Serum Soluble Interleukin-2 Receptor Research Articles

Elevated soluble interleukin-2 receptor and interleukin-2 receptor positive cells in carcinomatous pleural effusions

Soluble interleukin-2 receptor (IL-2R) level and IL-2R positive (IL-2R+) cells were studied in twenty patients with carcinomatous pleural effusions. The mean value of soluble IL-2R level in carcinomatous pleural effusions was 2930 +/- 1722 U/ml and that in sera was 965 +/- 610 U/ml. Soluble IL-2R level in carcinomatous pleural effusions was found to be significantly higher (p less than 0.001) than that in sera of patients with carcinomatous pleural effusions and that in transudates. Serum soluble IL-2R level in patients with carcinomatous pleural effusions was found, to be significantly higher (p less than 0.001) than that in normal controls (264 +/- 70 U/ml). We also studied IL-2R+ cells in pleural fluids and peripheral blood of patients with carcinomatous pleural effusions. The mean percentage of IL-2R+ cells in carcinomatous pleural fluid lymphocytes was 22.8 +/- 17.8%, as compared with 3.0 +/- 2.2% in peripheral blood lymphocytes of normal controls (p less than 0.001). No significant differences were observed among the cell types of lung cancer examined (adenocarcinoma, squamous, small cell and large cell carcinoma) and no correlation among levels of soluble IL-2R and IL-2R+ cell in either pleural fluid or blood. Our results suggest that in patients with carcinomatous pleural effusions, T cell-mediated active immune mechanisms (IL-2/IL-2R system) against cancer cells are more active in pleural fluid than in peripheral blood.

Is mycophenolate mofetil superior to pulse intravenous cyclophosphamide for induction therapy of proliferative lupus nephritis in Egyptian patients?

Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis. The aim of this study was to evaluate the efficacy of MMF compared with IVC in the induction therapy of proliferative lupus nephritis. We randomly assigned 47 patients with newly diagnosed active proliferative lupus nephritis class III or IV to open-label oral MMF 2 g/day for 6 months or intravenous cyclophosphamide 0.5-1 g/m(2) monthly for 6 months in addition to corticosteroids. In the intention-to-treat analysis, 14 of the 24 patients (58.33%) receiving MMF and 12 of the 23 patients receiving cyclophosphamide (52.17%) had remission (P = 0.48); complete remission occurred in 6 of the 24 patients (25%) and 5 of the 23 patients (21.74%), respectively (P = 0.53). Improvements in packed cell volume, the erythrocyte sedimentation rate, anti-double-stranded DNA antibodies titer (anti-dsDNA), serum complement, proteinuria, urinary activity, renal function, serum soluble interleukin-2 receptor alpha concentration and the systemic lupus activity measure score were similar in both groups. Two patients assigned to MMF and another patient assigned to IVC developed end-stage renal failure with commencement of dialysis. Adverse events were similar. Major infections occurred in two patients in each group. There was no difference in gastrointestinal side effects, but more diarrhea occurred in those receiving MMF. In this 24-week trial, MMF or IVC combined with corticosteroids demonstrated equal efficacy in inducing remission of proliferative lupus nephritis.

Levels of Transferrin in Bronchoalveolar Lavage Fluid in Sarcoidosis

There has been only one report showing high levels of transferrin (Tf) in bronchoalveolar lavage fluid (BALF) in patients with sarcoidosis. This study was designed to assess the levels of Tf in both BALF and serum and to examine the relationship between the levels of Tf and other disease markers in sarcoidosis. Subjects were 64 sarcoidosis and 10 healthy controls. Tf in BALF and serum was measured by nephelometric assay. Median Tf levels in BALF from sarcoidosis was 0.70 (range, 0.00-3.97) mg/dl, which was significantly higher compared with controls (0.36 (range, 0.00-1.02) mg/dl; p = 0.005). In contrast, median Tf levels in serum from sarcoidosis was 258 (range, 171- 383) mg/dl, which was significantly lower compared with controls (322 (range, 234-356) mg/dl; p = 0.003). Tf levels in BALF were significantly correlated with both the percentage of lymphocytes (r = 0.617, p = 0.001) and serum angiotensin-converting enzyme activity (r = 0.363, p = 0.003) and serum soluble interleukin-2 receptor (r = 0.450, p = 0.001) in sarcoidosis. Levels of Tf in BALF from patients with sarcoidosis were not influenced by smoking status. The levels of Tf in sarcoidosis are high in BALF, but low in serum. Increased levels of Tf in BALF may reflect the disease activity.

