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

Hodgkin’s disease is well known, but association with other lymphoproliferative
disorders is rare. To our knowledge, this is the second case of follicular lymphoma
associated with LCH. In the first case, LCH was diagnosed simultaneously
with the lymphoma. By contrast, in our case, LCH was diagnosed 3 years
after the lymphoproliferative disease, when there were no evidence of follicular
lymphoma progression. The origin of LCH is not clear, and there is controversy
as to whether it represents a true independent clonal neoplasm or a reactive
and/or therapy-related phenomenon. Reviewing the literature, FDG-PET study
appears to have higher sensitivity than bone scintigraphy, radiography and MR
imaging for the identification of active osseous lesions in LCH. However, it also
has a limited spatial resolution and requires complementary CT or MR imaging
to define the area of increased glucose metabolism. In summary, FDG-PET atypical
uptakes appearing in a patient with lymphoproliferative disease in complete
remission should not be considered as lymphoma progression without confirmation
by histologic examination.
1511
FLUDARABINE PLUS CYCLOPHOSPHAMIDE (FC) IN PATIENTS WITH PREVIOUSLY
UNTREATED LOW-GRADE LYMPHOMA
M. Dell’Olio, C. Bodenizza, A.M. Carella, A. Falcone, M.M. Greco,
A. La Sala, S. Mantuano, L. Melillo, E. Merla, M. Nobile, G. Sanpaolo,
P. Scalzulli, N. Cascavilla
Casa Sollievo della Sofferenza Hosp., SAN GIOVANNI ROTONDO, Italy
Background. In the last years, fludarabine alone or in combination with
other drugs has been reported to be effective in the treatment of previously
treated low-grade non-Hodgkin’s lymphomas (LG-NHL). The aim
of this study was to define the therapeutic efficacy and toxicity of a
combination of fludarabine and cyclophosphamide (FC regimen) in
untreated LG-NHL. Patients and Methods. Between January 2002 and June
2006, forty-five previously untreated patients with LG-NHL, were
enrolled in the study. All patients (M/F: 28/17, median age 62 years) vere
treated with three-day courses of fludarabine 25 mg/m2 /day, cyclophosphamide
300 mg/m2/day, every four weeks for a maximum of six courses.
Granulocyte colony-stimulating factor and Pneumocystis Carinii prophylaxis
was given. Among 45 patients, 21 (46%) were diagnosed with
small lymphocytic, 9 (20%) with malt gastric, 8 (18%) follicular grade I,
and 7 (16%) with immunocytoma subtypes. Results. Of the 45 patients,
43 (94%) achieved complete response (CR), 1 (3%) partial response,
while the remaining 1 (3%) showed no benefit from the treatment.
Regarding histology, in the follicular and malt gastric subtype we
observed an overall response (OR) rate and CR rate of 100%. Median
duration of follow-up was more than 27 months. Overall survival and
disease-free survival rates were 93% and 88%. Hematologic grade 3-4
toxicity was seen in only five (11%) patients; no opportunistic infections
or deaths were associated with the administration of the FC regimen
Conclusion. These preliminary data show that the FC regimen is a
high level of activity, with prolonged CR, well-tolerated combination
chemotherapy for untreated patients with LG-NHL.
1512
MANAGEMENT OF SEVERE MUSCULOSKELETAL PAIN CAUSED BY IMATINIBE MESYLATE
WITH DULOXETINE HYDROCHLORIDE IN A PATIENT WITH CHRONIC MYELOID LEUKEMIA
(CML). A CASE REPORT
S. Vakalopoulou, E. Pagourelias, Z. Katsarou, V. Perifanis,
S. Theodoridou, V. Garipidou
Ippokration General Hosital,Thessaloniki, THESSALONIKI, Greece
Imatinibe mesylate is an orally administered inhibitor of the breakpoint
cluster region-Abl tyrosine kinase, which is capable of blocking
proliferation and inducing apoptosis in chronic myeloid leukemia cell
lines. Its introduction in everyday clinical practice led to an advantageous
hematological and cytogenetic response in patients suffering from
CML, even though mild or more severe adverse effects of the drug may
present, affecting patients’ compliance or even calling for treatment withdrawal.
