F.G.C. Jones

High bax expression is a good prognostic indicator in acute myeloid leukaemia

Most cytotoxic drugs kill cells by instigating the process of apoptosis and it has been suggested that apoptotic markers may provide an indication of tumour chemosensitivity. The aim of this study was to determine if such a relationship exists in acute myeloid leukaemia (AML). The levels of spontaneous apoptosis, bcl‐2 and bax were evaluated in 56 newly diagnosed AML patients to determine if they correlated with a response to cytotoxic therapy. Spontaneous apoptosis was lower, but bcl‐2, bax and the bcl‐2/bax ratio were higher in AML compared with normal individuals. AML patients with high bax expression at diagnosis had significantly better prognosis for disease‐free survival, event‐free survival and overall survival (P = 0·016). In the standard risk group, high bax expression was in keeping with significantly improved survival. Multivariate analysis revealed bax to be an independent predictor of survival. There was a significant reduction in bcl‐2 and bax expression when AML patients entered complete remission and also in relapsed AML patients who entered a second remission. This study suggests that bax is a useful prognostic indicator in AML and may assist with therapeutic decision‐making for patients in the standard risk category.

Red Cell Disorders

Abstract Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme of the pentose phosphate shunt pathway a major function of which is to prevent cellular oxidative damage. Deficiency in red blood cells is associated with a number of varied clinical manifestations. Chronic non-spherocytic haemolytic anaemia is uncommon but is usually characterized by chronic haemolysis, often with severe anaemia. In the past splenectomy in this condition has been thought to be of questionable benefit. We report a case of G6PD Guadalajara where splenectomy produced transfusion independence and have reviewed the literature. Those cases with exon 10 mutations often have a severe clinical phenotype, which responds to splenectomy. This procedure should be considered in this condition.

Prolonged molecular remission in PML-RARalpha-positive acute promyelocytic leukemia treated with minimal chemotherapy followed by maintenance including the histone deacetylase inhibitor sodium valproate.

Prolonged molecular remission in PML-RAR α -positive acute promyelocytic leukemia treated with minimal chemotherapy followed by maintenance including the histone deacetylase inhibitor sodium valproate

Thrombus in harvested marrow from a patient with recent heparin-induced thrombocytopenia

A 28-year-old man who was in remission from acute myeloid leukaemia had a bone marrow harvest using heparin as the anticoagulant 5 weeks after acute heparin-induced thrombocytopenia and thrombosis (HITT) had been diagnosed; heparin had been discontinued and the platelet count had recovered. A large thrombus occurred in the collection bag, an in vitro HITT , preventing adequate collection of cells for autografting. Two months after the harvest the previously positive enzyme immunoassay for HITT was negative. HITT antibodies are typically undetectable 2–3 months following an acute episode. This case illustrates that at 5 weeks there may be enough antibody in the serum to lead to thrombosis of collected bone marrow exposed to heparin. An alternative anticoagulant should be used in the collection bag in these patients.

Hepatosplenic Candidiasis, its Treatment and Effect on Remission Status in Patients with Acute Leukaemia-a Report of Five Cases.

Hepatosplenic candidiasis is an increasingly encountered complication of treatment of patients with acute leukaemia [[1] Clin. Infect. Dis. 24 (1997) 375]. Management is difficult as delay in further chemotherapy may allow relapse of the leukaemia while the infection may progress if chemotherapy is continued [[2] Anticancer Res. 19 (1999) 757]. We report five cases of suspected hepatosplenic candidiasis in a single haematology unit over a 30-month period. All patients were treated with oral fluconazole following intravenous amphotericin or liposomal amphotericin B lipid complex. Chemotherapy was withheld during treatment of infection. Two patients remain in haematological remission despite suboptimal therapy for their leukaemia. One patient died from progressive fungal infection, 1 patient of cardiac disease and 1 patient has had recent relapse of their leukaemia. We demonstrate that hepatosplenic candidiasis may be treated with oral fluconazole while chemotherapy is discontinued and also suggest that this infection or its treatment may have had a beneficial immunomodulatory affect on the leukaemic process in the surviving patients.