Difference in uptake of tritiated thymidine by myelocytes from bone marrow and spleen in chronic myeloid leukaemia

Interphase ribosomal RNA cistron staining in chronic myeloid leukaemia

Aim-To evaluate the haemopoietic function of bone marrow blood forming cells in human chronic myeloid leukaemia (CML) by means of silver staining of nucleolar organiser region (AgNOR).Methods-Nucleoli were investigated in bone marrow blast cells and in erythroid, granulocytic, and megakaryocytic cells from 10 haematologically healthy subjects and from 26 patients with chronic myeloid leukemia (17 in benign phase, nine with blast crisis). The investigation was done before treatment, by means of a one step silver staining method. In every case 50 to 100 blasts, promyelocytes, myelocytes, immature (pronormoblastic and basophilic normoblastic) and mature (polychromatic normoblastic) erythroid elements, and megakaryocytes were evaluated for the mean numbers of nucleoli and for the average number of AgNORs per nucleus. Student's t test was used to compare the patient and control groups. Other statistical analyses were carried out by means of the computer assisted "HEMA" system.Results-Compared with controls, activation of NORs was noticed only in CML blasts, while there was a decrease in NORs in the erythroid elements, promyelocytes, and megakaryocytes. The AgNOR score of polychromatic normoblasts and megakaryocytes started to decrease in the benign stage of CML, whereas a similar decrease in pronormoblasts, basophilic normoblasts, and promyelocytes was detected only in patients with CML blast crisis.Conclusions-The loss of AgNOR sites in cell series in CML may be related to intrinsic defects in their proliferation.

Evidence following splenic radiotherapy for a highly dynamic traffic of CFU-GM between the spleen and other organs in chronic granulocytic leukaemia

Five patients with Ph1 +ve chronic granulocytic leukaemia and massive splenomegaly were given induction therapy with splenic irradiation, and their peripheral blood leucocyte count and granulocyte macrophage progenitor (CFU-GM) concentration monitored during the following six hours. In each patient there was a greater fall in CFU-GM than would have been expected from the fall in leucocyte count, but no evidence of a plasma inhibitor was found to explain the disproportionate reduction in CFU-GM. The difference between the estimated and observed decrease in CFU-GM/1 following splenic irradiation indicates a highly dynamic traffic of CFU-GM from the spleen to other organs in chronic granulocytic leukaemia.

Chromosome changes and splenectomy in Ph1-positive chronic myeloid leukemia. I. Predictive parameters in the blastic phase

The effects of splenectomy in the blastic phase (BP) of Philadelphia (Ph1)-positive chronic myeloid leukemia (CML) were correlated with the chromosome findings at the BP. The 53 patients studied were divided into four groups on the basis of the chromosome findings in the bone marrow and/or blood and whether splenectomy was performed after the onset of the BP, i.e., patients with only a Ph1 clone with or without splenectomy and those with abnormal clones containing karyotypic abnormalities in addition to Ph1 with or without splenectomy. Statistical analyses showed that splenectomy for patients with abnormal clones in addition to Ph1 at the BP affected positively both median survival and percentage of patients with a good therapeutic response and that splenectomy in patients with only a Ph1 clone contributed to an improvement in the tolerance to chemotherapy.

Splenectomy for palliation of chronic myelocytic leukemia

Sixty patients with chronic myelocytic leukemia (CML) (most, in the "terminal phase" of the disease) were subjected to splenectomy because of symptomatic splenomegaly, thrombocytopenia or anemia for which they required frequent transfusions. Surgical morbidity and mortality were high when the procedure was performed on a "casual" basis, but both were reduced sharply after care of these patients was restricted to a single medical-surgical-nursing team and improved technics of surgery and perioperative management were developed. Significant hematologic and clinical benefit was achieved in half of the patients and temporary arrest of the disease was often observed, but in most patients, the basic evolution of CML was not greatly altered. In eight patients, however, long-lasting improvement (one to nine years) was recorded. Measurement of the doubling time of circulating leukemic cells and other observations were consistent with the hypothesis that, in some patients, the spleen contains a more rapidly proliferating and "more malignant" population of leukemic cells than the marrow. We conclude that splenectomy is often a useful palliative procedure in advanced stages of CML, and that it may be strikingly beneficial in 10 to 15 per cent of such cases.

Cytogenetic differences between bone marrow and spleen in a case of agnogenic myeloid metaplasia developing blast crisis

Chromosome studies of cells from bone marrow and spleen were performed in a patient with agnogenic myeloid metaplasia (MM) developing blast crisis after a chronic phase lasting for 6.5 years. The proportions of blast cells were roughly the same in bone marrow and spleen. In the bone marrow 43 % of the metaphases were abnormal with a marker chromosome whereas all spleen metaphases were normal. The results indicate that chromosomal changes associated with blast transformation in MM may occur in the bone marrow prior to such changes in the spleen and support the concept that bone marrow and spleen may constitute relatively separate pools of haemopoietic tissue in chronic myeloproliferative diseases.