Proliferation Of Lymphoid Cells Research Articles

Study of Patterns of Leukaemia in a Tertiary Care Hospital

Introduction: Leukaemia arises from abnormal proliferation of hematopoietic or lymphoid cells, categorized as acute or chronic and originating from lymphoid, myeloid, or mixed lineages. Clinical manifestations result from leukemic cell proliferation and tissue infiltration. Objectives: This study aimed to determine the frequency and clinicopathological profile of leukaemia cases. Material and Methods: A three-year cross-sectional observational study was carried out in the Department of Pathology, Indira Gandhi Medical College, Shimla. Diagnosis of Leukaemia was based on complete blood count, peripheral smear examination, bone marrow analysis and cytochemistry wherever required. Data comprising of patient details, clinical examination and haematological parameters were analysed. Results: A total of 163 leukaemia cases were identified, including 102 (63%) acute and 61(37%) cases of chronic leukaemia. Acute leukaemia consisted of 58 cases of Acute Myeloid Leukaemia (AML), 25 Acute Lymphoblastic Leukaemia (ALL), and 19 undifferentiated leukaemia (UL), while chronic cases comprised 47 Chronic Myeloid Leukaemia (CML) and 14 Chronic Lymphocytic Leukaemia (CLL). Most patients were in the age group of 31-60 years, with a male predominance (M:F 1.7:1). Conclusions: Early diagnosis and typing are vital for prompt leukaemia treatment. Despite advanced technologies, cytomorphological examination with cytochemistry remains crucial, especially in resource-limited settings like India. Keywords: Leukaemia, acute, chronic, cytomorphology, observational study

Telomerase Inhibition in the Treatment of Leukemia: A Comprehensive Review

Leukemia, characterized by the uncontrolled proliferation and differentiation blockage of myeloid or lymphoid precursor cells, presents significant therapeutic challenges despite current treatment modalities like chemotherapy and stem cell transplantation. Pursuing novel therapeutic strategies that selectively target leukemic cells is critical for improving patient outcomes. Natural products offer a promising avenue for developing effective chemotherapy and preventive measures against leukemia, providing a rich source of biologically active compounds. Telomerase, a key enzyme involved in chromosome stabilization and mainly active in cancer cells, presents an attractive target for intervention. In this review article, we focus on the anti-leukemic potential of natural substances, emphasizing vitamins (such as A, D, and E) and polyphenols (including curcumin and indole-3-carbinol), which, in combination with telomerase inhibition, demonstrate reduced cytotoxicity compared to conventional chemotherapies. We discuss the role of human telomerase reverse transcriptase (hTERT), particularly its mRNA expression, as a potential therapeutic target, highlighting the promise of natural compounds in leukemia treatment and prevention.

Phosphatase, Mg2+/Mn2+ dependent 1B regulates the hematopoietic stem cells homeostasis via the Wnt/β-catenin signaling.

Hematopoietic stem cells (HSCs) are primarily dormant in a cell-cycle quiescence state to preserve their self-renewal capacity and long-term maintenance. How HSCs maintain the balance between activation and quiescence remains largely unknown. Herein, we found that Phosphatase, Mg2+/Mn2+ Dependent 1B (Ppm1b) is required for the expansion of phenotypic HSCs in vitro. By using a conditional knockout mouse model in which Ppm1b was specifically depleted in hematopoietic cells, we demonstrated that loss of Ppm1b impaired the HSC homeostasis and hematopoietic reconstitution. Ppm1b deficiency mice also exhibited B-cell leukocytopenia, which is due to the compromised commitment and proliferation of B-biased lymphoid progenitor cells from CLPs. With the aid of a small molecular inhibitor, we confirmed the roles of Ppm1b in adult hematopoiesis that phenocopied the effects with loss of Ppm1b. Furthermore, transcriptome profiling of Ppm1b-deficient HSCs revealed the disruptive quiescence of HSC. Mechanistically, Ppm1b interacted with β-catenin and mediated its dephosphorylation. Loss of Ppm1b led to the decrease of the active β- catenin (non-phosphorylated) that interrupted the Wnt/β-catenin signaling in HSC, which consequently suppressed HSC expansion. Together, our study identified an indispensable role of Ppm1b in regulating HSC homeostasis via Wnt/β-catenin pathway.

