[Histological lesions of the bone marrow in medullary aplasia. Results of a common protocol on 261 biopsies]

In a cooperative study on bone marrow aplasia, 261 bone marrow biopsies have been examined in triple blind. 13 cases were excluded for technical defect, and 37 cases (17%) excluded for erroneous diagnosis (myelofibrosis or leukemia). It remains 176 first biopsies and 35 second biopsies (10th or 20th month). A quantitative depletion of the marrow was observed in 87% of the cases, but in 13 a rich marrow gave way to discuss the morphological definition of marrow aplasia. Framework lesions (reticulin, vessels, bone) and cytologic modifications (histiocytic or plasmocytic infiltrations) have been appreciated, and their importance in the induction of aplasia and in the prognosis is emphasized. Comparison between first and second biopsy has shown a repletion of the marrow in two third of the cases, the early unfavourable character of reticulinic lesions, and the favourable signification of plasmocytosis. A more complete comparison between marrow histology and other parameters of the study will improve the knowledge of physiopathology and prognosis of marrow aplasia.

[Preservation of hematopoietic stem cells by slow freezing and elimination of the heat of fusion]

Previous experiments, in dogs with fresh bone marrow or bone marrow frozen with a modified freezing system have demonstrated a 100% recovery of frozen stem cells, stored for periods up to 5 months. Five patients, three with drug resistant acute leukemia and two with metastic carcinomas, have been treated with a high dose combination chemotherapy regimen (TACC) followed by reinfusion of marrow cryopreserved with the same modified freezing system. Following the reinfusion of marrow, autologous engraftment was demonstrated on bone marrow aspiration between days 5 and 10.

[Moschowitz's disease: efficacy of anti-platelet aggregation agents]

In November 1976, a 52 year old woman presented with a Moschowitz syndrome with clinical manifestations of continuous fever at 39 degrees and a transient Wernicke type aphasia. Laboratory findings included schizocytosis, a peripheral thrombocytopaenia and functional renal insufficiency. The ethanol tests was positive but there was no frank defibrination syndrome. After corticosteroid therapy failed, the patient was treated with Dipyridamole 400 mg/24 hours IV and acetylsalicylic acid 4 g/24 hours IV. Fever disappeared on the same day and the thrombocytopaenia was corrected in 48 hours. The patient was considered to be cured 15 days later. No precise aetiology to explain the Moschowitz syndrome was discovered apart from the recent ingestion of oestrogens. The authors emphasise the considerable progress which this use of a combination of Dipyridamole and aspirin represents, resulting in the cure of Moschowitz syndrome, a condition considered to be fatal up until a few years ago.

[Value of bone marrow biopsy in solid tumors. Apropos of 96 cases]

This study of 96 bone biopsies carried out in 84 patients with various malignant solid tumours showed 27 normal bone marrows, 21 hypoplastic marrows, 34 irritant marrows and 14 metastatic marrows. All the patients in the last group and 75% of those with signs of irritation already had other metastases. Tolerance to chemotherapy was better in the normal marrows than in the other cases. There was a significant relationship between the irritant or metastatic or metastatic aspect and the existence of peripheral leucoerythroblastosis (metastatic marrows) or increased platelets (irritant appearances). A significant difference existed during the first five months of survival between these cases with a metastatic marrow and those with an iritant marrow. Bone biopsy should, in our opinion, form part of the routine investigation of cancer patients. It may identify metasine investigation of cancer patients. It may identify metastases where radiography and bone scans have failed.

Combination of cyclophosphamide, vincristine, and prednisone, followed by maintenance chemotherapy, with and without radiotherapy, in the management of patients with non-Hodgkin's lymphomas

