Chemokine/chemokine receptor interactions in extramedullary leukaemia of the skin in childhood AML: differential roles for CCR2, CCR5, CXCR4 and CXCR7

Chemokine receptor/ligand interactions orchestrate the migration of cells to peripheral tissues such as the skin. We analysed chemokine receptor expression by acute myeloid leukaemic (AML) cells present in peripheral blood (n = 7), bone marrow (n = 6), or skin (n = 11) obtained from 15 paediatric AML patients with skin involvement and in 10 AML patients without skin involvement. High percentages of circulating CCR2(pos) AML cells were only detected in patients with extramedullary disease. Skin-residing AML cells displayed a different set of receptors in situ, namely: CCR5, CXCR4, CXCR7 and CX3CR1. These results suggest the involvement of different chemokine/chemokine receptor interactions in homing and retention of AML blasts in the skin.

Dense lymphocytic infiltrates associated with non-melanoma skin cancer in patients with chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy associated with an increased risk of non-melanoma skin cancer. Basal cell carcinomas and squamous cell carcinomas in these patients may have an associated dense peritumoral leukemic infiltrate. This infiltrate can lead to the diagnosis of CLL and may also obscure tumor margins and pose a challenge in the assessment of perineural tumor spread. Immunohistochemical stains are useful in distinguishing leukemic B-cell infiltrates from tumor-reactive T-cell infiltrates. Leukemic cells of CLL are CD20+/CD23+/CD5+/CD43+/CD3-, whereas benign reactive infiltrates are composed of CD20-/CD23-/CD5+/CD43+/CD3+ T-cells. Given the paucity of symptoms in early stages of CLL, a dense lymphoid infiltrate surrounding a cutaneous neoplasm may serve as the first indication of CLL. We report a series of three cases of SCC with a coexisting infiltrate of CLL, including one with perineural involvement, one involving metastatic SCC, and one in which this histologic finding spurred the initial diagnosis of CLL.

[Evaluation of biochemical metabolites by 31P MR spectroscopy in leukemic infiltration of liver]

OBJECTIVE

To evaluate the changes of phosphorus metabolites in leukemic infiltration of liver (LIL) with two-dimensional chemical shift imaging(2D CSI)(31)phosphorus MR spectroscopy ((31)P MRS).

METHODS

Fifteen patients with LIL and 12 healthy subjects (control group) were scanned with liver 2D CSI(31)P MRS by a 1.5T MR Scanner(Sonata, Siemens Corporation). Relative quantification of phosphorus metabolites including phosphomonoesters (PME), inorganic phosphate (Pi), phosphodiesters (PDE) and beta-adenosine- triphosphate (beta-ATP) were detected and after calibrated with model factor, the ratios of PME/PDE, PME/(PME+PDE), PME/ATP, PDE/ATP and Pi/ATP were analyzed.

RESULTS

Compared with control group, the PME value, PME/PDE ratio, PME/(PME+PDE) ratio and PME/ATP ratio were increased in LIL group (1.992 +/-0.876 Compared with 1.167 +/-0.427, P <0.05), (0.551 +/-0.339 Compared with 0.254 +/-0.059,P <0.01), (0.326 +/-0.13 Compared with 0.199 +/-0.049, P <0.01)and (1.402 +/-0.654 Compared with 0.792 +/-0.232, P <0.01) respectively.

CONCLUSION

(31)P MRS examination can be used as a non-invasive procedure to evaluate the changes of phosphorus metabolites of leukemic infiltration of liver. The increase of PME value and its ratios to PDE, ATP and PME+PDE may indicate leukemic infiltration of liver.

