Low Serum Gamma Globulin Research Articles

6014 POSTER G-CSF prophylaxis and neutropenic events in NHL patients receiving standard CHOP or R-CHOP – results from a retrospective study in the UK

To assess the treatment results in patients with advanced Hodgkin’s disease in a single center and to evaluate the clinical and therapeutic prognostic factors, including verification of the significance of the prognostic score.Treatment results were analyzed in 133 patients with newly diagnosed Stage IIIB and IV Hodgkin’s disease. Treatment consisted of six courses of hybrid chemotherapy (mechlorethamine, vincristine, procarbazine, and prednisone [MOPP]/doxorubicin (adriamycin), bleomycin, and vincristine [ABV]) followed by irradiation (RT) in patients with an indication for RT (84 patients). Chemotherapy was then continued for another two cycles. The indications for consolidation RT included bulky disease and/or partial response after six cycles of chemotherapy. In 31 patients, extended-field RT was performed, and in 53, limited fields were irradiated. The median radiation dose was 39 Gy.The median follow-up was 78 months. Complete remission after whole treatment was achieved in 88.7% of patients. The actuarial overall survival rate was 78% and 71%, and relapse-free survival rate was 73% and 65% at 5 and 10 years, respectively. The independent adverse prognostic factors in multivariate analysis appeared to be older age, low serum albumin, low serum gammaglobulin, lower number of chemotherapy cycles, and no RT. The value of the prognostic score was confirmed; the higher the prognostic score, the worse the survival.In patients with advanced Hodgkin’s disease, consolidation RT improved survival. The best results were achieved with the use of large-volume RT.

Evaluation of some etiological factors predisposing to diarrhoea in lambs in “La Serena” (Southwest Spain)

This study compares some etiological factors involved in the naturally occurrence of lamb scours in 18 Merino sheep farms randomly selected in the area of “La Serena” (Southwest Spain). A lack of influence of some variables (flock size, type of facilities, type of breeding, lambing percentage, isolation of Campylobacter jejuni, Rotavirus spp., Coronavirus spp. and Salmonella spp.) on lamb mortality rate was detected. The opposite was true for cleaning of the lambing areas, organization of lambing periods, accumulation of lambs in the pens, high content of fat, protein and lactose in milk and low serum gamma globulin and total protein in lambs and ewes. Cryptosporidium spp. and Escherichia coli isolation showed a trend to be linked to the presence of diarrhoea. A positive correlation was found between serum total protein in ewes and serum gamma globulin in lambs. Thus, the measure of serum total protein in ewes before lambing would be a valuable indicator of the risk of lamb scouring and it would be useful to establish an adequate programme to prevent this condition in the farms of this geographical area.

Unexpectedly High Incidence of Interstitial Pneumonia in Newly Diagnosed Diffuse Large B-Cell Lymphoma Treated with Rituximab-CHOP-14 Supported with Pegfilgrastim.

