[Brachmann-de Lange syndrome in 16 of our patients]

The Brachmann-de Lange-syndrome (Cornelia de Lange-syndrome) belongs to the group of well established multiple congenital anomalies/mental retardation syndromes. The main features are a characteristic dysmorphic face, short stature, defects mainly of the upper limbs and severe psychomotor retardation. A variety of internal anomalies belongs to the non obligatory features of the syndrome. Based on 16 own observations (7 females, 9 males) aged between 1 day and 16 years, we describe the clinical variability of the Brachmann-de Lange-syndrome. Relatively poor prognosis is shown by the fact that up to now 6 of the patients have died.

Fractionated total body irradiation and high-dose VP 16-213 followed by allogeneic bone marrow transplantation in advanced leukemias

Thirty-eight patients (median age, 21 years) with acute nonlymphoblastic leukemia (ANLL) (17 patients), acute lymphoblastic leukemia/lymphoma (ALL) (18 patients), chronic myelogenous leukemia (two patients), and refractory anemia received allogeneic bone marrow transplants from HLA-identical sibling donors or a one-antigen-mismatched brother (one patient) after a preparatory regimen consisting of fractionated total body irradiation and high-dose VP 16-213 (60 to 70 mg/kg body weight). Of the 33 patients with acute leukemia who received grafts from HLA-identical donors, three patients with ANLL received transplants in first remission and one patient with standard-risk ALL received a graft while in second remission. All other patients were in more advanced stages of their disease or exhibited other high-risk features. At the time of analysis, 20 of the 33 patients were alive, with 19 of them remaining in continued complete remission for 6 to 35 months (median, 18 months). The 3-year actuarial disease-free survival rate of 56.6% +/- 9.7% (SE) and the actuarial relapse rate of 11.9% +/- 6.8% (SE) demonstrate that the combination of fractionated total body irradiation and high-dose VP 16 is an effective mode of therapy in patients with advanced leukemias. Preliminary experience cautions against the use of VP 16 instead of cyclophosphamide in any clinical situation carrying an increased risk of graft rejection because the immunosuppressive potency of VP 16 is largely untested but may be inferior to that of cyclophosphamide.

Interstitial deletion of chromosome 13 involving the region 13q14

A patient with an interstitial deletion 13q14 is described who has decreased erythrocyte esterase D activity and who has not developed a retinoblastoma.

Recurrence of acute lymphoblastic leukemia in donor cells after allogeneic marrow transplantation associated with a deletion of the long arm of chromosome 6

This report concerns a woman who experienced a relapse of acute lymphoblastic leukemia (ALL) associated with an interstitial deletion of the long arm of chromosome 6 in donor cells more than 4 years after allogeneic bone marrow transplantation (BMT). Direct bone marrow preparations revealed the presence of two leukemic clones 46,XY,del(6)(q23q25) and 45,X,-4,del(6)(q23q25),+8,-15,-21,+i(21q), +mar, the former clearly indicating that male donor cells were involved in the malignant process. Relapse as evidenced by these chromosome anomalies was confined to metaphases from directly prepared marrow cells and phytohemagglutinin (PHA)-stimulated peripheral blood cells. Cytogenetic analyses of T cell colonies gave predominantly normal donor karyotypes (65 of 69 mitoses) along with three host mitoses and a single donor metaphase carrying the 6q- anomaly. The marrow stroma, as represented by first-passage adherent layer cells from long-term marrow cultures, showed 17 of 19 host metaphases. One of two donor cells found within the stromal elements exhibited a 6q- chromosome. In the subsequent remission mitoses derived from myeloid and lymphoid cells were exclusively of donor origin, and chromosomal abnormalities could no longer be detected. Stromal elements remained host-derived (14 of 16 mitoses).

[Isolated trisomy 21 in blasts of an acute lymphoblastic leukemia]

A two years and four months old boy without evidence of Down's syndrome exhibited a trisomy 21 in his acute lymphoblastic leucemic cells. During remission this chromosomal change disappeared. The cytogenetic examination of malignant cells serves an important tool in diagnosis and follow-up of acute leucemia as well as bone marrow transplantation.