Effect of ubenimex on the immune system of patients with hematological malignancies

The effect of in vivo administration of ubenimex (Bestatin) on the immune status of patients with hematological malignancies in remission was studied. Natural killer (NK) cell activities, lymphokine activated killer (LAK) cell activities, production of interferon-gamma (gamma-IFN) and surface antigens of peripheral lymphocytes were examined before and after administration of ubenimex. Analysis of the T, B and NK cell compartment ax conducted by assessing expression of the following antigens: CD3+CD19- (T), CD3-CD19+ (B), CD8+CD11b- (Tc), CD8+CD11b+ (Ts), CD4+Leu8-(Th), CD4+Leu8+(Ti), CD16CD57 (NK) using a 2-color flow cytometric analysis. NK and LAK activity was significantly lower in patients with hematological malignancies as compared to normal subjects. The absolute numbers of lymphocytes and NK cells were also lower than those in healthy controls. The reduced NK and LAK activity, however, was elevated after ubenimex administration. The absolute numbers of helper T cells, cytotoxic T cells and NK cells were also increased after administration of the drug. These findings were not observed in patients treated without ubenimex. Serum levels of IFN-gamma were not markedly changed after ubenimex administration. But peripheral blood mononuclear cells cultured with rIL2 showed appreciable levels of IFN-gamma production, and production increased after ubenimex administration. These results shows that ubenimex is a powerful immunomodulator that augments or restores some immune functions in patients with hematological malignancies.

Immune-deficient mice as models for human hematopoietic disease

The growth of human hematopoietic cells in immune-deficient mice promises to revolutionize our ability to study the normal developmental program of human hematopoiesis and the biological consequences of aberrant proliferation and differentiation. Advances in stem cell purification will require assays to test for function, and the identification and the characterization of novel hematopoietic growth factors will be aided by in vivo experiments. The engraftment of hematopoietic cells directly from patients with disease should ultimately lead to animal models for many human hemopathies and leukemias. Already important preliminary experiments have established the feasibility of such models for leukemia, cancer, infectious diseases, and autoimmunity. The production of human antibodies directed against toxic agents for which humans cannot be immunized could provide the basis for improved pharmaceuticals. Although an important foundation has been laid, much work remains to explore the full potential of this mouse transplantation system.

[Analysis of anti-platelet antibody]

Results obtained by analysis of anti-platelet antibody using flow cytometry (FCM) were as follows. The use of nest gating is useful in analysis of anti-platelet antibody and frequency of antibody production were 32.7% in patients with hematological disorders using FCM method. This method was much correlated to AHG-LCT method. The rate of coincidence was 92.1%. And effective rate of platelet transfusion of cross match carried out only by FCM method was 81.3%. Concentration of globulin fraction in patient's serum and avidin-biotin assay are useful for increasing the sensitivity of detection of anti-platelet antibody. Elimination of HLA (Class 1) antigen from platelet's surface is effective in both chloroquine and acid treatment. Background of fluorescent intensity was tendency to low by the acid treatment than by chloroquine one. It is possible that high titer serum of allogeneic anti-platelet specific antibody is able to be identified by means of its fluorescent intensity.

[Clinicopathological study of miliary tuberculosis in patients with hematologic disease]

Seven cases of miliary tuberculosis in patients with hematologic disease were analyzed clinicopathologically. Mean age of the patients was 65 years, and the hematologic diseases were CML, AML, ALL, MDS and malignant lymphoma. Diabetes mellitus was present as a complication in three patients. Miliary tuberculosis was found in 5 cases during the first admission to our hospital owing to hematologic problems. In 4 of 6 cases, fever had started more than two months before admission, consequently, the tuberculosis probably began about that time. After admission, chemotherapy was administered in 5 cases, and steroid in 6 cases for hematologic disease. The mean total quantity of steroid administered was 2,134 mg of prednisolone and average treatment duration was 69 days. The chest roentgenographic shadow was so atypical that miliary tuberculosis was suspected in only one case. The initial chest roentgenogram showed hilar and mediastinal lymph node swelling as well as the shadow of pulmonary tuberculosis in two cases. It was thought that the hilar and mediastinal lymph node swelling could be explained by primary complex, although the patients were of advanced age, or by "secondary complex" reported by Terplan, K in 1940. The diagnosis of tuberculosis was made in two patients before their death by smear of aspirated fluid of cervical lymph node and by bone marrow cell block in one patients, and by pathological examination of mediastinal lymph node biopsy in the other patients. Tubercles were found from bone marrow cell block in 2 out of 5 patients and from bone marrow biopsy in 1 out of 3 patients, but the positive results were reported in 2 patients following death. Smears of sputum, gastric juice, urine, spinal fluid and pleural effusion were negative in all cases. One patient diagnosed as miliary tuberculosis also had pneumocystis carinii pneumonia. This case was treated with antituberculosis drugs for 20 days without improvement. Another patient diagnosed as miliary tuberculosis improved under treatment with antituberculosis drugs, but died of cytomegalovirus pneumonia. Autopsy in 5 cases revealed non-reactive miliary tuberculosis, and pulmonary hemorrhage probably due to DIC was present as a complication in two cases. In these cases, severe immunosuppression, which is a major precipitating factor of miliary tuberculosis, is thought to be induced by hematologic disease itself, chemotherapy, steroid or other underlying disease such as diabetes mellitus. Miliary tuberculosis in such compromised host is cryptic and progresses rapidly. Consequently, early diagnosis is very important. Retrospectively, the unexplained pyrexia was most important to suspect tuberculosis.(ABSTRACT TRUNCATED AT 400 WORDS)

