Acute myelogenous leukemia: a human cell line responsive to colony-stimulating activity

A permanent human cell line that maintains the granulocytic characteristics of acute myelogenous leukemia cells has been established. The cells of this line form myeloid colonies in soft gel culture in the presence of human colony-stimulating activity. The cell line may be useful for studying human acute myelogenous leukemia and the mechanism of response to colony-stimulating activity.

Colony-stimulating activity

Hemopoietic cells, when placed in single-cell suspension in a semisolid growth medium for seven to 14 days, have been found to form visible colonies of granulocytes and monocytes. Colony growth appears only in cultures to which a source of colony-stimulating activity (CSA) is added. Because of these in vitro effects, CSA is thought to be an in vivo regulator of granulocyte and monocyte production from progenitor cells in the bone marrow.

The relationship between polymorphonuclear granulocytes and cartilage destruction in rheumatoid arthritis

The pannus-cartilage junction was investigated in cases of rheumatoid joint destruction. By a histochemical method for demonstrating the presence of neutrophil granulocytes, it became obvious that these cells in some cases were found in high numbers in the immediate vicinity of the cartilage in the process of being destroyed. It is concluded that these blood-carried cells may also participate in cartilage destruction in acute phases of chronic rheumatoid disease.

Cytodifferentiation in the acute myeloblastic leukemias of man

Correlation analysis of numbers of colony-forming progenitor cells was used as an approach to the quantitation of human pluripotent stem cells. Marrow specimens were obtained from 24 patients with untreated acute myeloblastic leukemia, 22 patients under treatment, and 29 patients with no hematologic malignant disease. Three classes of progenitor cells were assayed: burst-forming units dependent on erythropoietin (BFU-E), colony-forming units dependent on erythropoietin (CFU-E), and granulopoietic progenitors (CFU-C). Significant positive correlations between numbers of BFU-E, CFU-E, and CFU-C were found in all 3 groups of patients. In contrast, no such positive correlations were seen between marrow blasts and any of the classes of colony-forming progenitors. These results were compatible with a shared relationship of the colony-forming progenitors to a pluripotent cell of origin and raised the possibility that the immediate progenitors of the blasts may not be any of the myelopoietic progenitor cells monitored in these studies.

A factor in human saliva that induces differentiation of mouse myeloid leukemia cells

The differentiated functions of phagocytosis, locomotion, and morphological changes into cells resembling granulocytes and macrophages were induced in cultured mouse myeloid leukemic cells, M1 clone 34, by treatment with human saliva. The rates of induction of these differentiated phenotypes were proportional to the concentration of saliva added and the period of treatment. The factor inducing differentiation was nondialyzable and heat labile. This factor was purified 70-fold by fractionation with Diaflo membranes and DE52 column chromatography. The activities inducing the three differentiated characters examined were purified together, suggesting that they were all due to the same factor.

Defect of bone marrow granulocyte reserve in liver cirrhosis evaluated with etiocholanolone

In patients with cirrhosis, the etiocholanolone test showed a decrease in the bone marrow granulocyte reserve; in all the cases studied, the baseline counts of peripheral granulocytes were normla. The mechanisms leading to such a defect are explained.

Transplantable granulocytic leukemia in strain 13 guinea pigs

The occurrence of a granulocytic leukemia in 1 of 40 female strain 13/N guinea pigs given N-nitroso-N-butylurea continuously in their drinking water for 21 weeks is reported here. This leukemia has been successfully transplanted in this guinea pig strain for 13 transplant generations by i.p. inoculation of leukemic blood or marrow cells. Macroscopically and microscopically, this leukemia resembles the chronic myelogenous form in humans. Histochemical studies showed, however, that unlike the human leukemic cells those in the leukemic guinea pigs are alkaline phosphatase positive. Electron microscopic studies of the guinea pig leukemic cells revealed the presence of numerous intracisternal A-type particles that are not found in corresponding normal leukocytes.

