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Meeuwes FO, Brink M, Plattel W, Van der Poel MWM, Kersten MJ, Wondergem M, Böhmer L, Woei-A-Jin FJSH, Visser O, Oostvogels R, Jansen PM, Neelis KJ, Crijns APG, Daniëls LA, Snijders TJF, Vermaat JSP, Huls GA, Nijland M. Outcome of combined modality treatment in first-line for stage I(E) peripheral T-cell lymphoma; a nationwide population-based cohort study from the Netherlands. Haematologica 2024; 109:1163-1170. [PMID: 37794805 PMCID: PMC10985449 DOI: 10.3324/haematol.2023.283174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Indexed: 10/06/2023] Open
Abstract
Peripheral T-cell lymphomas (PTCL) comprise a heterogeneous group of mature T-cell neoplasms with an unfavorable prognosis; presentation with stage I(E) disease is uncommon. In clinical practice, an abbreviated chemotherapy treatment regimen combined with radiotherapy (combined modality treatment [CMT]) is commonly used, although evidence from clinical trials is lacking. The aim of this nationwide population-based cohort study is to describe first-line treatment and outcome of patients with stage I(E) PTCL. All newly diagnosed patients ≥18 years with stage I(E) anaplastic large cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AITL) and peripheral T-cell lymphoma NOS (PTCL not otherise specified [NOS]) in 1989-2020 were identified in the Netherlands Cancer Registry. Patients were categorized according to treatment regimen, i.e., chemotherapy (CT), radiotherapy (RT), CMT, other therapy and no treatment. The primary endpoint was overall survival (OS). Patients with stage I(E) ALCL, AITL and PTCL NOS (n=576) were most commonly treated with CMT (28%) or CT (29%), 2% underwent SCT. RT only was given in 18%, and 8% received other therapy and 16% no treatment. Overall, the 5-year OS was 59%. According to subtype, 5-year OS was superior for ALCL as compared to PTCL NOS and AITL (68% vs. 55% and 52%, respectively; P=0.03). For patients treated with CMT, 5-year OS was significantly higher (72%) as compared to patients treated with either CT or RT alone (55% and 55%, respectively; P<0.01). In multivariable analysis, age per year increment (hazard ratio [HR] =1.06, 95% confidence interval [CI]: 1.05-1.07), male sex (HR=1.53, 95% CI: 1.23-1.90), and CT, or no treatment (HR=1.64, 95% CI: 1.21-2.21, and HR=1.55, 95% CI: 1.10-2.17, respectively) were associated with a higher risk of mortality. For stage I(E) ALCL, AITL and PTCL NOS, 5-year OS is 59%, comparing favorably to historical outcome in advanced-stage disease. Superior outcome estimates were observed in patients treated with CMT.
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Affiliation(s)
- Frederik O Meeuwes
- Department of Hematology, Treant Hospital, Emmen, The Netherlands; Department of Hematology, University Medical Center Groningen, Groningen
| | - Mirian Brink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht
| | - Wouter Plattel
- Department of Hematology, University Medical Center Groningen, Groningen
| | - Marjolein W M Van der Poel
- Department of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | - Mariëlle Wondergem
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | - Lara Böhmer
- Department of Hematology, Haga Hospital, The Hague
| | | | - Otto Visser
- Department of Hematology, Isala Hospital, Zwolle
| | - Rimke Oostvogels
- Department of Hematology, University Medical Center Utrecht, Utrecht
| | - Patty M Jansen
- Department of Pathology, Leiden University Medical Center, Leiden
| | - Karen J Neelis
- Department of Radiotherapy, Leiden University Medical Center, Leiden
| | - Anne P G Crijns
- Department of Radiotherapy, University Medical Center Groningen, Groningen
| | - Laurien A Daniëls
- Department of Radiotherapy, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | | | | | - Gerwin A Huls
- Department of Hematology, University Medical Center Groningen, Groningen
| | - Marcel Nijland
- Department of Hematology, University Medical Center Groningen, Groningen.