Immunohistochemical study of colorectal cancer liver metastases: the immune/inflammatory infiltrate

Our study is focused on the investigation of the immune/inflammatory infiltrate in liver metastases secondary to colorectal cancer. Twenty cases of colorectal liver metastases have been studied, including eight with recurrent metastases occurred after a previous treatment by thermonecrosis (group 1) and 12 with primary metastases treated exclusively by surgery (group 2). The cases were investigated by routine histopathological exam and by immunohistochemistry, using CD3, CD20 and CD68 antibodies. The design of the study envisages a comparative qualitative and quantitative evaluation of the B- and T-lymphocytes and macrophages inside the tumor and at the interface between liver parenchyma and tumor. Student's t-test was used for all statistical comparisons. The qualitative exam revealed, for both groups, the presence of an important T-lymphocyte, and respectively B-lymphocyte cell population at the interface between the tumor and the liver parenchyma, the number of intratumoral cells being extremely reduced. The statistical analysis showed significant differences (p<0.05 for groups 1 and 2, T- and B-lymphocytes, intratumoral vs. peritumoral). However, the comparison of group 1 with group 2 revealed no statistically significant differences between the mean value of intratumoral and peritumoral T- and B-lymphocytes, respectively. The qualitative exam revealed the presence of a well represented macrophage cell population, with a heterogenous distribution from case to case. This finding was confirmed by numerical information, with a lack of a statistically significant difference between the mean number of macrophages quantified intra and peritumoral, for both study groups. However, statistically significant differences were noticed between intratumoral and peritumoral mean value, respectively, for group 1 vs. group 2 (p<0.05). T-lymphocytes are the most numerous, their peritumoral location being the landmark for the histoarchitecture of the immune/inflammatory infiltrate and conducting the immune response developed at the interface between the tumor and liver parenchyma. The quantitative assessment of the immune infiltrate shows similar features in surgically resected metastases and recurrent metastatic disease after thermonecrosis. On the contrary, the quantitative evaluation of the macrophage population indicates a functional association rather with the primary metastasis process than with the recurrent metastatic disorder.

T-Cell Lymphoblastic Lymphoma Presenting with a Breast Mass

Lymphomas secondarily involving the breast are uncommon, although they do represent the largest group of tumors metastatic to breast. A 20-year-old female with lymphoblastic lymphoma (LBL) presented here with 3 month history of weight loss, night sweats, fatigue and a mass in her left breast. Her physical examination revealed a left breast mass, lympadenopathy, bilateral pleural effusion and hepatomegaly. WBC count was 17,710/mm3 and LDH was mildly elevated. Breast ultrasound showed a 1.7 cm mass in the inner lower quadrant of left breast. Biopsy of the breast mass showed diffuse infiltration with small, round atypical cells which did not stain with CD20, CD43, CD34, cytokeratine and were positive for CD3. She was diagnosed as leukemic phase of a precursor T-cell LBL and treated with 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone), intrathecal methotrexate and cranial radiotherapy, achieving a complete response. She then was started on maintenance therapy. Four months later she returned with CNS involvement and was started on induction treatment. She had a very aggressive course of disease and died only 12 months after diagnosis. Breast involvement is very rarely seen in precursor T-cell LBL/ALL and in this patient occurred secondarily as part of widespread disease.

Drug-induced hypersensitivity syndrome with rapid hematopoietic reconstitution during treatment for acute myeloid leukemia

Drug-induced hypersensitivity syndrome (DIHS) is a rare but severe life-threatening, drug-induced, systemic hypersensitivity reaction. We report two patients who developed DIHS during treatment for acute myeloid leukemia. Awareness of DIHS is necessary when systemic eruptions and high fever occur in leukemic patients, especially with rapid hematopoietic recovery after chemotherapies.

Bilateral infiltrative disease of the extraocular muscles: a rare clinical presentation of early stage chronic lymphocytic leukemia

Orbital involvement in chronic lymphocytic leukemia (CLL) is highly unusual and most commonly involves hemorrhage or soft tissue infiltration in advanced disease. We report a case of rapid onset bilateral orbital muscle infiltration as the presenting feature of early stage CLL. In addition, we demonstrate clinico-pathological correlation with an identical chronic B-cell lymphocytic infiltrate in both orbit and bone marrow, with good response of the orbital disease to local radiotherapy.