Glycolysis Modulation by METTL7B Shapes Acute Lymphoblastic Leukemia Cell Proliferation and Chemotherapy Response.

Acute lymphoblastic leukemia (ALL) is a devastating hematological malignancy characterized by uncontrolled proliferation of immature lymphoid cells. While advances in treatment have improved patient outcomes, challenges remain in enhancing therapeutic efficacy and understanding underlying molecular mechanisms. Methyltransferase-like 7B (METTL7B), known for its methyltransferase activity, has been implicated in various solid tumors, yet its role in ALL remains unexplored. Here, we reveal that high METTL7B expression is correlated with poorer prognosis in ALL patients. Employing genetic manipulation strategies, we demonstrate that METTL7B depletion reduces ALL cell proliferation and enhances chemosensitivity. Mechanistically, we uncover METTL7B's involvement in modulating glycolysis, a crucial metabolic pathway supporting ALL cell growth. Furthermore, METTL7B's methyltransferase activity is identified as a determinant of its impact on glycolysis and proliferation. This study sheds light on METTL7B's multifaceted role in ALL, highlighting its potential as a therapeutic target and offering insights into the metabolic rewiring crucial for ALL progression.

Contribution of Computed Tomography in the Diagnosis of Multifocal Non-Hodgkin’s Lymphoma at the Mother-Child University Hospital the ‘’Luxembourg’’ About a Case

Lymphoma is a malignant proliferation of lymphoid tissue cells. We report a case of multi-focal lymphoma of lymph node, pharyngeal, cardiac and splenic sites. This was a 19-year-old patient received in February 2023, at the radiology and medical imaging department of the Mother and Child University Hospital Center ''Luxembourg'' as part of the CT exploration of a lateral mass. -left cervical. On admission, the clinical examination found a patient with an altered general condition, moderately colored conjunctiva, normal blood pressure and temperature. Examination of the lymph node areas revealed a left latero-cervical swelling, and fixed bilateral axillary swellings, of firm consistency and irregular contours. Palpation revealed hepatosplenomegaly. Cardiopulmonary auscultation was normal. A cervico-thoraco-abdominal CT scan revealed irregular thickening of the left lateral wall of the oropharynx, a hypodense tissue mass in the right cardiac chambers, heterogeneous splenomegaly, cervical, mediastinal, axillary and abdominal ADP. The histological examination carried out after lymph node biopsy revealed a histological appearance of small cell lymphoma. Conclusion: Lymphoma is a very common malignant tumor that can occur at any age. This tumor can affect all organs, however its cardiac location is rare. The positive diagnosis remains histological. Imaging plays an important role in the initial assessment, extension and surveillance.

Percutaneous Perirenal Mass Biopsy in a Sitting Position Revealed Extramedullary Relapse of Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia (ALL) is a blood malignancy characterized by a rapid proliferation of lymphoid progenitor cells. Extramedullary relapse (EMR) is the recurrence of leukemia that occurs outside the bone marrow. The central nervous system is the most prevalent site of EMR in ALL, whereas other organs, particularly the renal organs, are less commonly involved. A 49-year-old man diagnosed with Philadelphia chromosome-negative ALL (Ph-negative ALL) received a second umbilical cord blood transplant (uCBT) and was confirmed to be in his third hematological complete remission. However, the perirenal mass lesion emerged after two weeks, and was difficult to detect on echography in the prone position. We successfully performed a percutaneous biopsy of the mass in a sitting position and pathologically identified it as EMR. After the diagnosis, chemotherapy was restarted, and the patient was scheduled to receive a third uCBT. This is the first report of EMR in a perirenal lesion of ALL and shows that this novel biopsy can be performed as a renal biopsy, even in a sitting position. This case is the first to describe a biopsy technique in detail and demonstrates the value of collaboration between hematologists and nephrologists in diagnosing EMR of the kidneys.

