Polyamines as Biological Markers of the Effectiveness of Therapy in Acute Leukemia

Urinary polyamine levels were determined in patients with acute leukemia, before and during chemotherapy, in order to confirm whether tumor cell death, due to successful chemotherapy, increases the release in urine and serum of polyamines from tumor tissues (12). Comparison between the polyamine test and cytological data indicated that a rise in urinary spermidine levels occurs during the first 3 days of therapy, both in the responsive and unresponsive patients. However, in the responsive patients the spermidine increase was higher (at 5 % significant level) than in the unresponsive ones, and it was coincident with the fall of the blast cells and the revival of normal hematopoiesis. Increases in putrescine levels were also observed, but there were no significant differences (5 % level) between the 2 groups of patients. When polyamine determinations were carried out following chemotherapy cycles, the relapse of the disease was always accompanied by an increase in putrescine.

Hypokalaemia, hypomagnesaemia and hypocalcaemia in acute non-lymphoblastic leukaemia

Two cases of acute leukaemia, one monoblastic and one myelomonocytic, in which hypokalaemia, hypomagnesaemia and hypocalcaemia were documented, are reported. Urinalysis demonstrated renal loss of potassium and magnesium without other evidence of renal tubular dysfunction. The mechanism and clinical significance of these abnormalities are briefly discussed.

[Plasmocytoma, alkylating agents, and acute myeloid leukemia (author's transl)]

Two cases of the development of acute myeloid leukemia (AML) after treatment with alkylating agents are reported. In Case 1, melphalan and then cyclophosphamide had been given for multiple myeloma. 46 months after onset of cytostatic treatment AML occurred, as confirmed cytochemically and by qualitative determination of urinary lysozyme. In Case 2, cyclophosphamide had been given for rheumatoid arthritis. After a latency of 34 months 'smouldering leukaemia' developed with an atypical monocytic leukaemic cell population. In a third case, multiple myeloma and monocytic leukaemia developed synchronously. The causative role of melphalan and cyclophosphamide in the development of AML seems securely established. Despite the risk of alkylating agents in the treatment of multiple myeloma or Hodgkin's disease causing AML, they should not be replaced, as other drugs have been shown to be less beneficial. On the other hand, alkylating agents should be used with great caution in the treatment of non-malignant diseases.