Hemolytic disease of the newborn caused by anti-M antibody

An unusual case of hemolytic disease of the newborn caused by anti-M antibody is presented. Hyperbilirubinemia was noted in a full-term baby boy at 4 days of age. A total of 160 mL of M-positive packed red blood cells from the baby's father were transfused during the next 9 days and the hemolytic process became aggravated. The baby was referred to our hospital at 14 days of age. Maternal anti-M was detected and the baby was transfused with 50 mL of M-negative packed red blood cells. The baby's condition stabilized and he was discharged uneventfully at 18 days of age.

HLA-A, B antigens and their linkage with HLA-DR among blood donors in Taiwan

The distribution pattern of HLA antigens varies to a great extent among different ethnic groups. Availability of HLA antigen distribution information is very important for disease association study, paternity testing and recipient/donor matching. Analysis of 11,383 blood donors from the Taipei Blood Center, Chinese Blood Services Foundation (CBSF), gave evidence that the distribution pattern of HLA-A,B antigens was unique, yet closer to Southern Chinese with higher A11, A33, B16, B40 frequencies, and B46, B48, B54 as unique antigens when compared with Caucasians. Pairwise linkage disequilibrium analysis between HLA-A, -B and -DR antigens from 238 blood donors revealed unique linkages of A33-B17, A2-B46, A11-B15, A24-B40; A11-DR5, A2-DR9, B17-DR3, B40-DR8, B13-DR2. In addition, A33-B58-DR3 were the most frequent 3-loci haplotypes. Knowing linkage disequilibrium between HLA loci and preferential association of DR specificity among various HLA-A,B haplotypes may provide a more efficient strategy to obtain an HLA-DR or HLA-D region compatible unrelated bone marrow donor from an existing HLA data bank.

Evaluation of screening kits for the detection of anti-human immunodeficiency virus type 1 and 2 (HIV-1/2) antibodies

HIV-1/HIV-2 3rd generation (Abbott), Wellcozyme HIV 1 + 2 (Murex), Enzygnost Anti-HIV 1/-HIV 2 (Behring), and Genelavia Mixt (Sanofi Diagnostics Pasteur) are currently registered by authorities as enzyme immunoassays (EIAs) for detecting HIV-1/2 infection. The present study dissects these reagents by means of the major antigenic components, assay principles and their actual performance. The performances have been evaluated by their test results in international panels of seroconversion, mixed titer performance and HIV-1/2 combination, respectively. Those EIA tests were further used to examine 26 potentially false-reacting samples, serial diluted sera prepared from two confirmed positive specimens and 720 specimens obtained from random blood donors in the Taipei Blood Center, Chinese Blood Services Foundation (CBSF). The results showed that, although standard sera of the mixed titer, performance and HIV-1/2 combination rows could not distinguish significantly among various EIAs, the seroconverting samples clearly showed their differences. The differences, as calculated by using 3 of 4 seroconverting sera, was a backward window period ranging from 19 to 23 days as compared to the detection of HIV-1 antigens. Together, these studies strongly suggest that assays which are capable of detecting HIV-specific IgM and IgG antibodies have a shorter seroconversion window. Furthermore, the HIV-2 antigen seems to be crucial for successful detection of anti-HIV-2. Finally, testing anti-HIV-1/2 in the routine screenings is expected not to increase the exclusion rate of blood units currently acquired from the examination of anti-HIV-1. Consequently, with both HIV-1/2 specificities and the ability of early detection, IgM/IgG-captured EIAs may represent a better screening method than assays based solely on the detection of HIV-specific IgG.

