Dopamine-induced lymphoma cell death by inhibition of hormone release

Concomitant Primary CNS Lymphoma and FSH-Pituitary Adenoma Arising Within the Sella. Entirely Coincidental?

BACKGROUND AND IMPORTANCE: Collision tumors are the simultaneous occurrence of more than one type of neoplasm within an anatomic space. In the pituitary sella, collision tumors are exceedingly rare, and not much is known about their etiology and prognosis.

CLINICAL PRESENTATION: A 74-year-old man presented with a concomitant primary pituitary lymphoma (diffuse large B-cell non-Hodgkin's lymphoma; DLBCL) and follicle-stimulating hormone (FSH)-adenoma diagnosed histologically after clinical features of apoplexy prompted urgent surgical decompression and resection. Strong immunoreactivity for FSH by the lymphoma was evident. Full-body workup demonstrated no other source for the lymphoma. He subsequently underwent 4 cycles of chemotherapy and has been in remission for over 32 months. His ophthalmoplegia at presentation persisted with no further deficits.

CONCLUSIONS: Four cases of collision tumors of primary pituitary lymphoma and adenoma have previously been reported. This case represents the first combination of an FSH-adenoma and a DLBCL in the literature. Prompt involvement of the hematology-oncology team contributed to the good outcome seen in this case. The putative role played by pituitary hormones in tumorigenesis is reviewed in this case report. The association is either a chance occurrence or due to the induction of lymphoma cell proliferation by the binding of FSH produced by the adenoma to the FSH receptors on the lymphoma cells.

Multinomial modeling and an evaluation of common data-mining algorithms for identifying signals of disproportionate reporting in pharmacovigilance databases

MOTIVATION

A principal objective of pharmacovigilance is to detect adverse drug reactions that are unknown or novel in terms of their clinical severity or frequency. One method is through inspection of spontaneous reporting system databases, which consist of millions of reports of patients experiencing adverse effects while taking one or more drugs. For such large databases, there is an increasing need for quantitative and automated screening tools to assist drug safety professionals in identifying drug-event combinations (DECs) worthy of further investigation. Existing algorithms can effectively identify problematic DECs when the frequencies are high. However these algorithms perform differently for low-frequency DECs.

RESULTS

In this work, we provide a method based on the multinomial distribution that identifies signals of disproportionate reporting, especially for low-frequency combinations. In addition, we comprehensively compare the performance of commonly used algorithms with the new approach. Simulation results demonstrate the advantages of the proposed method, and analysis of the Adverse Event Reporting System data shows that the proposed method can help detect interesting signals. Furthermore, we suggest that these methods be used to identify DECs that occur significantly less frequently than expected, thus identifying potential alternative indications for these drugs. We provide an empirical example that demonstrates the importance of exploring underexpected DECs.

AVAILABILITY

Code to implement the proposed method is available in R on request from the corresponding authors.

CONTACT

kjell@arboranalytics.com or Mark.M.Gosink@Pfizer.com

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Haloperidol and spiperone potentiate murine splenic B cell proliferation

The neuroleptics haloperidol and spiperone potentiated anti-mu induced murine B-lymphocyte proliferation in vitro and lowered the threshold of anti-mu antibody needed to trigger proliferation. Because haloperidol and spiperone are best known for actions at D2, 5HT2, alpha 1 and sigma (sigma) receptors, a series of agonists and antagonists of these receptors were tested. Dopamine and norepinephrine inhibited, and serotonin (5HT) enhanced B-cell proliferation. Spiperone opposed the suppression of proliferation by dopamine and norepinephrine. However, antagonists of D1, D2, D3, D5, 5HT2, 5HT1A, and alpha 1 receptors did not mimic the effect of haloperidol and spiperone. Furthermore, a series of sigma agonists failed to affect B-cell proliferation. Therefore it is likely that the effects of haloperidol and spiperone are not due to actions at known dopamine, 5HT, alpha 1, or sigma receptors. These findings indicate neuroleptics act not only in the CNS, but also directly on B-lymphocytes of the immune system. The pharmacological site of this action is not clear at this time.