[Retrospective analysis of FOLFOX4 neurotoxicity for recovery from advanced colorectal cancer]

BACKGROUND

Oxaliplatin (L-OHP) in combination with infusional 5-fluorouracil/leucovorin (FOLFOX), has been established as a key drug for advanced colorectal cancer. Sensory neurotoxicity is its dose-limiting toxicity. No prior recovery from neurotoxicity data is available for Japanese patients treated by FOLFOX4 for advanced colorectal cancer.

PURPOSE

We performed a retrospective study on the recovery from chronic neurotoxicity and period for discontinuing FOLFOX4 therapy due to neurotoxicity.

PATIENTS AND METHOD

One hundred eighty-seven patients with advanced or recurrent colorectal cancer were treated with FOLFOX4 regimen between April 2005 and March 2006. We evaluated chronic peripheral sensory neuropathy by National Cancer Institute Common Terminology Criteria for Adverse Events (version 3.0), and calculated the period of recovery from grade 3 and grade 2 neurotoxicity by the Kaplan-Meier method.

RESULT

Seventy-two patients had to discontinue FOLFOX4 due to grade 3 and grade 2 neurotoxicity. grade 2 and grade 3 neurotoxicity was observed in 39 (20.8%) and 33 (17.6%) patients, respectively. Patients with grade 2 and grade 3 neurotoxicity had a median age of 59 years (range, 35-75 years), and 62 years (range, 36-73 years), respectively. The median number of courses until expression of grade 2 neurotoxicity was ten (range, 2-23 courses) and that for grade 3 neurotoxicity was also ten (range, 4-14 courses). The period of reducing grade 2 neurotoxicity to grade 1 was 56 days, while that for reducing grade 3 neurotoxicity to grade 1 was 106 days. FOLFOX4 was reintroduced in 15 patients with grade 2 neurotoxicity and in 14 patients with grade 3 neurotoxicity. The main reason that patients could not have reintroduction FOLFOX4 was early progression before reducing neurotoxicity to grade 1. The period from discontinuation of FOLFOX4 to disease progression was 88.5 days in partial response (PR) cases and 58 days in stable disease (SD) cases. PR cases took longer until disease progression than SD cases.

CONCLUSIONS

The incidences of neurotoxicity were similar in Japanese patients compared with those reported in Western studies. These findings provide useful information for clinicians and patients using oxaliplatin.

[Hematologist practices and attitude toward chemotherapy-related infertility]

High-dose chemotherapy using alkylating agents to treat leukemia and other malignancies can result in germ cell injury and infertility. The objective of this study was to investigate hematological practices and attitude towards chemotherapy-related infertility. In 2005,a nationwide,self-administered mail survey was conducted involving 500 hematologists selected randomly from the member list of the Japan Society for Hematopoietic Cell Transplantation. Of the surveyed hematologists, 144 responded at a response rate of 31.5%. Fifty-four (37.5%) of them always informed patients about the probability of contracting chemotherapy-related infertility before the treatment. Eighty-seven respondents (60.4%) stated that they might occasionally provide information depending on factors such as gender and severity of the disease. Information frequently given to patients included cryopreservation of sperm (87.5%), impact of chemotherapy on gonad functions (86.1%), and the likelihood and safety of having a baby after the cancer treatment (75.0%). Barriers to providing infertility-related information included short consultation time before the treatment, and lack of resources and information on fertility preservation. Hematologists should address the possibility of infertility with all patients who are in their reproductive years and discuss the availability of fertility preservation methods,while obtaining their consent for treatment. Furthermore, resources related to cancer treatment and fertility are urgently needed to enhance communication between patients and hematologists.