A Case of Intravascular Large B-cell Lymphoma (IVLBCL) with no Abnormal Findings on Chest Computed Tomography Diagnosed by Random Transbronchial Lung Biopsy

A 58-year-old woman was admitted with refractory fever despite receiving broad-spectrum antibiotics. She had hypoxemia, severe anemia, elevated levels of serum lactic dehydrogenase and soluble interleukin-2 receptor, and a positive direct Coombs test, which suggested an underlying autoimmune hemolytic anemia (AIHA). Chest computed tomography (CT) showed no abnormal findings, but she had hypoxia, and her alveolar-arterial oxygen difference (A-aDO2) was increased. A random transbronchial lung biopsy (TBLB) was performed, and pathological analysis showed massive proliferation of tumor cells in the lumina of the small vessels. Intravascular large B-cell lymphoma (IVLBCL) was diagnosed, and her general status improved after chemotherapy.

A Case of Tuberculous Peritonitis in a Hemodialysis Patient with High Serum Soluble Interleukin-2 Receptor and CA-125 Levels

A hemodialysis patient with tuberculous peritonitis with hypercalcemia and high serum soluble interleukin-2 receptor (sIL-2R) and CA-125 levels is reported. An 82-year-old woman who had been on hemodialysis therapy for 6 years was admitted to our hospital for evaluation and treatment of hypercalcemia. Laboratory examination and radiologic studies revealed markedly increased serum sIL-2R and CA-125 levels and exudative ascites, with high levels of adenosine deaminase (ADA) and CA-125, which was suggestive of malignancy or tuberculosis. She was finally diagnosed as having tuberculous peritonitis based on positivity for Mycobacterium tuberculosis in ascitic fluid. The ascites subsided with normalization of hypercalcemia and a marked decrease in serum sIL-2R and CA-125 levels in response to anti-tuberculosis treatment. This case indicates that serum sIL-2R and CA-125 levels can rise to levels suggestive of malignancy in tuberculous peritonitis, and that they can be used to monitor the response to anti-tuberculosis treatment.

Resolution of immune thrombocytopenic purpura associated with extranodal B-cell lymphoma of the petroclival region after radiotherapy

Background:Secondary immune thrombocytopenic purpura (ITP) associated with extranodal B-cell non-Hodgkin’s lymphoma (NHL) is extremely rare. The optimal management is not established. We report a first case of ITP in association with extranodal B-cell NHL originating in the lower petroclival region, successfully managed by local tumor control using conventional radiotherapy.Case Description:A 75-year-old man presented with a two-month history of hearing loss, hoarseness, and dysphagia. Neuroimaging revealed a large enhanced lesion in the left lower petroclival bone near the jugular foramen. Isolated unilateral parotid lymphadenopathy was also noted. Preoperative laboratory findings were normal, except for elevation of serum soluble interleukin-2 receptor level. A suboccipital craniotomy was performed and a biopsy sample was taken. Histological and immunohistochemical examination confirmed small B-cell lymphoma with plasmacytic differentiation. After initiation of radiotherapy, thrombocytopenia (24,000/µl) rapidly developed. Serological and bone marrow examination confirmed ITP. Prednisone was given at 1 mg/kg/day and radiation therapy was continued. After more than 32Gy, platelet count rapidly normalized. Radiotherapy to the tumor site achieved local tumor control and ITP was resolved. No evidence of recurrence and normal platelet count were confirmed at the two-year follow-up examination.Conclusion:Local control of the tumor was considered important in the resolution of secondary ITP in association with extranodal NHL of the skull base region.

Pre-Treatment Serum Soluble Interleukin-2 Receptor Value Significantly Predicts Survival in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma.

