[Treatment of atypical leukemia]

Treatment of atypical leukemia is reviewed with emphasis on the establishment of the concept of atypical leukemia and the treatment of this disease is discussed on a historical basis. Furthermore, a recent approach to this disease based on induction of differentiation of leukemia cells by low-dose cytosine arabinoside is discussed.

Hemodynamics of splenic artery aneurysm

Blood flow volume of the portal venous system of 3 patients with splenic artery aneurysm, an uncommon disease, was measured using an ultrasonic duplex system. A huge increase in splenic blood flow volume was found in each case. A large portasystemic shunt through which the portal blood flowed hepatofugally was present in 2 cases. We suspect the shunt is partially responsible for an increase in splenic blood flow volume, which would lead to the formation of splenic artery aneurysm together with portal hypertension.

Deficient induction of leukotriene synthesis in human neutrophils by lipoxygenase-deficient platelets

The effect of human platelets with deficient lipoxygenase activities on leukotriene B4 (LTB4) synthesis by neutrophils was studied. When arachidonic acid (AA) metabolites obtained from the incubation of washed normal neutrophils and platelets with N-formylmethionylleucylphenylalanine (FMLP), cytochalasin B, and AA were analyzed by reversed-phase high-performance liquid chromatography, the synthesis of 5-lipoxygenase products, including LTB4, was remarkably stimulated by platelets, with their maximal effect at a ratio of platelets to neutrophils of 15:1. However, the use of lipoxygenase-deficient platelets obtained from four patients with myeloproliferative disorders instead of normal platelets showed the deficient production of 5-lipoxygenase-derived products, whereas platelets with normal lipoxygenase activities obtained from MPD patients stimulated the 5-lipoxygenase pathway similarly to the way in which normal platelets did. The addition of 12-hydroperoxyeicosatetraenoic acid (12-HPETE), a labile AA metabolite via the platelet lipoxygenase pathway, could activate the 5-lipoxygenase pathway in neutrophils incubated with FMLP, cytochalasin B and AA, but its stable end product, 12-hydroxyeicosatetraenoic acid, could not. Thus, it is suggested that lipoxygenase-deficient platelets did not sufficiently stimulate LTB4 synthesis during platelet-neutrophil interactions because of defective formation of 12-HPETE. This altered interaction between platelets and neutrophils through the lipoxygenase pathway might result in deficient responses at sites of thrombosis or inflammation in patients with deficient platelet lipoxygenase activities.

Vacuolated plasma cells in multiple myeloma

Practically all myeloma cells had prominent vacuoles, around and within which the end product of acid phosphatase (AP) reaction was demonstrated. These vacuoles were considered to be autophagic. In remission, only a few myeloma cells were vacuolated. Serial determinations showed transition from an initial high AP score (3.86) to a low score (1.32) in remission. Moreover, there was a trend towards a lower average percentage of positive cells in remission (72%) as compared to the preinduction phase (100%). Intracellular Bence Jones proteins of the present case may be toxic and capable of causing vacuolation with activation of lysosomal enzymes.

"Congestion index" of the portal vein

The "congestion index" is used to mean the ratio between the cross-sectional area (cm2) and the blood flow velocity (cm/sec) of the portal vein, as determined by a duplex Doppler system. The indices as determined in normal subjects and patients with liver disease were as follows: normal subjects (n = 85), 0.070 +/- 0.029 cm X sec; acute hepatitis (n = 11), 0.071 +/- 0.014 cm X sec; chronic active hepatitis (n = 42) 0.119 +/- 0.084 cm X sec; cirrhosis (n = 72), 0.171 +/- 0.075 cm X sec; and idiopathic portal hypertension (n = 11), 0.180 +/- 0.107 cm X sec. There was a statistically significant difference between the congestion indices from the normal subject group and indices obtained from patients with chronic hepatitis, cirrhosis, and idiopathic portal hypertension. A weak positive correlation was obtained between the congestion index and the portal venous pressure, measured simultaneously through a percutaneously placed catheter (n = 64, r = 0.45, p less than 0.01). It is suggested that the congestion index reflects the pathophysiological hemodynamics of the portal venous system in portal hypertension.