[A case of gastroesophageal reflux disease with marked eosinophilia]

A 73-year-old woman without a history of allergic diseases visited our hospital complaining of sore throat and nocturnal cough. Blood tests showed marked eosinophilia (18000/mm(3);WBC 21900/mm(3), Eos 82.0%) with normal serum levels of C-reactive protein, non-specific and various allergen-specific IgE. Stool tests for protozoa or helminthic ova were negative. Chest X-ray films showed no pulmonary abnormalities. Endoscopic and histological examinations revealed reflux esophagitis (grade C according to the Los Angeles Classification System) with hiatal hernia with inflammatory infiltrates including eosinophils within the esophageal mucosa. A computed tomography showed the thickening of the esophageal wall. An administration of lansoprazole improved reflux esophagitis and also eosinophilia, and an alteration to famotidine caused heartburn with an increase in eosinophils. A re-alteration to omeprazole relieved the symptom and decreased eosinophils. It was shown that gastroesophageal reflux disease was one of the possible causes of eosinophilia.

Linalyl acetate as a major ingredient of lavender essential oil relaxes the rabbit vascular smooth muscle through dephosphorylation of myosin light chain

In a preliminary experiment, we found that lavender essential oil relaxes vascular smooth muscle. Thus, the present experiments were designed to investigate the relaxation mechanism of linalyl acetate as the major ingredient of lavender essential oil in rabbit carotid artery specimens. Linalyl acetate produced sustained and progressive relaxation during the contraction caused by phenylephrine. The relaxation effect of linalyl acetate at a concentration near the EC50 was partially but significantly attenuated by nitroarginine as an inhibitor of nitric oxide synthase, 1H-[1,2,4]oxadiazolo[4,3-a]quinoxaline-1-one as an inhibitor of guanylyl cyclase, or by the denudation of endothelial cells. In specimens without endothelium, the phenylephrine-induced contraction and phosphorylation of myosin light chain (MLC) were significantly attenuated after the pretreatment with linalyl acetate. The relaxation caused by linalyl acetate in the endothelium-denuded specimens was clearly inhibited by calyculin A as an inhibitor of MLC phosphatase, although not by ML-9 as an inhibitor of MLC kinase. Furthermore, suppression of the phenylephrine-induced contraction and MLC phosphorylation with linalyl acetate was canceled by the pretreatment with calyculin A. These results suggest that linalyl acetate relaxes the vascular smooth muscle through partially activation of nitric oxide/cyclic guanosine monophosphate pathway, and partially MLC dephosphorylation via activating MLC phosphatase.

[A case of primary duodenal cancer near the papilla of Vater which had initial symptoms of obstructive jaundice]

A 63-year-old man visited our hospital complaining of brown urine. A physical examination showed jaundice of the skin and conjunctiva bulbar. Blood tests showed elevated serum levels of bilirubin and hepatobiliary enzymes. A type 2-like mass lesion was found near the papilla of Vater during the endoscopic retrograde cholangiopancreatography and was histologically proven to be a well-differentiated adenocarcinoma. A diagnosis of obstructive jaundice due to primary duodenal cancer arising near the papilla of Vater was made. After the jaundice was decreased by endoscopic biliary stenting, a pancreatoduodenectomy was performed. A histopathological examination of the resected specimen concerning the location and manner of invasion of cancer cells revealed that the cancer arose from the duodenal mucosa near the papilla of Vater.

Unexpected changes in blood pressure and hematological parameters among fasting and nonfasting workers during Ramadan in Indonesia

OBJECTIVE

To examine the effect of Ramadan fasting on basic hematological parameters, in addition to the effects on body weight and blood pressure of fasters and nonfasters.

DESIGN, SETTING, AND SUBJECTS

One hundred male outdoor workers at a vehicle terminal in a city in East Java were recruited for this study. Anthropometric measurements and blood sampling were conducted on two separate occasions, just before the start of Ramadan and in the third week of the month of Ramadan (October-November 2004). The degree of subjective compliance with Ramadan fasting (complete, partial, or none) was evaluated using a questionnaire.

