Surface passivation by human albumin of plasmapheresis circuits reduces platelet accumulation and thrombus formation. Experimental and clinical studies

The contact of flowing blood with an artificial surface leads to adsorption of plasma proteins, followed by platelet adhesion and aggregation and thrombus formation. This phenomenon is enhanced by turbulent flow at joints, bifurcations, and constrictions. In therapeutic plasmapheresis using an IBM blood cell separator, blockage of the extracorporeal circulation system by platelet-fibrin thrombi imposed a halt in treatment for manual clearance of the circuit for 66 in 149 cases (44%). Thus it was decided to passivate the surface of the extracorporeal circuit by filling the tubing with 4% human serum albumin 15-20 min before the treatment session and then displacing the albumin solution with the patient's blood without creating an air-liquid interface. After introduction of this technique, a blockage was observed for only 11 in 239 cases (5%). In vitro measurements of platelet accumulation on the internal surface of the circulation system were carried out using washed human platelets labeled with 111In-oxine in the presence of a 40% hematocrit. Preadsorption of the surface with albumin reduced platelet deposition to 4-5% that observed for an equivalent pretreatment with physiological saline.

Establishment and characterization of somatic hybrids between human differentiated macrophages and mouse myeloma NS1 cells

Human macrophages obtained from circulating monocytes matured in vitro by culture for seven days in hydrophobic flexible teflon bags were successfully fused with murine myeloma NS1 cells. Six of 20 clones, selected for their adherence properties, were further studied. All possessed human chromosomes (mean number ranging from 4 to 14 depending on the clones studied), exhibited non-specific esterases (but no peroxidase activity) and expressed CD14 antigen and C3 receptors (but no MAX-1 antigen). Moreover, the hybridomas retained phagocytic activity and high interferon plus lipopolysaccharide-activable cytolytic activity against tumor cells.

VP-16, ifosfamide, and methotrexate combination chemotherapy for aggressive non-Hodgkin's lymphomas after failure of the LNH 84 regimen

A total of 20 patients with intermediate or high-grade non-Hodgkin's lymphomas who failed to LNH 84 regimen were treated with a combination of VP 16, ifosfamide and methotrexate (VIM regimen). Nineteen patients are evaluable for response. Eight patients (42%) achieved complete responses and four (21%) attained partial responses. Most of the complete responders are still in remission with a follow-up of more than 30 months for 5 patients.

Combination of recombinant interferon alpha-2a and vinblastine in advanced renal cell cancer

Among 40 evaluable patients with metastatic renal cell cancer treated by high-dose interferon alpha-2a in combination with vinblastine, the authors have observed a 42.5% response rate. The 8 months' median duration of remissions is relatively short but some patients experience very long remissions, lasting many months after discontinuation of therapy. The survival of responding patients is significantly longer than the survival of nonresponders. The diverging results of other studies of the same combination are discussed; its efficacy is certainly dependent on the type of interferon, on the dose actually administered, and on the compliance to this often poorly tolerated treatment.

Control of the antitumoral activity of human macrophages produced in large amounts in view of adoptive transfer

Purified human blood monocytes were grown in hydrophobic bags in RPMI medium containing additional amino acids, indomethacine and growth factors. Autologous serum was added after a few days of culture at 37 degrees C, 5% CO2. The antitumoral activity generated by activated monocytes against human tumor cells grown in vitro was mediated by soluble effectors in contrast to macrophages which acted by cell contact. Monocyte differentiation into macrophages was achieved after 7 days of culture and characterized by phagocytosis and expression of MAX 1 antigen and non-specific esterases. The macrophages remaining in suspension in the bags were activated by exposure to immunostimulating compounds used alone or in combination (recombinant human gamma-interferon and muramyldipeptide). Activated macrophages were cytotoxic in vitro against U 937 or ovary carcinoma tumor lines (95% cytotoxicity) at a 1/1 effector/tumor cell ratio. The antitumoral potency of activated macrophages was confirmed in vivo where adoptive transfer of one million human macrophages twice a week to nude mice bearing human ovary carcinoma caused a marked regression of the primary tumor.

[Treatment with a piperacillin and netilmicin combination of patients with agranulocytosis]

Sixty infections episodes in granulocytopenic patients have been treated in first line with a piperacillin and netilmicin combination. Treatment has been successful in 78% bacterial infections. So, this antibiotic combination appears as a very effective therapy of infection in neutropenic patients.