Lack of correlation between in vitro corticosteroid effect on hemopoietic colony formation and response to corticosteroid therapy in aplastic anemia

We performed hemopoietic colony culture assays in 15 patients with aplastic anemia (AA) in order to test the effect of hydrocortisone (HC) on late erythroid colony (CFU-e) formation of the patients' marrow and to correlate the in vitro culture results with the clinical response to corticosteroid therapy. HC enhanced CFU-e growth in four patients. All four patients failed to respond to corticosteroid, but three improved with with androgens. The addition of HC did not increase CFU-e colony formation in 11 patients. However, two of them responded to corticosteroid therapy. Among the nine patients showing no HC effect in vitro, two subsequently improved with androgens and one each with anti-thymocyte globulin and anti-lymphocyte globulin. The results suggest that the in vitro corticosteroid effect may not necessarily correlate with responsiveness to corticosteroid therapy.

Measurement of portal vascular resistance in patients with portal hypertension

Portal vascular resistance was measured percutaneously in 60 patients with chronic liver disease and in 5 control subjects. The portal vascular resistance (PVR) was calculated, using the following equation, from the portal blood flow (QPV), portal venous pressure (PPV), and hepatic venous pressure (PHV): PVR = (PPV - PHV)/QPV. The portal blood flow was measured using an ultrasonic Doppler duplex system, and the portal venous and hepatic venous pressures were measured using percutaneous transhepatic catheterization and venous catheterization, respectively. The wedged hepatic venous pressure was measured by occluding the hepatic venous branch using a balloon catheter. The portal vascular resistance was 0.25 +/- 0.13 mmHg X ml-1 X min X kg body weight (mean +/- SD, n = 5) in the control group, 0.64 +/- 0.29 mmHg X ml-1 X min X kg body wt (n = 13) in the chronic active hepatitis group, 1.34 +/- 0.79 mmHg X ml-1 X min X kg body wt (n = 30) in the cirrhosis group, and 0.85 +/- 0.69 mmHg X ml-1 X min X kg body wt (n = 13) in the idiopathic portal hypertension group.

Platelet prostaglandin D2 dehydrogenase in patients with myeloproliferative disorders

NADP-linked 15-hydroxyprostaglandin dehydrogenase for prostaglandin D2 (PGD2DH) transforms prostaglandin D2 (PGD2) to inactive 15-keto-PGD2. This enzyme activity was spectrophotometrically determined in the cytosol of platelets and platelet sensitivities to PGD2 were studied in patients with myeloproliferative disorders (MPD) as well as in normal subjects. Platelet sensitivities to exogenous and endogenous PGD2 were estimated by IC50 of added PGD2 for platelet aggregation and by the inhibitory effect of a specific thromboxane synthetase inhibitor (OKY-046) on collagen-induced aggregation, respectively. PGD2DH activities of MPD patients were significantly higher than those of normal subjects (p less than 0.01). Although decreased sensitivity to exogenous PGD2 was detected in some MPD patients, they were not always associated with the increased enzyme activities. Furthermore, no specific correlation was found between PGD2DH activities and the inhibitory effects of OKY-046. Thus, PGD2DH seems to have little effect on the action of PGD2 against platelet aggregation in MPD patients and normal subjects.

Effect of intracerebroventricular injection of vasoactive intestinal polypeptide on systemic blood pressure and pancreatic and gastric secretions in the rat

In order to examine the role of vasoactive intestinal polypeptide (VIP) in systemic blood pressure and pancreatic and gastric secretions in rats, the peptide was given to rats either intravenously (i.v.) through the femoral vein or intracerebroventricularly (i.c.v.) through the lateral ventricle. VIP, when given i.v., showed a systemic, hypotensive effect and a stimulatory effect on pancreatic secretion in urethane-anesthetized rats. When VIP was given i.c.v., there was no change in systemic blood pressure and pancreatic secretion in urethane-anesthetized rats, nor in gastric secretion both in urethane-anesthetized, stomach-perfused rats and in conscious, chronic gastric fistula rats. More research is needed to determine the central effect of VIP in digestive secretion.

