Prognostic significance of bone-marrow pattern and immunophenotypic score in B-chronic lymphocytic leukemia at diagnosis

INTRODUCTION

The clinical course and outcome of B-CLL is various and so far unpredictible. Defining prognostic parameters potentiating division of patients in groups with favorable and unfavorable prognosis which could help the benefit assessment of early treatment, improve treatment effects, and potentiate treatment modification for each patient.

AIM

To analyze the bone-marrow (BM) pattern and immunophenotypic score at diagnosis of B-CLL and determine the correlation of BM pattern with the clinical stage of disease and immunophenotypic score.

METHODS

A sample of 40 untreated patients with B-CLL was divided into two groups: group with clinical stage Binet A and group with clinical stages Binet B and Binet C. BM patterns were observed as a diffuse, interstitial, nodular and mixed. BM immunophenotyping included CD5, CD23, CD22, and CD20 as an indirect indicator of FMC7.

RESULTS

The overall sample mean age was 62.88 years +/- 11.10, without significant difference in the age of two compared groups (63.15 +/- 10.53 years vs. 62.60 +/- 11.50 years) (t = 0.16, df= 38, p = 0.88). Proportion of men was significantly higher in stages Binet B and C (12/20) compared to stage Binet A (5/20) (Z=2.24, p=0.025). The percentage of women was higher than men in Binet A stage (75% vs. 25%). The BM patterns in Binet A stage were observed as follows: mixed 50% (10/20), interstitial 30% (6/20), nodular 15% (3/20) and diffuse 5% (1/20). The BM patterns in Binet B and C stages were observed as follows: diffuse 50% (10/20), mixed 40% (8/20), interstitial 5% (1/20) and nodular 5% (1/20). Clinical stage and the BM patterns were significantly associated (c2=8.02, p=0,005). The chance for non-diffuse patterns was 19 times higher in stage Binet A compared to stages Binet B and C, respectively, analyzing 95% CI at least 2 times higher (95% CI: 2.02-866.6). Immunophenotypic score in total sample was observed as follows: score 4: 5% (2/40), score 3: 72.5% (29/40), score 2: 20% (8/40) and score 1: 2,5% (1/40). Immunophenotypic score 3 and > 3 had 77.5% of patients (31/40), but there was no significant association between the immunophenotypic score and the BM patterns (c2=0.76, p=0.38).

CONCLUSIONS

Diffuse BM pattern was significantly associated with the clinical stages Binet B and C, compared to non-diffuse BM patterns which were significantly associated with the clinical stage Binet A. Diffuse BM pattern represent the parameter of progressive disease compared to the non-diffuse BM patterns which are more often represented in stable disease. Immunophenotypic score improves diagnostic accuracy of B-CLL, but should not be used as a prognostic parameter of B -CLL.

The role of predictor factors in patients with non Hodgkin lymphoma in relation to the applied therapy

Lymphoma are defined as malignant neoplasms of immune system, or in other words the neoplasms of lymphocytes and their precursory cells which form the basic cellular elements of the immune system. The heterogeneity of lymphoma from the aspect of morphology and the aspect of clinical manifestations demanded the identification of all possible parameters which could influence the course and outcome of the disease on every single level. The aim of our study was to investigate which of the prognostic factors confirms the statistical importance of the remission state and overall survival and if the patients treated with standard PHT (poly chemotherapy) protocols with the addition of anti-CD20 antibody show more clinical benefit.

PATIENTS AND METHODS

Considering the applied protocol, patients were divided in two groups: group of patients treated with PHT protocol CHOP (Cyclophosphamide, Adriamycin, Oncovin, Pronison) and the group treated with PHT protocol with the addition of anti-CD20 antibody (Rituximab).

RESULTS

There was no statistically significant difference in values of Karnofsky score between patients in CHOP and CHOP+R groups before the therapy (U=133; Z = -1.87; p = 0.06), although this difference was on the border of statistical significance. The values of Karnofsky score before and after the therapy in CHOP group showed no significant difference (Wilcoxon Z = -1.62; p = 0.11), but CHOP+R group pointed significant differences before and after the treatment, (Wilcoxon Z = -2.34; p = 0.02) with generally higher values after the therapy. Looking from the aspect of B-symptomatology in CHOP group, there was a significant reduction of B-symptoms (50%; %95 CI = 19-50; p = 0.002) after the therapy (7/20; 35%) in comparison with patients before the therapy (17/20; 85%). According to those results, the reduction of symptoms in CHOP +R group was more evident (60%; 95% CI = 28-60; p < 0.001) after the therapy (3/20; 15%) comparing to the state before the therapy (15/20; 75%). Comparison of LDH values in the complete sample demonstrated that the value of LDH before the therapy was significantly higher (Z = -3.76; p < 0.001). There was a significant difference in number of patients in relation to the category of IPI prognostic index (chi2 = 10.38; df=3; p < 0.02), pointing out most of the patients with low intermediary risk in CHOP+R group, and largest number of patients with high and high intermediary risk in CHOP group.

