A case of Bloom syndrome manifesting with therapy-related myelodysplastic syndromes harboring a novel BLM gene variant

Bloom syndrome (BS) is an autosomal recessive genetic disorder caused by variants in the BLM gene. BS is characterized by distinct facial features, elongated limbs, and various dermatological complications including photosensitivity, poikiloderma, and telangiectatic erythema. The BLM gene encodes a RecQ helicase critical for genome maintenance, stability, and repair, and a deficiency in functional BLM protein leads to genomic instability and high predisposition to various types of cancers, particularly hematological and gastrointestinal malignancies. Here, we report a case of BS with a previously unreported variant in the BLM gene. The patient was a 34-year-old woman who presented with short stature, prominent facial features, and a history of malignancies, including lymphoma, breast cancer, and myelodysplastic syndromes (MDS). She was initially treated with azacitidine for MDS and showed transient improvement, but eventually died at age of 35 due to progression of MDS. Genetic screening revealed compound heterozygous variants in the BLM gene, with a recurrent variant previously reported in BS in one allele and a previously unreported variant in the other allele. Based on her characteristic clinical features and the presence of heterozygous variants in the BLM gene, she was diagnosed with BS harboring compound heterozygous BLM variants.

Investigation of biomarkers to predict outcomes in allogeneic hematopoietic stem cell transplantation

BACKGROUND

Various biomarkers have been developed and evaluated to predict the prognosis and complications of allogeneic hematopoietic cell transplantation (HCT). Most previous studies conducted on different biomarkers evaluated single effects such as those associated with inflammation, immunology, iron metabolism, and nutrition, and only a few studies have comprehensively analyzed markers.

OBJECTIVE

The study aimed to survey comprehensive multiple markers prior to HCT and extract those that significantly predict the outcomes.

STUDY DESIGN

A prospective multicenter observational study was performed. (UMIN000013506) Patients undergoing HCT for hematologic diseases were consecutively enrolled. Besides the usual clinical biomarkers, serum samples for extra-clinical biomarkers were collected and cryopreserved before starting the conditioning regimen. A total of 32 candidate biomarkers were selected, 23 from hematology, biochemistry, immunology, nutrition, and iron metabolism, and 9 from composite markers. Based on the area under the curve (AUC) values for survival, promising biomarkers was extracted. Internal validation for these markers was applied based on bootstrap methods. Setting the cut-off values for them, log-rank test was applied and outcomes including overall survival (OS), relapse, and non-relapse mortality (NRM) were evaluated using multivariate analyses. Furthermore, detailed analysis including transplant-related complications and external validation were conducted focusing on C-reactive protein (CRP) to platelet (Plt) ratio.

RESULTS

A total of 152 patients with hematologic malignancies were enrolled from April 2014 to March 2017. CRP, soluble interleukin-2 receptor (IL2R), CRP to albumin (Alb) ratio, CRP to Plt ratio, Plt to IL2R ratio, and IL2R to Alb ratio were identified as promising markers. Internal validation successfully confirmed their reliability of AUC and multivariate analysis demonstrated the statistical significance between the higher and the lower markers. Above all, a higher CRP to Plt ratio was significantly associated with a lower OS (hazard ratio [HR] 2.77; 95% confidence interval [CI] 1.30-5.91; P = 0.008) and higher non-relapse mortality rates (HR 2.79; 95%CI 1.14-6.80; P = 0.024) at 180 days. Furthermore, univariate analysis showed that a higher CRP to Plt ratio was significantly associated with a higher incidence of sinusoidal obstructive syndrome (P < 0.001) and bloodstream infection (P = 0.027). An external validation test confirmed the significance of the CRP to Plt ratio for these outcomes.

CONCLUSION

The multicenter prospective observational study successfully identified significant biomarkers in patients with hematologic malignancies who received HCT. In particular, CRP to Plt ratio was identified as a novel and useful biomarker for predicting transplant outcomes. Further investigations are needed to validate the novel markers, analysis of the pathophysiology, and application to treatment settings other than HCT.