Isolated extra-medullary relapse of acute leukemia following allogeneic bone marrow transplantation

Isolated extramedullary relapse (IEMR) of acute leukemia (AL) after allogeneic bone marrow transplantation (BMT) is a rare occurrence. It is seen more commonly after BMT than after conventional chemotherapy (CHT) alone. We describe the natural history and response to treatment in four patients with IEMR following allogeneic BMT. The results indicate a stronger graft-versus-leukemia (GVL) effect in the marrow than in the peripheral tissues (Fig. 4, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

Chronic subdural hematoma in a patient with acute myeloid leukemia and dural metastatic infiltration

Dural metastasis (pachimeningeal carcinomatosis) refers to involvement of dura mater and subdural or epidural spaces in systemic cancer. Although dural metastasis are relatively frequent in malignancies, (8-9% of patients with advanced systemic cancer in autopsy), they are rarely associated with subdural hematoma. We present the case of a 66-year-old male, refereed to the hematological unit for severe anemia of unknown cause and diagnosed as acute myeloid leukemia, developed in the 10th day from admission progressive gait disorders with marked imbalance and mental status change. A CT head scan showed a large, chronic subdural hematoma, which was surgically removed. Pathological examination of the dura and cytological examination of the subdural fluid revealed metastatic involvement of the dura, demonstrating the association of dural metastasis and chronic subdural hematoma.

Acute sciatica: an unusual presentation of extramedullary relapse of acute lymphoblastic leukemia

A 10-year-old boy who had been treated for acute lymphoblastic leukemia presented with persistent numbness of the left big toe and progressive pain of the ipsilateral lower leg. He had received allogeneic bone marrow transplantation 3 months after a testicular relapse. He was in hematologic remission at admission but as progressive swelling of his left leg continued, bone marrow relapse developed. A muscle biopsy revealed leukemic infiltrates in the surrounding muscles of the left sciatic nerve, and swelling of the nerve was found on a magnetic resonance imaging scan. His symptoms/signs subsided soon after reinduction chemotherapy. Unfortunately, he didn't survive because of a fungal sepsis that developed during the neutropenic state. This case represents a rare neurologic complication of what is currently an uncommon presentation for relapse of acute lymphoblastic leukemia, with acute sciatica and without coexisting epidural or leptomeningeal leukemia.

Leptomeningeal disease in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the western hemisphere, with an annual incidence of 3:100000. Commonly patients are asymptomatic but not rarely disease progression occurs in the setting of lymphadenopathy and extensive leukemic burden. Leptomeningeal involvement in patients with CLL is infrequent, with presenting symptoms of headache (23%), acute or chronic changes in mental status (28%), cranial nerve abnormalities (54%) including optic neuropathy (28%), weakness of lower extremities (23%) and cerebellar signs (18%). In this report, we discuss a CLL patient with leptomeningeal involvement, who presented with neurological symptoms as the first clinical sign, and a diagnosis of leptomeningeal was made based on CSF cytology and flow cytometry. Treatment consisted of radiation therapy and intrathecal chemotherapy with arabinoside-cytosine and systemic chemotherapy. On the basis of this patient-report together with 37 other previously reported cases, the clinical characteristics together with treatment options and outcome of leptomeningeal involvement in CLL are reviewed. Our case together with data from the literature indicate that a timely diagnosis and intensive treatment of leptomeningeal disease of CLL may lead to longstanding and complete resolution of neurological symptoms.

[Bilateral papilledema secondary to chronic lymphocytic leukaemia]

CASE REPORT

We present the case of a 65-year-old man who was seen in the casualty department complaining of bilateral visual loss. His past medical history was unremarkable except for chronic lymphocytic leukaemia diagnosed two years previously: he was no longer receiving treatment for this disorder. His visual acuity was 20/200 in the right eye and 20/63 in the left eye and he had a bilateral papilledema. Computed tomography and magnetic resonance imaging of the brain and orbit were performed and showed an infiltrative mass in the orbit with extension to the ethmoid bone and both optic nerves. Biopsy of the mass was compatible with chronic lymphocytic leukaemia.