Lateralized response of skull bone marrow via osteopontin signaling in mice after ischemia reperfusion

Skull bone marrow is thought to be an immune tissue closely associated with the central nervous system (CNS). Recent studies have focused on the role of skull bone marrow in central nervous system disorders. In this study, we performed single-cell RNA sequencing on ipsilateral and contralateral skull bone marrow cells after experimental stroke and then performed flow cytometry and analysis of cytokine expression. Skull marrow showed lateralization in response to stroke. Lateralization is demonstrated primarily by the proliferation and differentiation of myeloid and lymphoid lineage cells in the skull bone marrow adjacent to the ischemic region, with an increased proportion of neutrophils compared to monocytes. Analysis of chemokines in the skull revealed marked differences in chemotactic signals between the ipsilateral and contralateral skull, whereas sympathetic signals innervating the skull did not affect cranial bone marrow lateralization. Osteopontin (OPN) is involved in region-specific activation of the skull marrow that promotes inflammation in the meninges, and inhibition of OPN expression improves neurological function.Graphical

Phase Angle and Body Composition As a Prognostic Factor in Acute Lymphoblastic Leukemia

Acute lymphoblastic leukaemia (ALL) is a malignant proliferation of lymphoid cells blocked at an early stage of differentiation that can invade bone marrow, blood, and extramedullary sites. Age specific incidence is highest in children aged 1-4 years, then drops sharply through childhood (5-14 years), adolescence and young adulthood (AYA) (15-39 years), reaching the lowest point between 25 years and 45 years. Bioelectrical impedance analysis (BIA) is a method used to estimate body composition and cell membrane integrity. BIA is a useful tool as it is non-invasive, relatively inexpensive, can be performed on nearly any patient, does not expose the patient to ionizing radiation, is painless, and has both high intra and inter observer precision (coefficient of variation = 2.7%-4.0%). Phase angle (PhA) is obtained by BIA and is associated with cellular function. It is considered a reliable marker of malnutrition. PhA has been shown to predict survival in solid malignancies and hematopoietic stem cell transplant patients. To date, no studies have evaluated the usage of PhA in ALL patients. Therefore, this retrospective study sought to establish the prognostic significance of baseline PhA and lean mass index on OS and LFS in newly diagnosed ALL patients receiving intensive chemotherapy. Retrospective, cross-section, observational and descriptive study. The records of patients who received intensive chemotherapy from January 2019 to January 2023 were reviewed. Statistical analysis The qualitative variables were studied in frequencies and proportions, the quantitative variables were grouped into medians and ranges. OS and LFS were determined using Kaplan-Meier survival curves with log-Rank with a significant p <0.05 value. Statistical analysis was performed with SPSS version 25 and GraphPad Prism version 9.5.0. Results 85 patients were included, 56.7% (48) men and 43.5% (37) women. 79 patients with ALL-B and 6 patients ALL-T. The mean age was 25 years. 68 were AYA population and 17 not-AYA. The CR was 89%, ND MRD was 57%. The chemotherapy for AYA was CALGB 10403, and not AYA was Hyper-CVAD. Relapse was documented in 38%. The mean body mass index was 26.98±5.27 kg/m 2. The mean PhA was 4.547±0.9983°. The mean lean mass index was 17.8 (12.9-35.5) kg/m 2. The mean fat mass index was 9.195±4.425 kg/m 2. The mean OS was 86% at 1 year and OS at 3 years was 64.5%. The results that were statistically significant in LFS compared by Kaplan Meier curves were: male vs female p=0.0344, PhA >4, p=0.0235, lean mass index ≥16, p=0.0111. Conclusions In conclusion, our findings suggest that in newly diagnosed ALL patients undergoing intensive induction chemotherapy, PhA may provide important prognostic information for LFS and OS. PhA is an objective, repeatable, high-precision measure in ALL patients and, unlike other prognostic factors in this population, is potentially subject to intervention. Future studies of PhA in ALL patients should address the content validity of phase angle while further exploring the promising findings of the effect of strength training and nutritional supplementation on PhA and patient outcomes.

