Tung-Liang Lin

Clinical bleeding events and laboratory coagulation profiles in acute promyelocytic leukemia

Background:u2002 Bleeding is the leading cause of death for patients with acute promyelocytic leukemia (APL). Blood component transfusion to correct coagulopathy is the keystone in reducing bleeding. The benefit of fresh frozen plasma transfusion is unproven. Using laboratory profiles to predict bleeding is important guidance for the determination of transfusion policies in the treatment of APL.

CD5 positivity is an independent adverse prognostic factor in elderly patients with diffuse large B cell lymphoma

Diffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma. Age over 60xa0years is one of the five parameters of the International Prognostic Index (IPI), which is the most important clinical prognostic predictor in DLBCL. A previous study on German DLBCL patients over 60xa0years of age showed that immunoblastic morphology, but not germinal center B cell-like (GCB)/non-GCB subtype, correlated with short survival. We collected 174 DLBCL cases over 60xa0years of age in Taiwan and performed immunophenotyping and detection of Epstein-Barr virus (EBV)-encoded RNA (EBER) by in situ hybridization. Of the cases, 5.2xa0% were positive for CD5 and 5.7xa0% positive for EBER. Neither immunoblastic morphology nor GCB/non-GCB subtype correlated with survival. In univariate analysis, adverse prognostic factors included IPIu2009≥u20093 (Pu2009<u20090.000001), B symptoms (Pu2009=u20090.000075), bone marrow/peripheral blood involvement (Pu2009=u20090.017), EBER positivity (Pu2009=u20090.0013), and CD5 positivity (Pu2009=u20090.016). In multivariate analysis, CD5 positivity was the only independent adverse prognostic factor (HRu2009=u20093.16; 95xa0% CIu2009=u20091.34–7.47; Pu2009=u20090.0087) in addition to IPIu2009≥u20093 (HRu2009=u20093.07; 95xa0% CIu2009=u20091.84–5.11; Pu2009=u20090.000018). Surprisingly, despite an overall 5.2xa0% incidence of central nervous system (CNS) relapse in our patients, none of the CD5+ cases experienced CNS relapse (Pu2009=u20091.00). This is in stark contrast to the more frequent CNS relapse in Japanese CD5+ DLBCL patients. EBER positivity was associated with IPIu2009≥u20093 (Pu2009=u20090.010), stage III–IV (Pu2009=u20090.0082), and B symptoms (Pu2009=u20090.011). In multivariate analysis, EBER positivity was not an independent adverse prognostic factor (Pu2009=u20090.81), its effect being due likely to accompanying adverse clinical parameters.

Primary breast lymphoma: A single-institute experience in Taiwan

Background: Breast is an uncommon location of lymphoma involvement. The most common type of primary breast lymphoma (PBL) is diffuse large B-cell lymphoma (DLBCL). Rituximab is the widely used monoclonal antibody against CD20+ B-cell lymphoma, especially DLBCL. We aimed to analyze the clinical features, prognostic factors, and treatment outcome with or without rituximab in primary breast DLBCL. Methods: We retrospectively analyzed patients diagnosed with PBL from October 1987 to March 2012 in our hospital, excluding metastasis by whole-body computed tomography and bone marrow study. Results: Twenty-three patients were diagnosed with PBL. All were females. Eighteen patients were stage IE and five were stage IIE according to the Ann Arbor staging system. Two patients had lymphoma other than DLBCL. The median age of primary breast DLBCL patients was 48 years (range 27-79). Two were excluded from the analysis due to refusal or ineligibility for chemotherapy. No significant prognostic factor was found. Patients receiving chemotherapy with (RC) or without (C) rituximab were not significantly different in the 5-year overall survival (RC: 57.1%; C: 58.3%; p = 0.457) or progression-free survival (RC: 57.1%; C: 50.0%; p = 0.456). A high incidence of relapse in the central nervous system (CNS) (17.6%) was observed. Conclusions: In accordance with prior literature reports, our Taiwanese cohort of primary breast DLBCL seemed younger than those reported in Japan, Korea, and Western societies. Relapse in the CNS was not uncommon. The benefit of rituximab in addition to chemotherapy was not statistically significant. Treatment modality remained to be defined by further large-scale studies.

Study of conjunctival flora in patients after peripheral blood stem cell transplantation and its correlation with tear secretion

BACKGROUNDnDry eye is a major ocular complication of peripheral blood stem cell transplantation (PBSCT) and may predispose bacterial colonization to the conjunctiva. To investigate the conjunctival bacterial flora in patients receiving PBSCT, we encompassed patients who received PBSCT at least 1 year from 2002 to 2008 in this cross-sectional study.nnnMETHODSnPatients were divided into three groups in accordance to the result of the Schirmer Ia test. In the control group, we enrolled dry-eye patients with underlying disease other than hematopoietic stem cell transplantation of which the age range was similar to the study group.nnnRESULTSnThirty-six patients with 72 eyes were included in our study. The culture rates were 22% (8 in 36) in the first group (Schirmer Ia= 0-5 mm), 20% (4 in 20) in the second group (Schirmer Ia= 6-9 mm), and 0% (n=16) in the third group (Schirmer Ia ≥ 10 mm). The flora in patients receiving PBSCT were coagulase-negative Staphylococci, Staphylococcus aureus and Corynebacterium sp. The bacterial colonization rate in the post-PBSCT group was not higher than the control group (22.2% vs. 30.8% ), and coagulase-negative Staphylococci was the most common flora in the control group.nnnCONCLUSIONSnIn conclusion, despite not having statistical significance, there seems to be a positive correlation between the colonization rate and the severity of dry eye. However, bacterial profile isolated in post-PBSCT patients is not significantly different from other dry eye patients.