DISCUSSION

Leukaemic infiltration of the optic nerve and central nervous system is a rare complication of chronic lymphocytic leukaemia, although it is common in the acute forms of this disease. Optic nerve infiltration is the most important ophthalmologic manifestation of leukaemia because it threatens vision and it is treatable.

Central nervous system involvement of previously undiagnosed chronic lymphocytic leukemia in a patient with neuroborreliosis

Leukemic involvement of the central nervous system (CNS) in previously undiagnosed chronic lymphocytic leukemia (CLL) is very rare. We report the case of a 62-year-old man with neuroborreliosis in which cytologic, immunocytochemical, and flow cytometry analyses revealed the presence of clonal B-lymphocytes in the cerebrospinal fluid (CSF). After the patient received antimicrobial therapy, his meningeal symptoms cleared up, and the number of cells in the CSF decreased. Monoclonal lymphocytes were still detectable at the same percentage, however, despite systemic chlorambucil therapy. The application of intrathecal dexamethasone therapy led to the disappearance of B-cell CLL (B-CLL) cells in the CSF. We presumed that the neuroborreliosis enabled the transmigration of leukocytes, including B-CLL cells, across the blood-brain barrier via activation of matrix metalloproteinase 9, an enzyme known to open the blood-brain barrier.

Leukaemic infiltration of the mandible in a young girl

BACKGROUND

This report presents a case of leukaemic infiltration of the mandible in a 10-year-old female of Sudanese extraction.

CASE REPORT

The patient was in remission from acute lymphoblastic leukaemia when she presented with pain localized to the alveolar ridge overlying the unerupted lower right second permanent molar. Two days later, she developed right inferior alveolar nerve paraesthesia. Radiographic imaging demonstrated cortical line absence around the developing lower right second and third permanent molars, and distal displacement of the lower right third molar. In addition, the cortical outline of the right inferior dental canal lacked clarity. Biopsy confirmed leukaemia recurrence demonstrating the Philadelphia chromosome. Tailored chemotherapy was commenced, and a bone marrow transplant was carried out 12 weeks later. At 6-month dental review, the patient remained exceptionally well with no bone pain and normal sensation in the right lower lip.

CONCLUSION

The importance of regular and long-term dental examination of patients with leukaemia is discussed.

Oral fludarabine treatment of cutaneous infiltration in a patient with B-cell chronic lymphocytic leukaemia

In B-cell chronic lymphocytic leukaemia (B-CLL), cutaneous infiltration is far less common than in T-cell CLL. However, the effect of fludarabine on cutaneous infiltration in patients with B-CLL is uncertain. We describe a 63-year-old man with B-CLL presenting with cutaneous lesions, who was treated successfully with oral fludarabine. Skin biopsy of one of these lesions revealed diffuse infiltration of uniform lymphocytes. Using PCR analysis, the same immunoglobulin heavy-chain gene rearrangement was found in lymphocytes in all samples (peripheral blood, bone marrow and skin lesion). The patient received four courses of oral fludarabine. Simultaneously with the normalization of the peripheral blood lymphocytosis, the patient became free of the cutaneous infiltration of CLL after four courses of oral fludarabine. Skin lesions had not recurred by the 12-month follow-up examination. To our knowledge, this is the first case of B-CLL leukaemia cutis treated with oral fludarabine. The introduction of fludarabine may contribute to a better outlook for these patients in the future.

