M. Freund

Partial trisomy 1q: A nonrandom primary chromosomal abnormality in myelodysplastic syndromes?

Cytogenetic and clinical data of 11 patients with de novo myelodysplastic syndromes and partial or total trisomy of the long arm of chromosome 1 are presented. In eight of these patients trisomy 1q was the sole karyotypic change and therefore can be classified as a primary chromosome anomaly. A remarkably young median age of 36.5 years was noticed in this patient group.

Treatment of relapsed or refractory adult acute lymphocytic leukemia

Sixty‐six adult patients were treated for relapsing or refractory acute lymphocytic leukemia (ALL). The induction treatment consisted in a (1) first phase with vindesine 3 mg/m2 intravenously (IV) on days 1,8, and 15; daunorubicin 45 mg/m2 IV on days 1, 8, and 15; erwinia‐asparaginase 10,000 U/m2 IV on days 7, 8, 14, and 15; and prednisone 60 mg/m2 orally on days 1 to 21 and a (2) second phase with cytarabine 3000 mg/m2 as a 3‐hour infusion two times a day on days 1 to 4 (in patients > 50 years of age we used 1000 mg/m2), and etoposide 100 mg/m2 IV on days 1 to 5. Side effects of induction Phase I were predominantly hematologic with subsequent infections. In Phase II, some patients additionally had gastrointestinal, cutaneous, ocular, and hepatic toxicity. Five patients died during Phase I and another died during Phase II. Five of these patients had T‐cell ALL. Thirty‐four (64%) of 54 patients in their first relapse had a complete remission (CR) with a median disease‐free survival (DFS) of 2.9 months. The median overall survival (OAS) was 6.6 months. Seven of 12 patients with primary refractory disease, a second relapse, or relapse after bone marrow transplantation (BMT) had a CR. The CR rate and survival after first relapse was significantly better in patients with a preceding CR of more than 18 months compared with those with a shorter preceding remission. The leukocyte count was a second significant but not independent risk factor. There was a negative correlation between the leukocyte count and the duration of the preceding CR. The duration of the preceding CR was the major prognostic factor for survival in multivariate analysis. Twenty‐two patients received BMT. None of nine patients with autologous BMT is alive and disease‐free;5 of 13 who underwent allogeneic BMT are. It was concluded that this treatment efficiently induced remissions with tolerable toxicity. The remission duration should be improved by optimized consolidation treatment.

Effects of cytokines on in vitro colony formation of primary human tumour specimens

Although under study to alleviate chemotherapy-induced bone marrow toxicity, cytokines can stimulate in vitro growth of solid human tumour cell lines. The effects of granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF) and interleukin-3 (IL-3) on in vitro colony formation of primary human tumours was studied in a capillary soft-agar cloning system. Of 108 tumour specimens from 100 patients, 85 specimens were tested against all three factors at concentrations ranging from 0.1 to 1000 ng/ml. 44 of 100 tumours showed adequate growth in controls. 8 out of 43 (19%) specimens were significantly stimulated by GM-CSF, 6 of 40 (15%) by G-CSF and 10 of 44 (23%) by IL-3. Sensitivity to all three cytokines was observed in 4 of 44 (9%) specimens. By light microscopy the appearance of colonies from stimulated specimens was identical to that of controls. Sensitivity to cytokines was independent from sensitivity to epidermal growth factor, transferrin or insulin. Sensitivity to GM-CSF, G-CSF and IL-3 may be aberrantly expressed in a subgroup of solid human tumours.

Twenty-three cases of acute lymphoblastic leukemia with translocation t(4;11)(q21;q23): the implication of additional chromosomal aberrations

The translocation t(4;11)(q21;q23) is one of the most common specific chromosomal aberrations in acute lymphoblastic leukemia (ALL), occurring in 2% of childhood and in 5–6% of adult cases. Especially in adults, the t(4;11) is associated with a poor prognosis. In order to determine the significance of clonal chromosome aberrations that occur in addition to t(4;11), we studied the karyotypes and clinical courses of 23 patients with acute lymphoblastic leukemia and a translocation t(4;11)(q21;q23). Additional clonal chromosome aberrations were found in ten patients. An isochromosome i(7)(q10) and a trisomy 6 were observed most frequently as secondary anomalies. Clonal evolution was detected in four of six patients analyzed at diagnosis as well as at relapse. With treatment carried out according to modern risk-adapted therapy protocols, no difference in outcome was observed between patients with clonal chromosome aberrations in addition to t(4;11) at diagnosis and those without.

Simultaneous administration of granulocyte colony-stimulating factor (Filgrastim) and induction chemotherapy in acute lymphoblastic leukemia. A pilot study.