Morphometric angiogenesis parameters for indolent and aggressive non-Hodgkin's lymphoma

There is much evidence about importance of angiogenesis in development and progression of solid tumors. The role of angiogenesis, as an indicator of higher malignant potential in non-Hodgkin's lymphoma, is not clear at the moment. Morphometric characteristics of microvessels in lymph node sections, in previously untreated patients with small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) and diffuse large B-cell lymphoma (DLBCL), were studied and relationship between angiogenesis and histological malignancy grade of NHL was also evaluated. Lymph node biopsies samples of 30 newly diagnosed patients with SLL/CLL (n=30) and DLBCL (n=30) were studied. All samples were fixed in 10% buffered formalin solution and embedded in paraffin. Microvessels were visualized by immunohistochemical staining for anti F-8 antibody. In the area showing the most intense vascularization (i.e. the "hot spot"), microvessel density (MVD), total vascular area (TVA), as well as the size related parameters were estimated, by using image analysis program "analysSIS'. Number and size-related microvessels angiogenic morphometric parameters were statistically higher in group with DLBCL compared with SLL/CLL: MVD (p = 0.002), TVA (p < 0.0001), area (p < 0.0001), perimeter (p < 0.0001), minor axis length (p < 0.0001) and major axis length (p < 0.0001). It is to be noted that positive correlation existed between TVA and MVD in DLBCL and SLL/CLL. The present study supports the view that angiogenesis correlate with histological grade of NHL.

[Structure of chronic dialysis patients in Bosnia-Herzegovina--a multicenter study]

INTRODUCTION

In BiH there are no summary data about chronic dialysis patients (CDP). With this study we tray to make first step to establish B&H system for collecting necessary data.

METHODS

This is a retrospective study for 1999 years. We collect data with question form which have been distributed to dialysis centers (DC) in BiH.

RESULTS

We got answer from 6 (37.5%) DC: Tuzla, Sarajevo, Bihac, Odzak, Travnik and Tesanj. Totally number of CDP was 533, 256 female (48%) and 277 male (52%), and 79% of them are between 26-65 yrs. Leading primary renal diseases were: glomerulonephritis 22%, pyelonephritis 16%, endemic nephropathy 11%, unknown ESRD 10%, polycystic renal disease 9% and diabetes 9%. Peritoneal dialysis have ben performed in 10 patients only, and bicarbonat HD in 46% of CDP. Half of the patients had serum haemoglobin lower than 7 mmol/1 and only 12% received erythropoietin. 17% of the patients had coronary disease, and 7% peripheral vascular disease. We registered 43 (8%) HBsAg, but 294 (55%) antiHCV positive patients. 52% of the CDP have been vaccinated against B hepatitis. Last year died 76 patients (14.26%), mostly caused by coronary diseases (21%), cardial failure (20%), cerebrovascular accidents (15%) and sepsis (11%). 53% of patients are on dialysis between 1-5 yrs.

CONCLUSION

In this study participated 6 DC only, but we think that data we collect are good basis for establishing B&H system for registration and follow-up of the ESRD patients.

[Characteristics of the early posttransplantation period in kidney transplantation]

INTRODUCTION

Renal transplantation has become the procedure of choice and the most cost-effective strategy for the management of patients with end stage renal disease. Posttransplant period is very important because possible complications, which have to be detected and treated according to approve statements. The aim this paper with is to show all characteristics of early postransplant period in patients operated at the Clinical Center of Tuzla.

METHODS AND RESULTS

Eighteen patients with end stage renal diseases has been analyzed with average age 32 + 8.6 years. Glomerulonephritis as primary kidney diseases has been found in 16 patients, lupus nephritis and reflux nephropathy in one patient. We paid attention on: creatinine level, urine output and balance, level of cyclosporin, body weight, ultrasound fallow-up, number episodes of acute rejection and number of additional dialysis. Clinical and labs sign of acute rejection have been found in 6 patients. Two of them recidive pulse dose of corticosteroides and four ATG. Additional haemodialysis has been performed in 5 patients. One patient died because of the rupture aneurism of aorta. Other 17 patients have been discharged after average hospitalisation of 20.87 8.18 days.

CONCLUSION

We can say it's very important to recognise the sings of acute rejection and to start with therapy. In patients with cardiovascular risk, postoperative period has to be guided careful.

[PI-3 kinase/AKT/PKB signal transduction pathway in kidneys mediates angiotensin II-induced hypertension]

INTRODUCTION

The activation of PI-3 kinase/AKT/PKB signal transduction pathway has implicated in the cell growth regulation and proliferation.

AIM

To determine a role of PI-3 kinase/AKT/PKB signal transduction pathway in the kidney of Angiotensin II-induced hypertensive rats.

METHODS

NZW (New Zealand White) rats have been infused by Angiotensin II using osmotic minipump for six days (n = 8). Control group was untreated rats (n = 6). PI-3 inase and AKT/PKB activities were measured in the presence or absence of different inhibitors.

RESULTS

Angiotensin II elevated mean arterial blood pressure (MABP) to 182 +/- 2 mm Hg (p < 0.001) vs untreated control rats (95 +/- 3 mm Hg). Ras-GTPase and PI-3 Kinase activities were elevated in angiotensin II-treated group. Ras inhibitors FPT III and BMS/191563 attenuated MABP to 122 +/- 2 and 127 +/- 4 mm Hg (p < 0.05) and abolished Ras-GTPase and PI-3 Kinase activities. AKT/PKB activity followed the PI-3 kinase activity.

CONCLUSION

PI-3 kinase/AKT/PKB signal transduction pathway in the kidney is activated and mediates Angiotesin II-induced hypertension.