Cytogenetics detects infiltrations of a primary cutaneous acute myeloid leukemia to the kidney

Extramedullary manifestations of acute myeloid leukemia (AML) are rare and commonly involve one tissue. We report of a cutaneous acute myelomonocytic leukemia infiltrating the kidney next to the skin. A 61-year-old female patient with complex karyotype cutaneous AML FAB M4 underwent abdominal computed tomography scans. A lesion in her left kidney appeared suspicious of renal carcinoma as confirmed by histology. However, fluorescence in situ hybridization cytogenetics revealed a chromosome 11q23 abnormality in the nephrectomy specimen, which also appeared in the leukemic blasts of skin and bone marrow. Closer histomorphologic workup revealed an infiltration of the kidney with leukemia. This case report illustrates how modern diagnostic procedures can help to reveal rare sites of disease.

Neurologic complications associated with intrathecal liposomal cytarabine given prophylactically in combination with high-dose methotrexate and cytarabine to patients with acute lymphocytic leukemia

Central nervous system (CNS) prophylaxis has led to a significant improvement in the outcome of patients with acute lymphocytic leukemia (ALL). Liposomal cytarabine (Enzon Pharmaceuticals, Piscataway, NJ; Skye Pharma, San Diego, CA), an intrathecal (IT) preparation of cytarabine with a prolonged half-life, has been shown to be safe and effective in the treatment of neoplastic meningitis. Liposomal cytarabine was given for CNS prophylaxis to 31 patients with newly diagnosed ALL. All patients were treated concurrently with hyper-CVAD chemotherapy (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) including high-dose methotrexate (MTX) and cytarabine on alternating courses. Liposomal cytarabine 50 mg was given intrathecally on days 2 and 15 of hyper-CVAD and day 10 of high-dose MTX and cytarabine courses until completion of either 3, 6, or 10 IT treatments, depending on risk for CNS disease. Five patients (16%) experienced serious unexpected neurotoxicity, including seizures, papilledema, cauda equina syndrome (n = 2), and encephalitis after a median of 4 IT administrations of liposomal cytarabine. Toxicities usually manifested after the MTX and cytarabine courses. One patient died with progressive encephalitis. After a median follow-up of 7 months, no isolated CNS relapses have been observed. Liposomal cytarabine given via intrathecal route concomitantly with systemic chemotherapy that crosses the blood-brain barrier such as high-dose MTX and cytarabine can result in significant neurotoxicity.

Repeated relapses of acute myelogenous leukemia in the isolated extramedullary sites following allogeneic bone marrow transplantations

Isolated extramedullary (EM) relapses of acute myelogenous leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) have been reported to be rare, and are usually followed by bone marrow relapses. We report a 49-year-old man with AML with the unfavorable chromosome abnormality 7q-, who was treated by allo-HSCT. Fifteen months after allo-HSCT, the patient initially developed a relapse only in his inguinal lymph nodes, and then bone marrow relapse became evident one month after the EM relapse. Subsequently, the patient received chemotherapy and a second allo-HSCT from another donor, but he suffered another relapse in different EM sites including the skin and central nervous system with a persistently normal marrow. This case is characterized by repeated relapses in isolated EM sites after allo-HSCT and suggests that the anti-leukemic effects of chemotherapy and/or graft-versus-leukemia effects in the EM sites might not be so uniformly effective as that in the marrow. Accordingly, we should be aware that AML relapses can occur repeatedly only in isolated EM sites post allo-HSCT, resulting in treatment failure and a poor prognosis.

[Leukaemia cutis: clinical manifestation of chronic lymphocytic leukaemia relapse]

We present a 71 year old male patient with previous records of Chronic Lymphocytic Leukaemia who presented with a tumoral skin lesion. Histological and immunohistochemical studies confirmed the Leukaemia Cutis diagnosis. The patient underwent treatment with clorambucile and systemic steroids with remision of both haemathological and skin manifestation. The patient is still under close clinical follow up and remission continues eight months so far.

Extramedullary disease and targeted therapies for hematological malignancies—is the association real?

