[Critical role of rate previous freezing on the liberation of heat of fusion the preservation of hematopoietic cell lines]

71 bags of bone marrow cryopreserved and stored for periods up to 2 years, were thawed and CFUc recoveries were studied in relation to the rate of freezing following the heat of fusion. Excellent CFUc recoveries (greater than 50%) were obtained in all cases (11/11) for freezing rates smaller than 5 dgC/mn, whereas freezing rates greater than 10 dgC/mn produced poor recoveries in 78% of the cases (4/18). Intermediate freezing rates (5 less than 0 less than 10) resulted in intermediate yields of CFUc, with good recoveries in only 45% of the cases (19/42). These results indicate that CFUc recoveries and subsequently the kinetics of autologous engraftment following the infusion of cryopreserved marrow, which are already known to be related both to the freezing rate before the heat of fusion and the duration of the phase transition period, are also related to this new parameter, which should be carefully monitored during the freezing procedure.

[Diffuse normolipemic xanthomatosis and IgG monoclonal dysglobulinemia]

A 56-year-old man with diffuse cutaneous xanthomatosis had neither mucosal lesions nor diabetes insipidus. Cutaneous lesions were characterised by dermal histiocytic infiltration, without X bodies, associated with Touton's cells and abundant iron deposits. Plasma lipid levels were normal. A lambda G monoclonal dysglobulinemia was present without Bence-Jones proteinuria or myeloma, except for a moderate increase in medullary plasmocytic cell elements. The diagnosis of disseminated xanthomatosis was established, the differential diagnosis from other histiocytic proliferations, particularly diffuse plane xanthoma, being sometimes difficult. The relation between normolipaemic xanthomatosis and dysglobulinemia certainly exists, but no satisfactory pathogenic explanation was possible in this case, in the absence of cryoglobulin, paraprotein antilipoprotein activity, and cutaneous deposits of lipoprotein-paraprotein complexes.

[Adriamycin for the treatment of non HOdgkin's lymphomas (author's transl)]

One hundred and thirty one patients with non-Hodgkin's lymphomas (107 lymphomas and 24 histiocytic lymphomas) have been treated between January 1973 and January 1976, by an association of cyclophosphamide, vincristine and prednisone alone (CVP) or combined with adriamycin (CVP-A). All lymphomas stage I and II received CVP + radiotherapy: the actuarial analysis shows a stationary survival from 1 to 5 years at 89%. In the group of lymphoid lymphomas stage III and IV with nodular pattern, the survival is longer for patients who received CVP (69% at five years) than for patients treated with CVP-A (54% at three years). In the group of lymphoid lymphomas stage III and IV with diffuse pattern, the complete remission rate is 25% for the CVP and 67% for the CVP-A (p less than 0.01). However, the median duration of life is not different for the two groups (24 and 26 months respectively). In the group of histiocytic lymphomas, the complete remission rate in 50% for the CVP combination and 83% for the CPV-A. However, the median time of life which is 17 months for the CVP, is not reached for the CVP-A (Stationary survival at 90% from the 12th to the 36th months). These results show that the CVP combination is a good treatment for the lymphoïd lymphoma with nodular pattern. The addition of adriamycin gives hope of long remissions and perhaps cure for histiocytic lymphomas, until now of bad prognosis. For the lymphoid lymphoma with diffuse pattern, the prognosis is still bad although we obtained with adriamycin a better rate of complete remission. The high dose chemotherapy rescued by autologous bone marrow transplantation may be a new possibility for this last type of non Hodgkin lymphomas.

[Acute leukaemias with myelofibrosis. Clinical, cytohistological and evolutive aspects. Their place among malignant blood diseases with myelofibrosis (author's transl)]

In a series of 154 patients with acute leukaemia (AL), 31 had myelofibrosis. The authors report in detail on 9 of these and demonstrate the distinctive features of this form of AL: pancytopenia is severe, circulating blast cells are rare, myelograms are difficult to read, and bone-marrow biopsies are necessary to the diagnosis, severity assessment and prognosis of the disease. Owing to the small number of cells, it is uneasy to distinguish these AL from acute myelofibrosis (a nosological entity which needs to be more precisely defined) and from megakaryoblastic leukaemias, recently individualized.

[Bone marrow fibrosis in malignant hemopathies and cancers. Histological study of 2 786 biopsies (author's transl)]

This is a study of myelofibrosis concerning 2.786 bone marrow biopsies in malignant hemopathies, and cancers supposed to be metastatic. In a first group myelofibrosis is a permanent symptom and necessary for the diagnosis: agnogenic myeloid metaplasia, Waldenström's disease, hairy-cell leukemia, marrow extension of Hodgkin's disease and metastatic cancers. In a second group of hemopathies, myelofibrosis varies in frequency. Myeloid leukemia: 33% - Polycythemia: 40% - Thrombocythemia: 27% - Lymphoid leukemia: 17% - Acute leukemia: 20% - Kahler's disease: 30% - Aplastic anemia: 5% - Reticulin myelofibrosis is said possibly regressive. Collagen myelofibrosis is permanent.

[Red cell autoimmunization in a "normal" population. 63 cases (author's transl)]

Anti-red auto-antibodies were found in 69 out of 892 000 blood donors aged between 20 and 60 years, 63 of whom were followed for up to five years. This would suggest an overall incidence of 1 in 13 000 members of a "normal" population. Uncontrolled methyl-dopa treatment could be incriminated in 25% of cases. Only 10% of autoimmune subjects had slight confirmed anaemia, but 72% had biological evidence of red cell destruction (i.e. hyper-reticulocytosis, elevated serum bilirubin levels and shortened red cell life span), which demonstrates the presence of subclinical autoimmune haemolytic disease in apparently normal people. The anti-red cell auto-antibodies were of the IgG type in 97% of the subjects and were associated with various anti-tissue antibodies in 41%, thus pointing to a multisystem autoimmune disorder. In most cases the abnormality persisted or spontaneously regressed during the observation period, but long-term follow-up is required to determine whether asymptomatic red cell autoimmunization is harmless or potentially dangerous.