Recombinant alpha-interferon treatment of intracranial hemangioma and Kasabach-Merritt syndrome in an infant with cytomegalovirus

A 2-month-old girl presented with enlarged head girth, generalized petechiae, anemia, coagulopathy and hepatosplenomegaly. Imaging studies showed a huge, dumbbell-shaped intracranial hemangioma located between the falx, and involving the supra- and infra-tentorium, extending through the posterior fontanel to involve the subgaleal area. A urine culture grew cytomegalovirus. Severe thrombocytopenia was refractory to a massive platelet transfusion, intravenous immunoglobulin and corticosteroid therapy. Hypertension, pulmonary hemorrhage and sepsis complicated the course. After establishing a diagnosis of Kasabach-Merritt syndrome, subcutaneous injections of alpha-interferon were given with an initial dose of 1 x 10(6) IU/m2 followed by 3 x 10(6) IU/m2 per day for 12.5 mo. Her platelet count rose gradually and became stable after 1.5 mo of interferon treatment. The intracranial hemangioma regressed remarkably and the hepatosplenomegaly was also resolved. The infant showed good growth and development, without obvious side-effects during the 23-month follow-up period. The treatment with recombinant alpha-interferon appeared to be effective in reversing thrombocytopenia associated with the patient's massive intracranial hemangioma.

Immunomodulation treatment for childhood virus-associated haemophagocytic lymphohistiocytosis

The Epstein-Barr virus (EBV), or human herpesvirus-6 (HHV-6) associated haemophagocytic lymphohistiocytosis, has been found prevalent in Taiwan; it affects previously healthy children and is always fatal when treated only supportively. Recognition of the underlying pathogenesis for this disease prompted adoption of an immunomodulatory regimen of intravenous immunoglobulin (IVIG) and/or etoposide on 17 such patients treated between 1990 and 1993. Remarkable improvement in patients' prognoses was demonstrated. Eight patients are still alive with a median follow-up of 1 year and 2 months post-treatment. Both IVIG and etoposide had positive immunomodulation effects such as alleviation of fever and normalization of haematological and hepatic parameters. Sustained complete response was obtained in two of nine cases of EBV-associated diseases treated with IVIG only. EBV transcripts became undetectable after etoposide and/or IVIG treatment without antiviral agents. Etoposide given by split-doses schedule appeared to be superior to conventional three-consecutive-days schedule for both remission induction and disease-free survival. Our preliminary trial apparently provides a promising improvement in the treatment of this previously fatal disease. IVIG or etoposide is effective in reversing the process of lymphohistiocytic dysregulation resulting from virus infection of immune cells in this syndrome and probably helps hosts to control active virus replication in certain cases, through immunomodulation.

Allogeneic bone marrow transplantation for children with acute lymphoblastic leukemia in second remission or relapse

Most children with acute lymphoblastic leukemia (ALL) are successfully treated by chemotherapy. For those patients, who relapse on therapy, bone marrow transplantation (BMT) is considered most appropriate after a subsequent remission is achieved. Three boys with ALL aged from 9 to 13 years met these criteria and received BMT from their HLA-compatible sisters after marrow ablation with total body irradiation 12 Gy plus high dose cytosine arabinoside 3 gm/m2/12h x 12 doses and graft-versus-host disease (GVHD) prophylaxis with cyclosporine plus short course methotrexate from March 10, 1989 to May 23, 1992. Filgrastim (rhG-CSF) was used to hasten the recovery of granulocyte in one patient. All three patients got full engraftment and two had grade 1 acute GVHD. None of them developed chronic GVHD. Two patients have disease-free survival over 51 and 12 months respectively post BMT without further chemotherapy. One patient died of recurrent refractory leukemia 5 months after BMT. The toxicity of this conditioning regimen included photophobia, conjunctivitis and erythematous skin rashes. One patient who received filgrastim from day 1 to 21 developed severe bone pain. However, this patient had faster recovery of granulocyte count than the other two patients. The preliminary results of this work favors BMT for children with recurrent ALL whose ultimate survival is usually poor when treated with chemotherapy. Further efforts are necessary to investigate new methods for reducing leukemic relapse in ALL patients undergoing BMT.

