Gennaro De Rosa

Danazol: in vitro effects on human hemopoiesis and in vivo activity in hypoplastic and myelodysplastic disorders

Abstract:  We examined the effects of danazol on in vitro growth of human bone marrow and peripheral blood progenitor cells from 15 normal donors and 5 myelodysplastic patients, and on in vivo hemopoiesis in 30 patients with hypoplastic or myelodysplastic disorders. At concentrations similar to that reported as the plasma level after oral administration, danazol significantly increased CFU‐GM colony growth in all normal donors, while the influence on CFU‐E, BFU‐E, CFU‐MK and CFU‐GEMM colony growth was less evident. The stimulatory effect on CFU‐GM was observed even after accessory cell depletion. No stimulatory effect either in vitro on the growth of all hemopoietic progenitors or in vivo was observed in 15 myelodysplastic patients, while 7 complete and 3 partial hematological responses occurred in 15 patients with hypoplastic disorders. In conclusion, our results suggest that danazol exerts a direct stimulatory activity in vitro at least on CFU‐GM, and a hemopoietic stimulatory effect in vivo in hypoplastic but not in myelodysplastic disorders.

Estrogen-progestin therapy in women after stem cell transplant: our experience and literature review.

Women undergoing stem cell transplantation (SCT) are mostly young and have more than 90% probability of ovarian failure, which is often permanent. A womans age, use of radiotherapy and alkylating chemotherapy, and the allogeneic type of transplant are associated with a higher rate of premature ovarian failure and worse residual ovarian function. Premature ovarian failure has serious systemic and psychological effects that may need treatment and should be managed by practitioners trained to treat this particular population of women. Ultrasonographic evidence of ovarian follicles is often associated with a future resumption of cycles, but there are no serum markers to predict the return of ovarian function in these patients. In our center, the rate of ovarian function recovery was 7% after allogeneic SCT and 25% after autologous SCT (P < 0.05). There are no guidelines on how to manage premature ovarian failure induced by myeloablative treatments followed by SCT. Because of the likelihood of the need for long-lasting estrogen plus progestin therapy (EPT) and the increased risk of secondary neoplasia after SCT, the EPT should be as physiological as possible. In our experience, the cyclical sequential combination of estradiol (2 mg daily) plus dydrogesterone (10 mg for 14 d/mo) was associated with excellent compliance because of its simple administration and few adverse effects. Such a treatment led to a dramatic improvement in vasomotor, urogenital, and psychological symptoms related to estrogen deficiency. However, in the allogeneic transplantation setting, up to 25% of women may suffer from gynecological chronic graft-versus-host disease, which may become apparent as hematocolpometra after introduction of EPT. Thus, accurate pretreatment evaluation and frequent monitoring during treatment are required. Moreover, EPT absorption may be reduced in patients who received allotransplants and have gastrointestinal or skin chronic graft-versus-host disease.

High serum leptin in patients with chronic graft-versus-host disease after hematopoietic stem cell transplantation.

Background. Increased serum leptin has been described after various organ transplants, with a mechanism that is still unclear. Methods. We measured serum leptin in 60 patients before and after allogeneic (allo) or autologous (auto) stem cell transplant (SCT) and in 60 healthy controls, matched for age and body mass index (BMI). Results. Serum leptin was higher in patients after SCT than before and in controls. Leptin production was higher after allo- than after auto-SCT; the presence of chronic graft-versus-host disease (cGVHD) was associated with the highest values. The physiological correlation with BMI was lost in the allogeneic setting, indicating a strong influence of factors other than the nutritional status on circulating leptin. No relationship was found between serum leptin levels and time from transplant, age, cortisol, C-reactive protein, and T-lymphocyte CD4-to-CD8 ratio. Among the cytokines secreted by type-1/type-2 T-helper lymphocytes, only serum interferon-gamma significantly correlated with serum leptin levels. Anti-leptin blocking antibodies partially inhibited T-cell activation in mixed lymphocyte reaction, suggesting a link between leptin and T-lymphocyte activation in the allo-SCT setting. Conclusion. Taken together, these findings suggest that increased serum leptin concentrations may contribute to T-cell activation during development of cGVHD.

Tc99m-sestaMIBI uptake in nonsecretory multiple myeloma.

Abstract Staging and monitoring of multiple myeloma (MM) is mainly based on monoclonal component quantification; the absence of such a parameter renders difficult follow up of patients with nonsecretory MM (nsMM). In this study our aims were to determine the specificity and sensitivity of Tc99m-sestaMIBI scintigraphy at diagnosis and during follow up of nsMM patients. Nine nsMM patients were prospectively studied at diagnosis and during treatment for a mean time of 33 months (range: 12–65 +). Tc99m-sestaMIBI (MIBI) scintigraphy was compared to conventional imaging (CI: X ray with CAT or NMR details) at diagnosis and during follow up. At diagnosis, CI and MIBI were concordant in three patients; CI showed more focal lesions than MIBI in four patients, while MIBI revealed more focal lesions than CI in two patients. During the follow up, MIBI uptake was normal in the four patients who achieved remission. Five patients did not achieve remission: CI and MIBI were concordant in three, while MIBI was falsely negative in two patients. In conclusion, Tc99m-sestaMIBI scintigraphy has high sensitivity (no false positive cases) and 78% specificity (2/9 false negative cases) in tracing active nsMM lesions; it should be considered complementary to CI for monitoring this rare disease.

Mobilization of peripheral blood hematopoietic stem cells by granulocyte-colony stimulating factor and plerixafor in patients with cardiac AL amyloidosis

Immunoglobulin light chain (AL) amyloidosis is a plasma cell (PC) dyscrasia in which amyloid deposition from misfolded monoclonal immunoglobulin light chains adversely affects organ functions. Card...

Analysis of peripheral blood normal and malignant cells with the novel murine monoclonal antibody UN2.

The monoclonal antibody (mAb) UN2 was generated upon immunization of a Balb/c mouse with human thymocytes. mAb UN2 recognized an antigen expressed by a subpopulation of human thymocytes and peripheral blood lymphocytes. In thymus, mAb UN2 recognized cortical cells; its expression was higher on CD3bright than on CD3dim thymocytes. This antigen was also detected on peripheral blood granulocytes, monocytes, platelets and on cell lines MOLT4, U937 and KG1. mAb UN2 was submitted to the 5th International Workshop and Conference on Human Leukocyte Differentiation Antigens, Boston, MA, 1993, and was assigned to the CD31. Expression of the UN2-recognized antigen in malignant lymphoid cells from 57 cases of B-cell chronic lymphoproliferative disease and 4 of B-cell acute lymphoblastic leukemia was analysed in flow cytometry. Among the 57 cases of B-cell chronic lymphoproliferative malignancies studied, 49 were classified as B-cell chronic lymphocytic leukemia. These showed high (86 +/- 8%) UN2 antigen expression. In 8 cases of hairy-cell leukemia the percentage of cells reacting with mAb UN2 was 42 +/- 4%; the fluorescence intensity of labelled cells was lower than that displayed by cells of B-cell chronic lymphocytic leukemia and comparable to that of normal lymphoid cells. mAb UN2 could prove useful in analysis of the lymphoid development and diagnostics of B-cell chronic lymphoproliferative disorders.

Multiple myeloma cured by conventional chemotherapy: A report and a review

A young man presented with overt multiple myeloma at the age of 28, and received cyclophosphamide pulses every 3-4 weeks for more than 3 years. He has remained in continuous complete remission for the past 23 years without further treatment and without evidence of disease. Five cases of multiple myeloma cured by conventional chemotherapy reported in literature are reviewed here.