[Views on the treatment of acute myeloid leukemia in adults].
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Biomedical subjects
Publications and source records attributed to A Poros.
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The expression of receptors for Helix pomatia (HP) haemagglutinin, a T cell marker, was assayed on human lymphocytes cultivated with K562 or allogeneic lymphocytes. The receptor was detected on the cells after neuraminidase treatment by reactivity with FITC conjugated HP. By affinity chromatography the lymphocyte populations were separated into 3 subsets: (1) a subset which did not attach to the lectin column; (2) and (3) two subsets attaching with different avidities, and therefore eluting with different concentrations of the lectin-binding sugar hapten. The subsets were characterized for T cell markers, HP and E receptors, the B cell marker SIg and also for Fc receptors, and were tested for lytic potential against K562 and allogeneic blasts. A high proportion of HP receptor positive T blasts did not attach to the lectin column, and thus had low avidity HP receptors, confirming that activation of T lymphocytes is accompanied by decreased expression of T markers. The passed fraction which was enriched in blasts had the strongest cytotoxic function, while the fraction rich in cells with high avidity HP receptors and containing mainly small cells, had weak activity. This was true for both the anti-K562 and allospecific activities. Thus the phenotypic characteristics of the cells exerting the two types of lytic function were similar. The distribution of the lytic potential in the three subsets correlated with the presence of E and EA receptor positive blasts.
This is a report of the European Group of Bone Marrow Transplant (EGBMT) on the influence of immunosuppression (IS) on survival of patients with severe aplastic anaemia (SAA). Fourteen teams participated in this survey involving 170 cases treated from 1974 to December 1980. The 1 year survival was 62.7%. Three types of treatment were used: (1) anti-thymocyte globulin (ATG) alone, (2) anti-thymocyte globulin and haplo-identical related bone marrow infusion, and (3) high dose bolus-6-methyl-prednisolone (b-6 MePr). There was no statistical difference in survival between these three groups. Androgens did not modify survival. Blood counts before treatment had a significant prognostic value. Patients with less than 0.2 X 10(9)/l granulocytes and less than 10 X 10(9)/l reticulocytes had 40% 1 year survival; the others had more than 70% 1 year survival. Patients with complete or partial reconstitution had the same good prognosis. In contrast, patients with no improvement after IS had a 27% 1 year survival. Several successive courses of IS improved the prognosis of non-responding patients. This survey confirms that IS improves the survival of patients with SAA. A prospective study will be performed to define the best and safest form of IS and to correlate clinical results with in vitro tests.
Therapeutical partial plasma exchange was performed on 9 patients with acute leukaemia, 14 patients with monoclonal and polyclonal gammopathies and 3 with primarily immune complex disease. The procedure was effective in 21 out of the 27 courses performed on patients with gammopathies and in all cases of the primarily immune complex diseases. In acute leukaemic patients the course of the disease was favourably influenced by plasmapheresis. The results show that partial plasma exchange is an effective adjunct therapy in the treatment of patients with haematological diseases.
Acute lymphoblastic leukaemia of L-2 type was diagnosed in an 18-year-old female with breast tumour. Her peripheral leukaemic cells reacted with anti-human peripheral T cell serum and part of the cells expressed SRBC receptor indicating the T origin of her leukaemia. She had a tumoral mass in her breast consisting of the same leukaemic cells. Combination chemotherapy was applied and she went into complete haematological remission with simultaneous disappearance of the breast tumour.
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Three cytotoxic systems, NK, ADCC and the seemingly indiscriminative cytotoxicity of in vitro activated lymphocytes (cultivated with K 562) were found to require Ca++ and did not function in Mg++. The optimum concentration of Ca++ was identical for the three systems and for various lymphocyte subsets. 15 minutes after initiation of the interaction cell damage had already occurred in all three systems.
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Surface markers were applied for the study of the peripheral lymphocyte population in chronic lymphotic leukaemia. The proportion of B-lymphocytes recognized by EAC-rosetting and by surface-bound Ig was found higher in chronic lymphotic leukaemia than in normal controls. On the other hand, the E-rosette test revealed a very low proportion of T-cells. No relationships were demonstrable between the surface markers and the clinical features.
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