Infection with Toxoplasma gondii (T. gondii) in immunocompetent adults is usually asymptomatic and needs no specific therapy. We report the case of a 16-year-old previous healthy adolescent who presented with bleeding due to immune-mediated thrombocytopenic purpura during an acute acquired T. gondii infection. Treatment with prednisolone and immunoglobulin resulted in a relative increase in the platelet count. Taking into account the fact that the patient became immunocompromised under corticosteroids, specific antitoxoplasmal treatment has been added. The difficulties in treatment decision in this rare case are discussed.

American Journal of HematologyVolume 74, Issue 2 p. 147-147 Letters and Correspondence: Letters and CorrespondenceFree Access Autoimmune hemolytic anemia in a patient with acute myelocytic leukemia M. Deutsch, M. Deutsch Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this authorS.P. Dourakis, S.P. Dourakis Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this authorK. Papanikolopoulos, K. Papanikolopoulos Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this authorM. Belegrati, M. Belegrati Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this authorT. Kalmantis, T. Kalmantis Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this author M. Deutsch, M. Deutsch Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this authorS.P. Dourakis, S.P. Dourakis Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this authorK. Papanikolopoulos, K. Papanikolopoulos Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this authorM. Belegrati, M. Belegrati Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this authorT. Kalmantis, T. Kalmantis Academic Department of Internal Medicine, Hippocration General Hospital, Athens, GreeceSearch for more papers by this author First published: 19 September 2003 https://doi.org/10.1002/ajh.10401Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL REFERENCES 1Sokol RJ, Hewitt S, Booker DJ. Erythrocyte autoantibodies, autoimmune hemolysis, and myelodysplastic syndromes. J Clin Pathol 1989; 42: 1088– 1091. 2Solal-Celigny P, Vazeux R, Vroclans M, Amar M, Herrera A. Positive Coombs test in acute leukemia. Br J Haematol 1984; 57: 563– 569. 3Tamura H, Ogata K, Yokose N, et al. Autoimmune hemolytic anemia in patients with de novo acute myelocytic leukemia Ann Hematol 1996; 72: 45– 47. 4Enright H, Miller W. Autoimmune phenomena in patients with myelodysplastic syndromes. Leuk Lymphoma 1997; 24: 483– 489. 5Lin JT, Wang WS, Yen CC, Chiou TJ, Hsiao LT, et al. Myelodysplastic syndrome complicated by autoimmune hemolytic anemia: remission of refractory anemia following mycophenolate mofetil. Ann Hematol 2002; 82: 723– 726. Citing Literature Volume74, Issue2October 2003Pages 147-147 ReferencesRelatedInformation

The standard CHOP regimen may cure 30-40% of patients with advanced aggressive non-Hodgkin's lymphoma (ANHL). Mitoxantrone is an anthracenedione, which is active in NHL and its toxicity profile may be more favorable than doxorubicin with respect to alopecia, mucositis and cardiotoxicity. This study was designed to compare the effectiveness of an escalated dose of mitoxantrone with that of standard doxorubicin, used in the CHOP regimen in patients with ANHL. One hundred and forty three eligible patients with ANHL were randomized to receive 6 cycles of either CHOP (n = 71) or intensified CNOP (iCNOP) (n = 72); with mitoxantrone 20 mg/m(2), i.v., d.1 instead of doxorubicin. Complete responders (CR) were again randomized either to receive interferon-alpha (IFN-alpha) maintenance (3 MU t.i.w., s.c.) or not. The CR rate was 70 vs. 76% for iCNOP and CHOP (p = 0.45); and the overall response rate was 81 vs. 83%, respectively (p = 0.71). The 5-year failure free survival (FFS) was 48 and 50% in the iCNOP and CHOP arm, respectively (p = 0.45), and the 5-year overall survival (OS) was 61 vs. 64% (p = 0.56). IFN-alpha did not prolong relapse free survival (p = 0.91), iCNOP produced less alopecia (p = 0.001) but more febrile episodes (p = 0.04) than CHOP, while requiring more frequent G-CSF support (p = 0.01). Two cases of acute myelogenous leukemia (AML) were recorded, both in the iCNOP arm (p = 0.14). In conclusion, iCNOP was equally effective to CHOP in patients with ANHL, producing more leukopenia and febrile episodes, but less alopecia. The development of two cases of secondary AML in the iCNOP arm is of concern.

We present the case of a 66-year-old man with a history of coronary artery disease and chronic lymphocytic leukemia (CLL) who was admitted to the hospital complaining of chest discomfort and shortness of breath on exertion. The echocardiogram revealed a severe pericardial effusion and a large echogenic mass that infiltrated the lateral wall of the right atrium and ventricle and created a moderate tricuspid valve stenosis. B cell intracardiac non-Hodgkin lymphoma/CLL was diagnosed, and the patient was treated with six courses of CHOP chemotherapy. After the third course, the mass disappeared and the patient's general condition was substantially improved.