Comparison of standardized prophylactic high-dose and intrathecal methotrexate for DLBCL with a high risk of CNS relapse

The efficacy of high-dose methotrexate (HD-MTX) for central nervous system (CNS) relapse prophylaxis in patients with high-risk diffuse large B-cell lymphoma (DLBCL) is controversial. We compared the prophylactic effects of HD-MTX and intrathecal methotrexate (IT-MTX) on CNS relapse in high-risk DLBCL, in a multicenter retrospective study. A total of 132 patients with DLBCL at high risk of CNS relapse who received frontline chemotherapy and IT-MTX from 2003 to 2013 (n = 34) or HD-MTX from 2014 to 2020 (n = 98) were included. After a median follow-up of 52 months (range: 9-174), 11 patients had isolated CNS relapse: six (6.1%) in the HD-MTX group and five (14.7%) in the IT-MTX group. The median time until CNS relapse was 38 months (range: 11-122), and the cumulative incidence of CNS relapse at 3 years was 3.9% in the HD-MTX group and 6.1% in the IT-MTX group (P = 0.93). Similar results were obtained after adjusting for background factors using propensity score-matched analysis (4.5% HD-MTX vs. 7.6% IT-MTX, P = 0.84). The CNS relapse rate in HD-MTX-treated patients was equivalent to that in IT-MTX patients, demonstrating that HD-MTX was not superior to IT-MTX in preventing CNS relapse.

Prognostic significance of the CFA ratio for newly diagnosed acute myeloid leukemia: A multicenter retrospective study

The CFA ratio, calculated using pretreatment C-reactive protein (CRP), fibrinogen, and albumin levels (CRP × fibrinogen/albumin), was previously reported to be a significant prognostic factor for acute myeloid leukemia (AML). This multicenter retrospective study evaluated the prognostic value of the CFA ratio in 328 adult patients with newly diagnosed AML from April 2000 to March 2018. The median age was 49.5 years (range, 15-75 years), and 60.7% of the population were males. According to the European LeukemiaNet (ELN) risk classification, 67 patients (20.4%) were in the favorable-risk group, 197 patients (60.1%) in the intermediate-risk group, and 58 patients (17.7%) in the adverse-risk group. The median CFA ratio was 1.07 (0-67.69). Based on the calculated cutoff CFA ratio of 1.44, the cohort included 176 and 152 patients with low and high CFA ratios, respectively. At a median follow-up of 91.2 months, the 7-year overall survival (OS) and disease-free survival (DFS) rates were 51.2% and 48.6%, respectively, in the overall cohort. The 7-year OS rates were 61.7% and 39.0% in the low and high CFA ratio groups, respectively (p < 0.001). The 7-year DFS rates were 58.1% and 37.0% in the low and high CFA ratio groups, respectively (p = 0.004). In univariate analysis, age ≥50 years, male sex, ELN risk class, and comorbidities were associated with poor OS. Age, ELN risk class, comorbidities, and high CFA ratio were associated with poor OS in multivariate analysis. Subgroup analysis revealed that the CFA ratio was significant in the intermediate and adverse ELN risk classes. These findings indicate the prognostic significance of the CFA ratio in AML.

Impact of treatment-related weight changes from diagnosis to hematopoietic stem-cell transplantation on clinical outcome of acute myeloid leukemia

We hypothesized that treatment-related weight loss is associated with worse outcomes following HSCT. Overall, 184 patients with AML who underwent induction therapy were classified according to d-BMI (BMI at transplant minus BMI at diagnosis) (kg/m²) as < -2, - 2 to + 2, and > + 2. At 1 year, OS was 67.9% (95% CI, 60.7-74.2), DFS was 64.1% (95% CI, 56.7-70.6), and GRFS was 40.2% (95% CI, 33.1-47.2). For d-BMI groups < - 2, - 2 to + 2, and > + 2, GRFS at 1 year was 16.1% (95% CI, 5.1-31.4), 45.4% (95% CI, 36.4-53.7), and 41.7% (95% CI, 22.2-60.1), respectively (P = 0.0067). Multivariate analysis showed that both worse OS (HR, 1.78; 95% CI, 1.02-3.14; P = 0.007) and GRFS (HR, 2.34; 95% CI, 1.26-4.35; P = 0.007) were associated with reduced BMI (d-BMI < - 2). Treatment-related weight reduction in AML was associated with poor outcome after HSCT.

The role of leukotriene C4 in biphasic release of histamine from mouse mastocytoma cell line (P-815)

1. A biphasic change of compound 48/80-induced histamine release was observed in mastocytoma cell line (P-815). 2. The first and second phase of compound 48/80-induced histamine release were elicited via a different pathway. 3. The second phase of compound 48/80-induced histamine release was provoked with leukotriene (LT) C4. 4. The results suggest that this biphasic release may be one of the important regulatory mechanisms for the production of histamine.