Causes of Acute Lymphoblastic Leukemia (All), Diagnosis and Treatment

Acute Lymphoblastic Leukemia (ALL) is a malignancy of the blood and bone marrow affecting both adults and children. Despite significant advancements in the treatment of ALL, its etiology remains multifactorial and complex. This scientific article aims to comprehensively explore the current understanding of the causes of ALL, integrating genetic, environmental, and other potential risk factors with the intent to enhance future research, exploring methods of diagnosis and treatment, and ultimately improve preventative measures and therapeutic strategies. Acute Lymphoblastic Leukemia (ALL) is characterized by the uncontrolled proliferation of immature lymphoid progenitor cells in the bone marrow. Although dramatic progress has been made in treating this disease, its etiology challenges scientists and clinicians alike. A better understanding of the underpinning causes of ALL is imperative to develop tailored interventions and preventive strategies. The etiology of Acute Lymphoblastic Leukemia remains a complex puzzle, tightly intertwined with a combination of genetic, environmental, and lifestyle factors. While significant progress has been made in identifying key genetic alterations and environmental exposures associated with ALL, further research is essential to understand the intricate interplay between genetic predispositions and environmental triggers. Improved understanding of the causes of ALL will aid in developing effective preventive strategies, targeted therapies, and personalized treatment approaches, ultimately reducing the burden of this devastating disease.

Significance of Th17 and Treg in Treatment Efficacy and Outcome in Pediatric Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia represents a malignant proliferation of lymphoid cells blocked at an early stage of cell differentiation. It is the most common cancer occurring in children. Despite favorable prognosis, the survival rate of patients with poor treatment response or relapse remains dismal. The interaction between leukemic cells and the tumor immune microenvironment is pivotal in mediating tumor progression. In this study we evaluated associations between Treg and Th17 lymphocytes and the clinical presentation of ALL pediatric patients to validate their value in monitoring treatment outcome. The peripheral blood and bone marrow aspirates from 35 pediatric patients with ALL and 48 healthy control subjects were selected for the experiment. We demonstrated the numbers of Th17 lymphocytes and Tregs were increased in the bone marrow of ALL patients at the moment of diagnosis compared to the healthy control group, with the latter significantly decreasing during the course of ALL treatment. Patients with lower Th17 were found to demonstrate higher risk of blasts prevalence in bone marrow at day 33. ALL patients with lower WBC demonstrated higher frequency of Tregs. In summary, we identified a significant role of Th17 and Treg lymphocytes in ALL of pediatric patients and their contribution to disease-related parameters.

Acute Lymphoblastic Leukemia Immunotherapy Treatment: Now, Next, and Beyond.

Acute lymphoblastic leukemia (ALL) is a blood cancer that primarily affects children but also adults. It is due to the malignant proliferation of lymphoid precursor cells that invade the bone marrow and can spread to extramedullary sites. ALL is divided into B cell (85%) and T cell lineages (10 to 15%); rare cases are associated with the natural killer (NK) cell lineage (<1%). To date, the survival rate in children with ALL is excellent while in adults continues to be poor. Despite the therapeutic progress, there are subsets of patients that still have high relapse rates after chemotherapy or hematopoietic stem cell transplantation (HSCT) and an unsatisfactory cure rate. Hence, the identification of more effective and safer therapy choices represents a primary issue. In this review, we will discuss novel therapeutic options including bispecific antibodies, antibody-drug conjugates, chimeric antigen receptor (CAR)-based therapies, and other promising treatments for both pediatric and adult patients.

