The use of vinca alkaloids in adult patients with refractory chronic idiopathic thrombocytopenia

The aim of the study was to evaluate the application of vincristin or vinblastin in patients with chronic idiopathic thrombocytopenic purpura (ITP), resistant to corticosteroids or with partial contraindication to their application. Twenty-two patients were treated with vincristin or vinblastin in doses of 2 and 10 mg, respectively. Eight of these patients were additionally administered prednisone in an oral dose of 0.5 mg/kg body mass (bm). Two-hour intravenous infusions of drugs were made once a week, at least three times. In every patient, the platelet count was evaluated before and after the three infusions. A rise of the platelet count of at least 100 x 10(9)/l was assumed to signify improvement. Statistically significant improvement (P <0.01) was obtained in nine (41%) patients (including five (35%) patients treated with vinca alkaloids only and in four (50%) patients treated with vincristin and corticosteroids). On the average, 8 weeks after the termination of the treatment there was a 40% drop in the platelet. Patients with a shorter duration of the disease and without detectable platelet antibodies responded well to the treatment more frequently. Minor complications were observed in five patients (23%), notably in the form of paresthesia. Leukopenia was not present. Vinca alkaloids could find their application in clinical situations requiring short-term increase of the platelet count in chronically ill patients with ITP, resistant to corticosteroids or with counterindication to their application.

B cells CD19+ in patients with B-cell chronic lymphocytic leukaemia and autoimmune haemolytic anaemia

The study presents results of B and T lymphocytes population analysis in patients with chronic lymphocytic leukaemia B cells and autoimmune haemolytic anaemia (CLL-B + AIHA). We evaluated the following groups of patients: (1) with newly recognized CLL-B and co-existent AIHA (untreated), (2) after short-term treatment with corticosteroids, (3) after treatment with chemotherapy and corticosteroids. The control groups were made of patients with CLL-B without AIHA. The populations of lymphocytes and determination of cells immunophenotype were performed by means of flow cytometry. The analysed data were obtained from 25 patients. The untreated patients with CLL-B + AIHA presented significantly more numerous population of neoplastic cells CD19+ CD5+ in comparison with patients without AIHA. The patients with AIHA showed a reduced percentage of B CD19+ CD22+ cells in comparison with those without AIHA. Untreated patients with AIHA or after a short-term corticosteroid treatment showed a higher ratio of the number of CD19+ CD5+ cells to the number of T CD4+ and T CD8+ lymphocytes than CLL-B patients without AIHA. It can be presumed that the differences found may be related to the pathogenesis of the autoimmune haemolysis syndrome in patients with CLL-B.

Hemoglobin F in primary myelofibrosis and in myelodysplasia

Our study investigated two groups of adult patients with established diagnoses of primary myelofibrosis (21 patients) and myelodysplastic syndromes (MDS) (21 patients). The objective was to assess fetal hemoglobin (HbF) concentration and to investigate correlations with organomegaly and extramedullary hematopoiesis and with the level of anemia and blood transfusion requirement. In all patients, the diagnosis was confirmed by histopathological examination. Patients with myelofibrosis were investigated by ferrokinetics using 59Fe. The percentage of marrow sideroblasts was assessed in patients with refractory anemia with ringed sideroblasts. Increased values of HbF were found to occur both in patients with myelofibrosis and with MDS, although a higher incidence and higher concentrations were evident in patients with myelofibrosis. Statistically significant increases in HbF concentration were found when there was accompanying organomegaly, as compared to patients without this feature. The average HbF concentration in both groups of patients under study was twice as high in cases with as in those without marrow fibrosis. The difference was statistically significant. Increased HbF levels appear to correlate with extramedullary hematopoiesis. HbF concentration did not correlate with the level of anemia or with requirement for blood transfusion.

[A trial of treatment with thymus factor (TFX) for chronic autoimmune hemolytic anemias]

30 days treatment TFX was performed in 8 cases AIHA (autoimmune hemolytic anemia) with presence of warm antibodies refractory after routine treatment (glucocorticosteroids, azathioprine, splenectomy): After TFX treatment in 2 cases autoantibodies were not detectable, in 5 cases reaction DAT (direct antiglobulin test) was decreased. Eluate antibody level and serum antibody level were decreased, too. Decreasing amount of red cells autoantibodies was confirmed by enzyme-linked antiglobulin test (ELAT) in 2 cases. Autoantibody level measured by semiquantitative and quantitative methods did not increase in any other case. Adverse effects of TFX treatment were not observed.

[Autoimmune thrombocytopenia in pregnant women: diagnosis, treatment and prevention of complications in children]

9 pregnancies (in 6 women) complicated by autoimmune thrombocytopenia were studied. Corticosteroids and/or azathioprine and/or intravenous immunoglobulins (IgG i.v.) were administered to 5 women during pregnancy. 1 complete remission (CR) was achieved after 3 mo. of treatment by corticosteroids and azathioprine. In peripartum period the treatment was administered in 7 cases (corticosteroids, IgG i.v., platelet transfusion). There were no haemorrhagic complications during peripartum period (8 vaginal delivery, 1 cesarean section). In 3 of 5 examined cases IgG antiplatelet antibody was detected. Study group was to small to define the correlation between level of antiplatelet antibodies and neonatal thrombocytopenia. 10 infants were born. 4 infants (including siblings) were found to have normal platelet counts immediately after delivery. They mothers were treated by IgG i.v. in 2 cases and 1 women in CR at the time of delivery. 4 infants were thrombocytopenic but required no treatment. Duration time of thrombocytopenia was 1 to 4 weeks. In these cases mothers were treated only by corticosteroids or had no therapy.