During the past years targeted therapies have gained a major role in the treatment of cancer patients, including those with hematological malignancies. Extramedullary involvement is a rare manifestation of acute and chronic leukemias and of multiple myeloma. Nevertheless, with the expanding use of targeted treatments there is an impression that the incidence of extramedullary relapses is increasing. We reviewed the reports on this phenomenon in patients treated with all-trans-retinoic acid and arsenic trioxide for acute promyelocytic leukemia, thalidomide and bortezomib for multiple myeloma and imatinib for chronic myeloid leukemia. The pathogenetic mechanisms suggested are: life prolongation by these treatments allowing for disease progression arising from dormant cells; poor penetration of the drugs to sanctuary sites like the central nervous system; the requirement of some of these drugs, especially thalidomide, for the marrow microenvironment to exert their action; and finally, a possible active role for some of the drugs, like all-trans-retinoic acid. Since the use of these targeted therapies is expanding we should be aware of this association.

A case of leukemic pleural infiltration in atypical chronic myeloid leukemia

Pleural effusion in chronic myeloid leukemia (CML) is poorly understood and rarely reported in the literature. When the pleural effusion is caused by leukemic pleural infiltration, the differential white blood cell count of the effusion is identical to that of the peripheral blood, and the fluid cytology reveals leukemic blasts. We report here a case of bilateral pleural involvement of atypical CML in an 83-yr old male diagnosed with pancreatic cancer with abdominal wall metastasis and incidental peripheral leukocytosis. Based on bone marrow examination, chromosome analysis and polymerase chain reaction he was diagnosed with Philadelphia chromosome negative, BCR/ABL gene rearrangement negative CML. Following 3 months of treatment with gemcitabine for pancreatic cancer, he developed bilateral pleural effusions. All stages of granulocytes and a few blasts were present in both the pleural fluid and a peripheral blood smear. After treatment with hydroxyurea and pleurodesis, the pleural effusion resolved.

Clinical Presentations and Complications of Hairy Cell Leukemia

HCL typically presents in middle-aged men, and is characterized by splenomegaly and cytopenias. Hepatomegaly may be present, but it usually is not a salient feature. Peripheral adenopathy is uncommon. Other organ manifestations occur, but are unusual. patients are now presenting with a less tumor burden, as a result of earlier diagnosis. Leukocytosis/lymphocytosis should suggest HCl variant. Infectious complications, which were common in the past and the major cause of death, have become rare in the era of purine analog therapy. Whether there is a true increased risk for second malignancies remains controversial.

[Establishment of a nude mouse model of human monocytic leukemia with multi-organ infiltration]

BACKGROUND & OBJECTIVE

Acute leukemia is always accompanied by extramedullary infiltration, which may be the source of relapse. The mechanism of infiltration is unclear yet. This study was to establish a leukemic extramedullary infiltration model for exploring the mechanism.

METHODS

After being treated by splenectomy, cytoxan intraperitoneal injection, and sublethal irradiation, 4-and 6-week old BALB/c nu/nu mice were transplanted intravenously with 5x10(6) or 1x10(7) of SHI-1 human monocytic leukemic cells. The leukemic cells engrafted into the mice were tracked by reverse transcription-polymerase chain reaction (RT-PCR), histopathologic examination, immunohistochemistry, and flow cytometry (FCM).

RESULTS

SHI-1 cells were engrafted in nude mice and infiltrated into the stomach, liver, lungs, brain, kidneys, bone marrow, and so on, and formed green solid tumors in some positions. Autopsy revealed that neoplasms were found in more organs in 4-week old mice than in 6-week old mice. Human CD45-positive cells were detected in the bone marrow of 4-week old mice but not in 6-week old mice.

CONCLUSION

SHI-1 cells can be engrafted in the pretreated nu/nu mice, and this model provides a useful experimental system for the research of leukemic extramedullary infiltration.

Establishment of a nude mice model of human monocytic leukemia with CNS and multiorgan extramedullary infiltration

OBJECT

To establish a human monocytic leukemia model with central nervous system infiltration in BALB/c nude mice.