Bone marrow transplantation for childhood acute myelogenous leukemia

Six consecutive patients with acute myelogenous leukemia (AML) underwent 7 allogeneic bone marrow transplants at National Taiwan University Hospital. Marrow ablation for 4 patients consisted of busulfan 16 mg/kg and cyclophosphamide 120 mg/kg (BUCY 2). Two patients had busulfan 16 mg/kg and cyclophosphamide 200 mg/kg (BUCY 4) as marrow ablation. One had a second transplant following cytosine arabinoside 3 gm/m2/dose x 10 doses plus total body irradiation 12 Gy. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and short course methotrexate. Four patients received marrow from their HLA compatible siblings and two from their HLA-haplotype-matched fathers. Four transplants were performed during first remission and the other three during subsequent remission or relapse. All patients except one engrafted and achieved a complete remission (CR). Three of 4 patients transplanted in first CR are alive for over 10, 20 and 59 months respectively after transplant. One of the two patients who each received marrow from their fathers during 2nd CR and relapse, developed relapse 5 months later and the other developed aplasia 3 months later. Acute GVHD occurred in two of six patients. Localized chronic GVHD occurred in one of these two patients. Toxicities of BUCY 2 were minimal except veno-occlusive disease. One patient who received BUCY 4 developed hemorrhagic cystitis. There were no treatment related deaths except one patient who received 2nd transplant. These results demonstrate that BUCY 2 should be considered as a preparative regimen for allogeneic bone marrow transplantation for patients with AML in first remission.(ABSTRACT TRUNCATED AT 250 WORDS)

Epstein-Barr virus (EBV) infects T lymphocytes in childhood EBV-associated hemophagocytic syndrome in Taiwan

We have reported the prevalence of a fulminant hemophagocytic syndrome (HS) in previously healthy young children in Taiwan, most of which probably represent a lethal form of primary or active Epstein-Barr virus (EBV) infection. To further confirm their EBV association, in situ EBV hybridization (ISH) was performed on tissue biopsies from 15 pediatric HS patients (median age, 3 years and 4 months) using digoxigenin-labeled RNA probes EBER1. Double labeling immunostaining and ISH was then performed to define the immunophenotype of the lymphoid cells containing the EBV transcripts. Among the 13 patients who had serological evidence of acute or active EBV infection, 9 had demonstrable EBER1 transcripts in bone marrow, liver, and/or skin biopsies. EBER1-specific signal was not detectable in the two specimens from EBV-seronegative patients. The distribution of EBV-containing cells could be extensive or scattered. To our surprise, the EBER1 transcripts existed exclusively in T lymphoid cells in all nine cases examined rather than in B cells as previously believed in infectious mononucleosis. Considering the young affected age of the HS patients and the serological response to EBV, we suggest that EBV can infect T cells in primary EBV infection and the proliferation of these EBV-infected T cells may be responsible for the ominous outcome in childhood HS patients in Taiwan.

A comparative study of 99Tcm-HMPAO and 99Tcm-ECD as a leukocyte labelling agent

An attempt was made to use 99Tcm-ethyl cysteinate dimer (99Tcm-ECD) (Neurolite, Du Pont Merck, N. Billerica, MA) to label leukocytes. The radiochemical purity of 99Tcm-ECD, labelling efficiency of leukocytes, cell viability of labelled leukocytes and stability of 99Tcm-ECD-labelled leukocytes were calculated. Compared with the commercial cell-labelling agent, 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO): (1) the radiochemical purity of 99Tcm-ECD was higher than that of 99Tcm-HMPAO and at immediately, 1, 2, 4, 6, 8 and 24 h after 99Tcm labelling; (2) the labelling efficiency of 99Tcm-ECD-labelled leukocytes was lower than that of 99Tcm-HMPAO; (3) the viability of the labelled white blood cells (WBC) was high for both agents; and (4) the stability of 99Tcm-ECD-labelled leukocytes was worse than that of 99Tcm-HMPAO at 1, 2, 4, 6, 8 and 24 h. It is concluded that although 99Tcm-ECD is more stable than 99Tcm-HMPAO, because of the lower labelling efficiency and power stability of 99Tcm-ECD-labelled leukocytes, 99Tcm-ECD is not a good choice as a leukocyte-labelling agent to replace commercial 99Tcm-HMPAO.