Abstract 3948Poster Board III-884Serum soluble interleukin-2 receptor (sIL2R) is known to be elevated in patients with adult T-cell leukemia, non-Hodgkin lymphoma and Hodgkin lymphoma. Some studies reported the clinical usefulness of pre-treatment sIL2R value as a prognostic factor associated with survival in various NHL. However it has not been adequately examined about the significance of pre-treatment sIL2R value in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL), especially in rituximab era. We retrospectively analyzed the clinical significance of pre-treatment sIL2R value in 90 patients diagnosed as having DLBCL and treated in our hospital between 2004 and 2008. And we also compared them to patients with follicular lymphoma (FL) and to patinets with lymphadenopathy other than lymphoma. Median age of all 90 patients with DLBCL was 68 years (range, 18 to 88). Thirty-one (34%) patients were less than 60 years. Male/female was 53/37. Thirty-three (37%) patients had stage I or II diseases. Sixty-five (72%) patients were in 0/1 of ECOG performance status (PS). LDH value was elevated above normal range in 55 (61%) patients. Sixteen (18%) patients had 2 or more extranodal diseases. According to International Prognostic Index (IPI), 48 patients and 42 patients were classified as low/low-intermediate risk groups and high-intermediate/high risk groups, respectively. Seventy-nine of 90 patients were treated with R-CHOP or R-CHOP-like chemotherapies with or without radiotherapy. Two-year overall survival rate was 68% in all 90 patients with DLBCL. In all 90 patients with DLBCL, pre-treatment sIL2R value was 4258+/-6850 U/ml (mean+/-SD) which was significantly higher than that in 42 patients with lymphadenopathy other than lymphoma (870+/-892, p<0.0001, t-test). But it was not statistically different between patients with DLBCL and 56 patients with FL (2869+/-3642). In prognostic factor analysis in DLBCL, we examined 6 factors (age, stage, performance status, number of extranodal disease, LDH value and pre-treatment sIL2R value).Univariate analysis showed that stage, LDH, PS and sIL2R were statistically significant factors associated with survival, but age and number of extranodal disease were not. Thirty patients with lower sIL2R (less than 1000U/ml) showed better survival than 60 patients with higher sIL2R (1000U/ml or more). Two-year survival rates were 97% and 53%, respectively (p=0.0002, log-rank test). In these 4 significant factors, multivariate analysis showed sIL2R was the only statistically significant prognostic factor (HR 10.798, 95%CI: 1.320-88.304, p=0.0265). This retrospective analysis suggested that in rituximab era pre-treatment sIL2R value was a useful prognostic factor other than IPI in patients with newly diagnosed DLBCL. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Serum soluble interleukin‐2 receptor level and immunophenotype are prognostic factors for patients with diffuse large B‐cell lymphoma

Diffuse large B-cell lymphoma is the most common form of non-Hodgkin lymphoma. Although many studies have attempted to identify prognostic factors, most have focused on conventionally treated patients. The influence of anti-CD20 antibody (rituximab) should be considered now. We evaluated the prognostic significance of serum soluble interleukin-2 receptor levels and germinal center B-cell-like or non-germinal center B-cell like subgroups in 80 patients with diffuse large B-cell lymphoma, who had been treated with rituximab. Serum soluble interleukin-2 receptor levels ranged from 322 to 39900 U/mL (median 1365 U/mL). Sixteen (20%) were germinal center B-cell-like subgroups, and the remainder (80%) non-germinal center B-cell-like. Survival analysis associated lower serum soluble interleukin-2 receptor level and germinal center B-cell-like phenotype with better overall survival (P = 0.015), whereas multivariate analysis, including International Prognostic Index factors, revealed that only higher performance status score and higher serum lactate dehydrogenase levels significantly affected survival. However, serum soluble interleukin-2 receptor levels were elevated in patients with higher International Prognostic Index scores as well as in the non-germinal center B-cell-like subgroup. Serum soluble interleukin-2 receptor levels, International Prognostic Index, and subphenotypes were strongly correlated with each other. Our study showed that soluble interleukin-2 receptor is quite useful and may serve as a substitute for the International Prognostic Index, especially for patients undergoing treatment. Moreover, the differentiation between the germinal center B-cell-like and non-germinal center B-cell-like phenotypes is also useful for predicting patients with diffuse large B-cell lymphoma, even among those treated with rituximab.