METHODS

BALB/c nu/nu mice, pretreated by splenectomy, cytoxan intraperitoneal injection, and sublethal irradiation, were transplanted intravenously with human monocytic leukemic cell line SHI-1. The leukemic cells engrafted in the mice were traced by RT-PCR, histopathological examination, immunohistochemistry and FCM.

RESULT

After engraftment of SHI-1 cells in SCI-nu/nu mice, multiple organs were involved and green solid neoplasms were formed in some organs. Paralysis was developed in some mice at both of the rear legs. Histopathological examination found that vertebral and skull bone marrow were replaced by leukemic cells. Leukemic cells penetrated to the surface of vertebrae, forming neoplasm, and entering to the subdural space, but seldom involving in the spinal parenchyma. In the brain, leukemic cells filled in the subdural space and pia-arachnoid, covered the surface of cerebrum, cerebellum and along the virchow-robin space on the surface of pia mater, eventually invading into the brain parenchyma.

CONCLUSIONS

SHI-1 cells could engraft in the SCI-nu/nu mice, creating an efficient and reproducible experimental model of central nervous system leukemia (CNSL) and multiorgan infiltration. This experimental model may be useful for studies on the pathogenesis of CNSL.

Characterization of in vitro migratory properties of anti-CD19 chimeric receptor-redirected CIK cells for their potential use in B-ALL immunotherapy

OBJECTIVE

Cytokine-induced killer (CIK) cells are ex vivo expanded cells enriched in CD3(+)CD56(+) natural killer T (NKT) cells with major histocompatibility-unrestricted cytotoxicity against several tumoral targets, except B-lineage acute lymphoblastic leukemia (B-ALL). We redirected CIK cells cytotoxicity toward B-ALL with a chimeric receptor specific for the CD19 antigen and then explored if modified-CIK cells maintain the same chemotactic properties of freshly isolated NKT cells, whose trafficking machinery reflects their preferential localization into the sites of B-ALL infiltration.

MATERIAL AND METHODS

CIK cells were expanded ex vivo for 21 days and analyzed for expression of adhesion molecules and chemokine receptors regulating adhesion and homing toward leukemia-infiltrated tissues. CIK cells were then transduced with the anti-CD19-zeta-internal ribosomal entry site-green fluorescent protein retroviral vector and characterized for their cytotoxicity against B-ALL cells in a (51)Cr-release assay and for their trafficking properties, including chemotactic activity, adhesion and transendothelial migration, and metalloproteases-dependent invasion of Matrigel.

RESULTS

Similarly to freshly isolated NKT cells, CD49d and CD11a were highly expressed on CIK cells. Moreover, CIK cells expressed CXCR4, CCR6, and CCR7 (mean expression 72%, 60%, and 32%, respectively), presenting chemotactic activity toward their respective ligands. Anti-CD19 chimeric receptor-modified CIK cells became cytotoxic against B-ALL cells (mean lysis, 60%) and showed, after exposure to a CXCL12 gradient, high capacity to adhere and transmigrate through endothelial cells and to invade Matrigel.

CONCLUSION

The potential capacity to localize into leukemia-infiltrated tissues of anti-CD19 chimeric receptor-redirected CIK cells, together with their ability to efficiently kill B-ALL cells, suggests that modified-CIK cells represent a valuable tool for leukemia immunotherapy.

Chronic lymphocytic leukaemia skin infiltrates affecting prominent parts of the face and the scalp

Chronic lymphocytic leukaemia (CLL) infiltrating the skin is uncommon and can present in different forms. We report a case of CLL infiltrating the prominent parts of the face and the scalp. A 63-year-old male with a 10-year history of CLL presented with plum-coloured swelling of the skin of the ears, eyebrows, tip of the nose and the scalp. Histopathology showed dense sheets of lymphoid infiltrate of the dermis which stained positive with B-cell markers CD20 and CD5 in keeping with the infiltrate of CLL.