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Yan WW, Xu JY, Li LN, Lyu R, Shou LH, Sun Q, Wang HJ, Qiu LG, An G. [Angioimmunoblastic T-cell lymphoma with monoclonal B cell and plasma cell hyperplasia]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:783-786. [PMID: 38049326 PMCID: PMC10630570 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Indexed: 12/06/2023]
Affiliation(s)
- W W Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - J Y Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - L N Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - R Lyu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - L H Shou
- Department of Hematology, Huzhou Central Hospital, Huzhou 313000, China
| | - Q Sun
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - H J Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - L G Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
| | - G An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China Tianjin Institutes of Health Science, Tianjin 301600, China
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Kawakami A, Kuroda H, Suzuki T, Kobayashi H, Abe S, Ui M, Inoue K, Oshima K, Sone H, Takizawa J. [Angioimmunoblastic T-cell lymphoma after immune checkpoint inhibitor-combined chemotherapy for lung cancer]. Rinsho Ketsueki 2022; 63:759-763. [PMID: 35922944 DOI: 10.11406/rinketsu.63.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 68-year-old male patient with lung adenocarcinoma, who was treated with chemotherapy and immune checkpoint inhibitors (ICIs), developed lymphadenopathy during treatment. His para-aortic lymph nodes increased to 2.0 cm in diameter. Both inguinal lymph nodes were 1.5 cm in diameter, and multiple hepatic masses appeared. After the ICI readministration, both inguinal lymph nodes increased to 2.0 cm in diameter, but the para-aortic lymph nodes and hepatic masses remained. Angioimmunoblastic T-cell lymphoma (AITL) diagnosis was established after the right inguinal lymph node biopsy, which was accompanied by an infiltration of Epstein-Barr virus (EBV)-encoded small ribonucleic acid-positive B-cells. After the ICI discontinuation, the inguinal lymph nodes decreased to 1.5 cm in diameter, but the para-aortic lymph nodes remained, and hepatic masses increased. Hepatic lesions were possibly lung cancer metastasis. The ICI administration and EBV reactivation were potentially associated with AITL development in the present case. The natural shrinkage of lymphoma after the ICI cessation implied the immunological mechanism like that of the methotrexate-related lymphoproliferative disease.
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Affiliation(s)
- Ayako Kawakami
- Department of Hematology, Niigata Prefectural Shibata Hospital
| | - Hiroyuki Kuroda
- Department of Hematology, Niigata Prefectural Shibata Hospital
| | - Takaharu Suzuki
- Department of Hematology, Niigata Prefectural Shibata Hospital
| | | | - Seitaro Abe
- Department of Respiratory Medicine, Niigata Prefectural Shibata Hospital
| | - Masahiro Ui
- Department of Respiratory Medicine, Niigata Prefectural Shibata Hospital
| | - Kanako Inoue
- Department of Second Pathology, Kurume University
| | | | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolic Medicine, Niigata University School of Medicine
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolic Medicine, Niigata University School of Medicine
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Matsumoto Y, Nagoshi H, Yoshida M, Kato S, Kuroda J, Shimura K, Kaneko H, Horiike S, Nakamura S, Taniwaki M. Expression of Master Regulators of T-cell, Helper T-cell and Follicular Helper T-cell Differentiation in Angioimmunoblastic T-cell Lymphoma. Intern Med 2017; 56:2851-2856. [PMID: 28943543 PMCID: PMC5709626 DOI: 10.2169/internalmedicine.8570-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective It has been postulated that the normal counterpart of angioimmunoblastic T-cell lymphoma (AITL) is the follicular helper T-cell (TFH). Recent immunological studies have identified several transcription factors responsible for T-cell differentiation. The master regulators associated with T-cell, helper T-cell (Th), and TFH differentiation are reportedly BCL11B, Th-POK, and BCL6, respectively. We explored the postulated normal counterpart of AITL with respect to the expression of the master regulators of T-cell differentiation. Methods We performed an immunohistochemical analysis in 15 AITL patients to determine the expression of the master regulators and several surface markers associated with T-cell differentiation. Results BCL11B was detected in 10 patients (67%), and the surface marker of T-cells (CD3) was detected in all patients. Only 2 patients (13%) expressed the marker of naïve T-cells (CD45RA), but all patients expressed the marker of effector T-cells (CD45RO). Nine patients expressed Th-POK (60%), and 7 (47%) expressed a set of surface antigens of Th (CD4-positive and CD8-negative). In addition, BCL6 and the surface markers of TFH (CXCL13, PD-1, and SAP) were detected in 11 (73%), 8 (53%), 14 (93%), and all patients, respectively. Th-POK-positive/BCL6-negative patients showed a significantly shorter overall survival (OS) than the other patients (median OS: 33.0 months vs. 74.0 months, p=0.020; log-rank test). Conclusion Many of the AITL patients analyzed in this study expressed the master regulators of T-cell differentiation. The clarification of the diagnostic significance and pathophysiology based on the expression of these master regulators in AITL is expected in the future.
