpected remission before starting any specific anti-CLL therapy after being treated with with lamivudine for hepatitis B virus infection. The need for further research on CLL is discussed.

A letter to the editor is presented reporting on three patients with multiple myeloma and showing hyperbilirubinemia without jaundice due to paraprotein interference.

A letter to the editor is presented related to Direct Antiglobulin Test-negative hemolytic anemia in a chronic lymphocytic leukemia patient treated with alemtuzumab.

Presents a letter to the editor of the periodical 'Leukemia & Lymphoma' concerning the improvement of B-cell chronic lymphocytic leukemia (B-CLL) during hemodialysis. Role of endogenous production of factors involved in angiogenesis and apoptosis; Complications of hemodialysis; Molecular remission of B-CLL.

Presents a letter to the editor of the periodical 'Leukemia & Lymphoma; concerning the management of primary gastric lymphoma (PGL). Survival of patients with PGL; Clinical features; Types of treatment.

Normal promyelocytes express CD45RO, while acute promyelocytic leukemia (APL) blasts express CD45RA, both isoforms of common leukocyte antigen with mutually exclusive expression. Here we report a patient with accumulation of promyelocytes in the bone marrow and the diagnostic strategy is described along with the ability to quickly discriminate between normal and abnormal cells using the flow cytometric detection of expression of RA/RO isoforms of CD45. [ABSTRACT FROM AUTHOR]

The article discusses a study which examines the impact of lenalidomide, an immunomodulatory agent, on the CD20 antigen surface expression on chronic lymphocytic leukemia (CLL) B-cells using a flow cytometry (FC) analysis. Findings reveal the heterogeneous modulating effects of lenalidomide on CD20 expression in CLL B-cells. The outcomes' agreement with other studies are also mentioned.

A letter to the editor is presented in response to the article about the diagnosis of lymphoid disorders, which appeared in the previous issue.

We report a case of Guillain-Barré Syndrome (GBS) which appeared after mobilization therapy in a patient with B-cell chronic lymphocytic leukemia (B-CLL). After obtaining a partial remission with four cycles of fludarabine at standard dose, the patient underwent to high-dose Cytoxan in order to mobilize CD34+ hematopoietic progenitor cells. During neutropenia the patient experienced fever of unknown origin (FUO) and subsequently developed GBS with normalization of his neurologic condition after 2 months. It is possible that a viral-induced activation of an antigen-specific T and B-cell clone caused a local inflammation and toxicity of Schwann cells with demyelination and axonal damage with a self-limited course. [ABSTRACT FROM AUTHOR]

This article reports the response of rituximab treatment in adults with chronic idiopathic thrombocytopenic purpura. Using the classical schedule of rituximab administration authors found that about half of patients experienced a long-lasting complete or partial response. In addition, they described two main pattern of response to rituximab. The first one with a rise of the platelet count occurring early, usually after the first antibody administration. To perform surgical ablation of breast nodule, treatment with intravenous Immunoglobulins was started with a platelet rise to 66,000/ml. An increase of platelet count was observed after the first administration of rituximab, followed by reduction to pre-treatment value.

Investigates the use of quantitative flow cytometry in integrating morphological evaluation in the diagnosis of B-cell chronic lymphocytic leukemia (B-CLL). Comparison of typical and atypical forms; Kinds of membrane molecules; Characteristics of atypical B-CLL.