The quantitative distribution of the two main T lymphocyte subsets, recognizable by the 'high' and "low-affinity' E rosette-forming cell technique of West, was studied in both the bone marrow and peripheral blood from ten untreated multiple myeloma (MM) patients. A reduced total T lymphocyte count, with a relative predominance of 'low-affinity' T lymphocytes (putative suppressor T cells), was found in the peripheral blood. Within a normal total T lymphoid cell count, a predominance of the T lymphocyte subset with 'low-affinity' characteristics was also observed in the bone marrow. An inverse correlation, that was statistically significant, was seen between the monoclonal malignant cellular B component and the 'low-affinity' T cell percentage in all cases. It is concluded, therefore, that such an imbalance between the 'high' and "low-affinity' T subsets, with the latter predominating, could be of importance in the regulation of the growth rate of the monoclonal cellular B component.

Aged↗

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A good response rate to recombinant erythropoietin alone may be expected in selected myelodysplastic patients. A preliminary clinical study.

The use of recombinant erythropoietin for treatment of anemia in myelodysplastic patients has so far produced poorer results than expected. Most clinical studies have been conducted without any selection of patients. In the present study we report our experience with the use of rhEPO in a population of selected MDS subjects. Only patients affected by refractory anemia according to FAB criteria, without significant WBC and platelets reduction, with normal LDH and short history of disease were eligible for the study and were treated with rhEPO at a dosage of 150 mg/kg three times a week for 2 months. Among the 12 so treated patients, 7 (58.3%) achieved complete remission, 2 partial remission and 3 failed to respond. This high response rate makes more than acceptable the cost/benefit ratio for rhEPO in RA patients and may identify a subgroup of patients that can be treated successfully with rhEPO alone.

Aged↗

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Predictive factors of response to splenectomy in adult chronic idiopathic thrombocytopenic purpura.

A total of 26 surgical patients with chronic idiopathic thrombocytopenic purpura (ITP) were reviewed and results of splenectomy were statistically related to age and sex, length of and response to pre-operative corticosteroid therapy, pre-operative platelet count and time interval between diagnosis and surgery. Median age was 37 years (range, 17-81 years) and the male:female ratio was 1.16. Pre-operative platelet count ranged from 2-70 x 10(9)/l. The length of pre-surgical corticosteroid therapy (prednisone 1-2 mg/kg/day) varied from 2 weeks to 3 years. Steroid therapy was unsuccessful in 15 patients and only achieved temporary remission in the remaining 11 cases. The time interval between diagnosis and splenectomy ranged from 4-60 months. There were 21 responders (80.4%) and 5 non-responders (19.6%) to splenectomy. Using the chi-square test, differences in age, length and response to pre-operative steroid therapy and diagnosis-to-splenectomy interval did not achieve statistical significance when responder and non-responder groups to splenectomy were compared. Conversely, a significant difference was found comparing male to female groups, since 92.9% of males and only 66.7% of females were successfully treated by surgery (P approximately 0.01). In addition, patients with a pre-operative platelet count less than 30 x 10(9)/l responded at an higher rate (100% versus 70.6%; P approximately 0.05) to splenectomy.

Adolescent↗

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Alpha interferon as first line therapy for angioimmunoblastic lymphoadenopathy. Possible value of DR+ cells in monitoring therapeutical response.

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Aged↗

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Early response to alpha interferon in a patient affected by hairy cell leukemia.

A 61-year-old splenectomized male patient affected by hairy cell leukemia (HCL) in relapse was treated with interferon (IFN) at a dosage of 3 x 10(6) U/day. After only 11 days of treatment, IFN was stopped because the patient developed fever, jaundice and respiratory distress. Upon recovery from this infectious episode, the patient was judged to be in complete remission of HCL on the basis of clinical and laboratory findings, and he remained off-therapy for 2 years. When an overt relapse occurred, the patient was again treated with IFN and, after a very short time, he achieved a new, good partial remission that is maintained 28 months later without treatment. This observation remains speculative for understanding the mechanism of action of IFN in other comparable HCL cases.

Combined Modality Therapy↗

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Multiple myeloma and renal transplant.

Until now, no case of multiple myeloma (MM) had been reported among the B-lymphoproliferative disorders occurring in organ-transplant recipients. The history of a 58-year-old man who developed IgG-kappa MM 31 months after a cadaveric renal transplant is described. A possible relationship between drug-mediated immunosuppression and the development of MM is discussed.

Azathioprine↗

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