J. R. Schlumberger

Bone Marrow Graft in Man after Conditioning by Antilymphocytic Serum

Allogeneic bone marrow grafts carried out after previous administration of antilymphocytic serum alone were attempted in 16 patients. Of these, six had acute myeloblastic leukaemia, four acute lymphoblastic leukaemia, and one a blast cell crisis in polycythaemia vera. Ten of these patients were in an overt phase of the disease and resistant to chemotherapy, while nine had complete agranulocytosis. In five of these patients erythrocyte and leucocyte antigenic markers demonstrated the establishment of the graft. One patient had thalassaemia major, and four others had aplasia of the bone marrow, in one case due to chloramphenicol poisoning and in another to virus hepatitis. The grafts were successful in the last two patients and transformed their clinical condition. No signs of early acute secondary disease were noted in any of the patients, either when the donor had been given antilymphocytic serum or when he was untreated. The grafts had no adoptive immunotherapeutic effect on the acute leukaemia. These observations have clearly shown that antilymphocytic serum has an immunosuppressive effect in man when it is used alone.

Hydroxyurea, Leucopheresis, and Splenectomy in Chronic Myeloid Leukaemia at the Problastic Phase

Forty-three patients with chronic myeloid leukaemia have been treated with hydroxyurea in order to be subjected to leucopheresis for white cell transfusions. Hydroxyurea decreases leucocytosis when it is administered and the blood granulocyte number increases soon after the drug is stopped. The survival of the patients is not different from the survival of the patients treated with conventional chemotherapy (busulphan, mitobronitol) and it is superior to the survival of patients treated with external radiotherapy or with 32P. Half of the patients were subjected to splenectomy during first remission for a phase II trial. They were not randomized, but the distribution according to age was similar in the two groups. A slight difference appears in favour of splenectomy so far as survival is concerned, but there were three post-operative deaths out of 18 patients. We conclude that a phase II trial on the value of splenectomy is indicated ethically, but that the patients should be operated on and nursed in a microbiologically controlled environment.

Pathogen-free isolation unit — Three years' experience

The results obtained during the first three years of a pathogen-free isolation unit containing five beds have shown that this type of unit can reduce the risk of infection in patients treated with intensive chemotherapy or in those who have granulocytopenia from various causes. It is suggested that treatment of cancer which involves these risks should be carried out routinely in sterile isolation units, and that it is urgent to build many more and much larger units.

Treatment of Blastic Crisis in Chronic Myelocytic Leukemia

The development of an acute leukaemic syndrome can perhaps be considered to be the usual evolution of chronic myeloid leukaemia. Its occurrence is feared and its prognosis is still very poor, despite recent advances in treatment. Twenty-nine patients have been studied, 14 males and 15 females, their ages were 16–71 years (median 40 years). The acute leukaemic syndrome appeared 3 weeks to 7 years after the apparent onset of chronic myeloid leukaemia (median 26 months).

Five Years Experience of the Clinical Use of a Pathogen-Free Isolation Unit

Intensive chemotherapy and radiotherapy in current use in the treatment of malignant disease have given some outstanding results (Mathe et al., 1968) but they can cause, virtually inevitably, periods of profound hypo- or aplasia of the haemopoietic and lymphopoietic systems, whose main complication is infection. Infection has become one of the principal problems in the practice of modern cancer therapy, being particularly formidable in malignant disease of the haemopoietic system, especially in leukaemiC., where bone marrow insufficiency is often present before giving any treatment. In a recent study of acute leukaemia, treated with intensive chemotherapy, Frei and his colleagues (1965) reported 60 per cent incidents of bacterial infection with 40 per cent of septicaemia, and 64 per cent incidents of fungal infections with 34 per cent of septicaemia. Autopsy examination has confirmed that infection is the commonest direct cause of death in these cases.

Blastic Leukemia Complicating Reticulo-Sarcoma and Lympho-Sarcoma

A blastic leukaemia may appear in the course of a malignant lymphoma (Table 1): it is exceptional in Hodgkin’s disease, in follicular lymphoma, in reticulosarcoma, histiocytic type and in lymphosarcoma, lymphocytic type, but it is frequent in reticulosarcoma, histioblastic type (distinction between these two types of reticulosarcoma has been justified and illustrated by Mathe et al., 1967, 1970) and in lymphosarcoma, lymphoblastic type.

Methods and Strategy for the Treatment1 of Acute Lymphoblastic Leukemia

Acute lymphoblastic leukaemia (A. L. L.) is a malignant disease in which the proliferating cells are conventionally identified as “lymphoblasts”, cells that are theoretically the precursors of lymphocytes (see Mathe and SEman, 1963).