RESULTS

The mean body mass index (BMI) of the fasting group was, as expected, significantly lower at the second sampling period, and the decrease in BMI correlated significantly with decreased blood pressure in this group. The blood pressure was also reduced in the partial fasting and nonfasting groups, which was an unexpected result. While red blood cell production was suppressed, as evidenced by lower levels of hemoglobin, red blood cell (RBC), and packed cell volume (PCV) at the second sampling, the subjects were normocytic and normochromic, based on normal mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) levels.

CONCLUSIONS

These results indicate that, regardless of fasting status, blood pressure is lower and RBC production is suppressed in subjects during the Ramadan period. These findings should be taken into account when evaluating the effects of Ramadan on the general population. To avoid the adverse effects of anemia, increased intake of iron-rich foodstuffs is recommended during the Ramadan month, regardless of fasting practice.

Requirement for CD100-CD72 interactions in fine-tuning of B-cell antigen receptor signaling and homeostatic maintenance of the B-cell compartment

Co-receptors on the B-cell surface regulate B-cell antigen receptor (BCR) signaling; however, it remains unclear how BCR signals are coordinated to maintain immune homeostasis. CD72, a negative regulator of B-cell responses, has immunoreceptor tyrosine-based inhibitory motifs within its cytoplasmic region, and the tyrosine phosphatase SHP-1 binds these sites. The natural ligand of CD72, CD100/Sema4D, belongs to the semaphorin family and induces the dissociation of SHP-1 from CD72, thereby switching off the negative signals of CD72. In the absence of CD100, BCR signals are significantly suppressed due to the constitutive association of SHP-1 with CD72, resulting in B-cell hyporesponsiveness. Here we show that CD100 regulates the sensitivity of the BCR by preventing the association of the CD72 with BCR, and this interaction is required for proper B-cell homeostasis. Consequently, as CD100-deficient mice age, they accumulate marginal zone B cells and develop high auto-antibody levels and autoimmunity. Collectively, our findings indicate that the strength of BCR signals is strictly tuned by the interaction of CD100 with CD72, and this interaction is essential for maintaining immunological homeostasis as well as generating a proper immune response.

Characteristics of propofol-evoked vascular pain in anaesthetized rats

BACKGROUND

In this study we have assessed vascular pain caused by the i.v. anaesthetic agent, propofol, using the flexor reflex response and compared this with that of capsaicin in anaesthetized intact rats.

METHODS

Experiments were performed on 133 male Sprague-Dawley rats weighing 280-340 g. The animals were anaesthetized with urethane (1.3 g kg(-1), i.p.), and an arterial cannula was inserted to the level of the bifurcation of the femoral artery. The magnitude of the flexor reflex was examined by recording the electromyogram from the posterior biceps femoris/semitendinosus muscles.

RESULTS

Our data show that the flexor reflexes evoked by intra-arterial (i.a.) injection of propofol (1%, 25-100 microl) and capsaicin (0.05-0.2 microg) were dose dependent. An initial i.a. injection of procaine (2%, 200 microl) blocked both responses. Furthermore, the flexor reflex induced by these chemical stimuli were inhibited by morphine (5 mg kg(-1), s.c.) and restored with naloxone (1.5 mg kg(-1), s.c.). Pre-treatment with capsazepine (20 microg, i.a.), a selective VR1 antagonist, inhibited the capsaicin-evoked response, but not that of propofol. Indomethacin (10 mg kg(-1), i.p.), a non-selective cyclo-oxygenase inhibitor, inhibited only the propofol-evoked response and this recovered with arterial PGE2 (5 microg).

CONCLUSIONS

Collectively our data suggest that propofol-evoked vascular pain is mainly initiated by prostanoids.