Sixty patients with non-Hodgkin's lymphomas were treated with a cyclophosphamide, vincristine, and prednisone (CVP) induction regimen, either alone (stage IV) or in combination with radiotherapy (stages I, II, III). The response rates for lymphocytic and histiocytic lymphomas were 82 and 86%. The complete remission (CR) rates were 66 and 71% with a median duration of 13 and 5.5 months respectively. Nodular types responded better than diffuse ones in both lymphocytic (CR rate 85% vs 45%; median duration 24+ months vs 2.5 months) and histiocytic lymphoma (CR rate 100% vs 0%). In lymphocytic lymphomas, survival in the responder group was 90% at 24 months vs only 20% in the nonresponder group (median survival 14.2 months). In the group with nodular lymphocytic lymphoma responding to therapy, there was a 100% survival rate at 24 months. The median survival for patients treated with chemotherapy alone (stage IV) and not responding to therapy, was 22 months vs 14.5 months in the whole nonresponder group (stages I, II, III, IV), suggesting a detremental effect of rediotherapy in the nonresponder group. In histiocytic lymphomas, the median survivals in the responder and nonresponder groups were 19 months and 3 months respectively. These results corroborate the excellent efficacy of the CVP regimen. They also indicate that, after CVP induction, 2 major prognostic factors are the histologic type and the nature of the response to therapy.

[Refractory anemia with partial myeloblastic medullary infiltration. Examination of marrow biopsies (author's transl)]

77 marrow biopsies of smouldering leukemia have been examined in triple blind fashion with the following results: the cellularity of the marrow is normal in three quarters of the cases. In one quarter the blast cells were homogenous, which confirms the diagnosis of leukemia. The frequences of the sheets of blast cells increase with the duration of the disease and reached 80% at the 20th month. In the other cases, blasts were seldom seen. Eosinophilia was frequent. Erythroblasts were always rare, in contrast to what is seen in sideroblastic anemias. The reticulin network was thickened in 25% of the cases. Thus, bone marrow biopsy may demonstrate many of the features supporting the diagnosis of smouldering leukemia.

[Anatomo-pathologic forms of lymphoid and lymphoreticular fibrosis of the bone marrow]

The development, within the bone marrow, of reticulo-fibrosis with a lymphoid organ structure forms part of a pathological model common to several lympho- and reticulo-proliferative syndromes. Various cytological types develop within this reticulo-fibrous framework: lymphocytes, lymphoblasts, plasmocytes, "hairy cells" and histiocytes. This cytological variety has led to different names: leukaemic reticulo-endotheliosis, lymphoid myelofibrosis, histio-lymphocytosis, malignant histiocytosis, etc. Similar cell type sequence is seen in non-Hodgkins lymphomas, with the same problems of parent and daughter cells. In fact the architectural metaplasia of the bone marrow prevails over the cellular metaplasia in the definition of the single clinical, haematological nature and course of these syndromes which have been too widely dissociated by classical haematology.

[Acute transformation in 45 cases of chronic myeloid leukemia]

After a chronic phase, the average duration of which in this series was 38 months, the acute phase of myeloid leukemia was very short, not exceeding 7 months. The clinical signs which suggest an acute exacerbation are, in order of importance, increase in the volume of the spleen, changes in general health, fever. The blood signs, which are often found later than the clinical signs, are increased white cell count, anemia and marrow leukoblastosis higher than 20%. The laboratory criteria of acute exacerbation are of lesser importance. Chemotherapy gives very poor results at this stage.

[Infections during malignant blood diseases. Value of the carbenicillin-gentamicin combination]

The association of carbenicillin and gentamicin was used as a routine in the early treatment of 48 attacks of fever, in 38 patients who mostly had acute leukemia and marrow aplasia. The attacks of infection may be classified as follows: 30% septicemia, 30% local infections, 40% no bacteria were identified. Among the septicemias, we noted 5 septicemias due to pyocyaneus, 4 due to klebsiella. On the whole, in the attacks of fever, the association of carbenicillin and gentamicin proved effective in 70% of cases, but a cure was obtained in only 56% of cases. In vitro, the association carbenicillin-gentamicin proved justified in 70% of cases. There was no special intolerance, apart from a few cases of hypokalemic alkalosis. The association carbenicillin-gentamicin, by its broad spectrum and especially in view of its elective effect on the pyocyaneus is an excellent initial form of antibiotic therapy, when faced with infection in a patient with malignant blood disease. However, it should be recognised that the efficacy of this association depends on the number of circulating polynuclear cells and that some bacteria, such as the klebsiella, are clear cells and that some bacteria, such as the klebsiella, are often resistant to this antibiotic association.