Serum soluble interleukin-2 receptor levels in patients with malignant lymphoma of bone

BackgroundThe reliability of selected serum markers and radiological features for distinguishing malignant lymphoma of the bone from other osteolytic bone lesions was examined in an effort to improve the differential diagnosis. MethodsA total of 23 patients with histologically verified malignant lymphoma of the bone, 57 patients with other osteolytic malignancies (35 males, 22 females; mean age 62.8 years, range 13-89 years), and 13 patients with benign bone lesions that resemble malignant tumor radiographically (6 men, 7 women; mean age 48.1 years, range 20-73 years) were retrospectively reviewed. We evaluated the serum levels of soluble interleukin-2 receptor (sIL-2R), lactate dehydrogenase, and C-reactive protein in addition to radiographic examination and gallium-67 scanning. ResultsAlthough every clinical feature examined was found to show significant differences between lymphoma and the other two groups, the feature most highly suggestive of malignant lymphoma is a high serum sIL-2R level (sensitivity 0.95, specificity 0.70, accuracy 0.81). ConclusionsThe serum sIL-2R level can be a valuable marker for diagnosing malignant lymphoma of the bone.

Persistently increased serum soluble interleukin-2 receptors in continuously ill patients with schizophrenia

There is evidence suggesting that some patients with schizophrenia have increased circulating pro-inflammatory markers present in their serum. We hypothesize that serum soluble interleukin-2 receptor (sIL-2r) levels may serve as a biomarker for a subset of patients with schizophrenia. Serum sIL-2r levels were serially sampled from 59 medically stabilized subjects with schizophrenia and 57 control subjects. Serum sIL-2r levels were consistently elevated for subjects with schizophrenia when compared to controls. This finding was driven by a subgroup of patients (16/59) who had serum sIL-2r levels two standard deviations beyond the mean of the control sample. Elevated serum sIL-2r levels were associated with increased Positive and Negative Syndrome Scale total scores, negative symptom and general psychopathology subscale scores. These results suggest that a subset of patients with schizophrenia have an elevation in a marker of immune activation that is stable over time and is associated with increased levels of psychopathology.

Standardized uptake value on FDG-PET as a marker for disease activity in patients with non-Hodgkin’s lymphoma: comparison with serum soluble interleukin-2 receptor values

We compared standardized uptake values (SUVs) on positron emission tomography with a glucose analog, 2-[F-18] fluoro-2-deoxy-D-glucose (FDG-PET) and serum soluble interleukin-2 receptor (sIL-2R) values in patients with non-Hodgkin's lymphoma (NHL) in the pre-, mid- (after three or four cycles), and post-treatment periods of chemotherapy (pre, mid, and post, respectively), and we examined whether the SUV was a useful tumor marker for NHL. The SUVs on PET and sIL-2R values were retrospectively evaluated based on all the clinical information available in 40 patients (31 in pre, 24 in mid, and 24 in the post periods). Patients in complete remission status were classified as group A and those with active residual disease in the mid and post periods were classified as group B. In pre, the SUV and sIL-2R values exhibited sensitivity of 100% and 84%, respectively. In mid, the SUV was lower in group A than in group B, while sIL-2R was not different. The SUV yielded better specificity than sIL-2R (88% vs. 25%, respectively), though the difference was not significant. In mid, the SUV in patients later assigned to group A in post was lower than than the SUV in group B, whereas sIL-2R was not different. In post, the specificity and accuracy of SUV were better than those of sIL-2R (95 vs. 47%, and 96 vs. 58%, respectively). Both the SUV and sIL-2R were lower in group A than in group B. The SUV on PET was better than the serum sIL-2R as a marker to evaluate the disease status of NHL, and was considered to be a useful tumor marker for NHL.

Systemic IgG4-related lymphadenopathy: a clinical and pathologic comparison to multicentric Castleman's disease