A T chronic lymphocytic leukemia with large granular lymphocytes. Phenotype and functions of leukemic cells under in vitro treatment by differentiation inducers

We reported the morphologic, phenotypic and functional characteristics of leukemic cells with natural killer (NK) properties in a case of T chronic lymphocytic leukemia with large granular lymphocytes. These cells were cytologically and cytochemically characterized as phosphatase acid positive large granular lymphocytes (LGL), and presented parallel tubular arrays at the ultra structural level. They displayed a CD2, CD3, CD8, CD11, Leu 7, and Leu 11 positive phenotype while they lacked B cell markers including surface immunoglobulins. In addition, they expressed human leukocyte antigens (HLA) Class I, but no Class II antigens. These phenotypic studies were also performed after cells were cultured in vitro with 12-0-tetradecanoyl phorbol 13-acetate, gamma interferon, 5-azacytidine, sodium butyrate, phytohemagglutinin, and interleukin 2 (IL2). The cell surface markers underwent several significant changes. Among them we noted a higher percentage of labeled cells with anti-CD6 and CD7 monoclonal antibodies (moAbs), and a positivity with an anti-CD19 (B4) moAb. The leukemic LGL spontaneously developed a NK activity on K 562 tumor cells, which was not affected under the various T and B cells growth factors because they became more sensitive to IL2; but they were also stimulated by a 50-kilodalton (KD) B cell growth factor (BCGF) factor devoid of any T cell proliferation activity. Together these results gave a better characterization of azurophilic granules containing T chronic lymphocytic leukemia, and enabled the documentation of the differentiation of LGL with NK activity.

Decreased membrane "fluidity" of T lymphocytes from untreated patients with Hodgkin's disease

Plasma membrane "fluidity" of peripheral blood T lymphocytes from untreated patients with Hodgkin's disease (HD) and healthy controls was studied using the fluorescent probes 1,6-diphenyl-1,3,5-hexatriene (DPH) and 1-(4(trimethylamino)phenyl)-6-phenyl-1,3,5-hexatriene (TMA-DPH). In 13 consecutive patients a significant increase of T lymphocyte plasma membrane microviscosity was observed with both DPH and TMA-DPH. These alterations seemed unrelated to the cholesterol (Chol) and phospholipid (PL) content of HD T lymphocytes since the Chol/PL ratio was comparable in both HD and control cells. Since prostaglandin E2 (PGE2) from monocytic origin has been claimed to be responsible for the impairment of cell-mediated immunity (CMI) associated with HD, we studied the effect of exogeneously added PGE2 (0.1 microM) on control subjects T lymphocyte membrane "fluidity". Using the fluorescent probe DPH and the spin labelled fatty acid probe 16 NMS for electron paramagnetic resonance study, we observed a PGE2-induced fluidization of control T lymphocyte membranes which is specifically located in the inner part of the plasma membrane, whereas the plasma membrane surface seemed unaffected by PGE2 as judged by the TMA-DPH probe. Thus, PGE2 does not appear to be responsible for the alterations of T lymphocyte membranes observed in HD. Intrinsic alterations and/or other mediators might be involved.

Depressed NK cell activity of peripheral blood mononuclear cells in untreated hodgkin's disease: enhancing effect of interferon in vitro

Natural killer (NK) cell activity of unseparated peripheral blood mononuclear cells from 30 untreated patients with Hodgkin's disease and 22 age- and sex-matched normal controls was evaluated using the classical K 562 cells as targets. A significant defect was demonstrated in the patients with stage I-II and seemed to be more profound in patients with advanced disease (stage III-IV) and in those with B symptoms. The differences between subgroups of patients, however, were not statistically significant, mostly because of the wide dispersion of individual data. Pre-incubation of effector cells with alpha A leucocyte recombinant interferon led to a clear increase in NK cell activity in 4 of 6 patients tested, showing that depressed NK activity in Hodgkin's disease is still susceptible to the enhancing effect of interferon, at least in some patients.

High-dose intravenous IgG for chronic idiopathic thrombocytopenic purpura in adults

Sixteen adult patients of mean age 48 years with chronic ITP were studied for platelet response to high-dose (0.4 g/kg body weight per day for five consecutive days) intravenous polyvalent intact IgG in the absence of any concurrent treatment. The platelet count returned to normal values in nine patients, a partial response (rise in the platelet count between 50 and 150 X 10(9)/1) was observed in three cases. One patient refractory to any other treatment went into a sustained remission. In the other responsive patients the response was only transient. Among seven splenectomised patients only three responded to IgG infusions versus nine in the non-splenectomised group. The length of ITP history appeared as a more critical factor for the response to IgG than previous splenectomy.

[Comparative double-blind study: alizapride-metoclopramide]

The anti-emetic action of alizapride was compared to that of metoclopramide in a strict double-blind study of 57 cases files derived from 21 patients treated with anti-mitotic chemotherapy. For each treatment, each patient received two ampoules before and after the chemotherapy. Each ampoule contained either 50 mg of alizapride or 10 mg of metoclopramide. There were 24 good or excellent results and 4 nil results with alizapride and 16 good or excellent results and 13 nil results with metoclopramide. The superiority of alizapride over metoclopramide was therefore established with statistical significance (0.05 greater than p greater than 0.02).

[Surgical correction of interventricular communication with pulmonary stenosis in a hemophiliac]

Open heart surgery was performed in a 5 year-old boy with severe hemophilia A and large ventricular septal defect with pulmonary stenosis. High doses of Factor VIIIC superconcentrates delivered as small transfusion volumes allowed the use of extracorporeal circulation with heparin. Transfusions began 5 hours before surgery and were stopped 21 days later. No adverse reaction was observed. Thus major surgery is possible in severe hemophiliacs provided strict rules for replacement therapy are followed.