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myeloma

Immunotherapy

«-interferon treatment

In a previous study, undertaken by Jude et al. [38] in 1988, among a smaller series of 100 patients with positive LA, were 17 with a history of neoplasia, including haematologic malignant disease. The tumour neoplasias included carcinoma of the breast, uterus, ovary, tongue and lip (17%).

Finazzi et al. [39] followed 360 aPL positive patients for 5 years prospectively with regular 6-month follow-up examinations.

Five patients (age 42-70 years) developed a malignant neoplastic disease during the follow-up period.

One patient (age 42 years) with primary APS developed a breast carcinoma and 4 presented with NHL. These included one with Waldenstrom's Macroglobu-linaemia. Eighteen patients died during the follow-up period. Haematological cancers accounted for 5 of these deaths. The four new cases of NHL recorded with an estimated rate of 0.28% was far higher than the expected incidence of NHL which ranges between 5-15 x 1001000/year.

Not only are antibodies to cardiolipin and positive lupus anticoagulants found in patients with malignancies, but specifically antibodies to phosphatidylinosi-tol [40],

Faiderbe et al. [41] described antibodies to phos-phatidylinositol in sera of patients with malignant tumours, regardless of the type, grade or organ lo cation as well as finding them in female rats during the development of chemically-induced malignancy, mammary tumours or sarcomas [42]. Occasionally aPL have disappeared following surgical removal of a tumour [43].

It is well known that nonbacterial thrombotic endocarditis (NBTE) with Trousseau's syndrome is a common manifestation of malignant diseases, particularly in those affected with lung or gastrointestinal tract carcinomas and pancreatic adenocarcinomas. One such case with Trousseau's syndrome, NBTE and LA, accompanied by antibodies to phosphatidylinositol as well as B2-GPI was documented by Bessis et al. [44],

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