Purpose. To report on the risk of interstitial pneumonia (IP) in newly diagnosed diffuse large B-cell lymphoma (DLBCL) treated with dose-dense CHOP-14 plus rituximab supported with pegfilgrastim.Patients and Methods. In this phase II study of feasibility and toxicity, 50 patients with DLBCL, aged 18–70, with no major co-morbidities were treated with standard-dose CHOP every 14 days, preceded on day 1 by rituximab at the dose of 375 mg/m2 (R-CHOP-14) and followed on day 3 by pegfilgrastim (6 mg per cycle). No cotrimoxazole prophylaxis had been devised. In patients developing symptoms of possible pulmonary complications, standard chest X-ray, high-resolution CT scan and broncho-alveolar lavage (BAL) were performed, together with complete blood count, serum immunoglobulins level and CD4 lymphocytes determination. Cytomegalovirus (CMV) infection was investigated, as well, by either CMV-antigen or CMV-IgM determination.Results. Overall, 7 patients (14%) developed IP within 120 days from the start of therapy; their median age was 60 years (range: 22–65). Four patients developed IP after the end of therapy and no patient was neutropenic at the onset of pulmonary symptoms; the median absolute neutrophil count was 5.7x109/l (range: 3.0–11.1). Moderate or severe dyspnea and fever were constant. Diagnosis was made in all patients through high-resolution chest CT scan which documented bilateral interstitial damage, while standard chest X-ray was apparently normal in 5 of 7 cases. Clinical conditions did allow for BAL in 5 patients; Pneumocystis carinii (PC) infection was microbiologically documented in three patients, while hemorragic bronchiolitis and lymphocytic diffuse pneumonia were diagnosed in one case, each. CMV infection tests were invariably negative. Patients developing PC infection had low serum gammaglobulin levels (390, 790, and 200 mg/dL) and a lower than 400/mL number of circulating CD4+ lymphocytes (168, 359 and 190/mL, respectively). Wide spectrum antibiotics were administered in all cases until documentation of the etiology; PC infection was then treated with cotrimoxazole and low-dose steroids and lymphocytic pneumonia with high-dose steroids. The outcome was favorable in all patients, with no sequelae.Conclusions. Our data indicate a significant risk of IP in patients with DLBCL treated with R-CHOP-14 and supported with pegfigrastim; most worrisome is the risk of PC infection in the absence of cotrimoxazole prophylaxis. The risk of IP does not correlate with neutropenia, but it correlates with a low level of gammaglobulins and of circulating CD4+ lymphocytes. In this setting of patients, cotrimoxazole prophylaxis is mandatory and high-resolution CT scan and BAL should be done as early as possible at the onset of respiratory symptoms.

Analysis of treatment results in advanced Hodgkin’s disease: the case for adjuvant radiotherapy

Purpose To assess the treatment results in patients with advanced Hodgkin’s disease in a single center and to evaluate the clinical and therapeutic prognostic factors, including verification of the significance of the prognostic score. Methods and materials Treatment results were analyzed in 133 patients with newly diagnosed Stage IIIB and IV Hodgkin’s disease. Treatment consisted of six courses of hybrid chemotherapy (mechlorethamine, vincristine, procarbazine, and prednisone [MOPP]/doxorubicin (adriamycin), bleomycin, and vincristine [ABV]) followed by irradiation (RT) in patients with an indication for RT (84 patients). Chemotherapy was then continued for another two cycles. The indications for consolidation RT included bulky disease and/or partial response after six cycles of chemotherapy. In 31 patients, extended-field RT was performed, and in 53, limited fields were irradiated. The median radiation dose was 39 Gy. Results The median follow-up was 78 months. Complete remission after whole treatment was achieved in 88.7% of patients. The actuarial overall survival rate was 78% and 71%, and relapse-free survival rate was 73% and 65% at 5 and 10 years, respectively. The independent adverse prognostic factors in multivariate analysis appeared to be older age, low serum albumin, low serum gammaglobulin, lower number of chemotherapy cycles, and no RT. The value of the prognostic score was confirmed; the higher the prognostic score, the worse the survival. Conclusion In patients with advanced Hodgkin’s disease, consolidation RT improved survival. The best results were achieved with the use of large-volume RT.

Physiological Correlates of Neonatal Mortality in an Overpopulated Herd of White-Tailed Deer

We examined the relationship of development, immunocompetence, and tick burdens to neonatal mortality in an overpopulated herd of white-tailed deer ( Odocoileus virginianus ) during 1990–1992 in northeastern Oklahoma. Risk of mortality to 21 days of age was inversely related to body mass, body mass/length3, delayed hypersensitivity to phytohem-agglutinin, and serum concentrations of gamma globulin and gamma-glutamyl transferase (GGTP) for young ≤3days old. Serum GGTP and gamma-globulin concentrations were the most significant predictors of mortality to 21 days of age using multivariate-logistic regression. Increased probability of mortality was associated with lower serum gamma globulin and concentrations of GGTP, which suggested that inadequate absorption of colostrum leads to a partial failure in the passive process of transferring immunity from mother to offspring, and predisposes young to mortality agents among high-density herds.

