Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma: A Report of 2 Cases and Literature Review

Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is indolent and progresses more slowly than other malignant lymphomas. The clinical features are not specific and the diagnosis can often be difficult. Here, we present two rare cases of pulmonary MALT lymphoma. Both patients were incidentally found lesions in the lungs with chest computed tomography during physical examination. They were finally diagnosed by pathological biopsy. One received complete resection, the other was treated with chemotherapy. There were no recurrence in the two patients during follow-up. We also review relevant literature to provide a better recognition of this disease.

Primary Extramedullary Plasmacytoma of the Kidney: A Case Report and Literature Review

Extramedullary plasmacytomas (EMPs) usually occur in the upper respiratory tract, the occurrence in the kidney is extremely rare. The present study reported a case of primary renal plasmacytoma in a 46‑year‑old male patient with frequent and urgent urination, nocturia increased due to renal failure. Computed tomography (CT) imaging showed a 60×58mm enhanced mass at the lower pole of the right kidney. Following the radical nephrectomy, histopathological and immunohistochemistry analysis of the resected specimen supported the diagnosis of plasmacytoma. Bone marrow biopsy and total body skeletal survey was performed to demonstrate that there were no evidence of multiple myeloma (MM) and bone lesions. Consequently, a diagnosis of a primary renal EMP was proposed. Subsequently, the patient was treated with 4 course of chemotherapy VAD (vincristine, epirubicin and dexamethasone) + cyclophosphamide + thalidomide, and he was disease-free during 4 years’ follow-up time. The current study also presents a review of the literatures. Treatment of primary renal EMP is surgery, radiotherapy, chemotherapy or a combination of those, even hematopoietic stem cell transplantation may be also an option. Long-term follow-up is a necessity for systemic control due to the possibility to transform into MM.

Plasma Exchange to Treat Cytokine Release Syndrome and Immune Effector Cell-Associated Neurotoxicity Syndrome after Anti-CD19 Chimeric Antigen Receptor-T Cell Infusion: A Case Report

Adoptive cell immunotherapy with chimeric antigen receptor-T (CAR-T) cells has shown remarkable clinical outcomes. However, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are the two most significant toxicities during this therapy and can be life-threatening. We described a 12-year-old juvenile who had been diagnosed with relapsed and refractory B-cell acute lymphocytic leukemia (r/r B-ALL). The patient was recruited into our phase I clinical trial concerning ssCAR-T-19 (anti-CD19 CAR-T cells with shRNA targeting IL-6), and 5*106 /kg of engineered ssCAR-T-19 cells were administered. After infusion, the patient underwent a typical CRS reaction, with fever and increased cytokine levels. He was treated with antipyretic drugs, methylprednisolone, and tocilizumab, but the effect was limited. He developed coagulation abnormalities, multiple organ dysfunction, lung infection and ICANS. Apart from the necessary supportive and symptomatic treatment, plasma exchange was performed three times in four days while methylprednisolone pulse was performed for two consecutive days. After that, the body temperature, heart rate, and especially the cytokine levels declined. But digestive tract hemorrhage occurred to him and he was transferred to intensive care unit. To make things worse, he developed acute respiratory failure and received intubation and mechanical ventilation. In addition, symptomatic treatment such as suppression of stomach acid and anti-infection was given. The bleeding was controlled, and his respiratory function improved, and the CRS and ICANS-related symptoms were relieved. He received extubation and was transferred back to the general ward. Additionally, abone marrow smear showed no lymphoblast cells, and minimal residual disease in bone marrow was negative on day +22 and day +30. The patient was eventually discharged in a normal condition. In conclusion, CRS and ICANS as two most common toxicities after CAR-T therapy, which often cause patient death. Several methods such as anti-IL-6 therapy and/or corticosteroids have been adopted in the management guidelines of CRS and ICANS except plasma exchange. This case shows the validity of plasma exchange in a patient with severe CRS and ICANS after receiving ssCAR-T.

Hepatology Characteristics of patients with cryptogenic cirrhosis: a retrospective study

Backgrounds: This study aimed to achieve a better understanding of the characteristics of patients with cryptogenic cirrhosis (CC). Methods: We retrospectively enrolled 50 patients with CC between January 2018 and December 2020 who were admitted to our hospital. Clinical data, biochemical and immunological parameters, viral markers, imaging findings and liver histopathological features of the patients were analyzed. Results: The percentage of male patients with CC was 58% (29/50). The average age was 54 ± 17 years. Hepatitis C virus (HCV) IgG and hepatitis B surface antigen (HBsAg) were negative for all patients. Hepatitis B virus (HBV) DNA was tested in 68% (34/50) of the patients and the results were undetectable. Ceruloplasmin was detected in 96% (48/50) cases, while 10 cases were Kayser-fleischer ring negative. Immunological tests were conducted in 94% (47/50) of cases, antinuclear antibody (ANA) was elevated in eight cases, whereas anti-mitochondrial antibody (AMA) was elevated in three cases. Liver biopsy was conducted on 11 patients, of which seven were percutaneous and four were transjugular. Immunohistochemistry for HBsAg and HBcAg were all negative. Metavir scoring result showed that six of 11 patients had scores below G2S2. Conclusions: The common laboratory tests especially noninvasive ones were conducted for most of the patients. Diagnosis of CC requires further detection to exclude specific diagnosis such as HBV DNA or intrahepatic covalently closed circular DNA (cccDNA) in HBcAb positive patients, genetic screening of Wilson’s Disease in patients with low ceruloplasmin, etc.

