Purpose Plasmacytoid dendritic cells (pDCs) are commonly associated with myeloid malignancies. The association between lymphoblastic leukemia and pDCs has been little explored. Case presentation Here, we report a novel case of early T-cell precursor lymphoblastic leukemia (ETP-ALL) accompanied by prominent proliferation of blastic pDCs mimicking BPDCN. The diagnosis was established based on a comprehensive analysis of morphology, immunophenotype and clinical implications. We also present a literature review and discussion on the differential expression of reactive and neoplastic pDCs, the functional role of pDCs in lymphoblastic leukemia, and the etiological association of normal pDCs and BPDCN. Conclusions The current case demonstrates for the first time that prominent pDC proliferation can be associated with lymphoid neoplasms and can exhibit blastic morphology and immunophenotype. The underlying mechanism of the coexistence of these two blastic populations remains unknown. Further genetic profiling may be required to denote the progressive development of tumor stem cells to the lymphoid, myeloid or dendritic cell lineage. Moreover, the prognostic value of pDCs in hematological neoplasms needs further investigation.

Background Leishmaniasis is a zoonotic disease caused by Leishmania spp. and spreads through sandfly bites. Owing to the wide range of nonspecific clinical symptoms, patients with leishmaniasis are frequently misdiagnosed or underdiagnosed. Methods The study participants were 7 metagenomic next-generation sequencing (mNGS)-diagnosed patients with leishmaniasis who could not be diagnosed using conventional methods. Clinical data were retrospectively collected and analyzed. When searching PubMed for mNGS and leishmaniasis, 8 peer-reviewed case reports in English were retrieved. Results A total of 7 patients with recurrent fever, pancytopenia, and significant splenomegaly were included in this study. Only 3 individuals tested positive for rK39. Two individuals, 1 of whom was HIV-positive, had Leishmania amastigotes identified in their bone marrow. However, all patients' blood mNGS findings pointed to Leishmania infection, and they were finally diagnosed with leishmaniasis. Sodium stibogluconate therapy with a short course of amphotericin B was administered to all patients. The prognosis for the remaining patients was good, except for 1 who died of multiple organ failure. Conclusions mNGS could be used to identify leishmaniasis, particularly in patients who are difficult to diagnose using conventional approaches.

The British Journal of Haematology publishes original research papers in clinical, laboratory and experimental haematology. The Journal also features annotations, reviews, short reports, images in haematology and Letters to the Editor.

Background Anemia is a common complication of multiple myeloma (MM). Recombinant human erythropoietin (rhEPO) and blood transfusions are two general treatments for anemia. Methods In a retrospective study, we compared the efficacy and treatment response of rhEPO to those of blood transfusions on anemia and sought to determine its prognostic value in for these patients. The 94 patients who received rhEPO were divided into high-dose (≥160,000 U/month) and low-dose (< 160,000 U/month) groups; 97 other patients received blood transfusions. Results Patients receiving rhEPO had significantly higher hemoglobin concentrations after 3 (112.65 v. 86.10 dg/L) and 6 (128.96 v. 91.41 dg/L) months of treatment (P < 0.001 for both comparisons). Furthermore, the high-dose rhEPO group had higher mean hemoglobin concentrations than those of the low-dose group after 3 (41 v. 34 g/L) and 6 (57 v. 49 g/L) months of treatment, respectively. The risks of death and relapse were significantly lower in patients receiving either dose of rhEPO that in the transfusion group. Receiving rhEPO was associated with better overall and progression-free survival (68 v. 52 months, 39 v. 27 months). Conclusions We believe rhEPO should be preferred to blood transfusions for treating the anemia associated with MM.

RATIONALE:T-cell prolymphocytic leukaemia (T-PLL) is a rare aggressive lymphoid disease featured by a significant increased lymphocyte count and obvious hepatosplenomegaly with poor prognosis. The concomitant presentation of T-PLL and visceral leishmaniasis (VL) has not previously been reported.PATIENT CONCERNS:The patient initially suffered from anorexia, skin pigmentation, fever and hepatosplenomegaly. Bone marrow smear described leishmania and antibody test was positive. VL was diagnosed and he was given antimony gluconate therapy. His symptoms recurred.DIAGNOSIS:A combination of serological rk39 test, morphologic evaluation and immunophenotyping by flow cytometry finally supported the diagnosis of concomitant VL and T-PLL.OUTCOMES:Amphotericin B was used for the treatment of VL first and a referral for treating T-PLL after recovery from VL was suggested. Unfortunately, the patient requested to be discharged. Telephone follow-up indicated that he died a few days after leaving the hospital.LESSONS:Due to the rarity of the disease combination, the pathogenesis association of T-PLL and VL is unclear. However, a duly diagnosis is crucial for treatment. In immunosuppressed patients due to malignancies and treatment, VL should be considered as an opportunistic infection. In VL infections, the clinical manifestations mimicking hematological malignancies may cover up the underlying disease. Under such conditions, a complete work-up based on laboratory test is necessary to achieve a correct diagnosis.

OBJECTIVE:To investigate the expression level of circulating exsomal miR-451a and its significances in therapy monitoring in diffuse large B cell patients.METHODS:We isolated exsomal RNAs fractions from serum of 56 DLBCL patients before treatment,during treatment and after treatment. The serum of 56 healthy controls was collected at the same time. Quantitative real time polymerase chain reaction (qRT-PCR) were performed to detected the expression level of circulating exsomal miR-451a. Receive operater characteristic (ROC) curve was performed to comfirm the diagnostic efficiency of miR-451a. Chemotherapy effect corresponding with miR-451a was analyzed.RESULTS:Circulating exsomal miR-451a was down-expression in DLBCL compared with healthy controls (P<0.000 1), and the area under the ROC curve (AUC) was 0.737 (95%CI0.645-0.816) . In 43 patients who had complete follow-up information,the patients who obtained remission,including complete remission (CR) and partial remission (PR) ,had the levels of circulating exsomal miR-451a gradually increased. While in patients who did not get remission, including stable disease (SD) and progression disease (PD) ,had no significant changes of circulating exsomal miR-451a.CONCLUSION:Circulating exsomal miR-451a may be an potential indicator for therapy response monitoring in DLBCL.

This study was purposed to investigate the ratio of Th17 cells and CD4(+)CD25(+)Foxp3(+) regulatory T (Treg) cells in peripheral blood of patients with chronic lymphocytic leukemia (CLL) and to explore their roles in the pathogenesis and clinical diagnosis. Based on the number of peripheral lymphocytes and treatment condition, the CLL patients were divided into 2 groups: untreated group (n = 30) and remission group (n = 15), the healthy control group (n = 20) was set up as well. The frequencies of Th17 and Treg cells of all cases were detected by flow cytometry (FCM). The results showed that frequencies of CD3(+)CD4(+)T cells and Th17 cells were significantly higher in untreated group than that in healthy control group (P < 0.05), the frequencies of CD3(+)CD8(+)T cells and Treg cells were significantly lower in untreated group than that in healthy control group (P < 0.05), the ratio of Th17/Treg was significantly higher in untreated group than that in healthy control group (P < 0.05). The frequencies of Th17 were not statistically different between remission and healthy control groups, the frequencies of Treg cells were significantly lower in remission group than that in healthy control group (P < 0.05), the ratio of Th17/Treg was significantly higher in remission group than that in healthy control group (P < 0.05), frequencies of Th17 cells were markedly lower in remission group than that in untreated group (P < 0.05). It is concluded that Th17/Treg imbalance exists in patients with CLL, which may play a key role in pathogenesis and development of CLL.