Fever, Skin Eruption, Low Serum Gammaglobulin in a Child with Leukemia

Les catégories diagnostiques sont des schèmes théorico-pratiques qui, avant même que nous ne débutions le moindre traitement, peuvent exercer une action curative, tout comme ils risquent, à l’inverse, de comporter en soi un effet nocif. Le diagnostic de trouble somatoforme douloureux pourrait comporter ceci de nocif qu’il suggère que ce dont le patient souffre n’a qu’une « forme », au sens d’une apparence, somatique, mais est en « substance » un problème psychique. Quant au trouble de symptômes somatiques proposé par le DSM-V, sa définition se réfère pour l’essentiel à la notion problématique de « pensées, sentiments, comportements excessifs et disproportionnés ». Lorsqu’ils ont la parole, les patients souffrant de douleurs chroniques inexpliquées sont dominés par un sentiment d’impuissance : par rapport à leurs douleurs et par rapport au système de soins qui ne peut répondre à leur demande d’en être soulagés. D’un point de vue phénoménologique, leur vécu évoque en bien des points le vécu d’un trauma (« blessure »). Il entre dans la responsabilité du clinicien de trouver les moyens de qualifier ces douleurs innommables, au double sens du terme, en évitant de redoubler par un diagnostic en soi dégradant la honte de patients déjà accablés de douleurs insensées.Even before we begin any treatment whatsoever, diagnosis categories are theoretical-practical schemas that can have a curative action, but can also entail negative effects. The Somatoform pain disorder diagnosis can be harmful in that it suggests that what the patient is suffering from only has a somatic « shape », meaning that, that is how it appears to be, but that in its « substance », it is a psychological problem. As regards the Somatic symptom disorder proposed by the DSM-V, its definition is mainly based on the problematic notion of « excessive and disproportionate thoughts, feelings and behavior ». When they describe what they are experiencing, patients suffering the unexplained chronic pain are captured by a feeling of helplessness: in regards both to the pain and to the health care system that is unable to meet their demands for solace. From a phenomenological point of view, their experience is in many respects close to the experience of trauma (« injury »). It is the responsibility of the clinician to find ways to qualify these unspeakable pains so as not to add, through the diagnosis, to the shame carried by the patient already bearing insane pain.

Hypogammaglobulinemia associated with a severe wound infection.

In recent years agammaglobulinemia, more properly called reduced gammaglobulinemia or hypogammaglobulinemia, has been reported in children. 1 This recently described entity is characterized by recurrent, severe bacterial infections, which are evidence of deficient antibody production associated with almost complete absence of serum gamma globulin but with relatively normal total protein concentration. A patient with an abnormally low serum gamma globulin level, while under our care, developed a severe surgical wound infection. We believe this patient's hypogammaglobulinemia either was responsible for, or contributed to, her severe wound infection. To our knowledge no such condition has been reported as occurring in an adult; however, during the preparation of this paper, Sanford and his co-workers 2 reported on an adult female, 39 years of age, who had a low serum gamma globulin level accompanied by bronchiectasis and a sprue-like syndrome. Their patient improved markedly after administration of gamma globulin at monthly intervals. Subjective

Absence of serum gamma globulins in an adult.

THE syndrome of low serum gamma globulin in the presence of relatively normal quantities of the other protein factors has recently been described in children, but has not heretofore been observed in adults. The first case of agammaglobulinemia was reported by Bruton1 in a boy who, between the ages of four and a half and eight years, had 18 bouts of sepsis with 8 different types of pneumococci isolated, 5 episodes of otitis media, and 3 attacks of epidemic parotitis. Prophylactic antibacterial therapy was not always successful in preventing reinfection. After autogenous pneumococcal vaccine, typhoid vaccine and diphtheria immunization, no . . .