IgG4-related disease sometimes involves regional and/or systemic lymph nodes, and often clinically and/or histologically mimics multicentric Castleman's disease or malignant lymphoma. In this study, we examined clinical and pathologic findings of nine patients with systemic IgG4-related lymphadenopathy. None of these cases were associated with human herpes virus-8 or human immunodeficiency virus infection, and there was no T-cell receptor or immunoglobulin gene rearrangement. Histologically, systemic IgG4-related lymphadenopathy was classified into two types by the infiltration pattern of IgG4-positive cells: interfollicular plasmacytosis type and intra-germinal center plasmacytosis type. The interfollicular plasmacytosis type showed either Castleman's disease-like features or atypical lymphoplasmacytic and immunoblastic proliferation-like features. By contrast, the intra-germinal center plasmacytosis type showed marked follicular hyperplasia, and infiltration of IgG4-positive cells mainly into the germinal centers, and some cases exhibited features of progressively transformed germinal centers. Interestingly, eight of our nine (89%) cases showed eosinophil infiltration in the affected lymph nodes, and examined patients showed high elevation of serum IgE. Laboratory examinations revealed elevation of serum IgG4 and soluble interleukin-2 receptors. However, the levels of interleukin-6, C-reactive protein, and lactate dehydrogenase were within normal limits or only slightly elevated in almost all patients. One patient showed a high interleukin-6 level whereas C-reactive protein was within the normal limit. Autoantibodies were examined in five patients and detected in four. Compared with the previously reported cases of multicentric Castleman's disease, our patients with systemic IgG4-related lymphadenopathy were significantly older and had significantly lower C-reactive protein and interleukin-6 levels. In conclusion, in our systemic IgG4-related lymphadenopathy showed pathologic features only partially overlapping those of multicentric Castleman's disease, and serum data (especially C-reactive protein and interleukin-6) are useful for differentiating the two. Our findings of eosinophil infiltration in the affected tissue and elevation of serum IgE may suggest an allergic mechanism in the pathogenesis of systemic IgG4-related lymphadenopathy.

Epstein-Barr virus-positive inflammatory pseudotumor of the spleen managed with laparoscopic splenectomy.

We report a case of Epstein-Barr virus (EBV)-positive splenic inflammatory pseudotumor treated by laparoscopic splenectomy. A 66-year-old female without symptoms was found to have a solitary, avascular, solid tumor of the spleen by contrast-enhanced computed tomography. The tumor was compatible with a primary tumor of the spleen. A benign splenic tumor was the most likely diagnosis, but malignant lymphoma could not be ruled out because the serum-soluble interleukin-2 receptor (sIL-2R) level was elevated. Laparoscopic splenectomy was performed to enable a definite diagnosis. Removal of the whole spleen without injury was possible. Possible contamination of the extirpation orifice by cancer cells was carefully prevented by enclosing the spleen in a plastic bag. Histopathological examination showed the tumor to be an EBV-positive inflammatory pseudotumor. To the best of our knowledge, this is only the second report of an EBV-positive splenic inflammatory pseudotumor with an increased serum sIL-2R level. Although EBV-positive inflammatory pseudotumors have been reported to recur, no sign of recurrence has been detected in the present case in the 17months following splenectomy.

Graves' disease with splenomegaly and pancytopenia, mimicking B-cell lymphoproliferative disease

A 48-year-old woman was referred to our hospital because of fever and general fatigue. Peripheral blood analysis showed a hemoglobin level of 82 g/l, a white blood cell count of 1.95 x 10(9)/l and a platelet count of 80 x 10(9)/l. There were 9% CD5-positive B-cells in peripheral blood and 35% CD10-positive B-cells in bone marrow. The patient had a high serum soluble interleukin-2 receptor (SIL-2R) level of 5,185 U/ml and splenomegaly. Lymphoproliferative disease was suspected, however monoclonal rearranged band of immunoglobulin heavy chain was not detected. She also showed hyperthyroidism, Graves' disease and then treatment with thiamazole started. However, the treatment was stopped because of agranulocytosis and she received subtotal thyroidectomy. After treatment for hyperthyroidism, serum SIL-2R level decreased to 504 U/ml and pancytopenia gradually improved. Fifteen months postoperatively, the percentage of CD5-positive B-cells in peripheral blood and CD10-positive B-cells in bone marrow decreased to 8% and 2%, respectively. This clinical course suggests that polyclonal B-cell proliferation was caused by hyperthyroidism.

Chemotherapy-resistant intravascular lymphoma accompanied by ADAMTS13 inhibitor successfully treated with rituximab

