Cytogenetic Subclone Burden: A New Biomarker Predicting Chronic Lymphocytic Leukemia Patients Outcome

BACKGROUND

Chronic lymphocytic leukemia is the most prevalent adult leukemia that occurs in older patients and presents a variable course of the disease. Risk stratification of CLL is a matter of continuous improvement. Thus, this study aimed to assess the impact of the quantification of 17p del and 11q del cytogenetic subclones on the outcome of patients with chronic lymphocytic leukemia.

PATIENTS AND METHODS

This is a prospective study that involved 100 subjects with CLL. For all included patients; assessment of the cytogenetic subclones burden for 17p del and 11q del using the FISH technique was carried out.

RESULTS

CLL patients with a high 17p del (>33%) cytogenetic subclone burden showed significantly shorter lymphocyte doubling time (LDT), time to first treatment (TTFT), and progression free survival (PFS) compared to those with a lower burden. On contrary 11q del subclone(>30%) burden had an insignificant impact on LDT, TTFT and PFS.

CONCLUSION

Quantification of 17pdel burden (>vs.≤33%) could be used for refining risk stratification of CLL patients.

Primary Pulmonary Synovial Sarcoma with Hemothorax: a Case Report

Background

Synovial sarcoma is a rare and aggressive soft tissue malignancy most commonly arises from periarticular tissue of the extremities. Although several cases in the literature have reported different origins, primary pulmonary synovial sarcoma (PPSS) is an exceedingly rare and underrecognized entity, accounting for 0.5% of all lung malignancies. Clinical presentation includes chest pain, dyspnea, cough, and hemoptysis. The finding of hemothorax is a rare presentation and was barely reported in the literature. Due to its rarity and aggressive nature, the optimal treatment is unclear, while the mainstay remains surgical resection with chemo- and/or radiation therapy.

Objective

To report a case of hemorrhagic effusion subsequently diagnosed with primary pulmonary synovial sarcoma with the main objective of enriching the literature regarding this rare malignancy.

Case report

A 52-year-old male smoker with a background of coronary artery disease, hypertension, and diabetes mellitus was referred to our hospital. The patient presented with a history of chest pain, dyspnea, and massive right-sided pleural effusion. Laboratory investigations were unremarkable except for anemia. Chest x-ray showed a complete opacity on the right lower zone with right-sided pleural effusion. Thoracentesis was done and revealed hemorrhagic exudative effusion. Computed tomography (CT) scan showed a right heterogeneous lung mass compressing the medial segment of the middle lobe. Subsequently, the patient underwent bronchoscopy, which showed compression and edema on the right middle lobe bronchus with traces of blood coming from the right lower lobe. The patient underwent a right posterolateral thoracotomy, a fungating mass eroding the medial segment of the middle lobe was resected that was diagnosed as high-grade primary pulmonary synovial sarcoma. Radiotherapy was instituted. The patient died after two years due to recurrence.

Conclusion

PPSS is an aggressive disease with poor prognostic outcomes, and Its presentation is almost similar to other lung malignancies. Meanwhile, there is no definitive management guideline, and most management depends on surgical resection if feasible with adjuvant chemo-radiation therapy.

Acute pulmonary embolism in a child following SARS-CoV-2 infection: a case report

In children, coronavirus disease 2019 infection is rarely symptomatic. Severe forms with respiratory distress are rare, thromboembolic complications are exceptional. We report a rare case of a 14 years old girl with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who was admitted to the hospital for bilateral pulmonary embolism with intracardiac thrombus. The girl progressed well on anticoagulation.

FRI0028 JAK2 MUTATION MAY PREDICT RESPONSE AND GUIDE FIRST LINE TREATMENT IN RHEUMATOID ARTHRITIS

Background:

JAK2 mutation found to be associated with the myeloproiferative disorders[1] with possibility of measurement in blood by PCR[2] . There are many interesting parallels between the CTDs and MPDs[3] . STAT4 is activated by the JAK members as JAK2 in response to IL and TNF, with subsequent down-stream signaling for autoimmunity[4] . JAK inhibitorsare medications function by inhibiting activity of Janus kinase enzymes and have therapeutic application in treatment of cancer and rheumatoid arthritis[5] .

Objectives:

Impact of pretreatment JAK2 mutation on response to first line csDMARDS in RA.

Methods:

76 newly diagnosed RA patients and 50 matched controls were included. Pretreatment JAK2 mutation was measured in serum by PCR with TNF-α and IL 6 were assessed by ELISA in patients and controls. All patients started treatment by conventional synthetic DMARDs (including methotrexate). Response assessment at 3rdmonth was evaluated by DAS28 and ACR response criteria. JAK2 mutation was correlated with different clinical and laboratory parameters of patients.

