Advani et al reported that CsA was associated
Advani et al. reported that CsA was associated with good overall and durable responses. Although the mechanism remains unclear, CsA may inhibit the function of T cells, including their production of cytokines involved in the progression of AITL. Consequently, immunosuppressive therapies might exacerbate EBV infection and the occurrence of secondary cancer. Targeted therapies, such as rituximab, might have a potential role in the treatment of AITL. Rituximab may eradicate EBV-B atr inhibitor and activated B cells, and may prevent the progression to AITL. However, the authors of a multicenter phase II trial conducted by the Groupe d\' Etude des Lymphomes de l\' Adulte concluded that R-CHOP did not improve prognosis as compared with standard CHOP. EBV infection and proliferation of EBV-B cells are usually detected in patients with AITL, especially in advanced stages of the disease. These clinical features are thought to occur secondary to immunodeficiency. Zhou et al. reported that a higher tissue EBV load was correlated with disease progression and B cell clonality. Delfau-Laure et al. reported that a higher EBV load tended to be associated with a shorter progression-free survival, although the presence of EBV copies in peripheral blood mononclear cells (PBMC) was not associated with the response to R-CHOP.
We should discuss whether the presence of EBV-DNA in PBMC is more useful than repeated lymph node biopsy for determining the optimum salvage strategy at the time of relapse. EBV is generally detected at the initial diagnosis of AITL in most patients. Therefore, the detection of EBV-DNA in PBMC, alone, may be insufficient to determine the treatment starategy at relapse. If EBV-DNA in PBMC is negative or if its level is low at initial diagnosis of AITL, and if a higher EBV load is detected in these patients at relapse, these observations might indicate EBV infection/reactivation and proliferation of EBV-B cells, consistent with disease progression. However, EBV-positive lymphoproliferative disorder or diffuse large B-cell lymphoma were reported in some patients with AITL. Therefore, although repeated lymph node biopsy is invasive, it should be considered for patients with AITL who have high EBV loads or if expansion of B cells and/or EBV-B cells is suspected at relapse. The results of such tests may also help clinicians to differentiate between AITL and other EBV-positive disorders.
It is well demonstrated that chronic Hepatitis C Virus (HCV) infection can be associated to non-Hodgkin\'s lymphoma (NHL) and that antiviral treatment can produce NHL regression in HCV-related forms. We observed a case of Smoldering Multiple Myeloma (SMM) and hepatitis C in which a clear regression of SMM followed successful antiviral treatment. In a 54 year old woman routine blood tests revealed, in January 2005, a monoclonal IgG-k (1.87g/dl). Bence Jones protein (BJ) was positive, with free k light chains 1.20g/24h. No bone lesions were found and the bone marrow biopsy showed 20% plasma cell infiltration, restricted for kappa light chains. Renal function was normal while alanine transaminase (ALT) and aspartate transaminase AST) were elevated. An increased level of AST, ALT and gamma-glutamyl transpeptidase (GGT) was indeed present since 1985, but further investigations were not previously performed.