Peripheral T-cell lymphoma in childhood: a report of five cases in Taiwan

We encountered five children with peripheral T-cell lymphoma (PTL) at National Taiwan University Hospital (NTUH) from 1985-1989. The patients were four boys and one girl, aged between 5 and 13 years. The duration of prediagnostic symptoms varied from 1 month to 5 years. All had pyrexia and lymphadenopathy; one had a prolonged history of granulomatosis with repeated infection. Four had hepatosplenomegaly. One patient presented with diffuse pulmonary infiltration and impending respiratory failure. All patients were negative for human T-cell leukemia virus (HTLV)-I antibody, and positive for HBsAg. Four patients who had EBV-viral capsid antigen (VCA) IgG and who were IgM tested were positive for EBV-VCA IgG, but only two had evidence of active EBV infection. Tumor cell markers were examined and showed the following phenotypes: all patients were CD2, CD3, and CD7 positive but CD19 and CD20 negative; three patients were CD4 positive and CD8 negative; the other two patients were CD4 negative and CD8 positive. Four patients died 2-7 months after diagnosis. The remaining patient received allogeneic bone marrow transplantation and has survived free of disease for more than 22 months after transplant. Our five cases reconfirm the high frequency of diagnostic delay, the heterogenous immunophenotypes, high mortality, and poor responsiveness to conventional therapy for PTL. Bone marrow transplantation in the early stage might be a possible cure of this disease.

Bone marrow transplantation for severe aplastic anemia

Fifteen patients (nine male, six female) with severe aplastic anemia (SAA) undergoing HLA-identical allogeneic bone marrow transplantation (BMT) received preparative regimens consisting of cyclophosphamide and total lymphoid irradiation. Patients were aged from eight to 26 years (median 15 years). Prophylaxis of graft versus host disease (GVHD) including cyclosporine and short course methotrexate was administered. One early death occurred at day 8 post BMT. Among the other 14 patients, one died of sepsis at day 53 with no evidence of engraftment, 13 were engrafted despite the number of donors exposed in transfusions of previous blood components. Eleven patients have survived from six to 100 months (median, 54 months), post BMT. The remaining two patients died of acute GVHD-related infections on days 44 and 63. Acute GVHD occurred among eight of 13 engrafted patients, five of whom were grades II-IV clinically. Chronic GVHD developed among five patients, three of whom were clinically progressive and extensive. Two of three patients with extensive chronic GVHD had received transfusion of donor's buffy coat after BMT. Our data indicate an engraftment rate of 87% (13/15). The projected probability of disease-free survival was 73% (11/15) at 9.3 years after BMT according to the Kaplan-Meier model. Further efforts must be made to eliminate GVHD and to control fatal infections.

Anionic glutathione S-transferases in shrimp eyes

1. Two anionic isoenzymes of glutathione transferases (EC 2.5.1.18), QI and QII, have been purified from the eyes of the shrimp Penaeus japonicus by using a combination of S-hexylglutathione affinity column chromatography and Mono-Q fast protein liquid chromatography (f.p.l.c.). 2. Both QI and II glutathione S-transferases are homodimers. They show similarity in substrate specificities and pH optima, but not in isoelectric points. 3. QI is distinct from QII by anion-exchange f.p.l.c., reverse-phase h.p.l.c. chromatography and amino acid sequencing analysis. QI has N-terminal amino acid sequences homologous to mu glutathione S-transferase, whereas QII is homologous to theta glutathione S-transferases.

