Long term outcome of patients with low level of cryoglobulin (&lt;0.05g/L)

Eble, Vincent; Legallicier, B.; Joly, P; Vittecoq, Olivier; Caron, François; Tamion, Fabienne; Ducrotté, P; Lévesque, H.; Ménard, Jean-François; Jouen, F.; Guerrot, Dominique; Marie, I.

doi:10.1016/j.autrev.2016.01.012

Cited by 12 publications

(9 citation statements)

References 26 publications

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“…In relapsed/refractory setting, Leonard et al60 presenting the results of a randomized phase II trial on 91 patients affected by previously treated FL, whose median age was 63 years (range 34–89). Patients were randomized to receive rituximab (375 mg/m 2 weekly for 4 weeks), lenalidomide (15 mg per day on days 1 to 21, followed by 7 days of rest, in cycle 1 and then 20 mg per day on days 1 to 21, followed by 7 days of rest, in cycles 2 to 12), or a combination therapy rituximab plus lenalidomide (LR).…”

Section: Second-line Therapy and New Drugsmentioning

confidence: 99%

Follicular Lymphoma: The Management of Elderly Patient

Castellino

Vitolo

2016

Mediterr J Hematol Infect Dis

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Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma, which typically affects mature adults and elderly, whose median age at diagnosis is 65 years. The natural history of FL appears to have been favorably impacted by the introduction of Rituximab. Randomized clinical trials demonstrated that the addition of rituximab to standard chemotherapy induction has improved the overall survival and new strategies of chemo-immunotherapy, such as Bendamustine combined with Rituximab, showed optimal results on response and reduced hematological toxicity, becoming one of the standard treatments, particularly in elderly patients. Moreover, maintenance therapy with Rituximab demonstrated improvement of progression-free survival. Despite these exciting results, FL is still an incurable disease. It remains a critical unmet clinical need finding new prognostic factors to identify poor outcome patients better, to reduce the risk of transformation and to explore new treatment strategies, especially for patients not candidate to intensive chemotherapy regimens, such as elderly patients. Some progress were already reached with novel agents, but larger and more validated studies are needed. Elderly patients are the largest portion of patients with FL and represent a subgroup with higher treatment difficulties, because of comorbidities and smaller spectrum for treatment choice. Further studies, focused on elderly follicular lymphoma patients, with their peculiar characteristics, are needed to define the best-tailored treatment at diagnosis and at the time of relapse in this setting.

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Section: Second-line Therapy and New Drugsmentioning

confidence: 99%

Follicular Lymphoma: The Management of Elderly Patient

Castellino

Vitolo

2016

Mediterr J Hematol Infect Dis

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“…); if we considered patients subgroups, we observed the higher levels of free k and of k + λ sum in asymptomatic patients with low levels of microheterogeneous type III CGs and in symptomatic patients with type II CGs (Table ): this result strengthens the hypothesis that the microheterogeneous type III subgroup may represent an intermediate state from a polyclonal to a monoclonal selection of CGs and we suggest that free k could represent a marker of this transition. Type II CGs seem to cause systemic vasculitis mediated by the intravascular immune complex ; keeping in mind data on mortality and comorbidity occurring in patients with CGs and low cryocrit but without HCV infection reported by Eble , we can hypothesize that even low levels of CGs can trigger immunological disorders in HCV‐positive patients .…”

Section: Discussionmentioning

confidence: 72%

“…Eble and coworkers recently underlined the importance of an accurate assessment of CGs to improve clinical management . They analyzed clinical significance of low levels (≤0.05 g/L) of CGs in HCV‐negative patients, that may be associated with increased morbidity and mortality as well as in patients with high levels.…”

Section: Discussionmentioning

confidence: 99%

“…Low levels of CGs can be detected not only in a variety of infective and autoimmune disorders but also in normal human sera probably for specific physiological interactions between immunoglobulins (Maire MA, 1989). Eble and coworkers showed a high prevalence of low cryoglobulins level (≤0.05 g/L) in non‐HCV patients that may be accountable for renal and neurological complications in, leading to high morbidity and mortality . HCV infected patients are frequently positive for mixed cryoglobulins and follow‐up improvement is assessed by the serum level of cryoglobulinemia and surrogate markers (C4, RF) .…”