Selective IgA deficiency in Japanese blood donors: frequency and statistical analysis

The incidence of selective IgA deficiency (SIgAD) was determined in a healthy adult population of 222,597 Japanese volunteer blood donors. Of the blood donors screened, only 0.007% (1:14,840) were found to be IgA-deficient (less than 10 mg/dl) by means of the double diffusion method, while 0.005% (1:18,500) were less than 5 mg/dl, and 0.003% (1:31,800) were less than 1 mg/dl by means of the single radial immunodiffusion method. Statistical analysis of the results clearly showed that the incidence of SIgAD in Japanese blood donors is very much lower than that in blood donors of European ancestry. The Japanese population may occupy a unique position in the ethnical peculiarities. Anti-IgA antibodies were found in 3 (25.0%) of 12 IgA-deficient blood donors whose IgA levels were less than 5 mg/dl, a prevalence rate comparable to that in donors of European ancestry. Although it is difficult to develop a suitable file of IgA-deficient donors in Japan, the establishment of a Rare Donor Registry System on IgA deficiency is a matter of urgency.

Expression of interleukin-2 receptor on T cell chronic lymphocytic leukemia cells and their response to interleukin-2

We analyzed peripheral blood leukemic cells from six patients with T cell chronic lymphocytic leukemia (T-CLL) with monoclonal antibodies including the anti-Tac antibody, which recognizes the receptor for interleukin 2 (IL 2). The patients were divided into two groups according to the reactivity of the monoclonal antibodies. Leukemic cells from three patients with T-CLL reacted with OKT3 and T4 but not T8, whereas those from the remaining three patients reacted with OKT3 and T8 but not T4. IL 2 receptor, which is expressed on activated T cells but not on resting T cells, was preferentially expressed on T4+ T-CLL cells. The IL 2 receptor on T4+ T-CLL cells was indistinguishable from that on normal activated T cells with respect to molecular weight and downregulation by the anti-Tac antibody. Moreover, fresh T4+ T-CLL cells, but not T8+ T-CLL cells, proliferated in response to exogenous IL 2 without prior activation, and this proliferation was inhibited by the anti-Tac antibody. These results suggest that malignant growth of T4+ T-CLL cells can be regulated by IL 2 not only in vitro but also in vivo.

Dissociation of interleukin-2-mediated cell proliferation and interleukin-2 receptor upregulation in adult T-cell leukemia cells

We studied cell proliferation and interleukin-2 (IL-2) receptor upregulation mediated by exogenous IL-2 in leukemic cells from adult T-cell leukemia (ATL) patients to characterize some aspects of abnormal IL-2 receptor expression in ATL. Leukemic cells from 7 ATL patients examined showed no or very poor proliferative response to IL-2 though they expressed IL-2 receptors without any stimulation. In contrast, ATL leukemic cells cultured with IL-2 for 2 days expressed about twice as many IL-2 receptors as those of cells cultured without IL-2. Thus, in ATL leukemic cells, there seems to be a dissociation between the signal(s) for two different effects mediated by IL-2, cell proliferation and IL-2 receptor upregulation.

Effect of intracerebroventricular injection of vasoactive intestinal polypeptide on systemic blood pressure, and pancreatic and gastric secretions in the rat

In order to examine the central effects of VIP (vasoactive intestinal polypeptide) on systemic blood pressure, and pancreatic and gastric secretions in rats, the peptide was given to rats intracerebroventricularly (i.c.v.) through the lateral cerebroventricle. VIP, when given i.c.v., showed no effects on systemic blood pressure, and pancreatic and gastric secretions in rats. The present results indicate that VIP affects these functions not centrally but peripherally. Physiological role of VIP in the brain remains to be elucidated.

Auer rods in mature granulocytes and monocytes

In a 73-year-old man with acute myelomonocytic leukemia (M4 on FAB classification) Auer rods were demonstrated in mature granulocytes and monocytes in the blood as well as the bone marrow. Cytochemically, a significant number of leukemic blasts were positive for both alpha-naphthyl-acetate esterase and naphthol-AS-D-chloroacetate esterase. Auer rods in mature granulocytes were associated with immature cytoplasm and not infrequently with pseudo-Pelger anomaly. The significance of these observations is discussed.