Fludarabine-Cyclophosphamide-Rituximab Treatment in Chronic Lymphocytic Leukemia, Focusing on Long Term Cytopenias Before and After the Era of Targeted Therapies.

The widespread application of fludarabine, cyclophosphamide, and rituximab combination is limited due to its toxicity, particularly the prolonged cytopenias. The study aimed to compare the prolonged cytopenias depending on fitness and report real-life data on dose reduction measures and efficacy. According to our database, 120 and 14 patients were treated with FCR between 2011 and 2015 and between 2016 and 2019.

A Case of Therapy-related Acute Myeloid Leukemia Following Treatment with 5-Fluorouracil.

Therapy-related acute myeloid leukemia (t-AML) is most frequently observed after the use of alkylating agents and topoisomerase II inhibitors and is associated with the frequent occurrence of high-risk karyotypes, poor prognosis, and distinct clinical behavior. Therefore, identifying therapy-related causation among patients with newly diagnosed acute leukemia is of great interest. We report the case of a patient who developed therapy-related acute myeloid leukemia after exposure to antimetabolite chemotherapy and emphasize the importance of identifying genetic alterations when the possibility of a therapy-related origin arises.

[Drug treatment of acute myelogenous leukaemia. Current options and future perspectives].

Acute myelogenous leukemia is a heterogeneous disease. Recent molecular mutational analysis techniques have shed more light on different, genetically well characterised types of the disease. Treatment approach is uniform except for acute promyelocytic leukemia.

A phase II trial of two durations of Bevacizumab added to neoadjuvant gemcitabine for borderline and locally advanced pancreatic cancer.

Background: We report the results of a phase II trial of adding the anti-ascular endothelial growth factor (VEGF) bevacizumab to gemcitabine neoadjuvant chemotherapy for patients with borderline and unresectable non-metastatic pancreatic cancer.

Patients And Methods: Patients were assigned to one of the two treatment arms. Both groups received 1,000 mg/m(2) gemcitabine on days 1, 8, and 15 of a 4-week cycle for a total of four cycles.

[Treatment of acute myeloid leukemia -- a single center experience (2007-2013)].

Introduction: Mortality of acute myeloid leukemia is still 60-70% in young (<60 years) adults and 90% in elderly (≥60 years) patients.

Aim: The aim of the authors was to analyse the outcome of treatment in their patients with acute myeloid leukemia.

Method: From 2007 to 2013, 173 patients with acute myeloid leukemia were treated.

[Waldenström macroglobulinemia].

Waldenström macroglobulinemia is a rare lymphoproliferative disease of B-cell origin.These tumorous B-cells produce monoclonal IgM type protein. Diagnosis is based on the detection of lymphoplasmacytic invasion of the bone marrow and serum electrophoresis.

Identification of NPMc+ acute myeloid leukemia in bone marrow smears.

The most frequent genetic change currently known in acute myeloid leukemia (AML) is the mutation of the nucleophosmin (NPM) gene. Aberrant cytoplasmic accumulation of NPM protein (NPMc+) is the result of this mutation, and it can be demonstrated by immunohistochemistry for the identification of a favorable subgroup within "AML with normal karyotype" according to the World Health Organization classification. NPM staining pattern was defined in 71 AML and 15 control cases by the use of bone marrow smears in order to overcome limitations observed due to immunohistochemistry.

[Practical considerations and questions in the treatment of chronic lymphocytic leukemia].

Understanding the pathogenesis and refine the treatment of chronic lymphocytic leukemia have been tremendously improved in the past decade. Treatment outcome and estimated prognosis have become more accurate due to the advanced molecular biological techniques and the classical prognostic markers. Incorporation of fludarabine and rituximab into the standard protocols fundamentally improved treatment outcome in chronic lymphocytic leukemia.

[Successful treatment of B-cell prolymphocytic leukemia (B-PLL) with FCR-Lite (fludarabine, cyclophosphamide, rituximab) protocol].

