Low-dose of thalidomide in the treatment of refractory myeloma.
history of granulomatosis, hepatosplenomegaly, HBsAg and EBV-VCA positivity. The only surviving patient had received an allogeneic bone-marrow transplantation. Our two children had been infected by EBV with a chronic high titer of IgG against EBV-VCA, consistent with a life-long infection.9 EBV may infect T-cells creating reactive lymphoid proliferations without contributing to the neoplastic process; however EBV or other viral infections (i.e. Cytomegalovirus, hepatitis B), or immune defects suppressing NK activity – such as altered T4/T8 ratio – may lead to neoplastic transformation in particular hosts, and this could be the case with our patients. All available lymph node samples were therefore submitted to EBV-DNA detection without finding amplification of the viral genome. The presence of EBV-DNA is a feature of angioimmunoblastic PTCL found in Eastern Countries, being less common in Europe.3,10 As to optimal treatment, we agree with the Taiwan group:3 marrow transplantation can cure this disease. The role of retinoic acid cannot be assessed by anecdotal experiences, even though malignant cell differentiation and apoptosis might depend on retinoic acid administration.10 No national or international co-operative group is currently dealing with poor-prognosis PTCL: a common study is therefore needed, perhaps including both adults and children.