We present the case of a 23 year old patient with chronic
myeloid leukemia under imatinibe mesylate (Gleevec 400 mg once daily)
who developed severe musculoskeletal pain located at the lower
extremities (due to the above treatment) and its management with
Duloxetine Hydrochloride. After the patient was diagnosed to suffer
from CML (G-banding karyotype showed 46,XX,t(9;22)(q34;q11) and a
BCR-ABL transcript was demonstrated by reverse transcription-polymerase
chain reaction (RT-PCR) on bone marrow), a treatment with
Gleevec begun. After two weeks of treatment (400 mg once daily) the
patient complained for acute dysaesthesias and paraesthesias of the legs
as long as for severe pain on the same area. The above symptoms had
12 th Congress of the European Hematology Association
the typical distribution of an acute polyneuropathy. Despite that and
the findings of the clinical examination a full laboratory investigation
(including X Rays of the area, biochemical analysis and an electromyogramm)
didn’t prove the existence of polyneuropathy. Because of the
severity of pain the patient received large doses of paracetamol plus
codeine or even dextropropoxyphene hydrochloride without satisfactory
analgetic results. subsequently, duloxetine hydrochloride (Xeristar)
was administered initially at doses of 30 mg once daily for the first four
days and continuing with 60 mg once daily. The patient responded to
the treatment. One week later she needed no more opiates while after
two weeks the symptoms were fully relieved. Duloxetine Hydrochloride
is a new SSRI approved by FDA both for the treatment of depression as
along as for the management of diabetic polyneuropathy. As far as we
know it is the first time for this drug to be used successfully in the management
of acute musculoskeletal pains due to imatinibe mesylate. It is
certain that prospective studies are needed to evaluate the efficacy and
safety of the drug under conditions similar to the above. However, duloxetine
hydrochloride offers a new alternative choise for pain alleviation
in patients receiving Gleevec which seems to be much more attractive
than treatment withdrawal.
1513
GRAFT VERSUS HOST DISEASE AFTER ALLOGENEIC STEM CELL TRANSPLANTATION AND
ITS PREDICTION BY PROTEOMIC APPROACHES
A.K. Kaplanova
Department of Hematooncology, BRNO, Czech Republic
Background. Acute graft-versus-host disease (GvHD) is a frequent complication
of allogeneic stem cells transplantation (allo-SCT). The rapid
diagnosis of acute GvHD following allo-SCT is important for optimizing
the management of this life-threatening complication. Differentially
expressed or excreted polypeptides and proteins have potential for early
and accurate diagnosis of GvHD and other complications of allo-SCT.
Aims. Search for blood plasma proteins useful as potential biomarkers for
early detection of GvHD. Methods. 2-dimensional gel electrophoresis (2-
DE) was used for separation of blood plasma proteins. Proteins considered
as potential biomarkers for early prediction of GvHD were selected
by image analysis. Protein spots with different expression levels were
characterized by matrix-assisted laser desorption/ionization - time of
flight mass spectrometry (MALDI-TOF-MS) using peptide mass fingerprinting.
Samples of blood plasma, urine and lymphocytes, collected
from the same patient before and after allo-SCT were analyzed.
Analysed samples were collected at three time points: (1) approx. 10
days before GvHD manifestation, (2) approx. 2 days before GvDH manifestation
and (3) during GvHD manifestation. Results. Proteomic analysis
revealed several proteins differentially expressed during GvHD development.
These potential biomarkers included serum natural proteinases
(macroglobulin α2 and α1 anti-trypsin), components of complement
(complement 4 binding protein and complement factor I), proteins of
acute phase (haptoglobin, C-reactive protein and amyloid related serum
protein (SAA)) and other proteins such as fibrin, fibrinogen, inter-α (globulin)
inhibitor H4 and hemopexin precursor. Concentration of serum
natural proteinases, haptoglobin, inter-α (globulin) inhibitor H4 and
hemopexin precursor in blood plasma were significantly decreased in
both samples collected prior to GvHD manifestation. In these samples
was detected also slightly decreased expression of analyzed components
of complement in comparison to samples collected during GvHD manifestation.
On the other hand, expression of C-reactive protein and SAA
was detected only 14 days before GvHD manifestation and these proteins
completely disappeared 1 day before onset of disease and during
its manifestation. Summary/Conclusions. These potential biomarkers could
improve early prediction and treatment of GvHD and thereby reduce
GvHD incidence and complications.
This study was supported by several grant projects: IGA MZ CR NR8448-
3/205 and NR9293-3/2007, and grant projects of Ministry of Education, Youth
and Sports: MSM0021622430, MSM0021624215 and LC 06034.
1514
HER-2/NEU MRNA IN PERIPHERAL BLOOD & BONE MARROW IN FEMALE BREAST
CANCER PATIENTS
A. Abd El Hamid, 1 M. Elkamash, 1 G. Eskander, 1 A. Hassan, 1 F. Abdel
aziz, 1 F. Attia, 1 S. Hassan, 2 M. Hassan2 1 Suez Canal Univers, Faculty of Medicine, ISMAILIA,EGYPT, Egypt; 2 Karolinska
University Hospital, STOCKHOLM, Sweden
Background. The prognostic significance of the bone marrow
haematologica/the hematology journal | 2007; 92(s1) | 537