Characterization and clinical impact of the tumor microenvironment in post-transplant aggressive B-cell lymphomas.

Post-transplant lymphoproliferative disorders (PTLDs) are iatrogenic immune deficiencyassociated lymphoid/plasmacytic proliferations developing due to immunosuppression in solid organ or hematopoietic stem cell allograft patients. PTLDs are characterized by abnormal proliferation of lymphoid cells and have a heterogeneous clinical behavior. We profiled expression of >700 tumor microenvironment (TME)-related genes in 75 post-transplant aggressive B-cell lymphomas (PT-ABCLs). EBV-positive PT-ABCLs clustered together and were enriched for type I interferon pathway and antiviral response genes. Additionally, a cytotoxicity gene signature associated with EBV-positivity and favorable overall survival (OS; HR 0.61, P=0.019). In silico immunophenotyping revealed two subgroups with distinct immune cell compositions. The inflamed subgroup with higher proportions of immune cells had better outcome compared to non-inflamed subgroup (median OS >200.0 vs. 15.2 months, P=0.006). In multivariable analysis with EBV status, International Prognostic Index, and rituximab-containing treatment, the inflamed TME remained as an independent predictor for favorable outcome. We also compared the TME between posttransplant and immunocompetent host diffuse large B-cell lymphomas (DLBCLs) (n=75) and discovered that the proportions of T cells were lower in PT-DLBCL. In conclusion, we provide a comprehensive phenotypic characterization of PT-ABCLs, highlighting the importance of immune cell composition of TME in determining the clinical behavior and prognosis of PT-ABCL.

Клінічний випадок маніфестації первинного імунодефіциту з лімфоми Беркіта

Lymphoma is a group of neoplastic diseases characterized by the clonal proliferation of lymphoid cells, manifested by the response of various stages of differentiation of normal B-lymphocytes, less often T-lymphocytes or natural killer cells. The etiology of most lymphomas is unknown. Some of the proven causal-consequence factors are: viral infections and immunodeficiency conditions. Purpose - to draw the attention of non-immunologists to the peculiarities of detecting the primary immunodeficiency (PID) states and the problem of their late diagnosis based on the data of a clinical case. Clinical case. A clinical observation of severe non-genetically differentiated PID is given. Screening signs of PID in the form of recurrent infectious respiratory tract syndrome and frequent long-term use of antibacterial drugs are highlighted, which should alert doctors to clinical and immunological markers of primary immunodeficiency. The presence of Burkitt's lymphoma in the boy also does not exclude the possibility of the manifestation of an immunodeficiency state, both secondary to the drug treatment of lymphoma, and primary, which can manifest itself in puberty. Common variable immunodeficiency is one of those PIDs that "starts" with Burkitt's lymphoma. Conclusions. The problem of low detection of probable PID in children in Ukraine is urgent. Primary care physicians are the first to be able to partially solve this problem by examining the infectious history and laboratory screening tests. There is incomplete awareness of related medical specialties regarding the signs of PID in lymphoproliferative syndrome in children. This clinical case demonstrates signs of PID at an early age. Low detection is also associated with poor capacity and quality and/or lack of immunological laboratory testing, particularly in public facilities. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the of the child’s parents was obtained for the research No conflict of interests was declared by the authors.

Lymphoproliferation- a clue towards an underlying monogenic disorder of immune dysregulation- a retrospective analysis from a single center in India