Early Immunization Induces Persistent Tumor-Infiltrating CD8+T Cells against an Immunodominant Epitope and Promotes Lifelong Control of Pancreatic Tumor Progression in SV40 Tumor Antigen Transgenic Mice

The ability to recruit the host's CD8+ T lymphocytes (T(CD8)) against cancer is often limited by the development of peripheral tolerance toward the dominant tumor-associated Ags. Because multiple epitopes derived from a given tumor Ag (T Ag) can be targeted by T(CD8), vaccine approaches should be directed toward those T(CD8) that are more likely to survive under conditions of persistent Ag expression. In this study, we investigated the effect of peripheral tolerance on the endogenous T(CD8) response toward two epitopes, designated epitopes I and IV, from the SV40 large T Ag. Using rat insulin promoter (RIP) 1-Tag4 transgenic mice that express T Ag from the RIP and develop pancreatic insulinomas, we demonstrate that epitope IV- but not epitope I-specific T(CD8) are maintained long term in tumor-bearing RIP1-Tag4 mice. Even large numbers of TCR-transgenic T cells specific for epitope I were rapidly eliminated from RIP1-Tag4 mice after adoptive transfer and recognition of the endogenous T Ag. Importantly, immunization of RIP1-Tag4 mice at 5 wk of age against epitope IV resulted in complete protection from tumor progression over a 2-year period despite continued expression of T Ag in the pancreas. This extensive control of tumor progression was associated with the persistence of functional epitope IV-specific T(CD8) within the pancreas for the lifetime of the mice without the development of diabetes. This study indicates that an equilibrium is reached in which immune surveillance for spontaneous cancer can be achieved for the lifespan of the host while maintaining normal organ function.

Case report: central neurocytoma with concomitant cerebral involvement by acute lymphatic leukemia

Central neurocytomas are intraventricular tumors composed of round uniform cells. These tumors have usually favorable prognosis. Leukemic infiltrates are occasionally seen as a complication of acute lymphatic leukemia. This report describes a 7-year-old boy who was treated because of diagnosed lymphatic leukemia with central nervous system involvement and concomitant neurocytic tumor located in the fourth ventricle. These two entities might be problematic to differentiate from each other without proper histopathological examination.

[Therapy-resistant cutaneous infiltrates in chronic lymphocytic leukemia]

Chronic lymphocytic leukemia (CLL) is a low-grade B-cell non-Hodgkin lymphoma. Skin involvement is observed in up to 25% of patients. A 70-year-old men with presented with prominent erythematous facial infiltrates. After the diagnosis of CLL was established, he showed a good hematologic response to the monoclonal antibody rituximab, but the skin infiltrates were therapy-resistant.

Cholecystitis Caused by Infiltration of Immature Myeloid Cells: A Case Report

A 59-year-old man with myelodysplastic syndrome who was hospitalized for evaluation of fever and generalized fatigue had elevated levels of C-reactive protein and pancytopenia. A search for a site of infection and empiric treatment with antibiotics were unsuccessful. Over 5 to 6 weeks right upper quadrant pain and rebound tenderness developed. Sonographic Murphys sign was present. Computed tomography showed thickening of the gallbladder wall, and repeated ultrasonography demonstrated changes consistent with cholecystitis. Open cholecystectomy was performed as an emergency procedure. Macroscopically the resected gallbladder showed an edematous and thickened wall. Histopathologic examination revealed transmural infiltration by atypical mononuclear cells with distinct nuclei. The cells showed immunohistochemical staining for CD15, indicating myeloid lineage. By 10 days after surgery, counts of leukocytes and leukoblasts had markedly increased, reaching 36,700/microL and 76.0%, respectively. The blast crisis was thought to indicate progression from myelodysplastic syndrome to leukemia. The patient died of progressive disease 12 days after surgery. We have described a rare case of acute cholecystitis caused by infiltration of immature myeloid cells to the gallbladder. An acute abdomen complicating hematologic disorders is life-threatening and requires prompt and appropriate treatment.