Effect of specific antigen stimulation on intraepithelial lymphocyte migration to small intestinal mucosa

Migration of intraepithelial lymphocytes (IELs) into intestinal epithelium is not yet well understood. We established an IEL-cell line from ovalbumin (OVA) 23-3 transgenic (Tg) mice and investigated the effect of antigen stimulation on the dynamic process of IEL migration into small intestinal mucosa. The cell line was a T cell receptor (TCR) alphabeta(+) CD4(+) CD8(-) phenotype, expressing alphaEbeta7 integrin in 90% of cells. Under intravital microscopy, the lined IELs adhered selectively to the microvessels of the intestinal villus tip of the Tg mice. The accumulation of IELs was significantly inhibited by an antibody against beta7-integrin and MAdCAM-1. When IELs were stimulated with OVA, the accumulation was attenuated compared to that of resting cells, with decreased expression of alphaEbeta7 integrin. In Tg mice fed with OVA, the number of IELs which migrated in the villus mucosa was significantly smaller than in the non-fed controls. The preferential migratory capacity of IELs to villus mucosa may be altered by specific antigen stimulations.

Increased lymphocyte trafficking to colonic microvessels is dependent on MAdCAM-1 and C-C chemokine mLARC/CCL20 in DSS-induced mice colitis

Although enhanced lymphocyte trafficking is associated with colitis formation, little information about its regulation is available. The aim of this study was to examine how the murine liver and activation-regulated chemokine (mLARC/CCL20) contributes to lymphocyte recruitment in concert with vascular adhesion molecules in murine chronic experimental colitis. T and B lymphocytes isolated from the spleen were fluorescence-labelled and administered to recipient mice. Lymphocyte adhesion to microvessels of the colonic mucosa and submucosa was observed with an intravital microscope. To induce colitis, the mice received two cycles of treatment with 2% dextran sodium sulphate (DSS). In some of the experiments antibodies against the adhesion molecules or anti-mLARC/CCL20 were administered, or CC chemokine receptor 6 (CCR6) of the lymphocytes was desensitized with excess amounts of mLARC/CCL20. Significant increases in T and B cell adhesion to the microvessels of the DSS-treated mucosa and submucosa were observed. In chronic colitis, the accumulation of lymphocytes was significantly inhibited by anti-mucosal addressin cell adhesion molecule (MAdCAM)-1 mAb, but not by anti-vascular cell adhesion molecule-1. In DSS-treated colonic tissue, the expression of mLARC/CCL20 was significantly increased, the blocking of mLARC/CCL20 by monoclonal antibody or the desensitization of CCR6 with mLARC/CCL20 significantly attenuated the DSS-induced T and B cell accumulation. However, the combination of blocking CCR6 with MAdCAM-1 did not further inhibit these accumulations. These results suggest that in chronic DSS-induced colitis, both MAdCAM-1 and mLARC/CCL20 may play important roles in T and B lymphocyte adhesion in the inflamed colon under flow conditions.

Inhibin alpha-subunit (INHA) gene and locus changes in paediatric adrenocortical tumours from TP53 R337H mutation heterozygote carriers

The R337H TP53 mutation is a low-penetrance molecular defect that predisposes to adrenocortical tumour (ACT) formation in Brazilian and possibly other populations. Additional genetic defects may be responsible for the variable expression of ACTs in these cases. The inhibin alpha-subunit gene (INHA) on 2q33-qter has been implicated in mouse adrenocortical tumourigenesis. We studied 46 pediatric patients with ACTs from Brazil for INHA genetic alterations; 39 of these patients were heterozygous carriers of the R337H TP53 mutation. We first mapped the INHA gene by radiation hybrid analysis and determined 10 linked microsatellite markers in an area flanked by D2S1371 and D2S206 on 2q33-qter. These markers were then used for loss of heterozygozity (LOH) studies in nine paired germline and tumour DNA samples. Mapping placed the INHA gene in close proximity to D2S2848 (SHGC11864) with a log of odds (LOD) score of 5.84. LOH for at least one marker in the region was identified in 8/9 tumours (89%). Six patients were heterozygous for three INHA mutations: one in exon 1, 127C>G, and two in exon 2, 3998G>A and 4088G>A, all leading to amino acid substitutions (P43A, G227R, and A257T, respectively). A257T is located in a conserved INHA region, highly homologous to transforming growth factor-beta; both G227R and A257T change polarity, and, in addition, G227R changes the pH. We conclude that these sequence alterations and the detected 2q allelic changes suggest that INHA may be one of the contributing factors needed for ACT formation in pediatric patient carriers of the R337H TP53 mutation.

