[Value of plasma exchange in necrotizing angeitis. 11 cases]

Plasma exchanges proved useful in a series of 11 patients with necrotizing angeitis resistant to conventional treatment (corticosteroids alone in 6 cases and combined with cyclophosphamide in 5 cases). Among the 9 patients alive after 18 months' follow-up, 5 were in remission without treatment. The only disturbing complication of plasma exchanges was hepatitis B in 3 of the 4 survivors who received frozen fresh plasma as substitute. It is suggested that these immuno-compromized patients should receive diluted albumin instead of fresh frozen plasma.

[Value of plasma exchange in the management of acute immunoallergic thrombocytopenic purpura (author's transl)]

Plasma exchanges were performed in 5 patients with acute immunoallergic thrombocytopenic purpura (ITP) because of severe haemorrhages and/or inefficient or badly tolerated corticosteroid therapy. Plasma exchanges were carried out with cell separators and were usually well tolerated. They resulted in very rapid increase in platelet levels with disappearance of auto-antibodies and dramatic reduction of haemorrhages, and they brought about, or accelerated, recovery in 3 patients. One patient was slightly improved. In the 5th patient, who had meningeal haemorrhage, plasma exchange was effective in increasing platelet levels but was unable to prevent a fatal outcome. The main indications for plasma exchange seems to be acute ITP with severe, life-threatening haemorrhages.

Bone marrow transplantation in Fanconi anaemia

Five patients with Fanconi anaemia have been treated by bone marrow transplantation from HLA identical donors. Only one patient survived for more than 3 years. She is now perfectly healthy with complete haematological reconstitution with chimaerism and disparition of chromosomal abnormalities. In contrast, four patients died of acute severe GVHD soon after grafting. In addition, all had signs of severe cyclophosphamide toxicity. This evolution could be explained by a special sensitivity of FA cells to alkylating agents and may indicate the need to modify the conditioning regimen in FA patients.

Potential danger of thrombosis after plasma exchange in the treatment of patients with immune disease

Coagulation studies were serially performed before and after repeated plasma exchange in seven patients with myashtenia gravis. The fall in platelets and coagulation factor activities after plasmapheresis using a replacement material devoid of clotting factors was not so low that bleeding episodes were to be feared and no hemorrhages were observed. In contrast, thrombotic phenomena were suspected in two patients. Antithrombin III fell to undetectable levels in some cases. This finding associated with elevated values of factor VIII related antigen, factor VIII coagulant activity and von Willebrand factor suggested a potential danger of thrombosis in such treated patients.

Detective Platelet Surface Markers in Chronic Myeloid Leukemia (CML)

Leukemic platelets (LP) from patients suffering from CML were shown to express altered surface membrane glycopoteins (Vainer s Bussel, 1977, Intern. J. Cancer, 19, 143). The present study wax devoted to the examination of other platelet surface components in 8 patients with CML, before any treatment : i) UDP-Galactose: glycoprotein galactosyl-transferase (GTase) activity, evaluated from the amount of radioactivity incorporated a) into the acid-precipitable material and b) In the labeled soluble reaction products, eluted following autoraduichromatography - and ii) 14C epinephrine (E) binding sites on isolated LP membranes, determined by a filtration procedure.

It was found that i) LP can catalyze the transfer of 14C-Galactose from its activated form (UDP-Gal) onto endogenous and exogenous (ovomucoid) acceptors. The transfer reaction in LP was found at a rate 2 to 4 fold greater than in normal platelets (NP), without affecting the values of the apparent Km for UDP-Gal or other kinetic parameters, ii) Isolated membranes from LP specifically bind 14C-E to alpha adrenergic type sites, but the number of receptors for E, available on LP membrane was lower (or present in a cryptic form) than the level reported in NP (Vainer H., 1977, Cell Str. & Function 2, 267).

The modulation of both GTase activity level and E receptor number in LP from CML patients could be involved in or correlated with their abnormal function and morphology.

Cytomegalovirus infection in malignant blood diseases:clinical and laboratory data in 29 patients

Twenty-nine patients treated for malignant blood diseases developped CMV infection. Their clinical and laboratory features were studied. The results indicated that this infection apparently did not influence the prognisis of the underlying disease. The main hematological feature was pancytopenia. The data of viremia suggested active infection. A marked increase of CMV CF antibodies were observed in 27/29 patients, and the peak titers of 42% of our cases were greater than 1:1024. Homogenous Ig were detected in 7/29 patient's serum.

Allogeneic bone marrow transplantation in aplastic anemia--report of 25 cases

Bone marrow transplantation using an HLA-MLC-identical sibling is the most valuable treatment of severe aplastic anemia.2,6,7 Between November 1973 and March 1977, 25 consecutive patients have been treated by marrow transplantation in our unit. Nine patients are alive with complete hematologic restoration between 3 months and 3 years. The high mortality can be largely accounted for by marrow graft rejection (14 patients). Despite the small number of patients, we have tried to identify prognostic factors associated with marrow graft rejection. They are mainly the existence of anti-HLA antibodies, the sex difference, and the normal PHA and MLC response before grafting. After the graft, the disappearance of anti-HLA antibodies has a good prognostic value. The appearance of autolymphocytotoxins seems to correlate strongly either with rejection or graft-versus-host disease.