Outcome of enzyme replacement therapy in patients with Gaucher disease type I. The Romanian experience

AIM

This study reports the first evaluation of therapeutic response in Romanian patients with Gaucher disease type I, after therapy with Cerezyme recently became available in our country.

PATIENTS AND METHODS

24 patients (11-50 years) received Cerezyme 20-60 U/kg every two weeks for at least 18 months. Haemoglobin, platelet count, volume of the liver and spleen, plasma chitotriosidase and the severity score were assessed every 6 months; skeletal radiography and osteodensitometry were also monitored.

RESULTS

Eleven patients were splenectomized before start of therapy. Eight patients had anaemia (mean haemoglobin 9.4 g/dl) and 14 patients, of whom 13 were without splenectomy, had thrombocytopenia (mean 65,692/mm3). Haemoglobin values normalized after 6 months and the platelet count increased to 147,818/mm3 after 18 months of treatment. Splenomegaly improved (mean 13.8x to 5.6x normal), hepatomegaly improved (mean 1.4x to 1.06x normal), the severity score decreased (mean 15.9 to 8.4), plasma chitotriosidase levels showed a reduction from 40,956 to 11,266 nmol/h per ml plasma. Bone disease improved clinically in all patients; bone radiography and osteodensitometry showed no further disease progress. We observed a mean weight gain of 4.3 kg, an improvement in quality of life, and the absence of therapeutic adverse events.

CONCLUSIONS

Enzyme replacement therapy administered for 18 months in Romanian patients with Gaucher disease type I led to a marked improvement in haematological parameters and hepato- and splenomegaly. In the majority of patients we observed no further progress of bone disease; for an improvement in skeletal disease, a longer treatment period is required.

[Acute diffuse peritonitis of a rare cause]

The authors report a rare case of acute onset of non-Hodgkin lymphoma with diffuse peritonitis due to bowel perforation of secondary jejunal involvement. The admission diagnosis in the 18-years-old male with acute abdominal pain for 4 days, guarding on physical examination and pneumoperitoneum on abdominal ultrasonography was peptic ulcus perforation. The palpable splenomegaly and cervical lymph nodes on ultrasonography examination might have raised suspicion of lymphoma. Surgical exploration revealed the peritonitis origin--jejunal perforation, proximal to a stenosing tumor, a gastric tumor and confirmed the splenomegaly. Small bowel resection--end to end anastomosis--and gastric tumor biopsies were performed. The pathological diagnosis was diffuse large B-cell non-Hodgkin lymphoma. Some therapeutic considerations on digestive tract secondary lymphoma are made.