BackgroundLymphoproliferation is the persistent proliferation of lymphoid cells and it’s incidence in inborn errors of immunity varies from 0.7 to 18%. Materials and MethodsThis is a retrospective analysis of patients referred to the department of Immunology, B. J. Wadia Hospital for Children, Mumbai between March 2017 to December 2022. Inclusion criteria consisted of 3 months duration of significant lymphadenopathy and/or splenomegaly or history of lymphoma. The clinical characteristics, laboratory and molecular findings of the included patients were analyzed. ResultsA total of 66 patients were included. There was a male preponderance with male:female ratio of 25:8. Median age of onset of lymphoproliferation was 4.75 years(Range 1 year to 60 years). Splenomegaly was seen in 75%. Infections included recurrent pneumonia (14/66), recurrent ear infections(5/66), COVID(4/66), one episode of pneumonia(6/66), herpes zoster(3/66), recurrent subcutaneous abscess (3/66), abdominal koch(3/66), chronic sinusitis(2/66), dermatophytosis(2/66), esophageal candidiasis(2/66), recurrent malaria(1/66), recurrent varicella(1/66), cryptococcal meningitis(1/66), gram negative sepsis(1/66), BCG adenitis(1/66), pseudomonas osteomyelitis(1/66), impetigo (1/66), pseudomonas urinary tract infection (1/66), chicken pox(1/66), herpes keratitis(1/66), dengue(1/66), Other manifestations included Evans plus phenotype(10/66), Evans phenotype(8/66), Autoimmune hemolytic anemia(5/66), bronchiectasis(5/66), Type 1 diabetes(3/66), hyper reactive airway disease(2/66), inflammatory bowel disease(4/66), autoimmune thrombocytopenia(2/66), stroke(3/66), hemophagocytic lymphohistiocytosis(2/66), hypertriglyceridemia(2/66), hypothyroidism(2/66), celiac disease(1/66), Type 2 diabetes(1/66), autoimmune encephalitis(1/66), autoimmune hepatitis(2/66), anti-parietal cell antibody(1/66), arthritis(1/66), autoimmune enteropathy(1/66), systemic lupus erythromatosus(1/66), primary biliary cirrhosis requiring liver transplant(1/66), nephrotic syndrome(1/66), lymphoedema(1/66), hypersplenism(1/66), recurrent oral ulcers(1/66), gout(1/66), dermatitis(1/66), ovarian teratoma(1/66), alopecia areata(1/66). Hodgkin’s lymphoma(HL) was the most common malignancy(9/66), followed by non Hodgkin lymphoma(NHL)(6/66), transformation from NHL to HL(1/66), Burkitt to T-cell lymphoma(1/66), HL to DLBCL(1/66), HL to anaplastic T-cell lymphoma(1/66). EBV driven lymphoproliferation was seen in biopsy of21/66. Genetic testing showed mutations in LRBA(11/66), PIK3CD(5/66), CTLA4(3/66), TET2(2/66), IL2RA (1/66), IL12RB1(1/66), BACH2(1/66), PRKCD(1/66), TNFSFR13B(1/66), TNFAIP3(1/66), FAS(2/66), FASL(1/66), Caspase8(1/66), CARD11(1/66), RTEL1(1/66), AICD(1/66), PIK3R1(1/66), IKBKB(1/66). Treatment included IVIG, chemotherapy, rituximab, sirolimus, abatacept, HSCT. ConclusionAll children with persistent lymphoproliferation, with or without autoimmunity and/or infections should be worked up for an underlying monogenic disorder of immune dysregulation. Lymphomas presenting at abnormal site and/or age, relapse and EBV driven lymphomas require further evaluation. Presence of monogenic cause helps in providing targeted therapy.