Experimental hydronephrosis. Influence of infection on the histological picture

The present paper is concerned with a histological examination of 110 pairs of rat kidneys from an experimental investigation on unilateral hydronephrosis previously published. Urine sampled by puncture of the obstructed pelvis remained sterile in cultures from most of the cases, though in 22 of a total of 184 cases growth of bacteria occurred. Intravenous injection of E. coli resulted in substantial growth of the bacteria in similar samples. In 2 cases the untreated control kidney displayed histological evidence of infection. The histology indicated that damage to the renal parenchyma in hydronephrotic kidneys probably predisposes the kidney for hematogenous infection.

Detection, pathogenesis, and prevention of damage to human granulocytes caused by interaction with nylon wool fiber. Implications for filtration leukapheresis

Granulocytes collected by reversible adhesion to nylon wool fiber (NWF) function relatively well in standard in vitro tests; however, they have an abnormally shortened survival time in the circulation. Assuming that this rapid disappearance represents clearance and that recognition by phagocytes is important for such clearance, we used an autologous in vitro cell:cell recognition assay to determine whether phagocytes can detect cellular changes induced by exposure of normal granulocytes to NWF. Human granulocytes incubated with NWF 1 h at 37 degrees C, eluted with 20% acid citrate dextrose plasma, and washed stimulated the hexose monophosphate shunt activity of normal granulocytes an average of twofold (193+/-40% of controls), indicating a recognition response. NWF-induced granulocyte recognition was not dependent on plasma factors or activated complement components but was dependent on the time that the granulocyte was on the NWF and was maximal by 60 min of exposure. After elution from NWF, granulocytes demonstrated resting glucose oxidation rates only slightly higher than normal; however, during the first 20 min of exposure to NWF, granulocytes increased their rate of (14)CO(2) production from [1-(14)C]glucose three- to five-fold. Therefore, experiments were performed to determine whether toxic oxygen metabolites produced by NWF-adherent cells might contribute to recognition. The results showed that (a) normal granulocytes exposed to NWF in the presence of scavengers of superoxide anion (superoxide dismutase) or free radicals (ascorbate, mannitol, or benzoate) and washed before assay did not stimulate glucose oxidation of indicator granulocytes; and (b) NWF granulocytes prepared from cells unable to generate high levels of toxic oxygen metabolites, i.e. cells prepared anaerobically or from a patient with chronic granulomatous disease, also failed to stimulate indicator granulocytes. Human granulocytes placed in contact with NWF show an oxidative burst and become recognizable to other phagocytes. Free radical scavengers are effective in minimizing this recognition conferred on NWF-procured granulocytes.

Esophageal histology in gastroesophageal reflux. Morphometric findings in suction biopsies

Esophageal suction biopsies were taken in 24 subjects with proven gastroesophageal reflux, 12 subjects with suspected reflux, and 20 healthy controls. Sixty-two percent of the patients with proven reflux, 33% of the patients with suspected reflux, and 10% of the control subjects had neutrophilic and/or eosinophilic granulocytes in the lamina propria. Lymphocytes, plasma cell, and basophilic granulocytes were shown to be constituents of the normal esophageal mucosa. All epithelial dimensions showed marked individual variations in reflux patients and controls. The relative length of stromal papillae as expressed in percent of total epithelial thickness showed a linear correlation with relative basal cell thickness and an indirect linear correlation with epithelial thickness. Elongation of stromal papillae in proven reflux could only be demonstrated by arbitrary retrospective stratification of the data. Hyperplasia of the basal zone and thinning of the epithelium were not observed in the reflux patients. It is concluded that granulocytic infiltrates and not epithelial alterations are the most prominent histological finding in gastroesophageal reflux.

Impaired marrow granulocyte reserve and leukocyte mobilization in leukemic reticuloendotheliosis

Cytotoxic chemotherapy often induces sustained, severe granulocytopenia in patients with leukemic reticuloendotheliosis. Many of the patients so treated subsequently develop serious infections. Poor marrow reserve has been implicated but lacks supporting evidence as the cause of the granulocytopenia. In six patients we studied with leukemic reticuloendotheliosis, bone marrow showed severe granulocytopenia, blood neutrophil response after intravenous hydrocortisone injection was poor, and leukocyte migration to the site of inflammation showed suboptimal neutrophilia and poor or no mononuclear response. Splenic hypersequestration and pooling were probably not important factors in causing neutropenia, since similar results were seen in patients without spleens. These findings suggest that in this disease the marrow granulocyte reserve and leukocyte mobilization are impaired and the neutropenia is due to poor granulocyte production and not to increased migration of leukocytes to tissues. Cytotoxic chemotherapy should be used with caution in patients with this disease.