Social support and depressive symptoms among displaced older adults following the 1999 Taiwan earthquake

This longitudinal study examines changes in depressive symptoms among displaced older Taiwanese adults (N = 54, M = 68 years), and the impact of various social supports for them at between 6 and 12 months after an earthquake. The average depression score between 6 and 12 months following the earthquake was unchanged and kept high score. Child and extended family support levels related to depressive symptoms after 6 months. In contrast, after 12 months, significant factors associated with a lessening of the depressive symptoms were social support from the extended family and neighbors, and social participation. Intervention to promote increased social networks and social participation, within their new environment in a temporary community, is highly recommended for older adults.

An assessment of vascular pain using the flexor reflex in anesthetized rats

This study assessed the flexor reflex induced by intraarterial algogenic drugs in anesthetized rats. The experiments were performed on male Sprague Dawley rats weighing 290-350 g. The animals were anesthetized with urethane (1.3 g/kg i.p.) and an arterial cannula was inserted to the level of the bifurcation of the femoral artery. The magnitude of the flexor reflex was examined by recording the electromyograph from the posterior biceps femoris/semitendinous muscles. Results showed that the flexor reflex evoked by intra-arterial injection of capsaicin (0.05-0.5 microg) was dose-dependent. A similar reflex resulted from pinching the toe of the hindlimb. These responses were inhibited by morphine (5 mg/kg s.c.) and restored with naloxone (1.5 mg/kg s.c.). Intraarterial preinjection of procaine (2%, 200 microl) and capsazepine (20 microg), which is a selective vanilloid receptor antagonist, inhibited the capsaicin-evoked response, but not that of pinching. These results indicate that the flexor reflex is a useful tool for assessing vascular pain in anesthetized animals.

Occurrence of substance P(1-7) in the metabolism of substance P and its antinociceptive activity at the mouse spinal cord level

Substance P (SP), which is known as a pain transmitter or modulator in the spinal cord, was degraded by the synaptic membranes of the mouse spinal cord. The major metabolites of SP were phenylalanine, SP(1-6), SP(1-7), SP(1-9), SP(8-9) and SP(10-11). Degradation of SP was inhibited by a metal chelator, o-phenanthroline, and also by specific inhibitors of endopeptidase-24.11, thiorphan and phosphoramidon. In contrast, captopril (a specific inhibitor of angiotensin-converting enzyme), bestatin (a specific inhibitor of aminopeptidase) and Z-321 (a specific inhibitor of prolylendopeptidase) showed little effect on the degradation of SP. The accumulation of the major cleavage products was strongly inhibited by phosphoramidon and thirophan, as well as the initial cleavage of SP. Thus, endopeptidase-24.11 plays a major role in SP degradation in the mouse spinal cord. Additional in vivo experiments were performed to investigate the antinociceptive effect of SP(1-7), a major product of SP that was detected after incubation with spinal synaptic membranes. In the mouse tail-flick test, the intrathecal administration of SP(1-7) (1.0-4.0 pmol) increased tail-flick latency in a dose-dependent manner. These results suggest that degradation of SP by spinal endopeptidase-24.11 may lead to the formation of SP(1-7), which has an ability to produce antinociceptive effects at the mouse spinal cord level.

