TAD-induction therapy for 175 adults with acute myeloid leukemia, followed by consolidation and maintenance therapy. The joint study of Ulm and Tübingen

175 patients with acute myeloid leukemia were treated between February 1980 and March 1985 with a TAD-induction therapy, three intensified consolidation cycles (COAP, COAP, AD), and a two-year mild maintenance therapy. The median age of the patients was 44 years, range 15-68 years. 62.3% of all patients attained complete remission and 13.7% partial remission. The median duration of remission was 10 months and the median survival time of patients in complete remission was 20 months. Patients older than 50 years had a higher early death rate (17.6) than younger patients (8.9%), but no difference was found in remission rates or in the median duration of remission and of survival. These results are in line with those of comparable studies.

Age adapted induction and intensified consolidation therapy in acute myelogenous leukemia

52 patients entered a study for remission induction and intensified consolidation in AML. Group I (age less than or equal to 50 years) received a combination of DNR, ara-C and VP16-213 for induction and early consolidation and HDara-C/DNR for late consolidation. Of 34 evaluable patients (25 first diagnosis, 9 first relapse), 27 achieved CR. 13 patients received 1-2 courses of HDara-C/DNR. Toxic symptoms of HDara-C/DNR were severe myelosuppression, infections, skin reactions, diarrhea and hepatotoxicity. CNS toxicity was not observed. 2 patients died from infection. The duration of granulocytopenia (less than 500/microliter) was 7-43 days (range) and of thrombocytopenia (less than 25,000/microliter) 5-34 days (range). Patients of group II (age greater than 50 years) received a modified regimen with reduced toxicity. Their number is too small for evaluation as yet.

Deficient IFN alpha production in hairy cell leukemia

Since the application of low doses of IFN-alpha is necessary to maintain remissions in Hairy Cell Leukemia (HCL) it is of interest whether peripheral blood mononuclear cells (MNC) of HCL patients can be induced in vitro to produce IFN-alpha. 9 patients suffering from advanced HCL were included in the study. The diagnoses were confirmed by characteristic findings in peripheral blood and bone marrow biopsies. For IFN treatment we initially used natural IFN-alpha (Bioferon) and switched later to recombinant IFN-alpha2 (Boehringer). MNC of 5 patients before IFN therapy and of 6 patients during IFN therapy (2-47 weeks) were induced by phytohemagglutinin (PHA), Corynebacterium parvum (C.p.), and sendai virus (SV). PHA is known to induce IFN-gamma. Both, C.p. and SV induced IFN-alpha but no IFN-gamma in MNC of healthy controls and of IFN treated breast cancer patients. In HCL patients normal antiviral activities could be induced by PHA. Zero or only low antiviral activities could be induced in MNC from 9 patients tested on 22 occasions. It is concluded that MNC from patients with advanced HCL can be induced to produce IFN-gamma but no IFN-alpha. Since IFN-alpha but not IFN-gamma is produced by monocytes it is likely that reduced numbers of monocytes which were found in our HCL patients before and during IFN treatment account for the described deficiency of IFN-alpha production.

Conversion of acute undifferentiated leukemia phenotypes: analysis of clonal development

The cellular origin of acute undifferentiated leukemia (AUL) is still a matter of controversy. We report on two cases in which the diagnosis of AUL was established according to restricted criteria. Blast cells of both patients showed phenotypic conversion during the course of disease. In one case, within 24 days from starting treatment, the leukemic phenotype changed from AUL to acute myelomonocytic leukemia (FAB L1, TdT+ to FAB M4, TdT-). The initial phenotype of this acute leukemia was characterized by the co-expression of both B-lymphoid and myeloid markers on the same cell. Moreover, analysis of esterase isoenzyme pattern showed the whole spectrum of isoenzymes typically seen in myelomonocytic leukemias already at diagnosis, yet blast cells additionally contained all three isoenzymes of beta-hexosaminidase typically seen in AUL. However, examination of immunoglobulin (Ig) heavy chain gene rearrangement initially and after conversion revealed an identical monoclonal configuration of Ig heavy chain sequences in both samples. The second AUL patient relapsed after allogeneic bone marrow transplantation with common ALL-antigen (CALLA) positive acute leukemia. Subsequent Southern blot analysis showed a novel rearranged Ig fragment compared to the analysis before transplantation indicating that the leukemic clones prior to and after transplantation were not identical. No chromosomal abnormalities were observed in both cases. These data support the view that AUL cells originate from a pluripotent stem cell that is capable to differentiate in the myelomonocytic lineage (patient 1), and confirm the value of Ig gene analysis as marker for cellular clonality.