Intravascular large B-cell lymphoma (IVL) is a subtype of diffuse large B-cell lymphoma (DLBCL), in which lymphoma cells infiltrate blood vessels without mass formation, and its prognosis is generally poor due to diagnostic difficulties. The authors previously described a patient with IVL accompanied by features of thrombotic thrombocytopenic purpura (TTP), expression of ADAMTS13 inhibitor, and a severe deficiency in ADAMTS13 activity [1]. Although standard CHOP chemotherapy was initially effective, the disease gradually became resistant despite intensive high-dose chemotherapy with autologous peripheral blood stem cell support. However, the chimeric anti-CD20 monoclonal antibody, rituximab, induced complete remission (CR) for a prolonged period. We describe the clinical course of this patient and the unique effects of treatment with rituximab alone. A 54-year-old man was admitted to our hospital with the onset of a psychological disorder and convulsions. Laboratory data revealed obvious thrombocytopenia (3.6 9 10/ lL) accompanied by elevated levels of serum lactic dehydrogenase (LDH) and soluble interleukin-2 receptor. Multiple cerebral venous embolisms, bilateral adrenal gland swelling, and hepatosplenomegaly were present without nodal disease. Despite normal chest X-rays and thoracic CT scans, the patient developed rapidly progressive respiratory failure. A definitive diagnosis of IVL was made from transbronchial lung biopsy (TBLB) specimens. Bone marrow smears revealed no obvious lymphoma cell invasion and megakaryocyte hyperplasia without hemophagocytic syndrome (HPS), although the peripheral blood platelet count was markedly decreased. We concluded that the thrombocytopenia was caused by the same pathogenesis as TTP, since plasma ADAMTS13 activity had decreased to below 3%, and active ADAMTS13 inhibitor (IgG-type autoantibody) was confirmed. After standard CHOP chemotherapy cycles, the platelet counts immediately recovered to within normal limits and all symptoms improved. The ADAMTS13 activity improved to 49% and inhibitor levels, which had never been negative, decreased. Whole brain irradiation after chemotherapy resulted in relapse of systemic disease. Although we performed highdose conditioning chemotherapy followed by autologous peripheral stem cell transplantation, respiratory failure and high-grade fever appeared with severe thrombocytopenia and massive serum LDH elevation at day 50 after transplantation. Salvage combination chemotherapies had extremely limited effects against the disease, and we started to administer 375 mg/m of rituximab after its use for CD20-positive DLBCL was permitted according to the regulations established by the Japanese National Health Insurance system. The patient did not develop any major M. Kanno (&) Tumor Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara 634-8522, Japan e-mail: mkanno@naramed-u.ac.jp

Serum-soluble interleukin-2 receptor (sIL-2R) is an extremely strong prognostic factor for patients with peripheral T-cell lymphoma, unspecified (PTCL-U)

The aim of this study was to assess the prognostic factors of peripheral T-cell lymphoma, unspecified (PTCL-U). We retrospectively analyzed 30 cases fulfilling the criteria of PTCL-U defined by the World Health Organization classification. The patients were treated with 6-8 cycles of a CHOP or THP (pirarubicin)-COP regimen. A high serum sIL-2R level (> or =2,000 U/ml) at onset was associated with a low complete remission rate. Patients with high sIL-2R had significantly lower survival rates (5 year, 15.1%) than those with low sIL-2R (<2,000 U/ml) (100%) (P < 0.005). Factors associated with worse overall survival in a univariate analysis were high sIL-2R (P < 0.005), high age (>60 years) (P < 0.05), poor performance status (P < 0.01) and poor international prognostic index (P < 0.05). No correlation was observed between sIL-2R and other markers. Multivariate analysis showed that only sIL-2R was a prognostic factor for overall survival (P < 0.01). The results suggest that a high serum sIL-2R level predicts a poor prognosis in PTCL-U.

The effect of HAART to serum soluble interleukin-2 receptors in AIDS patients

To approach the effect of HAART to serum soluble interleukin-2 receptors in AIDS patients. 90 cases of AIDS patients were chosen for detection of their slL-2R levels by enzyme-linked immunosorbent assay (ELISA), peripheral blood CD4 T cell counts by flow cytometry and viral load by Branch DNA amplification. The slL-2R levels were (3154 +/- 905) m9icrog/ml before HAART and (2216 +/- 884) pg/ml after( P < 0.001), After HAART, the sIL-2R levels were(2846 +/- 963) microg/ml in ineffective HAART group and (1879 +/- 875) pg/ml in effective HAART group (P < 0.001). The serum sIL-2R levels of AIDS patients were lowered by effective HAART, and it could judge the efficacy of HAART in same extent.