Differential effects of yohimbine, naloxone and 8-OH-DPAT on ejaculatory response in male dogs

The aim of this study was to compare the effects of the alpha(2)-adrenergic-receptor antagonist yohimbine, the 5-HT(lA)-receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) and the opioid-receptor antagonist naloxone (all of which have been shown to stimulate male sexual arousal/motivation in rats) on sexual responses in male dogs. Sexual responses (i.e., ejaculation, penile erection and pelvic thrusting behavior) were elicited by manual penile stimulation. Systemic administration of yohimbine (0.03-1.0 mg/kg) produced a biphasic dose response curve for the amount of ejaculated semen collected during genital stimulation (for 5 min), whereas 8-OH-DPAT (0.03-0.3 mg/kg) dose-dependently decreased the amount of ejaculated semen. Thus, yohimbine increased the amount of ejaculated semen at lower doses (0.03-0.3 mg/kg), but decreased it at the highest dose (1.0 mg/kg). The highest dose of yohimbine (1.0 mg/kg) and 8-OH-DPAT (0.3 mg/kg) also produced a significant delay of onset in both ejaculation and penile erection latency (time from starting the stimulation to the first ejaculation and full erection), and a decrease in the incidence of pelvic thrusting behavior. In contrast, administration of naloxone (0.03-1.0 mg/kg) did not affect the sexual responses elicited by genital stimulation. These results indicate that yohimbine and 8-OH-DPAT, but not naloxone, affect sexual responses, particularly ejaculation, and that the drugs which stimulate the mechanisms regulating sexual arousal/motivation in male rats do not show identical effects for sexual function in male dogs. The present findings also confirm our previous observations that the ejaculatory capacity in dogs can be stimulated by lower doses of yohimbine, as evidenced by an increase in the amount of ejaculated semen.

Effect of Ginkgo biloba (EGb 761) on differential gene expression

Supplementation of diets with plant extracts such as ginkgo biloba extract (EGb 761) (definition see editorial) for health and prevention of degenerative diseases is popular. However, it is often difficult to analyse the biological activities of plant extracts due to their complex nature and the possible synergistic and/or antagonistic effects of their components. Genome-wide expression monitoring with high-density oligonucleotide arrays provides one way to examine the molecular targets of plant extracts and may prove a useful tool in evaluating their therapeutic claims. Here, we will briefly describe some of our work on the effect of EGb 761 on differential gene expression in relation to its potential anti-carcinogenic, photoprotective and neuromodulatory properties.

Class IV semaphorin Sema4A enhances T-cell activation and interacts with Tim-2

Semaphorins are a family of phylogenetically conserved soluble and transmembrane proteins. Although many soluble semaphorins deliver guidance cues to migrating axons during neuronal development, some members are involved in immune responses. For example, CD100 (also known as Sema4D), a class IV transmembrane semaphorin, signals through CD72 to effect nonredundant roles in immune responses in a ligand-receptor system that is distinct from any seen previously in the nervous system. Here we report that the class IV semaphorin Sema4A, which is expressed in dendritic cells and B cells, enhances the in vitro activation and differentiation of T cells and the in vivo generation of antigen-specific T cells. Treating mice with monoclonal antibodies against Sema4A blocks the development of an experimental autoimmune encephalomyelitis that is induced by an antigenic peptide derived from myelin oligodendrocyte glycoprotein. In addition, expression cloning shows that the Sema4A receptor is Tim-2, a member of the family of T-cell immunoglobulin domain and mucin domain (Tim) proteins that is expressed on activated T cells.

Requirement for the lymphocyte semaphorin, CD100, in the induction of antigen-specific T cells and the maturation of dendritic cells

CD100 belongs to the semaphorin family, several members of which are known to act as repulsive axonal guidance factors during neuronal development. We have previously demonstrated that CD100 plays a crucial role in humoral immunity. In this study, we show that CD100 is also important for cellular immunity through the maturation of dendritic cells (DCs). CD100(-/-) mice fail to develop experimental autoimmune encephalomyelitis induced by myelin oligodendrocyte glycoprotein peptide, because myelin oligodendrocyte glycoprotein-specific T cells are not generated in the absence of CD100. In vitro studies with T cells from OVA-specific TCR-transgenic mice demonstrate that Ag-specific T cells lacking CD100 fail to differentiate into cells producing either IL-4 or IFN-gamma in the presence of APCs and OVA peptide. In addition, DCs from CD100(-/-) mice display poor allostimulatory capabilities and defects in costimulatory molecule expression and IL-12 production. The addition of exogenous soluble rCD100 restores normal functions in CD100(-/-) DCs and further enhances functions of normal DCs. Furthermore, treatment of Ag-pulsed DCs with both soluble CD100 and anti-CD40 before immunization significantly enhances their immunogenicity. This treatment elicits improved T cell priming in vivo, enhancing both primary and memory T cell responses. Collectively, these results demonstrate that CD100, which enhances the maturation of DCs, is essential in the activation and differentiation of Ag-specific T cells.