[Interest of sequential "in vitro" cultures of granulomonocytic stem cells (CFUc) in the management of chemotherapy in a case of multiple myeloma (author's transl)]

Sequential measures of granulomonocytic stem cell (CFUc) pool were undertaken during chemotherapy in a case of multiple myeloma. Whereas the number of blood granulocytes remained unchanged, the total number of CFUc was markedly decreased. Therefore the CFUc marrow pool can be considered as one of the data in the management of chemotherapy. In multiple myeloma, the tumour mass can be evaluated by the secretion of monoclonal lg. It appears possible to adapt the schedule of chemotherapy considering both its effect against the tumoral cells and its toxicity on bone marrow stem cells.

In-vitro cloning techniques for hemopoietic cells: clinical applications

Proliferating populations of neutrophils, monocytes, eosinophils, erythroid cells, and T-lymphocytes from normal subjects or patients with various diseases can now be analysed by colony formation in semisolid cultures. These cultures accurately determine the number and proliferative activity of the precursor cells of each population and can also be used to monitor the levels of specific regulatory factors (for example, erythropoietin, colony-stimulating factor) in the serum or urine of such patients. Studies using semisolid cultures have shown that the leukemic cells in chronic and acute myeloid leukemia remain dependent on the normal regulator, granulocyte-macrophage colony-stimulating factor, for proliferation. The cultures have proved valuable in the prognostic assessment of acute leukemic patients and in monitoring impending changes in the clinical status of patients with acute or chronic myeloid leukemia or myeloproliferative disorders.

Felty's syndrome: an analytical review

The clinical and laboratory features of 72 patients with Felty's syndrome described within the last ten years have been compared with Felty's five original patients. Felty's syndrome appears to be a variant of rheumatoid arthritis with extra-articular manifestations in which leukopenia (usually due to neutropenia) and splenomegaly occur, although not always at the same time. Both are manifestations of the underlying disease process and are not necessarily otherwise related. The mechanism of the leukopenia is complex and abnormalities in leukocyte function appear to be as important as the leukopenia in predisposing patients with Felty's syndrome to infection. Functional abnormalities of the leukocytes in this syndrome are due in part to immune complex formation. Hypocomplementemia associated with this process may be another cause for the increased susceptibility to infection. It is proposed, therefore, that therapy in Felty's syndrome be directed at the underlying disease process, and gold salts and penicillamine should be considered for this purpose. Splenectomy should be reserved for specific situations, such as hemolytic anemia, severe thrombocytopenia, leg ulcers, and infections associated with profound leukopenia that are not responsive to medical therapy.

Chronic myelocytic leukemia: clonal origin in a stem cell common to the granulocyte, erythrocyte, platelet and monocyte/macrophage

Glucose-6-phosphate dehydrogenase (G-6-PD) isoenzymes types of granulocytes were determined in eight women with chronic myelocytic leukemia (CML). The patients were heterozygous at the X-linked G-6-PD locus for the common gene, GdB, and a variant, such as GdA, so that both B and A enzyme types were found in skin cells. In contrast to these normal cells, only one G-6-PD type was found in CML granulocytes. The fact that such single-enzyme phenotypes are found in CML granulocytes, but not in nonleukemic granulocytes, provides strong evidence that the disease has a clonal origin. Single-enzyme phenotypes were also found in erythrocytes, platelets and cultured blood macrophages indicating that these cells have a common stem cell which is the site of the abnormality in CML. In the one studied patient, no evidence was found for involvement of cultured marrow fibroblasts. Clonal origin of CML virtually excludes cell recruitment as a sole pathogenetic mechanism. Either the leukemia arises as a consequence of a rare initial event in a single cell, or a series of events occurs in a clone such that it evolves into CML, or both.

