The Significance of CD20 Intensity Variance in Pediatric Patients with B-Cell Precursor Acute Lymphoblastic Leukemia

B-cell precursor acute lyphoblastic leukemia (ALL) is a common pediatric malignancy and patients may have significant benefits from monoclonal antibodies therapy with increased survival rates. Positive CD20 expression is identified in about half of these patients and its presence may serve as a prognostic factor in disease evolution. We performed a retrospective study including 114 patients diagnosed with B-ALL and evaluated the expression of CD20 through flow cytometry at diagnosis and on day 15. Additional immunophenotypic analyses as well as cytogenetic and molecular genetic analyses were also performed. We observed an increase in the mean fluorescence intensity (MFI) of CD20 between diagnosis-1.9 (1.2-3.26) and day 15: 6.17 (2.14-27.4), (p < 0.0001). Furthermore, we assessed that both diagnosis and day 15 CD20 MFI had an impact on RFS and OS, respectively, for cut-off values of >8.08 at diagnosis and >28.65 at day 15. In conclusion, CD20 expression appears to be a poor prognostic feature of B-ALL in pediatric patients. In this study, stratification of the outcome by the intensity of CD20 has implications concerning the allocation to rituximab-based chemotherapy and may offer new, potentially useful information for pediatric patients with B-ALL.

EVOLUTION OF FIBROSIS, INFLAMMATION, STEATOSIS AND STEATOHEPATITIS IN HCV INFECTED PATIENTS AFTER TREATMENT WITH DIRECT- ACTING ANTIVIRAL THERAPY (A FIBROMAX® ANALYSIS)

Aim: The aim of this study is to assess the evolution of Fibromax® parameters (fibrosis, inflammation, steatosis, steatohepatitis) in patients with chronic HCV hepatitis at one year after sustained virologic response (SVR) achieved by direct acting antiviral agents (DAA). Methods: This is a retrospective observational trial including 73 patients with chronic HCV hepatitis, who obtained sustained virologic response under ombitasvir/paritaprevir/ritonavir and dasabuvir, ledipasvir/sofosbuvir or sofosbuvir/velpatasvir. All the patients were evaluated by Fibromax before the initiation of therapy and at 12 months after SVR. Results and Conclusion: The study included 42 women (57.53%) and 31 men (42.46%), without significant difference in mean age or BMI. We found a higher prevalence of patients with minimal or moderate fibrosis (F1, F2), compared to patients with advanced fibrosis (F3) (63.01% versus 10.95%). At one year follow-up, we found an increased number of patients in the lower levels of fibrosis, inflammation and NASH, with a relatively constant distribution of patients regarding steatosis. Necro-inflammatory activity was significantly diminished, with 58 patients in the no to minimal activity, compared to 37 patients before antiviral therapy. More patients presented N0 and N1 degree of NASH at follow-up than before therapy (63 patients versus 42 patients, p= 0.02). The mean values of Fibrotest (p= 0.03), ActiTest (p<0.01) and NashTest (p=0.02) decreased significantly. The mean value of Steatotest also decreased, but without statistical significance (p=0.12).

Ovarian Germ Cell Tumors: Pictorial Essay

Ovarian germ cell tumors of the ovary represent a histologically heterogenous group of tumors with a high incidence at reproductive age. Patients with this pathology are very often young women with amenorrhea. The aim of this article is to present a pictorial essay of this rare pathology and to promote a national tumor registry and protocol. The treatment is individualized according to age, and fertility-sparing surgery is the actual standard of surgical treatment for young patients in early stage of the disease.