Results:

62 females (81.6%) and 14 males (18.4%) with age mean ± SD; (48.8 ± 7.3). Pretreatment JAK2 mutation, TNF-α and IL 6 were significantly high in patients. JAK2 mutation was detected in 39 (51.3%) patients while 37 (48.7%) patients were JAK2 non mutant. Mutant JAK2 was significantly associated with severity of disease assessed by DAS28; 14 (70%) of patients with DAS28 (≤2.6) were non mutant JAK2 versus sex (30%) patients mutant JAK2 while 13 (76.5%) of patients with DAS28 (>5.1) were mutant JAK2 versus four (23.5%) patients non mutant JAK2 (P 0.03),table1. JAK2 mutation found to be significantly correlated with ACR 20, 50 and 70 response criteria; 40% of patients with non mutant JAK2 showed ACR 70 versus 17.9% in mutant group, 35.1% of patients with non mutant JAK2 showed ACR 50 versus 30.8% in mutant group while 24.3% of patients with non mutant JAK2 showed ACR 20 versus 51.3% in mutant group (P 0.02),table1. JAK2 mutation was associated with high pretreatment TNFα (mean±SD; 41.7±39.5 in mutant versus 24.3±23.04 pg/ml in non mutant group) with P (0.04), while no significant relation between JAK2 mutation and pretreatment IL6 level.

Conclusion:

Adult SLE with pretreatment JAK2 mutation significantly showed high disease activity, high pretreatment TNFα level and poor response to 1st line csDMARDs including MTX so they could get benefit with introduction of JAK inhibitors as first line mono or in combination with csDMARDS especially those with moderate to severe active RA.

References:

[1]Koppikar, P. and R.L. Levine,JAK2 and MPL mutations in myeloproliferative neoplasms.Acta Haematol, 2008.119(4): p. 218-25.

[2]Baxter, E.J., et al.,Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders.Lancet, 2005.365(9464): p. 1054-61.

[3]McQueen, F.M. and N. Dalbeth,Will Jill come tumbling after? The case for a JAK2-type mutation as a prequel to the connective tissue disorders.Med Hypotheses, 2009.73(5): p. 651-4.

[4]Watford, W.T., et al.,Signaling by IL-12 and IL-23 and the immunoregulatory roles of STAT4.Immunol Rev, 2004.202: p. 139-56.

[5]Norman, P.,Selective JAK inhibitors in development for rheumatoid arthritis.Expert Opin Investig Drugs, 2014.23(8): p. 1067-77.

Table 1.

JAK2 mutation with disease activity and response criteria.

DAS28Non Mutant JAK2Mutant JAK2XPRemission (≤ 2.6)14 (70%)6 (30%)8.60.03Low disease activity (≤ 3.2)13 (54.2%)11 (45.8%)Moderate disease activity (3.2 - 5.1)6 (40%)9 (60%)Sever disease activity (>5.1)4 (23.5%)13 (76.5%)ACRNon Mutant JAK2Mutant JAK2ACR 209 (24.3%)20 (51.3%)7.00.02ACR 5013 (35.1%)12 (30.8%)ACR 7015 (40.5%)7 (17.9%)

Disclosure of Interests:

None declared

Prosthetic thrombosis and coronary embolism during pregnancy: a delicate situation of antithrombotic therapy management

Mechanical heart valve thrombosis is not so rare in pregnant women because of the difficulties in managing anticoagulant treatment and the hypercoagulability state associated with pregnancy. Among the embolic complications of valve prosthetic thrombosis, the coronary embolism is rare, it requires an urgent pharmaco-invasive approach which must be adapted to this particular associated condition. We report the observation and the difficulties of managing antithrombotic therapy in a pregnant patient hospitalized for non-obstructive prosthetic valve thrombosis complicated by coronary embolism and resulting in ST elevation myocardial infarction.

Aflatoxins as a risk factor for hepatocellular carcinoma in Egypt, Mansoura Gastroenterology Center study

BACKGROUND/AIMS

Aflatoxin B1 (AFB1) is an important food-borne mycotoxin. The co-contamination of foodstuffs with this mycotoxin is well known and has been possibly implicated in the development of hepatocellular carcinoma in high risk regions around the world. This study investigates the serum aflatoxin B1 in patients with hepatocellular carcinoma and compares it to a control group.

METHODOLOGY

From January 2005 to January 2006, 80 cases with hepatocellular carcinoma diagnosed in the Gastroenterology center, Mansoura University, Egypt and 20 healthy subjects used as a control group were enrolled in the study. All patients were evaluated for age, sex, residence, occupation, history of other medical diseases, anti-bilharzial treatment, blood transfusion, viral markers, liver functions and serum level of aflatoxin B1.