'Myelokathexis'. Neutropenia with marrow hyperplasia

A 10-year-old girl was first seen at age 5 years with pneumonia and neutropenia. Since then, she has remained leukopenic, although manifesting a leukocytosis only when she has pulmonary infection. A rapid fall in her peripheral WBC count occurs with initiation of antibiotic therapy. Despite her neutropenia, marked myeloid hyperplasia is evident on marrow smear examination; many cells being hypersegmented with fine intralobular bridging with chromatin strands and cytoplasmic vacuolation. The peripheral WBC response to epinephrine adminstration did not indicate a shift from the circulating to marginal neutrophil pool. Results from a Rebuck skin window test suggested poor neutrophil tissue migration. A defect in granulocyte release from the patient's marrow may explain these bizarre hematologic findings.

Chronic myeloid leukemia: physical and functional similarities to acute leukemia

Blast crisis, closely resembling acute leukemia, is the usual terminal event in chronic myeloid leukemia. Using physical ("fingerprint") and cultural (colony-forming) methods, we have demonstrated distinctive patterns in the stable phase of chronic myeloid leukemia and in blast crisis. An unusual fingerprint alteration preceding the onset of the terminal phase is noted, and cell culture perturbation is evident at different stages of the disease. Our findings indicate that the application of these methods to the study of hemopoietic disorders is valid, and suggest that the use of such techniques may allow a better understanding of the complex cellular events occurring in the course of chronic myeloid leukemia.

Bone marrow colony-forming cells in mice with virus-induced lymphoid leukemia: relation to serum colony-stimulating activity and blood granulocytes

Mice with advanced lymphoid leukemia have elevated peripheral blood granulocytes and elevated serum colony-stimulating activity, which promotes the in vitro growth of granulocyte and/or macrophage colonies. The number of bone marrow precursor cells of the in vitro granulocyte and/or macrophage colonies varied from normal to 10% of normal. The elevation of colony-stimulating activity correlated best with a combination of increased blood granulocytes and a deficiency of bone marrow precursor cells, which suggested that colony-stimulating activity is a leukopoietin that increases the efficiency and rate of production of granulocytes.

Granulopoiesis : studies of bone marrow culture in chronic granulocytopenia and comparison with granulocyte kinetics

Granulopoiesis was studied in 20 cases of chronic granulocytopenia (adults and children; acquired and congenital). Bone marrow colony growth in methylcellulose culture was compared with the turnover-rate of blood granulocytes labelled with 51Cr and with the bone marrow granulocyte labelling index (L.I.) after "in vitro" flash labelling with 3H-thymidine (3H-TDR). There was a positive correlation between colony forming cells (C.F.C.) content and turnover rate and between C.F.C. content and bone marrow cellularity but there was no statistically valid correlation between C.F.C. content and labelling index. In patients with acquired granulocytopenia the colony counts were increased in cases with autoimmune destruction of neutrophils and in one patient during granulocytic regeneration. The C.F.C. numbers were low in cases with neutropenia associated with granulocyte hypoplasia but the prognosis was better in those cases with the highest colony count. On the other hand, colony counts were variable and had no prognostic value in cases of neutropenia secondary to a bone marrow abnormality in maturation or mutiplication, either acquired or congenital, as revealed by turnover studies and autoradiographic data.

Separation of lymphocytes and mast cells from the Furth transplantable mast cell tumor in an isokinetic gradient of Ficoll in tissue culture medium