SummaryThe present study was designed to determine whether Filgrastim, a neutrophil-specific hematopoietic growth factor, could be administered simultaneously with intensive induction chemotherapy for adult acute lymphoblastic leukemia (ALL). The effect of Filgrastim on the severity of chemotherapy-induced neutropenia, fever, and infections was assessed in 15 patients treated according to the protocol of the German multicenter ALL (GMALL) trial 04/89. Filgrastim (5μg/kg/day) was given concurrently with successive cycles of cyclophosphamide, cytosine-arabinoside (ara-C), 6-mercaptopurine (6MP), prednisone (PRD), intrathecal methotrexate, and prophylactic cranial irradiation. During the study period the median total duration of severe neutropenia (<0.5×109/l) in 13 evaluable patients was 8 days, individual periods of neutropenia typically were short. Infections occurred in six patients; seven patients remained fever-free during treatment with Filgrastim. We conclude that simultaneous treatment with Filgrastim and chemotherapy in this specific setting is feasible and well tolerated. The efficacy of this treatment approach in terms of overall treatment results requires further testing in a randomized trial.

Severe Raynaud's Syndrome Associated with Interferon Therapy A Case History

Side effects of long-term interferon (IFN) therapy for myeloproliferative disorders may be vasospastic Raynauds attacks and lupus-like illness. The authors report on a woman with chronic myelogenous leukemia who experienced severe trophic lesions of the fingers after forty-nine months of IFN therapy. Digital artery occlusions could be proven arteriographically.

17p Anomalies in Lymphoid Malignancies: Diagnostic and Prognostic Implications

Eighteen patients with lymphoid malignancies and abnormalities of the short arm of chromosome 17 were evaluated, in order to analyse whether this anomaly was associated with a particular subgroup of lymphoid malignancies. The patients suffered from acute lymphoblastic leukemia, high-grade non-Hodgkins lymphoma or plasma cell leukemia. No 17p anomaly was found in any patient with chronic lymphocytic leukemia or low-grade non-Hodgkins lymphoma. In four cases the aberration of the short arm of chromosome 17 was the sole cytogenetic abnormality, in fourteen patients additional chromosomal aberrations were found. Five out of 18 cases were Burkitts lymphoma/leukemia showing the typical rearrangement of 8q24. In cases with a karyotype evolution the 17p anomaly was always a late event. Concerning the clinical outcome of the patients with abnormalities of the short arm of chromosome 17 eight of nineteen patients died within 90 days after the diagnosis of the 17p anomaly only three were alive at the last follow up (26 months to 40 months after diagnosis of a 17p aberration). Rearrangements of 17p, especially as secondary cytogenetic events, seem to be associated with a poor clinical outcome in lymphoid malignancies.

Karyotype Instability in Myelodysplastic Syndromes-A Specific Step in Pathogenesis Preceding Clonal Chromosome Anomalies

In a prospective study, 20 (11.6%) out of 172 patients with myelodysplastic syndromes (MDS) and two patients with aplastic anemia showed an increased spontaneous karyotype instability. No clonal chromosomal aberrations were detectable at the time of first examination. In three patients clonal anomalies developed during the course of the disease. In 17 out of 22 cases (77.2%) chromosomes 1, 5 or 7 were involved in nonclonal anomalies. The same chromosomes were frequently affected in patients with clonal abnormalities too. Our data suggest that spontaneous karyotype instability may be specific to a high proportion of cases with MDS and may constitute the source of clonal chromosome anomalies in these disorders.

Effect of Recombinant Human Interferons in Inducing Differentiation of Acute Megakaryoblastic Leukaemia Blast Cells

The effects of interferons (IFN)-alpha, beta 2 and -gamma in inducing megakaryocytic differentiation of blast cells from a patient with acute megakaryoblastic leukaemia (AMegL) was investigated in liquid suspension culture by the increase in CD41 and CD42b expressions using monoclonal antibodies in the APAAP technique. After six days of culture, the percentage of CD41 and CD42b positive cells increased in control cultures from 15.2% and 10.6% on day 0 to 32.0 +/- 4.3% and 22.1 +/- 2.5%, respectively. The addition of IFN-alpha significantly increased the number of CD41 and CD42b positive cells by about two to three fold compared to control cultures (p < 0.01) and by about four to six fold compared to day 0 (p < 0.001) Similarly, IFN-beta 2 induced a significant increase in CD41 and CD42b positive cells. On the other hand, IFN-gamma failed to increase the number of CD41 and CD42b positive cells in comparison to control cultures on day 6 and instead stimulated a significant increase in the number of monocytes/macrophages by about ten fold compared to control cultures in IFN-gamma-treated cultures (p < 0.001). The present results suggest that megakaryocytic differentiation of blast cells in AMegL could be induced by IFN-alpha and beta 2 and support a clinical role for them in the treatment of AMegL patients. Also, the present results showed that monocytic differentiation of blast cells in AMegL could be stimulated by IFN-gamma, supporting the multipotent stem or progenitor cell origin of the AMegL subtype of acute myelogenous leukaemia.

Effects of Recombinant Human Erythropoietin on Clonogenic Growth of Primary Human Tumor Specimens in vitro

Background: Production of Erythropoietin has been reported for various tumor cell lines in vitro. Also, a number of clinical reports indicate aberrant synthesis and release of erythropoietin, particul