Sarah E. Strandjord

Burkitt lymphoma in a patient with classic hemophilia receiving factor VIII concentrates

PATIENTS WITH CLASSIC HEMOPHILIA (factor VIII deficiency) frequently develop expanding hematomas? The index of suspicion for a malignant tumor is therefore low when a hemophilic patient has a mass lesion. We describe a patient whose problems exemplified the difficulties that a clinician may encounter in diagnosing and treating a malignant tumor in a patient with classic hemophilia. The findings also raise the question of whether Burkitt lymphoma developing in a hemophilic patient may have resulted from the transmission of a blood-borne oncogenic agent through infusion of lyophilized preparations of factor VIII,

Differentiation of presumed sepsis from acute graft-versus-host disease by C-reactive protein and serum total IgE in bone marrow transplant recipients.

Fever after bone marrow transplantation may indicate the onset of bacterial or opportunistic infection, or acute graft-versus-host disease (GVHD). In an attempt to differentiate between infection and GVHD, we prospectively studied 41 bone marrow transplants in 38 patients (24 allogeneic, 17 autologous). Elevation of C-reactive protein (CRP) proved to be a good indicator of disseminated infections. In 40 episodes of documented (11) or presumed (29) sepsis, CRP rose above 5 mg/dl in 38 episodes (95%), and above 10 mg/dl in 32 episodes (80%). The CRP concentration paralleled the clinical course of the infectious episodes. Elevated CRP values were not observed in the 15 episodes of acute GVHD without concurrent infection. High peak values of serum total IgE, ranging from 4-fold to over 4000-fold baseline, were observed posttransplant in 18/22 allogeneic BMT recipients, temporally associated with activation of acute GVHD. IgE was elevated neither in episodes of sepsis without concurrent GVHD, nor in viral or focal bacterial infections. In general, septic infections were characterized by high CRP but low IgE levels. Acute GVHD without concurrent infection was characterized by high IgE but low CRP. We conclude that CRP and serum total IgE utilized together in serial fashion are helpful in distinguishing sepsis from acute GVHD.

Monthly Periods—Are They Necessary?

Menstrual suppression--the use of hormones to delay or eliminate menses--is often used in adolescents to manage conditions associated with the menstrual cycle and to accommodate lifestyle preferences. Reducing the frequency of menstrual bleeding does not cause any known physiologic harm and has potential short-term and long-term advantages. Different methods used for menstrual suppression, however, have associated risks and side effects that need to be weighed against the benefits of controlling menses. This article reviews the advantages and disadvantages of menstrual suppression and the different methods available for adolescents.

896 IMAGING NEUROBLASTOMA IN PATIENTS WITH RADIOLABELED MONOCLONAL ANTIBODY AS A BASIS FOR TARGETING THERAPY

We have shown in previous studies that iodine 131-labeled monoclonal antibody (Mab) 3F8 could image human neuroblastoma (NB) xenografts in mice with excellent tumor to tissue ratios and could ablate such tumors with minimal toxicities. We now report our human imaging studies as the basis for targeting radiotherapy. Patients with NB were injected iv with 1.5 to 5 mCi iodine 131 labeled Mab 3F8. Serial gamma scannings were done. Tumor localization was apparent by 15 hours. Tissue radioactivity (uCi/cc) was calculated based on orthogonal gamma images. There was no focal uptake in the normal brain, liver, spleen or the adrenal gland. Tumor to nontumor ratios were 10-20:1 between 15 to 140 hours after injection. Sites of uptake were confirmed as tumors at surgery in selected patients. Tumor to tissue ratio was 4-14: 1 for blood, 16-58:1 for liver, 5-19:1 for kidney, 10-36:1 for red marrow, and 540-1940:1 for CSF. In all patients sites of iodine uptake were consistent with tumor by conventional radiological studies. Deiodination with stomach excretion was significant. From tissue decay curves, relative radiation to normal organs were 4-12% (to blood 37%) of the tumor dose. Toxicities included pain and shortness of breath, both being reversible. No hematological side effects were noted. The radiolabeled Mab 3F8 might have clinical potentials for the imaging and therapy of human neuroblastomas.