12th Congress of the European Hematology ... - Haematologica

1473
DIARRHEIC SYNDROME, A CLINICAL SIGN OF INTESTINAL INVOLVEMENT IN
PROGRESSING CHRONIC LYMPHOCYTIC LEUKEMIA
T. Gimenez, E. Abella, M. Cervera, J. Gimeno, C. Pedro, E. Gimeno,
A. Salar, S. Serrano, C. Besses
Hospital del mar, BARCELONA, Spain
Introduction. B-chronic lymphocytic leukemia (B-CLL) is characterised
by a progressive accumulation of mature and immunoincompetent lymphocytes
in hematopoietic organs. Extrahematopoietic infiltration is
minimal or absent at diagnosis but can occur in end-stage disease. Lung,
pleura, skin, central nervous system and kidney are the most frequent
involved organs. B-CLL can also infiltrate gastrointestinal (GI) tract but
the frequency is considered to be low (5-17%) even in postmortem studies.
Aims. 1.To determine the incidence of GI involvement by B-CLL in
28 out of 129 B-CLL patients who underwent a gastroscopy and/or
colonoscopy examination by several reasons. 2.To investigate clinical
signs that could suggest GI involvement. Materials and methods. In 28
patients out of 129 B-CLL patients controlled in our institution, upper
(n:15) and lower (n:17) endoscopic procedures were performed, comprising
a total of 32 examinations. The reasons to perform a colonoscopy
were as follows: active intestinal bleeding (n=4), polyposis (n=1), adenocarcinoma
(n=1), ferropenia (n=1), changes in bowel habits (n=4) and
chronic diarrhea (n=6). Most of the endoscopic procedures were done in
the setting of advance stage and/or progresive disease excluding Richter
tranformation. Results. Gastroscopy did not show histological evidence
of B-CLL infiltration in any patient. The results of colonoscopy exams
were the following: villous adenoma (n:2), bowel involvement by B-
CLL lymphocytes (n:4) and no abnormalities (n:11). In three patients, GI
infiltration involved colonic mucosa, and in one of them sigmoid colonic
mucosa was affected , too. The fourth patient presented infiltration only
in terminal ileum . Rectum was not involved in any case. Biopsies
showed focal (n:3) and diffuse (n:1) infiltration by characteristic B-CLL
lymphocytes. Immunohistochemistry was performed in 3 out of 4 and
was consistent with B-CLL . Clonality pattern in intestinal mucosa infiltrates
was demonstrated in 2 out of 3 cases. Discussions. GI involvement
in B-CLL is uncommon according to previously reported data. In our
experience, no gastric involvement was detected. The incidence of intestinal
infiltration was 3.1% in the setting of clinically progressive disease.
In all patients with intestinal involvement, the main clinical sign was persistent
diarrhea. To summarize, B-CLL lower GI tract involvement shoud
be taken into account in those patients who present diarrheic syndrome
in the setting of progressive disease.
1474
THE INFLUENCE OF IPI, KI67 AND BCL-2, ON SURVIVAL IN PATIENTS WITH DLBCL
TREATED WITH R-CHOP REGIMEN - SERBIAN LYMPHOMA STUDY GROUP EXPERIENCE
M. Perunicic Jovanovic, Lj. Jakovic, T. Terzic, M. Gotic, S. Jankovic,
A. Sretenovic, M. Petrovic, D. Boskovic, B. Mihaljevic
Institute for Haematology KCS, BELGRADE, Serbia
Several clinical parameters including International Prognostic Index
(IPI) as well as biological parameters (Ki67, Bcl-2,), are considered to
have prognostic relevance in diffuse large B-cell lymphomas (DLBCL).
The international prognostic Index based on clinical parameters is strongly
predictive of outcome. High proliferative rate has been associated
with worse survival in some series while Bcl-2 expression has been associated
with poor prognosis in patients with DLBCL. The aim of study
was to investigate the correlation between IPI and expression of bcl-2
and Ki-67, and their influence on OS survival. Retrospective analysis
was performed on 50 patients (31 male/ 19 female, mean age 48 years,
range 17-87) randomly selected from a large group of patients (pts) diagnosed
and treated with R-CHOP regimen. Median follow up was five
years. Initial IPI was determined in all pts. Staining for bcl-2 and Ki-67
was performed on paraffin- embedded sections using an indirect
immunoperoxidase method and a specific monoclonal antibody. We
analyzed the percentage of neopastic cells with Ki67+ nuclear staining
on 10 different high power microscopy fields (HPF, 400x). The intensity
of these stainings was graded as weak (0-30% Ki-67+), moderate (31-
60% Ki-67+ cells), and strong (>60% Ki67+ cells). Tumors were considered
positive when at least 50% of tumor cells expressed bcl-2 protein.
According to the IPI , distribution of DLBCL patients was as follows: 0,1-
11pts, 2- 19pts, 3-5 in 20pts. Patients with high IPI had significantly
shorter survival comparing to pts in low and intermediate IPI (20,5 vs
52,3 m; p