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Celiac.com 11/03/2016 - Refractory celiac disease type II (RCDII) often transforms into an enteropathy-associated T-cell lymphoma (EATL), a serious condition that requires intensive treatment. Current treatment strategies for RCDII include cladribine(2-CdA) and autologous stem cell transplantation (auSCT). A team of researchers recently set out to assess long-term survival in refractory celiac disease type II, and to define clear prognostic criteria for EATL development comparing two treatment strategies. They also wanted to evaluate histological response as prognostic factor. The research team included P Nijeboer, RLJ van Wanrooij, T van Gils, NJ Wierdsma, GJ Tack, BI Witte, HJ Bontkes, O Visser, CJJ Mulder, and G Bouma. They are variously affiliated with the Department of Gastroenterology, the Department of Nutrition and Dietetics, the Department of Epidemiology and Biostatistics, the Department of Pathology, and the Department of Haematology at VU University Medical Centre in Amsterdam, The Netherlands. For their study, they retrospectively analyzed 45 patients. All patients received 2-CdA, after which they were either closely monitored (monotherapy, n=30) or received a step-up approach, including auSCT (step-up therapy, n=15). Ten patients (22%) developed EATL, nine of whom had received monotherapy. Absence of histological remission after monotherapy was associated with EATL development (p=0.010). A total of 20 patients (44%) died, with an average survival of 84 months. Overall survival (OS) in the monotherapy group was far better in those with complete histological remission compared to those with without histological remission. The monotherapy patients, who achieved complete histological remission, showed comparable EATL occurrence and OS as compared to the step-up therapy group (p=0.80 and p=0.14 respectively). Histological response is an accurate parameter to evaluate the effect of 2-CdA therapy and this parameter should be leading in the decisions whether or not to perform a step-up treatment approach in RCDII. Source: United European Gastroenterology Journal, April 2016; DOI: 10.1177/2050640616646529
Celiac.com 01/04/2013 - Currently, doctors must still use invasive techniques to distinguish between uncomplicated and complicated forms of celiac disease. In an effort to find a non-invasive approach to the issue, a research team recently set out to investigate the potential use of novel serum parameters, including IL-6, IL-8, IL-17, IL-22, sCD25, sCD27, granzyme-B, sMICA and sCTLA-4 in patients diagnosed with active celiac disease, celiac disease on a GFD, Refractory coeliac disease (RCD) type I and II, and enteropathy associated T-cell lymphoma (EATL). The research team included Greetje J. Tack, Roy L. van Wanrooij, B. Mary Von Blomberg, Hedayat Amini, Veerle M. Coupe, Petra Bonnet, Chris J. Mulder and Marco W. Schreurs. Their investigation revealed elevated levels of the pro-inflammatory IL-8, IL-17 and sCD25 in both active celiac disease and in refractory celiac disease, types I and II. They also found that RCDII patients displayed higher serum levels of soluble granzyme-B and IL-6 in comparison to active celiac disease patients. Furthermore, EATL patients showed higher levels of IL-6 as compared to all other groups. Otherwise, the team found no differences between RCDI and active celiac disease or RCDII. These novel serum parameters show distinct immunological differences in RCDII and EATL, compared with uncomplicated celiac disease and RCDI. Source: BMC Gastroenterology 2012, 12:159. doi:10.1186/1471-230X-12-159