Temsirolimus as base immunosuppressant for a recipient with metastatic renal cancer: adequate immunosuppression and oncological control--case report.

Treating organ recipients who have metastatic renal cell carcinoma (mRCC) is challenging because of the dilemma between transplant-required immunosuppression and cancer control via boosting immunity with immunotherapy. We report such a patient whose case was successfully maintained only with temsirolimus and low-dose steroids, while achieving good allograft function and oncological outcomes. After removal of his primary renal cancer, a kidney recipient was found to have multiple metastases.

Lymphocyte subsets associated with T cell receptor beta-chain gene rearrangement in patients with rheumatoid arthritis and neutropenia.

Objective: To determine the incidence of a clonal lymphoid disease in patients with chronic rheumatoid arthritis (RA) and neutropenia.

Methods: Lymphocytes from 23 RA patients with either current neutropenia or a history of this complication were studied.

Results: Eight patients had a clonal rearrangement of the T cell receptor beta-chain gene.

Eosinophilia resulting from administration of recombinant granulocyte-macrophage colony-stimulating factor (rhGM-CSF) in a patient with T-gamma lymphoproliferative disease.

A therapeutic trial of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) was attempted in a patient with neutropenia and frequent infections secondary to T-gamma lymphoproliferative disease (T-gamma LPD). During the 14 days of subcutaneous rhGM-CSF (500 micrograms/m2/day), the absolute eosinophil count increased from 0 to 9,455/microliters. By contrast, the absolute neutrophil count decreased.

Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide-purged marrow for acute lymphoblastic leukemia.

Ten patients age 13-52 years with acute lymphoblastic leukemia (ALL) in first complete remission (CR) (1), second CR (6), or relapse (3) were treated with cyclophosphamide 50 mg/kg daily x 4 and total body irradiation 3 Gy daily x 4 followed by infusion of autologous marrow purged with 4-hydroperoxycyclophosphamide (4-HC) at 100-120 micrograms/ml. The patients transplanted in relapse also received 2 mg vincristine and corticosteroids. All marrows were harvested while patients were in CR.

Acute tumor lysis syndrome in a patient with chronic myelogenous leukemia in blast crisis: role of high-dose Ara-C.

A patient with chronic myelogenous leukemia (CML) in lymphoid blast crisis developed acute tumor lysis syndrome following administration of high-dose busulfan, cyclophosphamide and cytarabine (Ara-C) in preparation for allogeneic bone marrow transplantation. Preconditioning cytoreduction, close monitoring and rapid institution of therapeutic measures were required to avoid renal failure and a fatal outcome. Acute tumor lysis syndrome has not been reported in marrow transplant patients receiving conventional preparative regimens as treatment for CML in blast crisis, and it is likely that its occurrence in this patient was precipitated by high-dose Ara-C.