Characterization of Philadelphia-chromosome-positive acute leukemia by clinical, immunocytochemical, and gene analysis

Philadelphia chromosome (Ph') was detected at presentation in 10 out of 110 patients with acute lymphoblastic leukemia (ALL) and five of 168 patients with acute myelogenous leukemia (AML). Two other ALL patients who had studies at relapse were also included in the analyses. One of the 12 Ph'-positive (Ph+) ALL patients had simultaneous expression of myeloid-associated antigen on the leukemic blasts, while all the five AML patients coexpressed markers of lymphoid cells. Double labeling of the cells with myeloperoxidase and CD10 on three Ph+ AML cases showed that most leukemic blasts expressed either myeloperoxidase activity or CD10 but not both. Cross-lineage gene rearrangements of T-cell receptor (TCR) beta-chain gene were detected in three of the eight Ph+ ALL patients tested. All the four Ph+ AML cases studied showed immunoglobulin heavy chain gene rearrangements, and three of them also had simultaneous rearrangements of TCR beta-chain gene. The results revealed that Ph+ acute leukemia in this study belonged either to ALL or mixed lineage leukemia, and none was pure AML. This finding is contrary to that of acute blast crisis of chronic myelogenous leukemia in which the majority of patients had myeloid transformation. Rearrangements of bcr were detected in four of the 10 Ph+ ALL and three of the four Ph+ AML patients tested. No significant difference was noted in the clinical or hematologic manifestations among Ph+ leukemia with or without bcr rearrangements.

Purification and characterization of an alpha-glucosidase from the hepatopancreas of the shrimp Penaeus japonicus (Crustacea: decapoda)

1. The alpha-glucosidase purified from the hepatopancreas of Penaeus japonicus is not membrane-bound and labile to heating at 65 degree C for 10 min. 2. The specific activity of the purified enzyme is 223 units/mg of protein. After polyacrylamide gel electrophoresis under denaturing conditions, the purified alpha-glucosidase from shrimp was found to consist of monomers of M(r) 105,000. 3.The alpha-glucosidase from shrimp has an isoelectric point (pI) of 3.8 and becomes more alkaline after the removal of sialic acid and phosphoric acid. 4.The shrimp enzyme has the pH optimum at 5.0 and its K(m) was 125 micrometer with 4-methylumbelliferyl-alpha-D-glucoside as substrate.

Comparative study of free and membrane-bound acidic beta-D-glucosidase from the hepatopancreas of the shrimp Penaeus japonicus (Crustacea: decapoda)

l. In the hepatopancreas of the shrimp Penaeus japonicus the beta-glucosidase is present, either free or membrane-bound. The specific activity of the purified enzyme is 237,333 units/mg of protein and 191,111 units/mg of protein for the free and the membrane-bound beta-glucosidase, respectively. 2.The non-membrane-bound beta-glucosidase appears to be the same molecular size as the membrane-bound enzyme, both being monomers and consisting of a polypeptide chain of apparent M(r) 65,000, as estimated by chromatography on Superose 12 and by SDS-PAGE. 3.Both enzymes share similarities in their molecular size and substrate specificities (with ratios of 100:17:4:12 for the non-membrane-bound and 100:32:13:12 for the membrane-bound enzyme for the activities with methylumbelliferyl-beta-D-glucoside, methylumbelliferyl-beta-D-galactoside, methylumbelliferyl-alpha -L-arabinopyranoside and methylumbelliferyl-beta-xyloside respectively, as substrates). 4.The membrane-bound beta-glucosidase can be differentiated from the non-membrane-bound enzyme by its isoelectric point (7.5 vs 6.6), Km (182 micrometer vs 76 micrometer), pH optimum (4.5 vs 5.5), phosphorylation,sialyation and thermostability.

