Tahmeena Ahmed

The role of therapeutic apheresis in the treatment of acute antibody-mediated kidney rejection.

Approximately 10% of renal transplant recipients experience acute antibody‐mediated rejection (AMR) due to alloimmunization against human leukocyte antigen (HLA) molecules and other antigens. While therapeutic apheresis is included in most treatment protocols for acute kidney allograft rejection, these protocols have been derived mainly from single center experience rather than controlled trials. This concise review focuses on the role of therapeutic apheresis in AMR treatment. Two groups have recently reported treating acute AMR using drug‐only strategies without therapeutic apheresis in particular situations, namely in clinically less severe cases or in resource‐limited situations without testing for donor specific antibodies. A randomized controlled trial, designed to test the efficacy of immunoadsorption apheresis in AMR treatment, was terminated early and suggested a benefit of apheresis. An observational study suggested efficacy of plasmapheresis in acute AMR treatment, but all patients who received plasmapheresis also received rituximab. As new therapeutic modalities are becoming available, therapeutic apheresis continues to play a role in the treatment of acute kidney allograft rejection. J. Clin. Apheresis, 2012.

Pediatric T-cell prolymphocytic leukemia with an isolated 12(p13) deletion and aberrant CD117 expression

T-cell Prolymphocytic leukemia (T-PLL) is a rare post-thymic T-cell malignancy that follows an aggressive clinical course. The classical presentation includes an elevated white blood cell (WBC) count with anemia and thrombocytopenia, hepatosplenomegaly, and lymphadenopathy. T-PLL is a disease of the elderly and to our knowledge it has never been described in the pediatric age group. We report a case of T-PLL in a 9 year old male who was initially diagnosed with T-cell acute lymphoblastic lymphoma (ALL), the diagnosis was later refined to T-PLL following additional analysis of bone marrow morphology and immunophenotype. Two unusual findings in our patient included CD117 expression and an isolated chromosomal 12(p13) deletion. The patient failed to respond to standard ALL induction chemotherapy, but achieved complete remission following treatment with a fludarabine and alemtuzumab-based regimen.

Lymphoproliferative disorder that resembles heptosplenic lymphoma during maintenance treatment for T-cell acute lymphoblastic leukemia

A 6‐year‐old male presented with a testicular mass, hepatosplenomegaly, and a pleural effusion while undergoing maintenance chemotherapy for treatment of T‐cell acute lymphoblastic leukemia (T‐ALL). He was subsequently diagnosed with a lymphoproliferative disorder that resembled hepatosplenic lymphoma (HSL). While the extranodal presentation and the protracted yet aggressive clinical course are consistent with HSL, the findings of monosomy 8 and polymorphic cell populations are unique and have not been previously described in this type of lymphoma. Pediatr Blood Cancer 2013; 60: E10–E12.

Contamination of Patient Blood Samples by Avian RBCs From Control Material During Automated Hematology Analysis

OBJECTIVES Atypical nucleated RBCs (NRBCs) found on several patient blood smears between 2010 and 2012 were noted to resemble avian RBCs. NRBCs are not normally found in the circulation beyond the neonatal period and may indicate hematologic disease, malignancy in the bone marrow, or other severe conditions. Our blood smears with unusual NRBCs did not contain other abnormalities that typically accompany NRBCs, such as immature cells or dysplastic granulocytes. To investigate this anomaly, we considered possibilities such as contaminated collection tubes and instrument problems. The Retic-C Cell Control used with the LH 750 Hematology Analyzer contains a mixture of human and avian RBCs. METHODS CBC count with differential tests were performed on blanks and routine laboratory samples run immediately after the Retic-C Cell Control on the LH 750 and LH 780 analyzers to recreate the conditions that might cause spillage into the next tube. RESULTS We experimentally reproduced the phenomenon of contamination of a subsequent tube with avian cells from a multiply punctured reticulocyte control tube. CONCLUSIONS We concluded that the NRBCs likely represented avian RBCs from the Retic-C Cell Control that had been introduced into the patient tubes.

Anti-CD19 chimeric antigen receptor targeting of CD19 + acute myeloid leukemia

Aberrant expression of CD19 in acute myeloid leukemia (AML) is commonly associated with t(8;21)(q22;q22), although AML cases lacking this translocation occasionally express CD19. Mixed-phenotype acute leukemia also frequently expresses CD19. Chimeric antigen receptor (CAR) technology is a major breakthrough for cancer treatment, with the recent approval of CD19-directed CAR (CD19CAR) for treating B-cell malignancies. However, little information exists on using CD19CAR for other CD19 positive neoplasms such as AML. Our findings indicate that CD19CAR therapy can potentially be used for those with mixed phenotype leukemia and a subset of AML cases.

Ring chromosome 11 with KMT2A (MLL; 11q23) amplification and deletion in a patient with acute myeloid leukemia

Abstract Background: Chromosome abnormalities are significant in the diagnosis, prognosis, and treatment of patients with hematologic malignancies. Rearrangements of the mixed lineage leukemia gene (KMT2A; i.e. MLL) can

Transformation of myelodysplastic syndrome with isolated 5q-syndrome to chronic myelogenous leukemia with a novel complex BCR/ABL1 translocation with rapid progression to blast crisis

Abstract We report a case of a 72 year old female who was referred to our institution in August 2010 for Myelodysplastic syndrome (MDS) with a deletion of part of the long arm of chromosome 5 [i.e., del(5) (q12q33)]. In June 2014, she