The multidrug resistance (MDR) transporter-proteins P-glycoprotein (Pgp), multidrug resistance protein (MRP) and lung resistance protein (LRP) have been associated with treatment failure. The aim of this study was to investigate prospectively the clinical significance of expression and function of the MDR proteins, considering other prognostic factors, such as age, immunophenotype, and cytogenetics. Mononuclear cells of peripheral blood or bone marrow from 61 patients with de novo acute myelogenous leukemia (AML) were analyzed. The monoclonal antibodies JSB1, MRPm6 and LRP56 were used for expression studies. Accumulation and retention studies were performed using the substrates Daunorubicin, Calcein-AM, Rhodamine-123 and DiOC(2) in the presence or absence of the modifiers Verapamil, Genistein, Probenecid, BIBW22S and PSC833. Induction treatment consisted of a 3+7 combination of Ida/Ara-C for patients < or = 60 years of age and a 3+5 Ida/VP-16 combination per OS for patients >60. MDR function was expressed as the ratio of mean fluorescence intensity substrate in the presence of modifier over the substrate alone (resistance index, RI). Patients with advanced age, low CD15 expression and high RI for accumulation of DiOC(2) in the presence of BIBW22S had significantly lower complete remission (CR) rates. No factor was prognostic for event-free survival analysis, which was limited to remitters only. Overall survival was shorter in patients with advanced age, poor prognosis cytogenetics, high CD7 expression, and high RI for Daunorubicin efflux modulated by Verapamil. These results suggest that MDR transporter-proteins have a limited role in the treatment failure of patients treated with Idarubicin-based regimens.

Simultaneous PML/RARα and AML 1/ETO gene rearrangements in a patient with acute myeloid leukemia

The first case of oral hairy leukoplakia (OHL) in an HIV-negative 56-year-old patient with acute lymphocytic leukemia (ALL) is reported. A white plaque was observed while the patient was in complete remission which followed the chemotherapeutic scheme. The clinical and histopathologic findings were typical for OHL and the polymerase chain reaction method was positive for Epstein-Barr virus DNA, Underdiagnosis and underreporting of OHL in patients with a malignant haematological disease and the apparent different environmental factors to which these non-AIDS patients have been exposed, probably constitute some of the reasons for the very few OHL cases reported in these patients.

Purpose Hemopoiesis in childhood malignancies is mainly influenced by the amount of neoplastic mass, the cytotoxic effect of treatment and the administration of growth factors. In order to evaluate in vitro the hemopoietic activity in childhood leukemia and solid tumors we studied the development of myeloid and erythroid colonies in semisolid cultures of bone marrow mononuclear cells. We also estimated the effect of metastatic infiltration of bone marrow neuroblastoma cells on hemopoietic colonies' growth.Material-Methods Bone marrow mononuclear cells from fifteen children with ALL at the time of diagnosis and in remission at different stages of therapy and eight children with solid tumors at different stages of the disease (diagnosis and following chemotherapy administration) were cultured in methylcellulose in the presence of growth factors. Hemopoietic activity was estimated by the development of BFU-E and CFU-GM colonies and compared with that of children without neoplastic disease used as controls.Results At the onset of leukemia diagnosis hemopoiesis is significantly affected. During remission granulopoiesis returns to normal whereas erythropoiesis remains impaired. The intensity of treatment does not seem to affect granulopoiesis but suppresses erythropoiesis which does not recover even within six months following discontinuation of therapy. Hemopoiesis is defective in children with solid tumors at diagnosis irrespectively of bone marrow neoplastic infiltration. Chemotherapy results in further reduction of granulopoietic activity.Conclusion Hemopoiesis in leukemia is being affected during treatment, but granulopoiesis returns to normal within six months after completion of therapy. Erythropoiesis seems to remain defective not only throughout treatment, but also following cessation of therapy. Hemopoiesis in children with malignancy is defective both prior to chemotherapy and during treatment.

The effect of recombinant human erythropoietin (rHuEPO) on the anemia of cancer was examined in 15 children with hematologic malignancies (group I) and solid tumors (group II), whose hemoglobin (Hb) was under the third percentile for sex and age. The response to rHuEPO was defined as an increase of Hb to above the 10th percentile following 8 weeks of therapy. The rHuEPO caused an increase in the Hb and hematocrit (Hct) in 46% of children of both groups at a dose of 150 IU/L, in 28.5% of children at a dose of 250 IU/L and in 25.5% of children at a dose of 400 IU/L. Leukocyte and platelet counts were not influenced by the rHuEPO treatment. The red cell transfusion requirement decreased to 66% in both groups after rHuEPO treatment. Erythropoietin (EPO) levels were measured prior to the treatment and then every 4 weeks during rHuEPO treatment. Children who responded to EPO had an initial EPO level of < 100 IU/L, while those who did not respond had an initial EPO level of > 100 IU/L. Erythropoietin was well tolerated in all children, with no side effects.

The difference between the effects of administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF) and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) was studied in 39 children with neutropenia secondary to chemotherapy (absolute neutrophil count (ANC) less than 1,500/mu L). The children were divided into two groups. The first group (G-CSF) included 25 children (12 with acute lymphoblastic leukemia [ALL]-non-Hodgkin's lymphoma [NHL] and 13 with solid tumors) and the second group (GM-CSF) included 14 children (5 with ALL-NHL and 9 with solid tumors). All 39 children received of either G-CSF or GM-CSF (5 mu g/kg/day) subcutaneously at the end of each chemotherapy course for a maximum duration of 14 days. The effect of G-CSF and GM-CSF on the ANC, the antibiotic therapy administration, and the length of hospital stay were studied for both groups at two cycles of chemotherapy. During both cycles a faster rise of ANC was observed in the children of the first group (G-CSF) compared with those of the second group (GM-CSF), but there was no difference in either the incidence of antibiotic therapy administration between the two groups (26% vs 25%) or the length of hospitalization. Both growth factors were well tolerated by all children studied with minimal side effects observed (including bone pain with G-CSF in 2 of 25 children and pruritus with GM-CSF in 1 of 14). We conclude that G-CSF reduces the duration of neutropenia more than does GM-CSF, but the incidence of severe infection and the duration of hospitalization do not differ between children, receiving either G-CSF or GM-CSF.