The biological environment of Hodgkin's lymphoma and the role of the chemokine CCL17/TARC

Hodgkin's lymphoma is a lymphoproliferative disease, which differs in its morphology and therapeutic response from other lymphomas. Neoplastic cells represent only a minor cell population of the tumour, while the major part of the tumour is formed by inflammatory cells. It results from the production of cytokines and chemokines both by neoplastic cells and by inflammatory cells. An important prognostic marker in Hodgkin's lymphoma appears to be the chemokine (C-C motif) ligand 17 (CCL17), also known as thymus and activation-related chemokine (TARC). This chemokine is expressed by many cell types and tissues, and in the case of Hodgkin lymphoma, also by Reed-Sternberg cells. CCL17/TARC binds to chemokine receptors CCR4 and CCR8 and displays chemotactic activity for T lymphocytes and some other leukocytes. The understanding of biological pathways in Hodgkin's lymphoma could be important for monitoring of disease activity and for the development of future targeted therapy.

[Cefepime as an empiric treatment of febrile neutropenia in patients after high dose therapy and autologous stem cell transplantation]

BACKGROUND

Febrile neutropenia is one of the most frequent complications in intensively treated hematooncological patients and almost inevitably occurs after high dose therapy and autologous stem cell transplantation. Empiric broad-spectrum antibiotic treatment is indicated in the initial management. Fourth-generation cephalosporins are the option. This retrospective study was initiated to assess efficacy and safety of cefepime as an empiric therapy of febrile neutropenia following high dose therapy and autologous stem cell transplantation.

METHODS AND RESULTS

319 high dose therapy procedures with autologous stem cell transplantation in 287 patients mostly with hematological malignancies were performed at our department between January 2002 and December 2005. We present analysis of 169 out of 229 febrile episodes in 163 patients (median age 53) being treated with cefepime in the initial empiric treatment of febrile neutropenia. 12 episodes (7.1 %) were clinically documented (pneumonia 9, sinusitis 2, acute cholecystitis 1), 60 (35.5 %) were confirmed microbiologically (presented as bacteremia) and 97 (57.4 %) were fever of unknown origin. 50 isolates (83.4 %) out of 60 microbiologically documented infections were G-positive bacteria, 8 isolates (13.3 %) were G-negative bacteria and 2 (3.3 %) were mixed G-positive and G-negative cultures. According to the MASCC score 14 episodes were assessed as high risk. Effect of cefepime as a single agent was observed in 85 episodes (50.3 %) and in 22 (13.0 %) episodes treated with combination therapy due to susceptibility of isolated pathogen in blood culture. Combination therapy of two antibiotics (cefepime + aminoglycoside or glycopeptide) given for persistent fever was effective in 13 patients (7.7 %). Treatment failure was observed in 48 (28.4 %) episodes, we registered 10 death.

CONCLUSIONS

Therapy with cefepime represents an appropriate choice for empiric antibiotic treatment of febrile neutropenia in hematooncological patients. Cefepime demonstrates clinical safety and efficacy and can be used in monotherapy or in combination with other drugs (overall response 72.2 %, as a single agent 50.3 %).