Monica Tozzi

“Fludarabine Containing-Regimens May Adversely Affect Peripheral Blood Stem Cell Collection in Low-Grade Non Hodgkin Lymphoma Patients”

Fludarabine (FLUDA) based chemotherapy has shown promise in both initial and salvage treatment of low-grade non Hodgkins lymphomas (LG-NHL). Recently, more aggressive therapies followed by autologous hemopoietic progenitor cell rescue, have also been successfully employed in these patients. However, this procedure, due to several factors including previous therapeutic regimens, is often limited by an inadequate collection of peripheral blood stem cell (PBSC). At present, very little data is available on the effect of FLUDA containing regimens in PBSC collection. We report our preliminary experience showing a possible correlation between FLUDA based chemotherapy regimens employed before mobilization and inability to collect an adequate number of blood derived hematopoietic progenitors for autologous PBSC transplantation in LG-NHL patients.

Imatinib does not impair specific antitumor T-cell immunity in patients with chronic myeloid leukemia

Imatinib does not impair specific antitumor T-cell immunity in patients with chronic myeloid leukemia

Long-lasting decrease of CD4 + /CD45RA + T cells in HCL patients after 2-chlorodeoxyadenosine (2-CdA) treatment

The CD45RA and CD45RO isoforms of the leukocyte common antigen identify functionally distinct CD4+ T cell subsets: CD4+/CD45RA+cells which represent a more ‘naive’ stage of T cell compartment and CD4+/CD45RO+ ‘memory’ cells. Phenotypic and functional abnormalities in T cell compartment have been frequently reported in patients with hairy cell leukemia (HCL) and, in more recent studies, a significant reduction in the absolute number of CD4+ lymphocytes bearing the CD45RO antigen has also been recorded. In our study we evaluated the CD45RA and CD45RO expression on CD4+ T cells by three-color staining in flow cytometry in 38 HCL patients, 19 untreated and 19 previously treated with 2-chlorodeoxyadenosine (2-CdA), administered at a daily dose of 0.1 mg/kg c.i. for 7 days. In HCL untreated patients, the proportion and the absolute number of CD4+/CD45RA+ and of CD4+/CD45RO+ T cell subsets were similar to normal controls. In contrast, HCL patients at 3–5 years by the end of treatment with 2-CdA, together with a reduction in the absolute number of CD4+ T cells, showed a persistent and significant decrease in the proportion and absolute number of CD4+/CD45RA+ cells as compared with both untreated HCL patients and normal controls (41 ± 16% vs 57 ± 14% and vs 65 ± 7%) (P = 0.01 and 0.0001) and (0.201 ± 0.137 × 109/l vs0.549 ± 0.238 × 109/l and vs0.696 ± 0.078 × 109/l) (P = 0.00009 and P = 0.00001). In addition, together with the reduction of CD4+/CD45RA+ cells, we recorded a concomitant increase in the proportion of the CD4+/CD45RO+cells as compared to untreated HCL patients and normal controls (62 ± 16% vs 47 ± 15% and vs 42 ± 12%) (P = 0.08 and 0.02). These findings may suggest that CD4+/CD45RA+ cells are more sensitive than CD4+/CD45RO+ to the toxic effect of 2-CdA.

Complete resolution of hepatic aspergillosis after non-myeloablative hematopoietic stem cell transplantation in a patient with acute myeloid leukemia

Abstract Fungal infections due to Aspergillus are a frequent cause of transplant-related mortality. For this reason, leukemic patients with severe fungal infection are usually excluded from conventional allotransplantation. Recently, some authors suggested a role for non-myeloablative hematopoietic stem cell transplantation (HSCT) in this subset of patients. We used this therapeutic approach in a patient with high-risk acute myeloid leukemia in second complete remission (CR) with pre-existing hepatic aspergillosis refractory to conventional anti-fungal therapy. A complete regression of hepatic lesions was observed after 3 months from allogeneic stem cell transplantation. Our work confirms previous reports suggesting that non-myeloablative HSCT is effective in patients not eligible for conventional transplantation because of invasive aspergillosis.

Human herpesvirus 6 infection in autologous bone marrow transplant recipients: A prospective study

After primary infection in early life, human herpesvirus 6 (HHV‐6) remains latent in the body and may reactivate in subjects with poor immune status. A 180‐day longitudinal study of HHV‐6 infection was carried out in 23 autologous bone marrow transplant recipients to evaluate reactivation of HHV‐6; two of these patients underwent a double transplant. The patients were monitored prospectively for HHV‐6 DNA in peripheral blood mononuclear cells (PBMC) by hot start nested PCR. Positive samples were typed by the enzymatic restriction protocol. Positive plasma samples were also tested for HHV‐6 DNA. Antibodies against HHV‐6 were measured by immunofluorescence. Five and two out of 23 patients had intermittent and persistent positivity to HHV‐6 DNA in PBMCs, respectively; four patients carried variant B, and the other three patients both A and B. None of the respective plasma samples were positive. Two patients were positive for HHV‐6 antibodies. Since the significance of HHV‐6 DNA in PBMCs is unclear, these findings do not necessarily indicate active infection but may be due to mild immunosuppression in autologous BMT recipients. J. Med. Virol. 60:39–42, 2000.

Disseminated Mucormycosis in a Patient with Acute Myeloblastic Leukemia Misdiagnosed as Infection by Enterococcus faecium

ABSTRACT Mucormycosis is a rare complication in cancer patients. This report presents the case of a acute myeloblastic leukemia patient who developed an ascending paralysis due to disseminated mucormycosis. The presentation was unusual because the early symptoms were fever and pain, and the disease was misdiagnosed because of a concomitant infection by Enterococcus faecium.