Prognostic impact of lipid profile in adult Egyptian acute leukemia patients

Introduction: Acute leukemia is a malignant disorder which results from clonal proliferation of lymphoid and myeloid blast cells. Several studies have reported changes in lipid metabolism at the time of diagnosis of leukemia. Although investigators have reported decreased total cholesterol, decreased high-density lipoprotein, and elevated triglyceride (TG) in leukemic patients, there is a lack of agreement about these changes among different types of leukemia and between children and adult patients, in addition to different data about their impacts on prognosis. In this study, lipid profile has been examined at the time of diagnosis of acute leukemia in order to correlate it with response to therapy. Material and methods: This is a prospective study carried out at the Oncology Center at Mansoura University, Egypt between 2018 and 2019. Fifty patients newly diagnosed with de novo acute leukemia were included. Thirty-four patients were diagnosed with acute myeloid leukemia (AML) (68%), while 16 patients were diagnosed with acute lymphoblastic leukemia (ALL) (32%). Lipid profile and body mass index (BMI) data was obtained. Results: Overweight/obese patients showed a more statistically significant association with female patients than with male patients ( p = 0.009). By comparing the lipid profile between overweight/obese patients and other patients, there was no statistically significant association. 76.7% of AML patients were overweight or obese ( p = 0.015), and 81.3% of ALL patients showed hypertriglyceridemia ( p = 0.014). There was no statistically significant association between lipid profile and complete response (CR) rate; however, there was a marginally significant association between non-CR rate and overweight and obese patients ( p = 0.051). In addition, there was no impact of BMI or lipid profile on overall survival among acute leukemia patients. Conclusions: Female, and acute myeloid leukemia, patients were more commonly associated with overweight and obesity, and high TG level was found to be associated with acute lymphoid leukemia. Changes in lipid profile showed no impact on complete response rate or on overall survival in acute leukemia patients.

The progress in the relationship between trace elements and acute lymphoblastic leukemia.

Trace elements are very important substances with low content in the human body. If the content of some trace elements changes, they are also related to diseases. Acute lymphoblastic leukemia (ALL) is a malignant blood tumor, and its relationship with trace elements has also been a concern by scholars. Not only have the trace element levels in ALL patients changed, but the efficacy of different treatment methods has also been linked to the corresponding trace element changes. The characteristics of ALL may be related to the dysregulation of differentiation and proliferation of lymphoid precursor cells. Cell proliferation and differentiation are often affected by changes in DNA levels. However, trace elements are involved in DNA damage and repair mechanisms. In recent years, as an increasing number of studies believe that ALL is related to the abnormal metabolism of trace elements in the body, this paper intends to discuss the research progress on the relationship between trace elements and ALL to provide more information on trace elements for the diagnosis, treatment, and prevention of ALL.

Oncoguía de leucemia linfoblástica aguda 2023

Acute lymphoblastic leukemia (ALL) is a malignant proliferation of lymphoid cells (lymphoblasts) that can be precursors of B or T cells. The most frequent age of onset is 1-4 years and in adolescents and young adults of 15-39 years old. The disease response is regulated by heterogeneity, disease biology, risk factors, chromosomal rearrangements, structural variations, and contact sequences that alter the lymphoid lineage's maturation; that causes cell activation and alterations in its regulation. The introduction of schemes based on L-asparaginase, the use of tyrosine kinase inhibitors, as well as immunotherapy with blinatumomab have significantly improved the response and survival of patients between 60 % and 70 %. The objective of these guidelines of acute lymphoblastic leukemia is to show the current panorama of this pathology, guide the use of diagnostic tools, risk staging and, finally, offer the best available treatment options.

Correlation of TB LAM Ag (Tuberculosis Lipoarabinomannan Antigen) Results from Urine with Adenosine Deaminase Levels from Pleural Fluid Patients with Pulmonary TB Accompanied by Pleural Effusion