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Affiliation(s)
- Yosuke Matsumoto
- Departments of Hematology and Laboratory Medicine, Aiseikai Yamashina Hospital, Japan
| | - Hisao Nagoshi
- Division of Hematology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | - Mihoko Yoshida
- Departments of Hematology and Laboratory Medicine, Aiseikai Yamashina Hospital, Japan
| | - Seiichi Kato
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Japan
| | - Junya Kuroda
- Division of Hematology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | - Kazuho Shimura
- Departments of Hematology and Laboratory Medicine, Aiseikai Yamashina Hospital, Japan
| | - Hiroto Kaneko
- Departments of Hematology and Laboratory Medicine, Aiseikai Yamashina Hospital, Japan
| | - Shigeo Horiike
- Division of Hematology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Japan
| | - Masafumi Taniwaki
- Departments of Hematology and Laboratory Medicine, Aiseikai Yamashina Hospital, Japan
- Center for Molecular Diagnostics and Therapeutics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
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Wang L, Lee HY, Koh HY, Busmanis I, Lee YS. Cutaneous Presentation of Angioimmunoblastic T-Cell Lymphoma: A Harbinger of Poor Prognosis? Skinmed 2016; 14:469-471. [PMID: 28031140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 62-year-old woman presented with a 2-year history of extensive, pruritic dermatosis over her face, trunk, and limbs. She was initially treated for psoriasis with methotrexate 5 mg twice weekly and topical clobetasol cream; however, her condition worsened, and she was admitted for generalized exfoliative dermatitis. Examination showed generalized erythema and scaling affecting her face (Figure 1A), chest (Figure 1B), back, and limbs. There were also cervical, axillary, and inguinal lymphadenopathy. Laboratory studies revealed a high white blood cell count of 125×109/L (reference range: 4-10×109/L), hemoglobin level of 11.9 g/dL (reference range: 12-16 g/dL), and normal platelet level of 396×109/L (reference range: 140-440×109/L). Results from direct Coombs test were negative and lactate dehydrogenase levels were normal.
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Mourad N, Mounier N, Brière J, Raffoux E, Delmer A, Feller A, Meijer CJLM, Emile JF, Bouabdallah R, Bosly A, Diebold J, Haioun C, Coiffier B, Gisselbrecht C, Gaulard P. Clinical, biologic, and pathologic features in 157 patients with angioimmunoblastic T-cell lymphoma treated within the Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials. Blood 2008; 111:4463-70. [PMID: 18292286 PMCID: PMC2343588 DOI: 10.1182/blood-2007-08-105759] [Citation(s) in RCA: 225] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 02/13/2008] [Indexed: 12/11/2022] Open
Abstract
To evaluate the prognostic significance of clinicobiologic and pathological features in angioimmunoblastic T-cell lymphoma (AITL), 157 AITL patients were retrieved from the GELA LNH87-LNH93 randomized clinical trials. One hundred forty-seven patients received a cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-like regimen with intensified courses in half of them. Histologically, 41 cases were classified as "rich in large cells" and 116 as "classic" (including 19 rich in epithelioid cells, 14 rich in clear cells, and 4 with hyperplastic germinal centers). Sixty-two cases were scored for CD10 and CXCL13 expression according to the abundance of positive lymphoid cells. Median age was 62 years, with 81% advanced stage, 72% B symptoms, 65% anemia, 50% hypergammaglobulinemia, and 66% elevated LDH. Overall 7-year survival was 30%. In multivariate analysis, only male sex (P = .004), mediastinal lymphadenopathy (P = .041), and anemia (P = .042) adversely affected overall survival. Increase in large cells and high level of CD10 and CXCL13 did not affect survival. Intensive regimen did not improve survival. In conclusion, AITL is a morphologically heterogeneous T-cell lymphoma commonly expressing CXCL13 and CD10 and carrying few prognostic factors. It portends a poor prognosis even when treated intensively. However, AITL is not always lethal with 30% of patients alive at 7 years.
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Abstract
PURPOSE OF REVIEW Angioimmunoblastic T cell lymphoma is a complex lymphoproliferative disorder. While recent evidence suggests that the Epstein-Barr virus and B cell disregulation are implicated in the disease's pathogenesis, their mechanistic roles remain largely unknown. The prognosis with traditional chemotherapy has been poor, but improved understanding of the disease's pathobiology has led to several promising novel therapeutic strategies. RECENT FINDINGS The recent finding of overexpression of the chemokine CXCL13 by the neoplastic cells of angioimmunoblastic T cell lymphoma suggests that it is derived from follicular helper T cells. In addition, gene-expression profiling has demonstrated overexpression of several genes characteristic of follicular helper T cells. Vascular endothelial growth factor-A is also highly expressed. Novel therapeutic strategies including immunomodulation with agents like cyclosporine and angiogenesis inhibition with drugs such as bevacizumab are being investigated, and show early promise in this disease. SUMMARY Diseases such as angioimmunoblastic T cell lymphoma can help illuminate the biology of the normal immune system. Significant progress has been made in understanding the biology of angioimmunoblastic T cell lymphoma. This has paved the way for the development of new therapeutic strategies and these have shown interesting results.
