No abstract

Summary.-The receptor patterns of cell suspensions from 29 cases of non-Hodgkin lymphoma were correlated with the histology of the nodes from which the cells were taken. Twenty-two were judged to be predominantly or largely B-cell, and because of this preponderance these were divided by a method based on the distribution of surface immunoglobulin and the expression of Fc and C3 receptors." Mature " B-cell and B-mixed tumours showing capping surface Ig with Fc and/or C3 receptors correlated well with a nodular growth pattern, and consisted of what Rappaport (1966) calls "poorly differentiated" lymphocytes equivalent to the "small cleaved " cell as defined by Lukes and Collins (1975). Ten of the 14 patients in this receptor category are alive between 12 and 30 months after diagnosis.Receptor-silent and " immature " B-cell tumours with non-capping surface Ig correlated predominantly with the Rappaport histiocytic lymphoma and Lukes and Collins' large cleaved and large non-cleaved lymphomas, though these histological categories also included a wide variety of other receptor types such as T-cell, Receptor-overlap and the single true Macrophage tumour. Five of the 11 patients with receptor-silent or immature B-cell tumours are alive between 7 and 15 months after the diagnosis.Diffuse mixed and diffuse poorly differentiated lymphocytic lymphomas in Rappaport's classification correlated poorly with receptors, mature and immature B-cell tumours being equally represented.

SUMMARY Cell suspensions from six anaplastic thyroid tumours were studied for expression of lymphocyte and macrophage surface markers, and the results were correlated with electron microscopy, clinical extent of disease, and response to radiotherapy. The clinical presentation of the disease was similar in all six patients.In five cases, many of the cells showed surface immunoglobulin. Electron microscopy was available on three of these and showed appearances in keeping with malignant lymphoma. The single case whose cells did not show surface immunoglobulin had an entirely different ultrastructure and was probably a carcinoma. This case was the only one that did not achieve complete remission with radiotherapy and the patient died from extensive local recurrence. It is concluded that receptor techniques are of value in distinguishing between malignant lymphoma and other anaplastic tumours of the thyroid, particularly when the results are correlated with histology.

SummaryA case is described of a patient who presented with severe oedema due to protein-losing enteropathy caused by amyloidosis secondary to bronchiectasis.

BACKGROUND LMD from systemic cancer has a dismal prognosis with median survivals of 8-10 weeks. A phase 2 trial of PD-1 inhibitor monotherapy in LMD showed median overall survival (OS) of 3.6 months (Brastianos P et al., 2020). We determined the safety/efficacy of avelumab, a PD-L1 inhibitor with WBRT in patients with LMD (NCT0371768). This combination can treat the tumor directly and increase BBB permeability (Li, 2003; Nordal, 2005) allowing the increased egress of activated T cells into the meninges/CSF. METHODS Patients received concurrent avelumab 800 mg IV q2 weeks for ≤ 5 cycles (unless PD or unacceptable toxicity) with WBRT 3000 cGy in 10 fractions. Primary endpoints are safety/DLTs and OS at 3 months. Secondary endpoints are CSF T-cell/cytokine profiles (scRNAseq, phosophoproteomics etc.). RESULTS A total of 15 patients (7 breast, 7 lung & 1 other) were enrolled (n = 13 F, ages 32-79). Pts receiving anti-PD-1/PD-1L/PD-L2/CD137,CTLA-4 therapy ≤ 6 months prior were excluded. Three of 15 patients had grade 3/4 AEs (diarrhea, lymphopenia, decreased WBC count in 3 patients). Seven patients (50%) were alive at 3 or 6 months. The estimated median follow up in 14 patients is 4.75 months (range, 0.92 – 30.05 months, 95% CI is 1.32 ~ 19.82). The median PFS is 3.75 months (95% CI = 0.85-15.16) and median OS is 6.89 months (95% CI = 1.18-14.7). CONCLUSIONS The combination of avelumab and WBRT is safe, well tolerated, and demonstrates encouraging activity in patients with LMD with an OS that is longer than other published series. Multiple platform interrogation of CSF (analysis underway) will determine mechanisms of LMD therapeutic/resistance effects.