B-cell prolymphocytic leukemia (B-PLL) is a rare disorder characterized by marked lymphocytosis in the peripheral blood, matured lymphocytic infiltration in the bone marrow and splenomegaly. It has a distinct immunophenotype (CD19, CD20, CD22, FMC7, intensive surface immunoglobulin positivity) which helps to differentiate from other lymphoproliferative malignancies. It has a poor prognosis and its treatment is unsettled.

Behçet's disease in a patient with myelodysplastic syndrome.

A 75-year-old man presented with painful oral and groin ulcers. The lack of any infections and the location of the ulcers suggested Behçet's disease. Subsequently, pancytopenia developed and bone marrow examination revealed myelodysplastic syndrome.

[Immunohistochemical demonstration of mutant nucleophosmin in acute myeloid leukemia: biological and clinical features related to NPMc expression].

The mutation of the nucleophosmin gene (NPM1) is the most frequently occurring genetic aberration in acute myeloid leukemia (AML). Due to the high frequency and the obvious impact on disease outcome, the current WHO classification also defines the new (tentative) entity of "AML with NPM mutation". Mutations of NPM1 exon 12 affect both nuclear complexion and nuclear export signaling (NES) domain resulting in redistribution and accumulation of the NPM protein in the cytoplasm of leukaemic cells.

[Transformation of chronic lymphocytic leukemia to myelodysplastic syndrome: case presentation and review of the literature].

Chronic lymphocytic leukaemia (CLL) may transform to either malignant lymphoid disorder or increase the occurrence of solid neoplasms. However myeloid malignancies seldom develop. We report a case of a patient who has remained untreated for CLL and developed myelodysplastic syndrome (refracter anemia with ringed sideroblasts) six years after the diagnosis of CLL.

[Effective PAD (bortezomib, doxorubicin, dexamethasone) treatment of a patient with plasma cell leukaemia that has developed after autologous stem cell transplantation].

The most aggressive and rare manifestation of multiple myeloma is plasma cell leukaemia (PCL). While secondary form of PCL represents those heavily pretreated cases when leukaemic transformation develops terminally after intensive chemotherapy in patients with multiple myeloma, primary cases are characterized by leukaemic symptoms present at diagnosis. The secondary form has a rapid progression.

[Mantle cell lymphoma: case report].

Mantle cell lymphoma (MCL) is a moderately aggressive disease, which is not curable with chemo-immunotherapy. The median survival duration is short, approximately three years. Most of the patients have advanced stage disease at the time of diagnosis.

[Successful alemtuzumab treatment of a patient with atypical hairy cell leukaemia variant].

Although hairy cell leukaemia and hairy cell leukaemia variant are characterized by much alike clinical features, these two diseases are disparate in nature and treatment. While hairy cell leukaemia responds quite well to 2-chlorodeoxyadenosine (cladribine) treatment, hairy cell leukaemia variant has much worse response rate and has no effective treatment option yet. With other treatment modalities, including monoclonal antibody treatment, we have less experience.

[Chronic neutrophilic leukemia: a long-term analysis of seven cases and review of the literature].

Chronic neutrophilic leukemia is an uncommon hematological entity. According to the WHO classification it is recognized as part of the family of myeloproliferative disorders. In the last 20 years seven patients have been diagnosed with chronic neutrophilic leukemia at our department.

[Successful combined treatment with rituximab and high dose immunoglobulin in a patient with chronic lymphocytic leukemia with fludarabine-induced severe immune thrombocytopenia].

Chronic lymphocytic leukemia is rarely associated with immune thrombocytopenia. Although fludarabine treatment is widely used in the treatment of chronic lymphocytic leukemia, it can also increase the incidence and severity of immune thrombocytopenia. The authors present a case of chronic lymphocytic leucaemia after relapse of the disease.

Chromosomal aberrations and CD38 expression in two siblings with B-cell chronic lymphocytic leukemia: a report of two siblings.