Section: Introductionmentioning

confidence: 99%

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Serological profile of asymptomatic HCV positive patients with low level of cryoglobulins

et al. 2018

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Clinical spectrum of hepatitis C virus (HCV)-related cryoglobulinemia varies from an asymptomatic presentation to severe vasculitis and lymphoma. A recent study in HCV-negative patients suggests that low cryoglobulins (CGs) levels are responsible for severe renal and neurological complications. The aim of this study was to identify a panel of serological biomarkers associated with low levels of CGs in HCV-positive patients. We studied a population of 79 untreated patients with chronic HCV infection: 13 naïve patients without CGs; 28 patients with asymptomatic mixed cryoglobulinemia (MC) and low levels of CGs (16/28 with polyclonal type III and 12/28 with microheterogeneous type III CGs); 38 patients with symptomatic MC and high levels of type II CGs. Serum samples were collected and examined for rheumatoid factor (RF) IgG and IgM, free light chains (FLCs) and C3 and C4 complement components. We found that RF-IgG and IgM, free k chains and k+λ were increased while C4 component was reduced, both in symptomatic and asymptomatic patients. Our results suggest that, even in absence of MC symptoms, the low levels of CGs may represent a trigger of activation for immune system in course of HCV infection. The identification of a correlated biomarkers panel could improve the clinical management of these patients and pave the way for target treatment strategies. © 2018 Bio-Factors, 45(3):318-325, 2019

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“…A high prevalence of cryoglobulin ≤0.05 g/L in clinical practice may be responsible for severe renal and neurological complications, leading to high morbidity and mortality in these patients. Therefore both appropriate therapy and careful follow-up is required to improve such patients’ outcome 58,61…”

Section: Resultsmentioning

confidence: 99%

Cryoglobulin Test and Cryoglobulinemia Hepatitis C-Virus Related

Gulli¹,

Santini

Napodano

et al. 2016

Mediterr J Hematol Infect Dis

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Cryoglobulins are immunoglobulins that precipitate in serum at temperatures below 37°C and resolubilize upon warming. The clinical syndrome of cryoglobulinemia usually includes purpura, weakness, and arthralgia, but the underlying disease may also contribute other symptoms. Blood samples for cryoglobulin are collected, transported, clotted and spun at 37°C, before the precipitate is allowed to form when serum is stored at 4°C in a Wintrobe tube for at least seven days. The most critical and confounding factor affecting the cryoglobulin test is when the preanalytical phase is not fully completed at 37°C. The easiest way to quantify cryoglobulins is the cryocrit estimate. However, this approach has low accuracy and sensitivity. Furthermore, the precipitate should be resolubilized by warming to confirm that it is truly formed of cryoglobulins. The characterization of cryoglobulins requires the precipitate is several times washed, before performing immunofixation, a technique by which cryoglobulins can be classified depending on the characteristics of the detected immunoglobulins. These features imply a pathogenic role of these molecules which are consequently associated with a wide range of symptoms and manifestations. According to the Brouet classification, Cryoglobulins are grouped into three types by the immunochemical properties of immunoglobulins in the cryoprecipitate. The aim of this paper is to review the major aspects of cryoglobulinemia and the laboratory techniques used to detect and characterize cryoglobulins, taking into consideration the presence and consequences of cryoglobulinemia in Hepatitis C Virus (HCV) infection.

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Long term outcome of patients with low level of cryoglobulin (<0.05g/L)

Cited by 12 publications

References 26 publications

Follicular Lymphoma: The Management of Elderly Patient

Follicular Lymphoma: The Management of Elderly Patient

Serological profile of asymptomatic HCV positive patients with low level of cryoglobulins

Cryoglobulin Test and Cryoglobulinemia Hepatitis C-Virus Related

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