- Post-transplant Lymphoproliferative Disorders, EBV infection and Disease in Solid Organ Transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. [Journal Article]
- CTClin Transplant 2019 Jun 23; :e13652
- These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, management and prevention of post-transplant lymphoproliferative …
These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, management and prevention of post-transplant lymphoproliferative disorders (PTLD) and other Epstein-Barr virus (EBV) syndromes after solid organ transplantation. PTLD are a heterogeneous spectrum of predominantly B cell disorders, often extra-nodal, with complex distinct pathogeneses and variable clinical presentations determined by pathologic subtype. Recent epidemiologic studies report a decrease in early EBV positive (+) PTLD and an increase in late EBV negative (-) PTLD. Pre-transplant EBV seronegativity and primary EBV infection, often from donor-transmitted infection, is an important risk factor for EBV syndromes and early EBV+ PTLD. Low quality evidence supports pre-emptive prevention strategies for early EBV+ PTLD in EBV seronegative recipients that involve EBV DNA measurement in peripheral blood using assays requiring further result harmonization, combined with interventions to lower viral load. Reduction in immunosuppression [RIS] is the best validated intervention. WHO pathology classification of a tissue biopsy remains the gold standard for PTLD diagnosis; optimal staging procedures are uncertain. Treatment of CD20+ PTLD with the response-dependent sequential use of RIS, rituximab and cytotoxic chemotherapy is recommended. Evidence gaps requiring future research and alternate treatment strategies including immunotherapy are highlighted. This article is protected by copyright. All rights reserved.
- Unclassified Vasculitis with Episcleritis, Thrombophlebitis, Deep Vein Thrombosis, Pulmonary Vasculitis, and Intracranial Vasculitis: An Autopsy Case Report. [Journal Article]
- AJAm J Case Rep 2019 Jun 23; 20:886-895
- CONCLUSIONS: This is the first case report of unclassified vasculitis, which is characterized as medium-to-small-sized arteritis and phlebitis, causing episcleritis, thrombophlebitis, deep vein thrombosis, pulmonary vasculitis, and intracranial vasculitis. The clinical conditions share some similarities with granulomatosis with polyangiitis and Behçet's disease; however, they meet no classification criteria of any specific vasculitis. More cases need to be analyzed to confirm our findings.
- Noncellular Immune Therapies for Non-Hodgkin Lymphoma. [Review]
- HOHematol Oncol Clin North Am 2019; 33(4):707-725
- Non-Hodgkin lymphomas (NHL) are a diverse group of diseases, encompassing mature B-cell, T-cell, and natural killer cell malignancies and ranging in behavior from indolent to highly aggressive. For m…
Non-Hodgkin lymphomas (NHL) are a diverse group of diseases, encompassing mature B-cell, T-cell, and natural killer cell malignancies and ranging in behavior from indolent to highly aggressive. For many years, the traditional treatment of NHL centered on chemotherapy. However, the introduction of rituximab ushered in the era of immunotherapy for NHLs. This article reviews novel immune therapies that have been used for the treatment of NHL. The data supporting the use of rituximab have been reviewed extensively; this article focuses on novel immunotherapies other than rituximab that remain in use or are actively being studied in clinical trials.
- Considerations for the Treatment of Diffuse Large B Cell Lymphoma in the Elderly. [Review]
- CHCurr Hematol Malig Rep 2019 Jun 21
- Diffuse large B cell lymphoma (DLBCL) is a curable and common malignancy in elderly population. Elderly patients, especially those 80 and older, have poor outcomes compared with those < 60. This may …
Diffuse large B cell lymphoma (DLBCL) is a curable and common malignancy in elderly population. Elderly patients, especially those 80 and older, have poor outcomes compared with those < 60. This may be due to the disease biology, comorbidities, and/or functional limitations.
- B cell depletion treatment decreases CD4+IL4+ and CD4+CD40L+ T cells in patients with systemic sclerosis. [Journal Article]
- RIRheumatol Int 2019 Jun 21
- Recent data suggests that rituximab may favorably affect skin fibrosis and lung function in patients with systemic sclerosis. Based on experimental data suggesting a key role of B and T cells in scle…
Recent data suggests that rituximab may favorably affect skin fibrosis and lung function in patients with systemic sclerosis. Based on experimental data suggesting a key role of B and T cells in scleroderma we aimed to explore the effect(s) of rituximab treatment on T cell subpopulations. Fifteen patients with scleroderma who received rituximab treatment and six who received standard treatment alone were recruited. Peripheral CD4+IL4+, CD4+INFγ+, CD4+IL17+ and CD4+CD40L+ T cells were assessed using flow cytometry. Using ELISA, serum levels of IL4 were assessed. Skin CD4+IL4+ T cells were assessed with confocal microscopy from skin biopsies. Following rituximab treatment skin CD4+IL4+ T cells obviously decreased as seen with confocal microscopy. Moreover, peripheral CD4+IL4+ T cells decreased significantly compared to those from patients who received standard treatment alone: median (IQR): 14.9 (22.63-12.88) vs 7.87 (12.81-4.9)%, p = 0.005 and 9.43 (19.53-7.50)% vs 14.86 (21.96-6.75)%, p = NS at baseline and 6 months later respectively, whereas there was no difference in serum IL4 levels. Peripheral CD4+CD40L+ T cells also decreased significantly following rituximab treatment compared to those from patients who received standard treatment alone: median (IQR): 17.78 (25.64-14.44)% vs 8.15 (22.85-3.08)%, p = 0.04 and 22.13 (58.77-8.20)% vs 72.11 (73.05-20.45)%, p = NS at baseline and 6 months later respectively. Furthermore, peripheral CD4+INFγ+ and CD4+IL17+ T cells revealed no differences following rituximab treatment. Our study demonstrates a link between rituximab treatment and CD4+IL4+ T cell decrease both in the skin and peripheral blood of patients with SSc.