Long-term observation of pediatric aplastic anemia

Fifty-nine verified cases of acquired aplastic anemia (AA), diagnosed at the Pediatric Department of the National Taiwan University Hospital from 1977 to 1987, were reviewed and analyzed. The demographic features showed a high relative incidence (acute myelogenous leukemia/AA ratio, 2.2/1), a high percentage of non-severe AA (39%) and a high association with hepatitis (20.8%). No evidence of hepatitis A, B or C virus infection was found in five cases of hepatitis-associated AA. No sex preponderance was noted in this pediatric series. The 10-year projected survival rate of the total series approached 55%. The crude two-year-survival and two-year-transfusion-free-survival rates were 59% and 44%, respectively, in the conservative therapy group treated with androgens and steroids; 36% and 32%, respectively, in patients with severe AA in the conservative therapy group; and 73% and 64%, respectively, in the aggressive therapy group treated with cyclosporin, anti-lymphocyte globulin or bone marrow transplant. The major causes of death were hemorrhage (44%) and infection (56%) in the conservative therapy group; but in the aggressive therapy group, two out of three deaths were related to therapeutic complications. Multivariate analysis of prognostic factors revealed that severity and treatment modality were independent risk factors. Only two out of 31 patients who survived more than two years (long-term survivors) experienced late mortalities. At two, five, seven and 10 years after diagnosis, 61%, 55%, 41% and 40% of the long-term survivors had inadequate hematopoietic recovery.

Acute myelofibrosis terminating in acute lymphoblastic leukemia: report of one case

A four-year-old boy suffered from acute myelofibrosis which became acute lymphoblastic leukemia during the course of the disease. Histologic and immunophenotypic studies revealed that the leukemic cells were lymphoblasts. Immunophenotypic examination also excluded the possibility of acute megakaryoblastic, monocytic and myeloid leukemia. Thus terminal leukemic transformation, in some cases of acute myelofibrosis, may be of a lymphoid nature.

Analysis of hemoglobin gamma chain in patients with Cooley's anemia in Taiwan

The beta-like globin gene cluster, consisting of five genes and a pseudogene, is located on chromosome 11 and is arranged in the order 5'-epsilon-G gamma-A gamma-phi beta-delta-beta-3'. With the fast and sensitive method of high-performance liquid chromatography (HPLC) in the gradient mobile system, we studied the G gamma values of fetal hemoglobin in 34 patients with Cooley's anemia, 100 normal adults and 100 newborns. There were 84 newborns with a mean G gamma value of 67.41 +/- 2.37%, 15 newborns with a G gamma value of 83.45 +/- 1.92% and one newborn with a G gamma value of 100%. Because the medium value of 67.41% and 100% is near the value of 83.45%, we speculate that there are different g gene genotypes; that is, the group with a G gamma value of 100% has a genotype of G gamma-G gamma/G gamma-G gamma, the group with a G gamma value of 83.45% has a genotype of G gamma-G gamma/G gamma-A gamma, and the group with a G gamma value of 67.41% has a genotype of G gamma-A gamma/G gamma-A gamma. The G gamma value for normal adults was 41.84 +/- 20.91%. While the G gamma values for patients with Cooley's anemia were divided into two groups, 56.23 +/- 6.55% and 80.60 +/- 3.05%. There was no case having a G gamma value of 100%. Our results suggest that the expression of the gamma gene in Cooley's anemia is similar to that of the newborns.

Results of therapy for beta-thalassemia major

During the last 10 years, 92 transfusion-dependent beta-thalassemia patients have been encountered at the National Taiwan University Hospital and Provincial Taoyuan General Hospital. Seventy-seven of them were followed up regularly. Long-term results of conventional therapy in 63 cases and allogeneic bone marrow transplantation (BMT) in 14 cases are reported. The conventional therapy included regular red cell transfusion and desferrioxamine iron chelation therapy. Preliminary results of conventional therapy showed a mortality of 7/63 (11%). Of those who were alive, the morbidity was 56/56 (100%). There was no disease-free-survival (0/56; 0%). BMT was performed after preparatory regimens of busulfan, cyclophosphamide, and/or total body or lymphoid irradiation. Preliminary results of BMT showed a mortality of 5/14 (36%). For those who were alive, the morbidity was 3/9 (33%), and the disease-free-survival rate was 6/9 (67%) during a follow-up period of three to six years. It is concluded that the only way to cure beta-thalassemia major at present is BMT. However, the risks of BMT and donor non-availability make conventional therapy unavoidable. Further study is needed to decrease the risk of BMT and to improve the efficacy of conventional therapy.

