Peripheral Stem Cell Transplantation

To study the efficacy of topical and combined topical and subconjunctival interferon alfa 2b (IFN alfa 2b) in the treatment of recurrent conjunctival intraepithelial neoplasia (CIN) in those patients who present resistance or intolerance to topical mitomycin C (MMC) treatment or when it is not indicated.

Four patients (age range from 52 to 70) with histological confirmation of recurrent CIN were studied prospectively. Two patients were resistant to topical MMC, another one did not tolerate it, and in the last case, this treatment was not indicated due to a stem cell insufficiency associated to a trophic corneal ulcer. Three patients were given just topical interferon (1 million IU/ ml four times a day for three months), while the last one received topical therapy and subconjunctival IFN alfa 2b injections (3 millions IU/ 0.5 ml).

Complete regression of the tumour was evident in all cases. sixteen to 24 months after treatment no patient had clinical evidence of recurrence. No side effects were observed in any patient, not even with subconjunctival administration.

IFN alfa 2b is effective as an alternative treatment to topical MMC in selected cases of recurrent CIN.

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon blood stem cell disorder. The acquired defect is in the cell membrane of the precursor of the affected clone, which renders erythrocytes, platelets and granulocytes unusually sensitive to the hemolytic effects of complement. It is characterized by chronic hemolysis, intermittent hemoglobinuria, thrombotic events and bone marrow hypoplasia. Hemolysis is precipitated by infection, strenuous exercise, surgery or menstruation. The dilemma of managing a PNH patient is that both the periodontal infection and the surgical treatment are precipitating factors. Management is further complicated by the fact that the patient is receiving corticosteroids. The treatment of the PNH patient is complex and potentially hazardous. It requires close cooperation between the periodontist and the hematologist. This paper describes the management of one such case.