Oral Versus Intravenous Chemotherapy in COVID-19 Epidemic

The novel coronavirus has a significant impact on the routine clinical practice for cancer patients in China since December 2019. During the epidemic in mainland China, especially Wuhan, the intravenous chemotherapies of cancer patients were considerably delayed. Up to now, cancer patients throughout the world directly encounter similar obstacles. For patients who have the right to choose chemotherapeutic regimens with different administration routes, oral drugs can be considered to be applied. In this mini-review, oral chemotherapeutic drugs were compared with intravenous drugs in seven types of tumors. Accordingly, we intended to provide useful suggestions for clinicians to balance the benefits and risks of oral against intravenous chemotherapies and to choose properly substituted oral chemotherapeutic regimens for cancer patients amid the coronavirus disease 2019 (COVID-19) pandemic.

Roles of Toll-like Receptor 3 in Intrauterine Transmission of Hepatitis B Virus in Mothers with High Viral Load

Backgrounds: Despite passive and active immunization, perinatal mother-to-infant transmission (MTIT) of hepatitis B virus (HBV) still occurs in women with high levels of viremia. Thus, understanding the mechanisms of MTIT is essential to prevent MTIT. The aims of this study were to clarify the roles of toll-like receptor 3 (TLR3) in the prevention of hepatitis B transmission in mothers with a high viral load. Methods: Placental samples were collected from 87 HBV-positive pregnant women and 25 normal pregnant women. Choriocarcinoma JEG-3 cell lines were exposed to different HBV viral loads to mimic the trophoblast barrier affected by HBV in the placenta. The mRNA and protein expression levels of TLR3 were analyzed by qRT-PCR and western blotting assays in placenta and JEG-3 cells, respectively. Results: In terms of mRNA and protein expression, the expression of TLR3 in the placenta among the control, low viral load, medium viral load and high viral load groups were significantly different, showing significant upregulation in the medium load and high load groups compared with the control; TLR3 expression in the placenta of the HBeAg-positive group was higher than that in the HBeAg-negative group, and TLR3 expression in the placenta of the infant-infected group was lower than that of the infant-noninfected group. Expression of TLR3 was gradually increased in JEG-3 cells exposed to low HBV viral loads or with shortterm HBV exposure and was decreased in JEG-3 cells exposed to high HBV viral loads or with longterm HBV exposure. Conclusions: TLR3 contribute to HBV intrauterine infection in mothers with a high viral load and, importantly, prevents mother-to-infant transmission.

Clinical Progress of Adjuvant Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

Concurrent chemoradiotherapy (CCRT) is the foundational standard-of-care for patients with locoregionally advanced nasopharyngeal carcinoma (LANPC). Adding adjuvant chemotherapy (AC) or induction chemotherapy (IC) to CCRT has been shown to benefit LANPC patients. During recent five years, large numbers of prospective randomized controlled clinical trials have demonstrated the superior efficacy of IC+CCRT than CCRT alone in LANPC patients. However, prospectively designed studies concerned with AC are limited. The efficacy of CCRT+AC in treating LANPC remains unclear. For better understanding and more properly clinical usages of AC, we reviewed the studies of CCRT+AC in the treatments for LANPC patients. In summary, adding AC to CCRT is a feasible therapeutic strategy for patients with EBV positive LANPC.

Human Glioma Nude Mouse Xenograft Model in situ

Backgrounds: Surgery and chemotherapy are difficult because of the specific location of the glioma. The establishment of a suitable in situ model of glioma is the premise of the treatment of glioma. 8 week-old female BALB/c nude mice were chose to establish the glioma model. Methods: For the orthotopic glioma mice model, 1 × 105cells/5 μL U87-MG-Luc or U87-MG cells which were trypsinized and resuspended in sterile PBS were slowly injected into the right corpus striatum (1.8 mm lateral, 0.6 mm anterior to the bregma and 3.0 mm in depth) by a stereotactic fixation device using a mouse adaptor. Results: The othotopic U87 glioma mice model identified by imaging on IVIS Spectrum and magnetic resonance imaging after 2 weeks from surgery. H&E-stained tumor sections in brain of the mice model were also observed. Conclusions: After identification, the glioma mouse xenograft in situ model obtained could be used in the evaluation system of therapeutic drugs or methods.