Participation of pertussis toxin-sensitive GTP-binding regulatory proteins in the suppression of baroreceptor reflex by neurotensin in the rat

We evaluated the molecular mechanism that may underlie the suppressive effect of neurotensin (NT) on the baroreceptor reflex (BRR), using Sprague-Dawley rats that were anesthetized with sodium pentobarbital (50 mg/kg, i.p.). Intracerebroventricular (i.c.v.) application of NT (15 nmol) significantly inhibited the BRR response. Such an inhibition was appreciably antagonized by pretreating animals with i.c.v. injection of pertussis toxin (10 or 20 pmol), N-ethylmaleimide (1 or 2 nmol), forskolin (30 or 60 nmol) or phorbol 12-myristate 13-acetate (2 or 4 nmol), but not by cholera toxin (15 or 30 pmol). More specifically, pretreatments with bilateral microinjection into the nucleus tractus solitarius (NTS) of pertussis toxin (80 or 160 fmol), N-ethylmaleimide (80 pmol), forskolin (480 pmol) or phorbol 12-myristate 13-acetate (16 or 32 pmol) also blunted the NT-induced suppression of BRR, although cholera toxin (120 or 240 fmol), or 1,9-dideoxyforskolin (480 pmol) had no appreciable effect. These results suggest that a pertussis toxin-sensitive guanine nucleotide-binding regulatory protein(s), which is not likely to be Gs, possibly Gi or Gp, may be involved in the transmembrane signaling process that underlies the suppression of BRR response by NT at the NTS.

A new codon 31 (-C) mutant resulting in beta zero-thalassemia

A new beta zero-thalassemia mutation, a frameshift mutation with deletion of a single cytosine nucleotide in codon 31, is described. The propositus, which is compound heterozygous for this mutation and the 17 beta A-T beta zero-thalassemia mutation, has the phenotype of severe beta-thalassemia major.

A novel -32 (C-A) mutant identified in amplified genomic DNA of a Chinese beta-thalassemic patient

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A pathologic study of childhood lymphoma in Taiwan with special reference to peripheral T-cell lymphoma and the association with Epstein-Barr viral infection

The authors retrospectively reviewed the clinicopathologic and immunologic features of 65 consecutive cases of childhood lymphoma reported between 1980 and 1989. Southern blot hybridization was also performed in 23 cases to study their association with Epstein-Barr virus (EBV) and human T-cell leukemia virus type 1 (HTLV-1). The 65 cases included 56 non-Hodgkin's lymphoma (NHL) (86%) and 9 Hodgkin's disease (HD) (14%). The NHL could be classified into the following groups: Group I, small noncleaved cell lymphoma (20 cases); Group II, lymphoblastic lymphoma (17 cases); Group III, large cell lymphoma (17 cases); and miscellaneous (2 cases). There was no follicular lymphoma case. Immunohistochemical study on paraffin sections and/or frozen specimens in 47 cases of NHL showed that all the Group I cases belonged to B-cell neoplasm (17 of 17 cases); most of the Group II cases belonged to T-cell neoplasm (9 of 14 cases); and most of the Group III cases were peripheral T-cell lymphoma (PTL) (8 of 16 cases), including 2 cases of Ki-1 lymphoma. The majority of childhood NHL belonged to high-grade malignancy with an aggressive clinical course (median survival time, 8 months). The EBV DNA could be detected from the tumor tissues in 4 of 6 PTL, but in none of the remaining 19 cases of NHL including 6 Burkitt's type lymphomas. HTLV-1 proviral genome was not detected in all specimens examined. The authors concluded that the distribution pattern and clinicopathologic feature of childhood lymphoma in Taiwan are comparable to that in Japan and western countries. The frequent association of EBV with aggressive PTL was unique and deserves additional investigation.