[Several years observation of a Catergen (cyanidanol-3) induced immunohemolysis]

A report is presented on repeated severe episodes of cyanidanol-induced immune hemolysis in a 75-year-old woman suffering from chronic active hepatitis. One year after the first hemolytic episode, high titers of anticyanidanol antibodies were still demonstrated in the patient's serum (as well as sensitization of the patient's lymphocytes by the drug). 4 years later virtually no decrease of the antibody titer was found. Further investigations of the patient's serum revealed antibodies against flavonoids with free hydroxyl groups (cyanidanol and rutin). However, no antibodies against flavonoids with derivatized hydroxyl groups (troxerutin, mixture of hydroxy-ethyl-rutin and silibinin) could be demonstrated. Sensitization with flavonoids other than cyanidanol preceding cyanidanol-induced hemolysis has been proposed by others. In this case storage of approximately 75 flavonoid containing preparations in a chemist's shop in the patient's house may have contributed to the astonishing persistence of dry dependent antibodies.

New enzyme-linked immunosorbent assay methods for measurement of serum erythropoietin levels and erythropoietin antibodies

For clinical studies with erythropoietin (EPO), enzyme-linked immunosorbent assays for the determination of EPO and EPO antibodies were developed. Using polyclonal and monoclonal EPO antibodies in a sandwich technique, serum EPO levels greater than 10 pg/ml (corresponding to 1 mU/ml, calibrated with the 2nd WHO IRP EPO) can be determined. In 103 healthy blood donors, a mean (+/- SD) value of 36 +/- 19 pg EPO/ml was found. Very high EPO concentrations were found in patients suffering from myelodysplastic syndrome and aplastic anemia; elevated levels were associated with rheumatoid arthritis and myelomatosis. No EPO antibodies were detectable in EPO-treated patients.

Dominantly transmitted hematologic dysfunction clinically similar to Fanconi's anemia

We report a family with a dominantly transmitted syndrome resembling Fanconi's anemia and spanning two generations. This syndrome was characterized by an ill-defined hematologic stem cell disorder, immune dysfunction, poor dentition, hyperpigmented skin, warts, and multiple second trimester spontaneous abortions and included one case of acute myelomonocytic leukemia (acute non-lymphocytic leukemia, M4). This family lacks the characteristic chromosomal aberrations of Fanconi's anemia. We believe this constellation of findings represents an entity not previously described.

[Experience with Cefobid in severe infections complicating immunodeficiency diseases]

As a 3rd generation cephalosporin Cefobid monotherapy was applied during 1985-1986 with 16 hematological patients in immunodeficient, immunosuppressive states where the available aimed and combined antibiotic therapy failed to be effective for the treatment of bacterial infections of grave course and septic character. 4 g/day was the average I.V. dose of Cefobid, higher doses were applied only in especially grave septic states. The hematological patients tolerated well the Cefobid in monotherapy. Recovery form the septic state and excellent clinical effect was found with 9 patients, good effect with 4 and satisfactory effect with 1 patient. In 1 case the therapy had to be stopped owing to drug hypersensitivity. Cefobid is regarded as an antibiotic drug that is effective if used in monotherapy for treating grave, septic infections of hematological patients in immunodeficient--immunosuppressive--myelodepressive states having received earlier antineoplasmic polychemotherapy.