Prognostic value of serum soluble interleukin-2 receptor level in patients with diffuse large B cell lymphoma, treated with CHOP- or RCHOP-based therapy

The emergence of rituximab has changed the clinical outcome of patients with B-cell lymphoma, which necessitates reassessment of previously determined prognostic factors. Thus, we evaluated the prognostic significance of serum soluble interleukin-2 receptor (sIL2R) levels in patients with diffuse large B cell lymphoma (DLBCL), treated with CHOP (n = 108) or RCHOP (n = 94). Serum sIL2R level ranged from 316 to 23 800 U/mL (median 1064 U/mL) and levels were generally higher in higher IPI risk group. Multivariate analyses revealed that sIL2R ≥1000 U/mL was associated with shorter progression free survival [hazard ratio (HR) = 2.52, p = 0.011] and overall survival (HR = 2.34, p = 0.037) independent of IPI risk group or rituximab use. Further subgroup analyses revealed that the impact of sIL2R was most apparent in patients with IPI low risk, both in CHOP alone and RCHOP group. Our study confirmed the prognostic value of sIL2R in patients with DLBCL with low International Prognostic Index (IPI) risk, also in the era of rituximab.

A clinicopathological study of 13 cases of intravascular lymphoma: experience in a single institution over a 9‐yr period

Intravascular lymphoma (IVL) is a rare type of extranodal lymphoma in which the lymphoma cells proliferate exclusively in lumina of small vessels. Here, we report a clinicopathological study of 13 cases IVL diagnosed at our institution between March 1999 and July 2007, and evaluated the clinical characteristics, usefulness of random skin biopsy and response to chemotherapy containing rituximab. Three of 13 patients were diagnosed at autopsy. The most common clinical features were unexplained fever, neurological deterioration, respiratory failure, and poor performance status. Thrombocytopenia, high serum lactate dehydrogenase and soluble interleukin2 receptor levels were the most common laboratory abnormalities. Adrenal tumor was detected in four cases and pituitary involvement was seen in all three autopsied cases and in two surviving patient by brain magnetic resonance imaging. Bone marrow invasion was seen in all 13 cases by bone marrow smear, and it was subtle in trephine biopsy. Immunohistochemical analyses revealed that CD5 was positive in one-third of the cases. Most of the cases were positive for MUM1/IRF, Bcl-2 and negative for CD10 and BCL-6 indicating the postgerminal center cell origin of this peculiar type of lymphoma. On random skin biopsy, the most recent seven patients were diagnosed promptly and chemotherapy containing rituximab was successfully administered. Patients with IVL exhibit the characteristic clinical and immunophenotypic features cited above and the use of random skin biopsy facilitates prompt diagnosis. Early commencement of chemotherapy containing rituximab appears promising for this peculiar lymphoma. As the recent seven patients were diagnosed by random skin biopsy over the past 13 months, the incidence of IVL is thought to be much higher than generally accepted.

Clinical significance of the serum IL-2R level and Ga-67 scan findings in making a differential diagnosis between sarcoidosis and non-Hodgkin's lymphoma

To compare the serum-soluble interleukin-2 receptor (sIL-2R) levels of non-Hodgkin's lymphoma patients and active sarcoidosis patients in relation to the (67)Ga scan findings. A total of 29 adenopathy patients suspected of having non-Hodgkin's lymphoma or sarcoidosis were enrolled in the study. All patients underwent a whole-body (67)Ga scan and single-photon emission computed tomography studies 48 h after intravenous injection of (67)Ga citrate. The sIL-2R levels were compared between the sarcoidosis patients and non-Hodgkin's lymphoma patients, the patients with and without the panda and/or lambda sign, the lymphoma patients with stage I/II disease and with stage III/IV disease, and the sarcoidosis patients and non-Hodgkin's lymphoma patients with stage III/IV disease. The range of the sIL-2R levels was 195-3750 U/ml in sarcoidosis and 240-62 300 U/ml in non-Hodgkin's lymphoma. The sIL-2R levels of the six non-Hodgkin's lymphoma patients with stage III/IV disease were significantly higher than those of the 15 sarcoidosis patients (P < 0.001). The sIL-2R levels of the sarcoidosis patients with the panda and/or lambda sign were significantly higher than those with neither sign (P < 0.005). The sIL-2R levels of the non-Hodgkin's lymphoma patients with stage III/IV disease were significantly higher than those of the patients with stage I/II disease (P < 0.005). Measurement of sIL-2R levels was sometimes useful in differentiating between sarcoidosis and stage III/IV non-Hodgkin's lymphoma, staging non-Hodgkin's lymphoma, and predicting the presence of the panda and/or lambda sign in sarcoidosis patients.