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Introduction
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
The idea that CFS is a cytokine-mediated disorder was strengthened by frequent detection of various T-lymphocyte markers suggesting immune activation. Cytokines are produced when T-lym-phocytes are activated. In 1987 and 1988 I found that HLA-DR and IL-2 receptor levels were increased in some patients, and that many had an increased CD4/CD8 ratio, perhaps indicating inadequate suppression of the immune response, although a subset of CD8 cells measuring numbers of cytotoxic T lymphocytes was frequently elevated. Beta-2 microglobulin, a measure of T-cell receptor turnover, was virtually never increased. I was not able to measure serum neopterin at the time, but other workers have recently reported it to be sometimes elevated.16 Dr. Cheney finds the soluble CD8 receptor to be elevated in about 50% of patients. He states that IL-2R and CD8R levels can be used as measures of disease activity in CFS, perhaps being the elusive “CFS sed rate” many of us have been looking for.
The Non-Hodgkin’s Lymphomas and Plasma Cell Dyscrasias
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Lynne V. Abruzzo, L. Jeffrey Medeiros
Plasma cell myeloma is a progressive disease with a poor prognosis. The median survival with conventional therapy is approximately 3 years. The length of survival is closely related to the stage of the disease at diagnosis. Patients are monitored with periodic determinations of serum and urine M-protein levels, and serum beta-2 microglobulin levels. Elevated levels of serum beta-2 microglobulin are associated with progressive disease and a worse prognosis. Complete remissions are unusual, and patients die of the disease. Infection is the most common cause of death. Renal failure is a contributing factor in many cases.
Case 30
Published in Atul B. Mehta, Keith Gomez, Clinical Haematology, 2017
Bone marrow aspirate and possibly aspirate of the cervical lesion will confirm the diagnosis. A skeletal survey is more sensitive than a bone scan at detecting myeloma deposits and magnetic resonance imaging (MRI) is more sensitive than x-ray. Both the beta-2 microglobulin level and the plasma C-reactive protein give useful prognostic information in myeloma.
Avapritinib for Systemic Mastocytosis
Published in Expert Review of Hematology, 2021
Prithviraj Bose, Srdan Verstovsek
A key concept is that the KIT D816V mutation is not restricted to the neoplastic mast cells, but is also found in other cell types in the bone marrow, e.g. eosinophils, monocytes, thus making it a better indicator of overall disease burden in patients with SM-AHN than traditional measures of mast cell burden, such as serum tryptase levels and the percentage of mast cells in the bone marrow [20–22]. Conversely, several other mutations commonly encountered in myeloid malignancies have been demonstrated in both mast cells and other cell types involved in the AHN in the bone marrow of SM patients [23,24]. Some of these have been found to be prognostically adverse, viz., SRSF2, ASXL1, RUNX1 (the so-called ‘S/A/R’ mutations) [25], EZH2 [26], NRAS [27] and DNMT3A [28]. A number of prognostic models for AdvSM, incorporating just clinical [16] or a combination of clinical and genomic variables [27,29], have recently been published. A recent study by the European Competence Network on Mastocytosis (ECNM) found only age ≥60 years and serum alkaline phosphatase ≥100 U/L to be prognostic for overall survival (OS) in non-advanced SM [16]. Serum beta-2-microglobulin levels have been shown to powerfully predict progression in non-advanced SM [28].
Effect of clinical factors on trajectory of functional performance in patients undergoing hemodialysis
Published in Renal Failure, 2021
Jin-Bor Chen, Lung-Chih Li, Wen-Chin Lee, Sin- Hua Moi, Cheng-Hong Yang
We attempted to determine the association between uremic toxins and trajectory of functional performance in patients undergoing HD. We analyzed this association with the indicators of small uremic solutes and middle molecules in circulation. Our result did not exhibit a positive association between uremic toxins and trajectory of KPS scales in patients undergoing HD, except with BUN and beta-2-microglobulin. In our previous study, we found that BUN was one of the major determinants of functional performance in patients undergoing HD by the classification and regression tree approach [8]. It is well known that HD patients have high beta-2-microglobulin levels [22]. The deposit of beta-2-microglobulin is mainly in musculoskeletal system. The preferential deposition in tendons and bones can result in physical functional impairment [22–24]. Our findings elicit a hypothesized strategy to utilize large-pore hemodialyzers to remove large-size uremic toxins. The effects of improving physical functional impairment by these hemodialyzers in HD patients warrant to be investigated in the future. Our study also implied that holistic evaluation should be taken into account in making decisions for the management of impaired functional performance in patients undergoing HD. It is concerned with not only dialysis adequacy but also other potential contributors in clinical scenario.
Intravascular large B-cell lymphoma in Hispanics: a case series and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Often, diagnosis was delayed or missed due to nonspecific symptoms. Fever of unknown origin (FUO) is the most common systemic symptom in IVLBCL [9]. In general, FUO is a common and challenging clinical condition. Over 200 causes of FUO have been described in the literature. The suspicion for IVLBCL was often low due to its nonspecific symptoms. Similarly, our three patients initially presented with persistent fever without lymphadenopathy. Each of them underwent extensive work-up for infection, autoimmune, and malignancy etiologies before leading to the definitive diagnosis. Interestingly, the common laboratory tests altered in our three cases were severe anemia, thrombocytopenia, hypoalbuminemia, elevated ferritin, ESR, CRP, and serum LDH without sign of hemolysis. Moreover, beta-2 microglobulin was also elevated in the setting of slight monoclonal gammopathy (MG), which gave suspicion for possibility of an underlying lymphoma. As such, the association of MG with B-cell non-Hodgkin’s lymphomas is well known and is not only a highlight of plasma cell disorders. These findings are also common clinical characteristics of IVLBCL in the large study conducted by Murase et al., 2007 [10]. While the presence of MG in diffuse large B-cell lymphoma (DLBCL) predicted an inferior overall survival and progression-free survival [11], prognostic role of MG in IVLBCL is not yet known. In our series, two patients presented with MG and were treated with good outcome. The third patient was not screened for MG as her initial bone marrow evaluation already established the diagnosis of lymphoma.