[Relationship between various erythrocyte antigens and hematologic disorders]

The antigen pattern pertaining to the ABO (A, B, AB, O (H)), Rh (D, C, c, E, e), Duffy (Fya and b), Kell (K, k) and MNS (M, N) systems were determined in 144 patients between 1 and 74 years of age who had leukemia, lymphoma or myeloma. An association of phenotype Fy (a-b+) with acute lymphatic leukemia and phenotype NN with chronic myeloid leukemia was demonstrated (p less than 0.05, chi sq). Other associations were statistically not significant. Thus, a susceptibility of the aforementioned phenotype patterns to the type of leukemia described is suggested by these findings.

Erythrocyte complement receptor type I in patients with hematologic diseases

Erythrocyte complement receptor type 1 (CR1) was measured in 37 normal controls and in 95 patients with various hematologic diseases. Levels of erythrocyte CR1 were significantly decreased in patients with acute myelocytic leukemia (AML), acute lymphocytic leukemia (ALL), chronic myelocytic leukemia, non-Hodgkin's lymphoma (NHL), aplastic anemia, idiopathic thrombocytopenic purpura, and multiple myeloma when compared to normal controls. There was also a trend of recovery of erythrocyte CR1 levels in AML and ALL patients when they were in a state of complete remission compared to those at time of onset or relapse. Further investigation is needed as to determine whether the level of erythrocyte CR1 can serve as a predictor for relapse of leukemia. This study also showed that the level of erythrocyte CR1 was not related to prognostic factors in NHL patients.

Changes of immunological parameters in immunocompromised patients under selective decontamination of the digestive tract. Second Part: Investigations on the influence of drugs on zymosan-induced and luminol-enhanced chemiluminescence of peripheral leucocytes

The influence of drugs used for selective decontamination, given in therapeutically effective concentrations, was examined in healthy controls and immunocompromised patients with hematologic systemic diseases by measuring the zymosan-induced and luminol-enhanced chemiluminescence of peripheral leucocytes. Drug-induced repression of phagocytic activity could usually be found both in healthy controls and in patients with hematologic systemic diseases. The combination of trimethoprim and sulfamerazine had a pronounced repressive effect. Such indications should be taken as a basis for further investigations in order to avoid additional iatrogenic restriction of defence. If possible, drugs with effects leading to repression of phagocytosis should not be used for selective decontamination.

[Measurement of anti-HLA antibody by lymphocytotoxicity test in patients with hematopoietic diseases]

Evaluation of anti-HLA antibody (HLA-Ab) by lymphocytotoxicity test (LCT) was reviewed in 69 patients with hematopoietic diseases. Twenty-five (36.2%) of these 69 patients developed HLA-Ab at some time during their treatment course. In patient characteristics, eleven of 32 patients with ANLL (34.4%), one of ten patients with ALL (10%), four of nine patients with CML-BC (44.4%), six of seven patients with AA (85.7%), two of four patients with MDS (50%), and one of seven patients with other types (14.3%), who had random-donor transfusion, developed HLA-Ab. Transfused leukocytes count during two months from initial transfusion were compared between LCT positive group and LCT negative group. There were no significant differences between leukocytes count (13.8 x 10(9] of LCT positive group and that (14.2 x 10(9] of LCT negative group. As the result, we can enumerate the following factors, which are important to develop HLA-Ab. The HLA phenotype and immunity of patients may have a more important role than total transfusion volume. The longterm and continuous transfusion may increase the possibility to develop HLA-Ab. The transfusion purging leukocytes may diminish the occasions of alloimmunization. HLA-matched platelet transfusions were best against the patients who developed HLA-Ab and became refractory to platelet transfusion.

Changes of immunological parameters in immunocompromised patients under selective decontamination of the digestive tract. Third Part: Behaviour of some plasma proteins

We studied the importance of changes in plasma protein concentrations in patients with hematologic systemic diseases treated by selective decontamination of the digestive tract. The concentrations of albumin, acute-phase proteins, immunoglobulins and fibronectin were determined by laser nephelometry in 125 serum samples of eight patients. Results obtained allow the following conclusions: 1. There was a correlation between the clinical condition and concentrations of acid alpha-1-glycoprotein, IgG, CRP and fibronectin. These concentrations might be important for assessment of the course of the disease, effectiveness of therapy and the detection of pathogenetic relations. 2. The acid alpha-1-glycoprotein is of particular importance since relations exist between changes in its concentration and therapeutic results as well as the prognosis of the disease.