RESULTS

The mean age of our patients was 52.88 +/- 7.27 years versus 53.17 +/- 6.78 years for the controls, p>0.05. The serum level of AFP1 was highly significant in HCC patients compared with control (32.47 +/- 92.46 versus 7.33 +/- 5.5 P<0.0001) and it was statistically high between 51:60-years-old (P<0.05). Males represented 82.5% of the patients versus 17.5% for females. AFB1 was higher in males compared with females (P<0.05), higher in rural residents compared with urban residents (P<0.05), higher in Kafer Elchek government are versus others (P<0.01) and higher in farmers compared with those with other occupations (P<0.05). The serum level of AFB1 was high among patients with a history of anti-bilharzial treatment with tarar emetic versus oral treatment by Brazequantil (P<0.05). Hepatitis C antibody was positive in 70% of the patients. The serum level of AFB1 was statistically high in HCV-positive patients compared with HCV-negative ones (P<0.05) but showed no statistical significance in HBs-positive patients compared with HBs-negative ones (P>0.05). The serum level of AFB1 was statistically high in Child class B patients compared with class A (P<0.05), high in patients with tumor size > 5 cm compared with tumor size < 5 cm (P<0.05), high in right lobe tumor patients compared with left lobe tumor (P>0.05), high in multifocal hepatoma patients compared with single lesion patients (P<0.05). The serum level of AFB1 showed a statistically significant positive correlation with serum SGPT and alpha-fetoprotein.

CONCLUSIONS

Aflatoxin B1 may play an important role in the occurrence of HCC in the north Nile delta area and especially in males, farmers, and rural residents, HCV infection, cirrhotic liver and multifocal hepatoma patients. Aflatoxin B1 in high concentration is associated with high incidence of chronic HCV, and affects hepatic parenchyma and multifocal lesions.

[Appendicitis and advanced pregnancy. Apropos of 3 cases in the National Hospital of Niamey, Niger]

Acute appendicitis during pregnancy is uncommon but a serious situation even in developed countries with imaging and laboratories' poor means. Failure to diagnose this disease during advanced pregnancy exposes foetus and mother to serious complications. In this atypical clinical picture associated with non-significant biologic sign only using sonogram can help to early diagnosis. In our developing countries where obstetrical exam was performed by paramedical or general doctor, in doubt the patient must be transferred in medical centre with a capacity of imaging or laboratory exams. Surgical treatment must be undertaken after surgeon, obstetrician, and other physicians's consultation. Antibiotic and tocolytic treatments are urgent. In this study, all babies were lost by premature labour occurred after surgery.

Transcriptional activation of the interleukin-8 gene by respiratory syncytial virus infection in alveolar epithelial cells: nuclear translocation of the RelA transcription factor as a mechanism producing airway mucosal inflammation

The most common cause of epidemic pediatric respiratory disease, respiratory syncytial virus (RSV), stimulates interleukin-8 (IL-8) synthesis upon infecting airway epithelium, an event necessary for the development of mucosal inflammation. We investigated the mechanism for enhanced IL-8 production in human A549 type II pulmonary epithelial cells. Infection with sucrose-purified RSV (pRSV) produced a time-dependent increase in the transcriptional initiation rate of the IL-8 gene. Transient transfection of the human IL-8 promoter mutated in the binding site for nuclear factor-kappaB (NF-kappaB) demonstrated that this sequence was essential for pRSV-activated transcription. Gel mobility shift assays demonstrated pRSV induction of sequence-specific binding complexes; these complexes were supershifted only by antibodies directed to the potent NF-kappaB transactivating subunit RelA. Both Western immunoblot and indirect immunofluorescence assays showed that cytoplasmic RelA in uninfected cells became localized to the nucleus after pRSV infection. RelA activation requires replicating RSV, because neither conditioned medium nor UV-inactivated pRSV was able to stimulate its translocation. We conclude that RelA undergoes changes in subcellular distribution in airway epithelial cells upon pRSV infection. The ability of replicating RSV to activate RelA translocation may play an important role in activating IL-8 and other inflammatory gene products necessary for airway mucosal inflammation seen in RSV disease.

Study of interleukin-2 receptor in schistosomiasis mansoni and its analogous changes in collagen diseases and schistosomal arthropathy

An enzyme linked immunosorbent assay was used to quantify soluble interleukin-2 receptor (sIL-2R) in the serum of patients with different stages of S. mansoni infection, rheumatoid arthritis, systemic lupus erythematosus (SLE) and schistosomal arthropathy. The results demonstrated significant higher level of sIL-2R in different patient groups compared to the control group. The highest level of sIL-2R was recorded in hepatosplenic schistosomiasis complicated with ascites. The difference was statistically significant compared to other groups. There was no significant difference in sIL-2R regarding rheumatoid arthritis and SLE. Schistosomal arthropathy group showed significant higher level of sIL-2R compared to rheumatoid arthritis, SLE and early S. mansoni infection while the difference was insignificant compared to hepatosplenic schistosomiasis without ascites.