- IgG4-related disease in a multi-ethnic community: clinical characteristics and association with malignancy. [Journal Article]
- QJMQJM 2019 Jun 21
- CONCLUSIONS: We report a large UK-based cohort of IgG4-RD that shows no clear ethnic predisposition and a wide range of affected organs. We discuss the use of serum IgG4 concentrations as a disease marker in IgG4-RD, the association with malignant disease and outcomes according to differing treatment regimens.
- [Unexpected positive outcome following rituximab treatment in a patient with pemphigus vegetans resistant to conventional therapies: a case report]. [Case Reports]
- PAPan Afr Med J 2019; 32:101
- Pemphigus vegetans is a rare form of pemphigus. It accounts for only 2%. There is a broad range of effective options available to treat this disease: topical and/or oral corticosteroids as first-line…
Pemphigus vegetans is a rare form of pemphigus. It accounts for only 2%. There is a broad range of effective options available to treat this disease: topical and/or oral corticosteroids as first-line treatment, immunosuppressants such as Azathioprine, Cyclosporine, Methotrexate, Cyclophosphamide and Mycophenolate mofetil to reduce the side effects of steroids. Some patients are resistant to all these treatments. Rituximab has revolutionized the treatment of pemphigus, pemphigus vegetans in particular. We here report the case of a 42-year old female patient, admitted with pemphigus vegetans confirmed by histology. She initially received corticosteroid therapy associated with immunosuppressive therapy without improvement. Then she was treated with Rituximab and had an unexpected positive outcome.
- Stand-alone intrathecal central nervous system (CNS) prophylaxis provide unclear benefit in reducing CNS relapse risk in elderly DLBCL patients treated with R-CHOP and is associated increased infection-related toxicity. [Journal Article]
- BJBr J Haematol 2019 Jun 20
- Central nervous system (CNS) relapse following R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) occurs in 2-5% of patents with diffuse large B-cell lymphoma (DLBCL). Many …
Central nervous system (CNS) relapse following R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) occurs in 2-5% of patents with diffuse large B-cell lymphoma (DLBCL). Many patients aged ≥70 years are unsuitable for high-dose methotrexate (HDMTX) prophylaxis and therefore often receive stand-alone intrathecal prophylaxis. The CNS international prognostic index (CNS-IPI) is a clinical CNS relapse risk score that has not specifically been validated in elderly patients. The value of CNS prophylaxis in patients aged ≥70 years remains uncertain. Data on 690 consecutively R-CHOP-treated DLBCL patients aged ≥70 years were collected across 8 UK centres (2009-2018). CNS prophylaxis was administered per physician preference. Median age was 77·2 years and median follow-up was 2·8 years. CNS-IPI was 1-3 in 60·1%, 4 in 23·8%, 5 in 13·0% and 6 in 3·3%. Renal and/or adrenal (R/A) involvement occurred in 8·8%. Two-year overall CNS relapse incidence was 2·6% and according to CNS-IPI, 1-3:0·8%, 4:3·6%, 5:3·8% and 6:21·8%. Two-year CNS relapse incidence for R/A was 10·0%. When excluding HDMTX (n = 31) patients, there remained no change in unadjusted/adjusted CNS relapse for intrathecal prophylaxis effect according to CNS-IPI. CNS-IPI is valid in elderly R-CHOP-treated DLBCL patients, with the highest risk in those with CNS-IPI 6 and R/A involvement. We observed no clear benefit for stand-alone intrathecal prophylaxis but observed an independent increased risk of infection-related admission during R-CHOP when intrathecal prophylaxis was administered.
- Aortitis caused by antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis: a case-based review. [Review]
- RIRheumatol Int 2019 Jun 19
- Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a systemic necrotizing small vessel vasculitis primarily affecting elderly patients. Neutrophil apoptosis and release of pr…
Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a systemic necrotizing small vessel vasculitis primarily affecting elderly patients. Neutrophil apoptosis and release of pro-inflammatory mediators promote small vessel inflammation and hence multi-organ disease. It rarely affects larger vessels with extremely rare aortic involvement. Diagnosis is made based on clinical presentation, tissue biopsy of affected organ, as well as immunofluorescence and ELISA assays for ANCA. Management includes immunosuppression (e.g., glucocorticoids, cyclophosphamide and rituximab) and supportive therapy. We present a rare case of a younger patient with AAV involving the aorta. The patient's diagnosis was supported by clinical presentation, systemic organ involvement, strongly positive c-ANCA, and skin as well as aortic tissue biopsy results. After failing multiple immunosuppressants, he responded well to rituximab with improved symptoms, inflammatory markers, and imaging findings. Based on our literature review, we were only able to find ten cases of ANCA-related vasculitis involving the aorta. This is the first reported case of successful treatment of AAV-related aortitis using rituximab. Our case report and literature review provide insight into treatment of severe cases of AAV with aortic involvement.
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- Neuroinvasive West Nile Virus Disease in an Elderly Patient with Diffuse Large B-Cell Lymphoma Treated with R-CHOP Therapy: A Case Report [Journal Article]
- BMBalkan Med J 2019 Jun 20
- CONCLUSIONS: sCT reduced pain by increasing the concentrations of monoamines and the metabolites derived from them in the PAG area.