[Studies of immunological status, following autologous bone marrow transplantation in man (author's transl)]

Following transplant, circulating immunoglobulin levels fell moderately and remained depressed less than 2 months for IgG, and for variable and longer periods of time for IgM and IgA. Repeated quantitative determinations of antibodies against multiple antigens did not show any decrease in the pretransplant levels. Indeed some patients developed herpes and cytomegalovirus infections to which they responded by a sharp increase in antibody titers. In 2 cases, a primary immunization was demonstrated (against CMV and BK virus) with increasing levels of IgM and IgG antibodies. Lymphocyte counts in peripheral blood returned to 500 mm# between day 10 and 29 (median day 18) and to pretransplant values within 6 weeks. Non specific stimulation of lymphocytes by mitogens in the immediate post-transplant period showed a decreased response to PHA and Con A, whereas the responses to pokeweek mitogens and alloantigens were only slightly diminished. The degree of the responses was related to the dose of cryopreserved marrow infused. We conclude that:--although the minimum dose for autologous bone marrow transplantation in man is around 0,5 10(8) nucleated bone marrow cells/Kg, much higher doses should be used to ensure faster and better restoration of immune reactivity.--The similarity of the immunological dysfunction following autologous and allogeneous bone marrow transplantation suggest that, in the immediate post-transplant period, the role of GVHD in cellular immunity depression may be minimal.

[Haemolytic anaemia with acanthocytosis and erythrocytic glutathione peroxidase deficiency in severe hepatic diseases. 5 cases (author's transl)]

In 5 patients, haemolysis was intrasplenic. Red cell deformity could be acquired by foreign red cells transfused into the patient. Association of the two abnormalities (acanthocytosis and glutathion peroxydase deficiency) was necessary for the onset of haemolysis. They progressed in parallel and varied in relation with the severity of the hepatic disease. The relationship between these two abnormalities is unknown but would appear to be dependent upon a factor of hepatic origin.

[Acute leukaemia during pregnancy: favourable course of pregnancy in two patients treated with cytosine arabinoside and anthracyclines (author's transl)]

A report of two cases of acute leukaemia discovered during pregnancy. The first was treated from the 24th week with cytosine arabinoside, daunorubicine and vincristine and then rubidazone. Only an incomplete remission was obtained. The pregnancy ended with the birth at the 36th week of a normal child, which remains well at the age of 13 months. The second patient received during the 29th week of pregnancy chemotherapy combining cytosine arabinoside and daunorubicine. Signs of foetal distress appeared at 31 weeks. Delivery took place during the 33rd week in a phase of aplasia. The child was born apparently dead and was resuscitated. A complete remission of the leukaemia was obtained. The child was well at the age of 13 months. A transient neutropaenia was noted at the age of 2 months in both children.

[Lymphomas of the spleen and bone marrow lymphoid nodules (author's transl)]

Many nodular primitive non-Hodgkin's lymphomas of the spleen have a favourable course after splenectomy or chemotherapy. Several observations of this type have been reported in the literature, in which the concept of malignancy is discussed, authors referring to a presarcomatous state or to an idiopathic splenomegaly. The evaluation of the extension of those sarcomas, however, very often show hepatic lesions, and always an increase in the lymphoid marrow nodules. The significance of these nodules is discussed here, with reference to 14 personal observations. These nodules may not always reflect a real extension of the sarcoma to the marrow. From a practical point of view, the presence of lymphoid marrow nodules, when associated with an isolated splenomegaly, is a strong argument to suspect a sarcoma of the spleen, and indicates a splenectomy.

[Histological study of the bone marrow in 96 cases of Waldenstrom's macroglobulinemia. An evaluation with clinical, haematological and biological data (author's transl)]

Bone marrow biopsy in Waldenstrom's macroglobulinemia shows three types of lesions: lympho-plasmocytic and reticular infiltration, which is the most common, reticular infiltration, and aplastic marrow, more seldom. In all cases the reticulinic network is increased and thickened. These lesions are diffuse or nodular. Diffuse infiltration is more severe and has a median duration of 62 months instead of 82 months in nodular infiltration.

[Non secretary plasma cell leukemia with intracytoplasmic kappa light chains (author's transl)]

A 53 years old female patient with plasma cell leukemia (more than 90% plasma cells in the peripheral blood, and an absolute plasma cell count reaching 147,000/mm3) is described. Electrophoresis and immunoelectrophoresis of serum and concentrated urine did not reveal any paraprotein. No surface immunoglobin has been detected on plasma cell cytoplasmic membranes. The presence of intracytoplasmic kappa light chains has been demonstrated by immunofluorescence and electron microscopy using the immunoperoxydase technique.

[Massive medullary forms of Hodgkin's disease and acute myelofibrosis (author's transl)]

Ten cases of Hodgkin's disease was massive bone marrow invasion. This particular form of the disease is seen either at the outset or in Stage IIIB with a rapid course. It is reflected by a pancytopaenia with poor marrow with little or no superficial nodes. These very atypical forms of Hodgkin's disease must thus always be considered as a possibility in the context of acute malignant myelofibrosis. They indicate a special and unexplained behaviour of the host to the Hodgkin's tumour.