Background: One of the newest testing methods for active TB uses TB LAM Antigen, in which lipoarabinomannan (LAM) as the examined substance serves as the main component of the cell wall of M. tuberculosis (MTB) and the degradation product of MTB by macrophages in the human body. Patients with active TB with or without HIV infection may experience a decreased antibody response, which causes LAM not to bind to antibodies so that it can pass through the normal glomerular basement membrane and can be detected in the urine. Lateral flow urine lipoarabinomannan assay (LF-LAM) can detect this material with urine samples from active TB patients. Another TB screening method uses the measurement of adenosine deaminase (ADA) activity. ADA has a very important function for the proliferation and differentiation of lymphoid cells, especially T cells, and assists in the maturation of monocytes into macrophages. Objective: This study aims to qualitatively prove the correlation between the pleural fluid ADA levels of pulmonary TB patients with pleural effusion using the LF-LAM test results and examine the potential of TB LAM Ag, which correlates with increased pleural fluid ADA levels, as a diagnostic tool for diagnosing pulmonary TB. Method: It is an observational analytic study with a crosssectional design. Materials for this study included temporary urine from active TB patients at Dr. Soetomo Regional Public Hospital collected in May-August 2022. The descriptive analysis was conducted using SPSS 25.0. The data were tested for normal distribution and with the homogeneity test of Shapiro-Wilk's data. The statistical analysis was performed using the Mann-Whitney test, while the kappa suitability test was carried out to determine the correlation and level of concordance between the ADA cut-off value of pleural fluid and the TB LAM Ag test results. Results: This study involved 50 subjects consisting of 22 (44%) subjects with ADA test results between 40-100 IU/L compared to 28 subjects (56%) with ADA test results below 40 IU/L. There were 14 (28%) subjects with positive TB LAM Ag test results, consisting of 10 (45%) active TB subjects with a high ADA test cut-off of 40-100 IU/L and 4 (14%) active TB subjects with a low ADA test cut-off below 40 IU/L, with a p-value = 0.012. Conclusions: There is a correlation between TB Lipoarabinomannan antigen test results of TB patients with pleural effusion. TB LAM Ag can be detected positive on ADA test results of < 40 IU/L and more positive in active TB patients with high ADA test results of > 40-100 IU/L. Therefore, the TB LAM Ag test is more sensitive than the ADA test. The cut-off value of the ADA test reached 76.4 U/L, and a positive TB LAM was found.

Reactive lymphoid hyperplasia in the oral cavity of a cardiac patient – case report

This descriptive observational study reports a case of reactive lymphoid hyperplasia in the oral cavity of a pediatric cardiac patient followed up at a public tertiary care hospital. This male patient was five years old, with hypoplastic left heart syndrome, treated with Carvedilol, Furosemide, Losartan, Warfarin, Montelukast, and beclometasone. His legal guardian reported an increased amount of tissue on the floor of the mouth ongoing for approximately 24 hours, followed by prostration, fever, bilateral lymphadenopathy, and a refusal to eat. After removal of the oral infectious foci (carious lesions) in the operating room, regression of the lesion and symptoms was observed, suggesting a diagnosis of a lesion caused by reactional lymphoid hyperplasia, a rare and benign condition in which there is an increase in tissue volume, caused by the proliferation of lymphoid cells to fight an aggressor agent.

What can hide an enlarged lymph node of a patient with prostatic adenocarcinoma?

Introduction. Adenocarcinoma is the most common prostatic malignancy where clinical management, Gleason score and recent updates in prostate cancer staging play critical role. Mantle cell lymphoma originates from malignant transformation of B lymphocyte in the outer edge of lymph node follicle, with pathognomonic overexpression of cyclin D1. We present a rare case of two neoplasms occurred in the same individual person. Case report. In a 68-year-old patient planned for radical prostatectomy during the hospital preoperative examinations using multislice computed tomography tumor mass confined to the prostate but also excessive lymph node enlargement were revealed. Tissue specimens were analyzed after using hematoxylin and eosin staining, as well as immunohistochemical biomarker panel. Having performed a thorough histological examination, a diagnosis of prostatic adenocarcinoma, Gleason score 3+4=7, ISUP GG2, was given. Microscopic analysis of lymph node involvement showed unexpected, diffuse proliferation of small lymphoid cells, with irregular nuclei, wide mantle zone and hyalinized blood vessels. After using immunohistochemical staining for specific markers, another diagnosis was set, and it was non Hodgkin mantle cell lymphoma. Conclusion. A prostatic adenocarcinoma can extremely rarely be in a coexistence with undiagnosed lymphoproliferative disease, such as non Hodgkin mantle cell lymphoma in our case.