[High-dose cytosine arabinoside in the treatment of recurrent or acute refractory myeloid leukemias]

10 adult patients (age 27-62 years) with refractory or relapsed acute nonlymphocytic leukemia were treated with high dose cytosine arabinoside (HDAraC: 3 g/m2 q 12 h by IV infusion, d 1-6) either alone (7 patients) or with additional treatment, consisting of bone marrow transplantation (1 patient), m-AMSA (1pt.) and VP16 (1 patient). All patients had received conventional dose AraC (CDAraC); 8 patients were resistant to CDAraC, having failed 1 or more courses of CDAraC just before treatment with HDAraC. Recovery of granulocyte count (0,5 X 10(9)L) occurred at a median of 26 d (23-27 d) after initial therapy, and recovery of platelet counts (50 X 10(9)/L) at a median of 24 d (22-27 d). 6 patients became severely septic, 3 of them requiring granulocyte transfusions. Consequently, sophisticated blood banking facilities and supportive care are required. The non-myeloid toxicities associated with HDAraC were not severe. Vomiting (9/10), erythematous skin rash (4/10), conjunctivitis and photophobia (2/10) were found most commonly. CNS-toxicity, pulmonary toxicity or drug fever were not observed. 4 patients achieved a complete remission and 1 a partial remission. 2 patients failed to respond and 3 patients died during the period of pancytopenia. Thus, HDAraC is effective treatment for refractory or relapsed ANLL, even in cases of apparent resistance to CDAraC.

Genetic resistance to Leukosis virus infection: effects on mortality and egg production in Leghorn hens

The influence of genotypic differences in resistance to infection from Lymphoid Leukosis (LL) on mortality and egg production was studied in three pairs of sublines. One subline of each pair had been selected for resistance and the other for susceptibility to infection. At 10 months of age, almost no hens with neutralising antibodies against LL were found in the resistant sublines, while in each susceptible subline more than 40% of the hens had LL antibodies. At 21 months of age, very few hens of the resistant sublines had group-specific (gs) antigen in their eggs. Susceptible sublines differed considerably in this respect, from 81% gs antigen-positive hens in one subline to 9% or no positive hens in the others. On the whole, the susceptible sublines had 6% higher mortality during the laying period (8 months) but the size of the difference was influenced by vaccination against Marek's disease (MD) and varied considerably between pairs of sublines. Significant interactions between strain and genotype of resistance to LL infection were observed for mortality from "other causes" in hens vaccinated against MD, as well as for mortality from "Leukosis" and from "MD" in non-vaccinated hens. The average rate of lay from 1 to 8 months was 8% lower in susceptible hens. In the subline with the highest frequency of eggs containing LL group-specific antigen in the albumen, the reduction of laying rate was twice as large as in the other susceptible sublines.

[Intravital diagnosis of left-atrial tumors--a clinical problem]

It is reported on a myxoma of the left atrium in a 44-year-old female. A diagnosing of the tumors intra vitam was not successful, the patient died under the signs of the severe apoplectic insult. Autoptically the myxoma with multiple arterial embolisation was proved. The author deals with the difficulties of diagnosing in life-time, the clinical main symptoms of atrial tumours and differential-diagnostic viewpoints are mentioned. As a matter of principle a successful diagnosis and therapy in this disease are nowadays possible, the importance of thinking of that fact in adequate symptomatology is emphasized.

[The problem of sequential cancers after antineoplastic chemotherapy or radiotherapy]

It is reported on 4 patients who in a period of 2 to 14 years after successful therapy of a malignant tumour using the therapy with cytostatics and (or) radiotherapy fell ill with a genuine secondary neoplasia. A connection of the therapeutic procedures mentioned with the repeated tumour induction is obvious, a genetic disposition (cancer diseases in parents and brothers and sisters) might favourably cooperate in three of the cases mentioned. It is referred to the necessity of strongest indication to the therapy with cytostatics and ionising rays.

[Problems in the diagnosis of Addison's disease in the absence of hyperpigmentation]

At the example of a 62-year-old female patient with a "white" Addison as a sequela of a bilateral tuberculosis of the adrenal glands the problems of the diagnostics of this clinical picture are described. It is referred to the necessity of thinking of an existing chronic primary insufficiency of the adrenal cortex, also when there is no hyperpigmentation which otherwise serves as principle sign.