In this study our purpose was to define chromosomal aberrations and CD38 expression in male siblings 69 and 66-years-old with B-cell chronic lymphocytic leukemia (B-CLL). Cells from peripheral blood were analysed by comparative genomic hybridization (CGH) and fluorescence in situ hybridization (FISH). The alteration detectable by CGH was the over-representation of the Y chromosome in both samples.

[New perspectives in the evolution of prognosis and treatment of chronic lymphocytic leukaemia].

Chronic lymphocytic leukaemia is a disease with a variable clinical course and prognosis. New prognostic factors like immunoglobulin gene mutational status, cytogenetic abnormalities, CD38 and ZAP70 expression of malignant cells have been described recently. Conventional and biological prognostic factors allow to identify patients with unfavorable prognosis at early stage.

Successful control of massive coumarol-induced acute upper gastrointestinal bleeding and correction of prothrombin time by recombinant active factor VII (Eptacog-alpha, NovoSeven) in a patient with a prosthetic aortic valve and two malignancies (chronic lymphoid leukaemia and lung cancer).

Severe, life-threatening acute upper gastrointestinal bleeding may occasionally occur in patients receiving coumarol prophylaxis for prosthetic heart valves. These patients are exposed to two potential, serious risks: bleeding due to the severe blood loss induced by excessive anticoagulant effect or as a consequence of the cessation of anticoagulation subsequent thrombotic occlusion of the valve and loss of patency. Herein a short case report is presented.

Frequent methylation of p16INK4A and p14ARF genes implicated in the evolution of chronic myeloid leukaemia from its chronic to accelerated phase.

The frequency and mechanism of p16(INK4A) and p14(ARF) gene alterations were studied in cell samples from 30 patients with Philadelphia (Ph) chromosome-positive chronic myeloid leukaemia (CML), both at diagnosis and at the onset of the accelerated phase (AP) of the disease. No alterations in the p16(INK4A) or p14(ARF) genes were found in any of the chronic phase (CP) samples. DNA sequencing analyses detected p16(INK4A) or p14(ARF) mutations in 17 AP samples.

[Prognositc value of CD38 cell surface marker in chronic lymphocytic leukemia].

CD38 is expressed on the surface of leukemic cells in a significant percentage of patients with B-cell chronic lymphocytic leukaemia (CLL). From the literature it is known that CD38 expression has prognostic value in CLL, suggesting an association between CD38 expression and the mutational status of IgV genes. Peripheral blood samples from 82 patients with CLL were analyzed by flow cytometry for CD38 expression on CD19+ leukemic cells.

[Detection of trisomy 8 and monosomy 7 in chronic granulocytic leukemia and myelodysplastic syndrome by cytogenetic analysis and fluorescence in situ hybridization].

Introduction And Aims: In this retrospective study the authors studied how interphase fluorescence in situ hybridization can be applied to the diagnosis of numerical chromosomal anomalies failed to be identified by cytogenetic analysis.

Methods: Thirty-four patients, 27 with chronic granulocytic leukemia and seven with myelodysplastic syndrome, were studied in order to identify disease-specific aberrations, trisomy 8 and monosomy 7 using both traditional cytogenetic analysis and fluorescence in situ hybridization on interphase bone marrow cells. Using alphoid-satellite centromeric specific probes, trisomy 8 indicating the progression of the disease and poor prognosis in chronic granulocytic leukemia as well as monosomy 7 in myelodysplastic syndrome were identified.

"Pros and cons" on how to measure multidrug resistance in leukemias.

Drug resistance is one of the most significant challenges in the treatment of various types of malignancies, however most of the experimental and clinical data in multidrug resistance (MDR) has been obtained in leukemias. MDR is the term that describes innate or acquired resistance of tumor cells to a wide range of anticancer drugs. As its presence determines treatment outcome in several forms of leukemias, it is imperative that clinical laboratories provide the most useful data on its expression.