[Cyclosporin in the treatment of idiopathic aplastic anemia]

Five patients with aplastic anemia were treated with cyclosporine A. In four cases a positive response was noted. In three out of these patients frequency of blood transfusions was decreased. Platelet count increased to 50 x 10(9)/L in two cases and in one case agranulocytosis disappeared. Synergistic effect of cyclosporine A with oxymetholone and prednisone was seen. In one case an improvement lasted only for 1 year. Hepatotoxicity being a complication of therapy was noted in one patient.

[Treatment of low-malignancy lymphomas by spleen irradiation]

The spleen was irradiated in 8 patients with chronic lymphatic leukaemia using RTG radiation in doses of 225 to 800 cGy for one treatment course. The follow-up after radiotherapy lasted 12.5 months on average. In 7 cases a considerable reduction was observed in the size of the spleen, and in 6 cases the absolute leucocyte and lymphocyte counts decreased by a mean of 46% and 50% respectively. In patients in late phase of the disease the improvement was short-lasting; 5 patients died (2 from infectious complications). In patients in early phase remissions of 30 months were obtained with normalization of the proportions or T and B cells During the radiotherapy a significant rise was observed in the per cent of granulocytes and a fall of albumin level. Increased gamma-globulin and uric acid levels and decreased hemoglobin level and erythrocyte count were not significant. Variable changes were noted in the platelet count. No bleeding tendency was noted. Spleen irradiation may be used in the treatment of non-Hodgkin lymphoma associated with malignant proliferation prevailing in the spleen, that is in chronic prolymphocytic leukaemia and hairy-cell leukaemia Favourable effects of spleen irradiation were observed in chronic lymphatic leukaemia and this induced us to use this method in our eight cases.

[Analysis of pregnancy, labor, child development and disease course in women with Hodgkin's disease]

Twenty pregnancies were observed in 16 women with Hodgkin's disease. During 3 pregnancies cytostatic treatment was given. In 6 cases the disease was diagnosed in pregnancy and the treatment was started after labour. Eleven pregnancies were diagnosed during remission, after a mean period of 4 years (range: 6 months to 8 years) from the completion of treatment. All pregnancies had a normal course and labours were not complicated. In 2 cases of successive pregnancies disease recurrence developed. in 1 case the active disease was exacerbated. Twenty healthy babies were born, in one low birth weight was noted. The development of all children in a period of 6 years, on average, was normal.

[Clinical analysis of 15 cases of T-cell malignant lymphoma in adults]

In the years 1981-1987 T-cell lymphoma was diagnosed in 7 women and 8 men (2.2% of all hospitalized cases of malignant lymphomas). Chronic lymphatic and prolymphocytic leukaemias and T-zone lymphomas prevailed. In most cases systemic symptoms and lymphadenopathy were characteristic features. In 6 cases cutaneous changes coexisted having the appearance of desquamative erythema, in 2 cases cutaneous changes preceded by 10 years the generalization of the process. In 10 cases other organs were involved. Absolute lymphocyte count ranged from value below normal to values above normal range. In 8 cases hypergammaglobulinaemia was present. The results of treatment were bad. Early drug-induced myelosuppression was observed. Nine patients died. In the group of lymphoblastic lymphoma and Pinkus lymphoma all 5 patients died.

[Results of the treatment of patients with advanced Hodgkin's disease by the ABDiC and/or BVCPP protocols]

In 22 patients with phase IV of Hodgkin's disease refractory to treatment by the programmes MOPP and/or CVPP, and ABCD and/or BACOP, and in patients with recurrences after this treatment the ABDIC and/or BVCPP programmes were applied. In 5 cases this treatment was associated with radiotherapy. Complete remission lasting 30 months was achieved in one case. In 9 cases only clinical improvement was noted. Twelve patients failed to respond to this treatment. Ten patients died. The mean survival time of all patients from the beginning of treatment by ABDIC and BVCPP programmes to the end of the observation was 14 months, and the time from the diagnosis to the end of the observation was 69 months. The results of this treatment are not satisfactory.

Immunoregulatory factors controlling terminal differentiation of malignant B-lymphocytes

B-lymphocytes of patients with chronic lymphocytic leukemia differentiate in vitro towards plasma cells upon activation with Pokeweed mitogen (PWM) and Cowan. The level of response is much lower than that of normal cells and so is the helper T-cell function. However, concanavalin A-activated suppressor T-cell function of Ig synthesis is normal. Malignant B-cells have a normal capacity to stimulate Ig synthesis in the mixed lymphocyte cultures, but they respond poorly to an allogeneic stimulus. Thymosin (TFX) causes a marked enhancement of PWM-driven differentiation of malignant B-cells.

Observations on behavior of platelet adhesiveness at the late stage of burn disease

Results of investigations on platelet adhesiveness in burned patients after the stage of shock were presented. In all cases studied (17 patients) the values of platelet adhesiveness were lower than in healthy subjects. Further investigations are required to explain this finding.