Cell suspensions of the transplantable Furth murine mast cell tumor were separated both by velocity sedimentation in an isokinetic gradient and by isopyknic sedimentation. Prior to separation, the suspension of tumor cells contained 60.3+/-13.1% (S.D.) malignant mast cells, 9.8+/-10.4% lymphocytes, 4.3+/-2.1% granulocytes, 1.7+/-1.9% macrophages, 0.6+/-0.4% unidentified cells, and 22.8+/-8.5% red blood cells. After either isokinetic or isopyknic sedimentation, more than 97% of the nucleated cells in the purest modal fraction were malignant mast cells. Velocity sedimentation in the isokinetic gradient offered several advantages over isopyknic separation of this tumor; namely, in isokinetic sedimentation, the cells are exposed to a lower centrifugal force for a shorter period of time; a much larger proportion of mast cells were in the highly purified zone of the gradient following velocity sedimentation; and lymphocytes were more highly purified (88.9+/-10.1% of the nucleated cells) following velocity sedimentation. Granulocytes and macrophages were purified more than 8-fold over the nucleated cells in the starting sample suspension. The purified cells from this tumor offer the opportunity to study the interactions between highly purified, easily identified, malignant cells and cells that may participate in the defense of the host against cancer.

[Bone-marrow biopsy in chronic myeloid leukemia. Significance during development]

In 29 patients bone marrow biopsy carried out during the course of chronic myeloid luekemia, permitted the authors to divide up the patients into 5 histologically different groups according to the association of 3 parameters: the richness in granulocytes, the state of the matrix, the degree of leukoblastosis. There was, in most cases, correspondence between the histological appearance and the clinical and laboratory symptoms. This was particularly clear when the patient entered the terminal phase of the disease. 4 of the 5 histological groups had an unfavourable short-term prognosis, i.e., granulocyte hyperplasia with myelofibrosis, aplasia with normal matrix or with myelofibrosis and massive leukoblast invasion.

Colony-forming ability of marrow from patients receiving immunotherapy during chemotherapy-induced remission in acute myeloid leukaemia

An in vivo culture system, the agar diffusion chamber technique, has been used to measure the population of colony-forming precursor cells in the bone marrow of patients receiving immunotherapy during acute myeloid leukaemia in remission. The results of these assays indicate that (1) the level of committed granulocytic stem cells usually remains below the range found in normal marrow throughout remission, and (2) the maintenance of adequate cell counts in the blood may be due to increased cell production by these early granulocytic precursor cells. The relevance of these findings to the possible protective effect of immunotherapy against cytotoxic chemotherapy is discussed.

Anorectal disease in patients with non-haematological malignancy

A frequent and previously uncharacterised association of anorectal inflammatory disease in seven of twenty-two patients undergoing therapy for nonhaematological malignancy is described. Sepsis and secondary pulmonary infection were distant complications of the anorectal lesions. The degree of granulocytopenia induced by chemotherapy appears to be the major predisposing factor. Management includes early surgical intervention, and preventive measures specific for this patient population.

C-G translocation in acute myelocytic leukemia with low neutrophil alkaline phosphatase activity

A consistent chromosome abnormality of C-G translocation, t(8;21)(q22;q22), was found in 15 acute myelocytic leukemia (AML) patients with low neutrophil alkaline phosphatase (N-AP) activity. Granulocytes of these patients also had specific morphologic abnormalities. The bone marrow showed a tendency to relatively good maturation of leukemic cells for the disease AML. Clinical courses of the patients were mild and median survival was longer than that of patients with normal or high N-AP activity (p = 0.065, suggestive difference). Three out of six male patients with these type of AML had missing Y chromosome in addition to C-G translocation. The results suggest that specific cytogenetic abnormality of C-G translocation would be significantly associated with AML. Contrasting with low N-AP activity and the Philadelphia chromosome in chronic myelocytic leukemia, the findings in AML may offer additional evidence towards the possible relations between alkaline phosphatase activity and C or G chromosome.

Influence of humoral regulators on proliferation and maturation of normal and leukemic cells

Factors that influence the proliferation of marrow elements can be detected in sera. To determine the function and to compare the effect of these factors, cells were obtained from patients with normal and leukemic bone marrows. The effects of drug-induced stimulatory and inhibitory sera and leukemic pretreatment sera over time (0 to 6 days) on proliferation and granulocytic morphology of normal and leukemic bone marrow cells in culture were evaluated. Increased proliferation was associated with stimulatory sera, while inhibitory and leukemic pretreatment sera retarded proliferation of both normal and malignant cells. Exposure of normal proliferative cells to inhibitory or leukemic pretreatment sera yielded the greatest increase in mature granulocyte forms. In contrast, although the proliferative response of leukemic cells to these sera was similar to normal, maturation was minimal. These data suggest that leukemic pretreatment sera are similar to inhibitory sera and are not leukemogenic. Both retard proliferation of normal and leukemic bone marrow cells while enhancing maturation of normal cells. Leukemic myeloblasts, however, cannot be made to mature by these humoral regulators.