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Affiliation(s)
- Kieron Dunleavy
- Metabolism Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
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Christopoulos C, Tassidou A, Golfinopoulou S, Anastasiadis G, Manetas S, Anagnostou D. Concomitant angioimmunoblastic T-cell lymphoma and low grade B-cell lymphoproliferative disorder. Clin Lab Haematol 2001; 23:139-42. [PMID: 11488855 DOI: 10.1046/j.1365-2257.2001.00384.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The presence of a rearranged immunoglobulin gene, in addition to the expected T-cell receptor gene rearrangement, is a frequent, albeit poorly understood, finding in the setting of angioimmunoblastic lymphadenopathy. A case of an angioimmunoblastic T-cell lymphoma is presented, where this apparently paradoxical dual gene rearrangement could be ascribed to the coexistence of an occult B-cell lymphoproliferative disorder.
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Affiliation(s)
- C Christopoulos
- Second Department of Internal Medicine, Thriasio General Hospital, Athens, Greece.
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Tamura M, Iki S, Yagisawa M, Mitani K, Ohbayashi Y, Sato H, Urabe A. [ Immunoblastic lymphadenopathy-like T cell lymphoma accompanied by autoimmune hemolytic anemia]. Rinsho Ketsueki 1992; 33:396-401. [PMID: 1578646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 62-year-old man was admitted to our hospital because of generalized lymphadenopathy, fever and skin eruptions. The histology of the right cervical lymph nodes showed immunoblastic lymphadenopathy (IBL)-like T cell lymphoma. His laboratory data were as follows: hemoglobin concentration 7.1 g/dl, red blood cells 1,850,000/microliters, reticulocytes 4.2%, total bilirubin 2.6mg/dl, direct bilirubin 0.5mg/dl, haptoglobin less than 10mg/dl, positive Coombs test. He was diagnosed as having IBL-like T cell lymphoma accompanied by autoimmune hemolytic anemia. He was successfully treated with combination chemotherapy (Pro-MACE), and lymph node swelling and hemolytic anemia disappeared. He has been in complete remission for more than 1 year.
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Affiliation(s)
- M Tamura
- Division of Hematology, Kanto Teishin Hospital
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Peter HH, Hartel R, Lang B, Weber S. [Chronic immunoproliferative syndromes]. Immun Infekt 1991; 19:73-7. [PMID: 1916867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Immunoproliferative syndromes are etiologically unclear, rare diseases which involve polyclonal B- and/or T-cell proliferations and frequently develop into malignant non-Hodgkin-lymphoma. Typically, these diseases are characterized by lymphadenopathies, hepatosplenomegaly, general fatigue and autoimmune phenomena. Here we briefly outline 6 syndromes, two of which--the "pluripotential chronic immunoproliferative syndrome" (CPIS) and the "angioimmunoblastic lymphadenopathy" (AILD)--are discussed in more detail. We favor the notion that CPIS is a variant form of AILD clinically dominated by severe autoimmune hemolytic anemia. Both diseases share the high frequency of anti-cytoskeleton autoantibodies.
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Affiliation(s)
- H H Peter
- Abteilung für Rheumatologie und Klinische Immunologie, Medizinische Universitätsklinik Freiburg
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Affiliation(s)
- I L Levey
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas 78234
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Bodensteiner D, Brown P, Skikne B, Plapp F. The enzyme-linked immunosorbent assay: accurate detection of red blood cell antibodies in autoimmune hemolytic anemia. Am J Clin Pathol 1983; 79:182-5. [PMID: 6823902 DOI: 10.1093/ajcp/79.2.182] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The enzyme-linked immunosorbent assay (ELISA) was employed in the study of red blood cells from patients with autoimmune hemolytic anemia. The ELISA was more sensitive and correlated with severity of hemolysis better than the direct antiglobulin test (DAT). It was helpful in diagnosing and following the clinical course in these patients. This was particularly true in the DAT-negative group, since the ELISA can detect smaller increases in red blood cell IgG than are required for a positive DAT.
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