Males in rural Bangladeshi communities are more susceptible to chronic arsenic poisoning than females: analyses based on urinary arsenic

Spot urine samples were collected from the inhabitants of two rural communities in northwestern Bangladesh. We compared arsenic levels in the urine samples ([As](u); n = 346) with those in water from tube wells ([As](tw); range < 1-535 microg/L; n = 86) on an individual basis. The small variation of [As](u) within subjects and highly positive correlation with [As](tw) indicate that [As](u) is a useful indicator of exposure. Analyses of [As](u) showed that creatinine correction was necessary, that [As](u) only reflected recent exposure, and that there were substantial interindividual differences for a given [As](tw) level. To evaluate the toxic effects of arsenic exposure, we constructed a system for rating skin manifestations, which revealed distinct sex-related differences. Comparison of males and females in the same households confirmed that skin manifestations were more severe in the males, and in the males of one community a dose-response relationship between [As](u) and the degree of skin manifestation was evident. The results of this study indicate that [As](u) in spot urine samples can be used as an exposure indicator for As. They suggest that there might be sex-related, and perhaps community-related, differences in the relationship between [As](u) and skin manifestations, although several confounding factors, including sunlight exposure and smoking habits, might contribute to the observed sex difference. The existence of such differences should be further confirmed and examined in other populations to identify the subpopulations sensitive to chronic arsenic toxicity.

Clinical relevance of in vitro chemoresistance in childhood acute myeloid leukemia

To determine the clinical relevance of in vitro drug chemoresistance in childhood acute myeloid leukemia, we used an MTT assay to test leukemic cells from 132 newly diagnosed children. Patients were diagnosed according to the French-American-British (FAB) classification as follows: M0 (n = 12), M1 (n = 16), M2 (n = 53), M4 (n = 17), M5 (n = 19) and M7 (n = 15). The results revealed that, compared to leukemic cells from complete-responders (n = 107), those from non-responders who failed induction therapy (n = 17) were 1.4 to 5.0 times more resistant in vitro to cytarabine (P = 0.005), melphalan (P = 0.003), etoposide (P = 0.011), L-asparaginase (P = 0.017), aclarubicin (P = 0.026) and dexamethasone (P = 0.039). For seven other drugs tested, the median lethal dose of 70% and leukemic cell survival of non-responders were higher than those of complete-responders, but the difference was not statistically significant. We sought correlations between FAB subtypes and in vitro drug resistance. Leukemias of the FAB M4 and M5 subtype were more sensitive to L-asparaginase (P = 0.01, P = 0.0036) than those of the FAB M2 subtype. FAB M5 leukemia was more sensitive to etoposide than were the FAB M2, M4 and M7 subtypes (P = 0.001, P = 0.034, P = 0.023, respectively). By contrast, FAB M5 leukemia was significantly more resistant to prednisolone and dexamethasone than were the FAB M0, M1, M2, M4 and M7 subtypes. We sought correlations between in vitro drug resistance and long-term clinical outcome, but found no associations in this case. These results suggest that in vitro resistance to cytarabine, melphalan, etoposide, L-asparaginase, aclarubicin and dexamethasone might represent factors that can predict response to the early course of therapy. Selecting an appropriate anti-cancer drug according to the FAB classification together with drug sensitivity testing may contribute to improved prognoses in childhood acute myeloid leukemia.