Terminal transferase in human bone-marrow lymphocytes

Activity of the enzyme terminal transferase (TdT) has been localised in normal human bone-marrow lymphocytes. These cells may represent a prothymocyte population, which, on malignant transformation, may give rise to acute lymphoblastic leukaemia, and to some cases of chronic granulocytic leukaemia in the blastic phase.

Human preleukaemia cell culture studies in sideroblastic anaemia

Cell structure abnormalties are found in acute leukaemia and preleukaemic states. Studies on bone marrow cells and peripheral leucocytes of 4 patients with idiopathic acquired sideroblastic anaemia showed patterns in cell culture similar to those reported in acute leukaemia: 2 of these patients later developed leukaemia. Other patients with idiopathic, secondary or congenital sideroblastosis showed no such cell culture abnormalities, and none developed leukaemia. Studies such as this suggest that cell culture methods detect altered cellular function preceding overt leukaemia and that these abnormal findings may be helpful in the evaluation of patient groups with an increased incidence of leukaemia.

Proliferation of macrophages in inflammation

Proliferation of macrophages in chronic inflammatory loci is an essential part of granuloma development and as such helps to defend the host against dissemination of harmful microorganisms. Its induction seems to depend in part on local appearance of soluble mitogenic factors since sterile cell-free exudates will induce mitotic activity in vitro in a macrophage population otherwise unable to divide. Macrophage proliferation is probably checked and controlled by inherent restrictions on the number of divisions possible. This in turn probably depends on the rapid appearance of gross chromosomal defects, the effete cells being eliminated by their incorporation into multinucleate giant cells which then form non-viable polyploid cells.

Leukemic anaplasias reflecting physiologic cytogenesis of myeloid system

Naphthol AS-D chloroacetatesterase activity in peripheral blood granulocytes is confined to neutrophils which are all positive and to a minor part of monocytes. Its occurance in eosinophils and basophils indicate a myeloproliferative disease. This chemical property can reliably be applied to separate neoplastic from reactive forms of quantitative and qualitative leukocyte alterations. The developmental line of this specific myeloid cellular attribut has been presented to elucidate its diagnostic significance and its validity as proof for existence of a common promyelocyte from which neutrophils, monocytes, basophils and eosinophils originate.

Granulocytic stem cells in Friend leukemia

Friend virus induces a leukemia characterized by the proliferation of neoplastic hematopoietic cells believed to be erythroid precursors. In vitro studies were conducted with spleen cells from mice with terminal Firend leukemia in order to determine their capacity for leukocytic differentiation. Spleen cells were obtained from leukemic DBA/2 mice 1 to 2 days before anticipated death and cultured in the presence or absence of colony-stimulating activity (CSA). Growth in liquid culture in dissusion chambers was dependent on CSA and resulted in the generation of normally differentiated granulocytes and macrophages. Colony formation in agar was also dependent on CSA, and the cloning efficiency of leukemic spleen cells was found to be approximately 10 times normal. The colonies formed were composed of leukocytes, which appeared morphologically normal. Total in vitro colony-forming units per leukemic spleen exceeded normal by more than 300-fold, but cells elaborating CSA were decreased. Although it is uncertain whether the stem cells stimulated by CSA are "normal" or leukemic," it is clear that Friend leukemia has profound effects on the proliferation and differentiation of nonerythroid stem cells.