Effect of calcium-channel blockers on cell proliferation, DNA synthesis and collagen synthesis of cultured gingival fibroblasts derived from human nifedipine responders and non-responders

Human gingival fibroblasts from six patients who developed gingival hyperplasia as a result of nifedipine medication and five who did not were studied for the effects of calcium-channel blockers (nifedipine, diltiazem, verapamil and nicardipine) on cell proliferation, DNA synthesis and collagen synthesis. Phenytoin was used as a positive control. The fibroblasts from reactive patients gave trends toward better cell proliferation rates, DNA synthesis ([3H]-thymidine incorporation), and collagen synthesis ([3H]-proline incorporation) than those from non-reactive patients in the presence of 1 microM of calcium-channel blockers or phenytoin.

Gingival hyperplasia induced by nifedipine

We describe 4 cases of gingival hyperplasia induced by nifedipine, together with clinical and histological findings. Hyperplasia of the interdental papillae was observed in all cases. Histologic examination showed multilayered epithelial parakeratosis with variations in the width, proliferation, reticulation and elongation of the rete pegs. Substitution of another drug and improvement of oral hygiene led to reduction of the gingival overgrowth without gingivectomy. These treatments are essential for gingival hyperplasia induced by nifedipine.

Saliva inhibits the chemiluminescence response, phagocytosis, and killing of Staphylococcus epidermidis by polymorphonuclear leukocytes

Saliva inhibited several functional properties of polymorphonuclear leukocytes (PMNs) from murine peritoneal exudate, namely, luminol-mediated chemiluminescence (CL) induced by either Staphylococcus epidermidis or formylmethionyl-leucyl-phenylalanine (FMLP), phagocytosis, and killing of bacteria in vitro. The concentration of saliva in the reaction mixture that caused a complete inhibition of the CL response of PMNs to both S. epidermidis and FMLP was 25%. However, there was no catalase or superoxide dismutase activity in saliva that could influence the CL response of PMNs. The production of superoxide by PMNs stimulated with S. epidermidis was assayed in the presence or absence of saliva by inhibition of the reduction of cytochrome c by superoxide dismutase. In the presence of 50% saliva, O2- generation by PMNs was only 7.3% of that observed in the absence of saliva. After gel filtration of salivary material through Sephadex G-25 or Sephacryl S-200, several fractions were obtained that inhibited the CL response of PMNs to either FMLP or S. epidermidis or to both. Two inhibitory fractions were analyzed. One contained immunoglobulin A, and the other contained a peptide which was composed of 14 different amino acids. The two fractions of high molecular weight included in the first protein peak of Sephacryl S-200 gel filtration were able to inhibit the CL response to S. epidermidis and to inhibit phagocytic activity, while fractions of low molecular weight (under 12,500 Mr) inhibited the CL response to FMLP and to S. epidermidis but did not inhibit phagocytic activity.

Exercise stress body surface isopotential map in patients with coronary artery disease: comparison with coronary angiographic and stress myocardial perfusion scintigraphic findings

to locate the ischemic area in 22 patients with angina pectoris, exercise stress body surface isopotential maps (MAPs) were assessed and compared with coronary angiography and myocardial stress scintigraphy. Taking coronary angiographic findings into consideration, 4 types of ischemic MAP responses, i.e., septum and anterior, lateral, inferior, and posterior wall ischemia were postulated. Sensitivity of stress MAP was 71% for the average and more than stress imaging. Specificity of stress MAP was 46% for the average and less than stress imaging.

Changes in the cells of the adenohypophysis associated with the diadromous migration of the threespine stickleback, Gasterosteus aculeatus L

The adenohypophysis of the threespine stickleback, Gasterosteus aculeatus, was studied light-microscopically to determine and estimate the cell types and their function. For these purposes, the adult specimens obtained during the period from migration to spawning were examined. Further, the juveniles caught in the spawning bed were subjected artificially to sea water. The rostral pars distalis (RPD) consists mainly of two types of cells: dorsally shifted lead hematoxylin (PbH)-positive cells bordering the neurohypophysis correspond to corticotrophs, and antero-ventrally shifted acidophil cells are identified as prolactin cells. The latter undergo marked hypertrophy and active state just at the time of entering the river (February), while no detectable change was seen in the former throughout anadromous migration. The role of prolactin on the osmoregulation in freshwater environment is thus suggested. The proximal pars distalis (PPD) consists mainly of two cell types: the basophil cells in round shape are regarded as the gonadotrophs and the acidophil cells in ellipsoid shape are considered to be somatotrophs. The size of the gonadotrophs reaches the maximum at the time of spawning. A few AF-positive cells of elongate shape occur in the dorsal region and are identified as thyrotrophs. In the pars intermedia (PI), two types of cells are discernible: PAS-positive and PAS-negative cells. The latter attained their maximal size in the earliest time of anadromous migration.