Critical analysis of an epidemetrons model for the assessment of bancroftian filariasis endemicity in some areas in Egypt

This study attempted a trial fit of observed epidemiological data in Egypt using the Sasa-WHO-Southgate epidemetrons model to quantify the endemicity and risk of transmission of filariasis. The geometric and arithmetic means (GM, AM) were tried in addition to the recommended four epidemetrons of the model, prevalence rate (PR); median microfilaria density (MfD50); and linear regression coefficients (a and b). Data were based on microfilaria counts in 20 mm3 finger-prick night blood samples from all individuals 6 years of age and older of both sexes in a cluster of eight filaria-endemic villages. The study results showed that the model fits satisfactorily in each individual village but major discrepancies occurred when comparisons were made between the villages. PR was closely but by no means perfectly correlated with MfD50, was more closely correlated with GM but less with AM, and showed a rather weak negative correlation with each of a and b by linear regression and by rank order. A possible explanation for these discrepancies is that in areas of recent importation or increase of transmission of filariasis and in areas of great population mobility, observed microfilaria prevalences and microfilaria intensities will not conform to the PR, MfD50, a and b epidemetrons recommended by Sasa (1967), WHO (1967) and Southgate (1974) as descriptive epidemetrons of microfilaraemia. Further studies are warranted.

A placebo-controlled double-blind trial for the treatment of bancroftian filariasis with ivermectin or diethylcarbamazine

Therapeutic efficacy and clinical side-effects of ivermectin (single dose of 100 micrograms/kg) and diethylcarbamazine (DEC) (3 mg/kg for one day, then 6 mg/kg daily for 12 d) were evaluated for microfilaricidal effect in Bancroftian filariasis. Seventy-one microfilaraemic consenting adult male patients (greater than or equal to 100 microfilariae (mf)/ml) were randomly assigned to receive ivermectin, DEC or placebo and kept in hospital for 15 d. Those receiving placebo were treated with ivermectin on day 9. Ivermectin (19 'double-blinded' and 22 'unblinded' patients) caused an abrupt reduction in mf count to 1.5% of the pre-treatment level 12 h after drug administration and to 0.06% on day 14, with recrudescence to 1.8% after one month and to 9.2% after 3 months. DEC (30 patients) caused a gradual drop in mf count to 1.1% of the pre-treatment level on day 14, which increased to 2.4% after one and 3 months. The total scores of side-effects were 77 (1%), 305 (2.1%) and 311.5 (3.0%) for placebo, ivermectin and DEC respectively; the differences between DEC or ivermectin and placebo were statistically significant. Ivermectin produced lower side-reaction scores than DEC and the differences were highly significant at the 95% confidence level. Side-effects were mainly headache and body aches in the ivermectin patients, which appeared as early as 4 h after drug administration, resolved within 36 to 48 hours, and were significantly related to mf densities. Side-effects in DEC patients were mainly testicular and epididymal pain and swelling, unrelated to mf densities, which began at day 2 and continued to day 7.(ABSTRACT TRUNCATED AT 250 WORDS)

A quantitative approach to the relationship between Wuchereria bancrofti microfilaria counts by venous blood filtration and finger-prick blood films

Counts of nocturnally periodic Wuchereria bancrofti microfilariae (mf) in 20 mm3 finger-prick blood films were compared with membrane counts after filtration of 1 ml of venous blood for their efficacy in determining the prevalence of Bancroftian filariasis. The technique used for spreading and staining the blood films was critically important to the sensitivity of this screening procedure. There was good agreement between the 2 methods. Four statistical approaches were used to measure the correlation between the 2 sampling methods: 2 linear regression methods using untransformed and transformed data, and 2 non-parametric rank correlation methods. Based on the statistical analyses, this study strongly supports the general observation that finger-prick blood samples tend to contain more mf than equivalent volumes of venous blood, at mf densities high enough to be detectable by the finger-prick technique. It also demonstrates that finger-prick samples provide good estimates of mf densities and prevalence of infection except in areas of very low mf densities, where the membrane filtration method would provide a more accurate estimate of prevalence. Regression analyses using untransformed and transformed data, and the rank correlation tests, demonstrated a strong statistically significant correlation (P less than 0.001) between venous and finger-prick mf counts.