Myocardial damage during protracted anaphylactic shock in guinea pigs

In ovalbumin-sensitized, mepyramine-treated guinea pigs protracted anaphylactic shock was elicited by i.v. injection of antigen. Diffuse or focal necrosis of myocardial cells was found in animals which died in protracted shock, as well as perivascular and interstitial edema. The antigen effects could be partially imitated by i.v. infusion of high amounts of adrenaline into nonsensitized guinea pigs. When adrenaline was infused during protracted anaphylactic shock, the catecholamine effects did not add to the histological effects of the antigen. Rather, the morphological alterations in the hearts were reduced, whereas the survival times were not increased, but decreased. - The findings are discussed in view of the nature of protracted anaphylactic shock.

Clinical applications of bone-marrow culture

The use of in-vitro culture methods for studying human haemopoietic cells has advanced greatly since 1970. These methods have contributed to our understanding of the mechanisms controlling granulopoiesis though the physiological role of colony-stimulating factor needs further clarification. In leukaemia they offer an approach to the study of possible causal factors and to the characterisation of leukaemic-cell defects. Results already obtained support the concept that the bone-marrow in acute myeloid leukaemia consists of coexisting populations of normal and leukaemic cells, with a leukaemic clone predominating in relapse and normal clones regenerating in remission. For the individual patient, in-vitro methods may prove useful in assessing prognosis and in confirming the completeness of remission; the detection of early relapse may then indicate the need for changing or re-instituting therapy. Further studies may aid the classification of the "preleukaemic" states and may help in the identification of the various causes of neutropenia.

A new hematologic syndrome with a distinct karyotype: the 5 q--chromosome

Five patients, four women and one man, age 32-8- yr, all whites, had refractory anemia with the same abnormal bone marrow karyotype, i.e., a partial deletion of the long arm of the No. 5 chromosome. The hematologic syndrome was practically the same in these five cases. Examination of the blood revealed a moderate to severe, generally macrocytic anemia with slight leukopenia but normal or elevated platelet count. The bone marrow showed a depressed erythroid series and some abnormalities of the granulocytic series with an occasional excess of myeloblasts. Most of the megakaryocytes had a nonlobulated nucleus. These features, as well as cytogenetic, electron microscopic, isotopic, platelet function, and immunologic studies, are described in detail. The relationship of this newly established syndrome to other hematologic diseases is discussed. The syndrome constitutes another example of the association between a specific abnormal chromosome and a distinct hematologic disorder.

Acute leukemia in adults: assessment of remission induction with combination chemotherapy by clinical and cell-culture criteria

Remission induction was assessed by clinical and cell-culture criteria for 65 patients with acute myelogenous leukemia (AML), 11 patients with chronic myelogenous leukemia (CML) in blast crisis and 19 patients with acute lymphoblastic leukemia (ALL). Cyclophosphamide, cytosine arabinoside and vincristine (CAV) therapy resulted in complete remission in 23 of 50 previously untreated patients with AML and in 3 of the 11 patients with CML. Fourteen patients with ALL responded to vincristine-prednisone induction therapy and two to induction therapy with CAV. The median duration of survival of the responding patients was 2.2 years, compared with 4 months for the patients who did not respond to treatment. Granulopoietic colony formation, assessed by assay of colony-forming units dependent on colony-stimulating activity in culture (CFU-C), was abnormal in 37 of 42 bone marrow aspirates from patients with AML before treatement. CFU-C concentration increased when leukocyte-conditioned medium (LCM) was added to the cultures; 13 cultures had normal or elevated CFU-C concentration with LCM. Marrow cells of patients with ALL or CML in blast crisis demonstrated a similar pattern. Serial studies of marrow CFU-C concentration of 31 patients with AML demonstrated a change to a normal pattern with successful remission induction. Results of this study suggest that administration of purified LCM to leukemic patients might increase granulocyte production from potential but unstimulated granulopoietic precursors. This therapy would lessen the probability of death from infection during remission induction.

[Granulocyte dysfunction. Part II. Secondary defects. (authors transl)]

In the first part we reviewed both the molecular basis of granulocyte function and the inborn defects. The present chapter summarizes our knowledge of the secondary defects of chemotaxis, opsonisation, phagocytosis and intracellular microbicidal activity.