Circulating immune complexes in patients with hematologic diseases

Circulating immune complexes (CIC) were measured by C1q-solid phase method in ninety-five patients with various hematologic diseases. The results showed significantly higher CIC levels in patients with acute myelocytic leukemia, chronic myelocytic leukemia, aplastic anemia and idiopathic thrombocytopenic purpura (ITP) than CIC levels in normal controls. However, there was no significant difference in such levels in patients with acute lymphocytic leukemia, non-Hodgkin's lymphoma and multiple myeloma when compared to normal controls. In this study, the level of CIC did not relate to prognosis for patients with non-Hodgkin's lymphoma. The findings demonstrated that a high level of CIC in patients with ITP usually responded poorly to steroid treatment. Other immunosuppressive agents were indicated in these cases. Therefore, the CIC level may serve as a therapeutic guide for the treatment of patients with ITP.

[Pimafucin in the treatment of mycoses of the oral cavity in children with chronic blood diseases]

2.5% solution in the form of oral drops (Gist-brocades) has been used in the treatment of Candida albicans infections of the mucous membranes in children with chronic blood diseases. Out of 34 children 28 recovered completely which is 82.3% of all cases. The highest effectiveness of the preparation was found in the group of children with acute infections. In all cases of chronic candidiasis the improvement of the clinical condition was obtained. Only few children have not shown the growth of Candida albicans in the control investigations.

[Characteristics of lymphocyte autoantigens]

Specificity of autoantibodies against lymphocyte antigens was assayed in sera of patients with autoimmune hematologic diseases, leukemias, secondary immunodeficiencies as well as in sera of persons seropositive to antibodies against retroviruses HTLV-I and HTLV-III. Autoantigens of the lysates of stimulated peripheral blood lymphocytes and Hut-102 cells were characterized with the aid of immune blotting and radioimmunoprecipitation. No differences were found in autoantigen spectra identified by sera from patients belonging to different groups. Autoantigens 75 cd, 60 cd, 50 cd and 12 cd occurring in both cell types were demonstrable at a greater frequency. Some of the sera also demonstrated the total antigens 34 cd and 29 cd. The role of autoantigens in the pathology development is discussed.

Quantitation of platelet antigens after chloroquine treatment

The effect of chloroquine treatment on the expression of various platelet antigens was studied. For this purpose, the binding of several human platelet-reactive antibodies (polyspecific HLA antibodies; platelet-specific PlA1, PlA2, Baka antibodies; platelet autoantibodies) and of murine monoclonal antibodies specific for epitopes on the glycoprotein (Gp) complexes IIb/IIIa or Ib/IX were quantitated by means of a competitive enzyme-linked immunoassay (CELIA) using fresh and stored chloroquine-treated platelets. We found that HLA antigens were substantially removed from platelets following chloroquine treatment (confirming earlier results) while platelet-specific antigens on the Gp complex IIb/IIIa were but little affected. Epitopes on the Gp complex Ib/IX did not show any alteration. Storage of chloroquine-treated panel platelets known to interfere with immunofluorescence had no effect on quantitative IgG determinations by CELIA. We conclude that chloroquine treatment of platelets is practicable for platelet antibody analysis, but exerts its effect unspecifically and requires cautious interpretation.

[Systemic lupus erythematosus in children with renal and hematologic manifestations. Relation to anti-nDNA antibodies]

We studied prospectively 22 children with systemic lupus erythematosus. Serologic tests included: immunoglobulins, C3 and C4 determinations. Antinuclear antibodies, by the indirect immunofluorescence test, anti-nDNA, anti-nRNP, anti-Sm and anti-SSB (La) studies were also obtained. From the 22 patients there were 16 girls and 6 boys. The mean age at the onset of the disease was 12.4 years (range 8-15 years). Four patients had the disease before being 10 years old. We mainly observed two clinical subgroups, those with kidney injury, which included 11 patients (50%), and a second group of 8 patients (36%) with prominent hematologic manifestations, 4 with hemolytic anemia and 4 with thrombocytopenic purpura. The patients with kidney disease included 7 with diffuse proliferative glomerulonephritis, one with focal and one with mesangial glomerulonephritis. No biopsies were obtained in two patients. From the group with hematological disturbances, only one patient with hemolytic anemia developed renal involvement during her evolution. Three of the 22 patients presented lymphoproliferative disorders in coexistence with systemic lupus erythematosus. The presence of anti-nDNA antibodies and the decrease of C3, were statistically associated with kidney disease, but not with the hematologic manifestations. Nevertheless 50% of patients with hemolytic anemia and thrombocytopenic purpura have positive anti-nDNA and low C3 determinations. If immunochemical differences between the anti-nDNA antibodies in these groups of patients with systemic lupus erythematosus can establish a distinction in their clinical evolution with or without nephropathy is an interesting question that remains to be determined.