Effects of long-term treatment with recombinant human granulocyte-macrophage colony-stimulating factor in patients with myelodysplastic syndrome

We examined the effects of long-term treatment with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) in 61 patients with myelodysplastic syndrome (MDS). Patients were randomly assigned to receive daily subcutaneous injection of 60 micrograms/m2, 125 micrograms/m2 or 250 micrograms/m2 for 8 weeks. A significant increase in granulocyte counts including neutrophils and eosinophils was shown from one week after the start of the treatment in all three dose groups. The increase in granulocyte counts reached a plateau at the 4th week and was sustained during the treatment period. However, no consistent change in other cell lineages including monocytes, lymphocytes, reticulocytes and platelets were observed. Nevertheless peak-levels of these cells were significantly higher than the pre-treatment levels. In higher dose groups, the number of patients developing infections was reduced. There was no significant difference in the incidence of adverse events among the 3 dose groups, and the toxicity was generally well-tolerated. These observations indicate that treatment with rhGM-CSF can be of potential therapeutic benefit to patients with MDS.

Protective effects of prostaglandin E2 on the paraquat-induced constriction of the fetal ductus arteriosus in the rat

Pregnant rats on day 21 of gestation received a subcutaneous injection of paraquat (25 mg/kg). Two hr later, some fetuses of these rats received a subcutaneous injection of prostaglandin E2 (PGE2). The caliber of the ductus arteriosus (DA) of fetuses was measured 1 hr later. The DA of fetuses of paraquat-treated pregnant rats was significantly constricted compared with that of fetuses of control pregnant rats given physiological saline. However, the DA of PGE2-treated fetuses of paraquat-treated pregnant rats had a caliber comparable to that of control rats. The maternal plasma PGE2 level decreased following paraquat treatment. These results suggest that the decrease of maternal PGE2 level results in a constriction of the DA of fetuses.

Effect of cadmium in the zinc deficient rat

Three-w-old male Sprague-Dawley rats were given a zinc (Zn)-deficient (0 ppm Zn) or a Zn-adequate diet (30 ppm Zn) supplemented with 0, 0.5 or 100 ppm cadmium (Cd) for up to 5 mo. The proximal convoluted tubules of the kidneys had degenerative changes in the rats fed the Zn-deficient diet containing 100 ppm Cd [Zn 0, Cd 100], but there were no lesions in other groups. Electron microscopy showed cytoplasmic vacuolation of the proximal tubules, mitochondrial swelling and coagulative necrosis in Zn 0:Cd 100 rats. The present study revealed diminished bone growth and cortical thinning of the femur, but there was no osteomalacia seen in Itai-Itai disease patients. The results indicate that Zn deficiency may enhance the renal toxicity of Cd, but that dietary Cd did not cause osteomalacia even under severe Zn-deficient conditions.

Phase I study of NKT-01

A phase I study of NKT-01 (deoxyspergualin), which is a derivative of an antitumor antibiotic, spergualin, was performed by a cooperative study group. NKT-01 was given intravenously by 3-h infusion. The effect of single administration was studied prior to evaluation of daily administration for 5 consecutive days. In all, 5 and 33 patients with various malignancies, including leukemia, were entered into the trials of single and daily administration, respectively. In the single-administration study, all patients were evaluable and no clear adverse effect was observed at doses ranging from 20 to 320 mg/m2. In the daily-administration study, 28 evaluable patients (16 men and 12 women; median age, 55.5 years) were treated with a daily dose of 20-500 mg/m2. Toxicities such as myelosuppression, mild nausea/vomiting, anorexia, alopecia, tongue and perioral numbness, and hypotension were observed dose-dependently during or after the treatment. Grade 2 leukopenia, thrombocytopenia, and anemia were experienced at a dose of 500 mg/m2. These usually recovered to normal values by approximately 3 weeks after treatment. A pharmacokinetic analysis of single administration revealed rapid plasma clearance, with mean half-lives for the alpha and beta phases being 28 min and 6.9 h, respectively. Approximately 12% of the infused dose was excreted into the urine in unmetabolized form. The pharmacokinetic parameters obtained after 5-day administration were similar to those recorded after single administration. Concerning treatment response, a transient but significant reduction in the number of leukemic cells was observed in one patient with adult T-cell leukemia. In this study, perioral numbness, hypotension, and hematological toxicity were concluded to be dose-limiting, with the maximal acceptable dose being 500 mg/m2. The recommended dose for a phase II study of NKT-01 against solid tumors was judged to be 400 mg/m2 given daily by 3-h infusion for 5 days, every 3 weeks. In hematological malignancies, however, higher myelosuppressive schedules of administration should be investigated.

WT1 as a new prognostic factor and a new marker for the detection of minimal residual disease in acute leukemia

The WT1 gene encoding a zinc finger polypeptide is a tumor suppressor gene that plays a key role in the carcinogenesis of Wilms' tumor. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to examine relative levels of WT1 gene expression (defined in K562 cells as 1.00) in 45 patients with acute myelogenous leukemia (AML), 22 with acute lymphocytic leukemia (ALL), 6 with acute mixed lineage leukemia (AMLL), 23 with chronic myelogenous leukemia (CML), and 24 with non-Hodgkin's lymphoma. Significant levels of WT1 gene were expressed in all leukemia patients and for CML the levels increased as the clinical phase progressed. In striking contrast with acute leukemia, the levels of WT1 gene expression for NHL were significantly lower or even undetectable. Clear correlation was observed between the relative levels of WT1 gene expression (< 0.6 v > or = 0.6) and the prognosis for acute leukemia (AML, ALL, and AMLL). Patients with less than 0.6 levels had significantly higher rates of complete remission (CR), disease-free survival, and overall survival than those with > or = 0.6 levels, whereas CR could not be induced in any of the 7 patients with acute leukemia having greater than 1.0 levels of WT1 gene expression. The quantitation of the WT1 gene expression made it possible to detect minimal residual disease (MRD) in acute leukemia regardless of the presence or absence of tumor-specific DNA markers. Continuous monitoring of the WT1 mRNA was performed for 9 patients with acute leukemia. In 4 patients, MRD was detected 2 to 8 months before clinical relapse became apparent. In 2 other patients, the WT1 mRNA gradually increased after discontinuation of chemotherapy. No MRD was detected in the remaining 3 patients with AML who received intensive induction and consolidation therapy. Simultaneous monitoring of MRD by RT-PCR using primers for specific DNA markers in 3 patients (2 AML-M3 with PML/RAR alpha, and 1 AML-M2 with AML1/ETO) among these 9 patients detected MRD comparable with that obtained from quantitation of WT1 gene expression. In a patient with acute promyelocytic leukemia, the limits of leukemic cell detection by RT-PCR using either WT1 or promyelocytic leukemia/retinoic acid receptor-alpha gene primers were 10(-3) to 10(-4) and 10(-4) for bone marrow, and 10(-5) and 10(-4) for peripheral blood, respectively. Therefore, we conclude that WT1 is a new prognostic factor and a new marker for the detection of MRD in acute leukemia.

Expression of the interleukin-6 (IL-6), IL-6 receptor, and gp130 genes in acute leukemia

Expression patterns of interleukin-6 (IL-6), IL-6 receptor (IL-6R), and gp130 genes in 39 patients with acute myeloid leukemia (AML), in 23 patients with acute lymphoblastic leukemia (ALL), and in 7 patients with acute mixed lineage leukemia (AMLL) were studied by quantitative reverse transcriptase-polymerase chain reaction. Significant levels of IL-6 were expressed in 8 (21%) of 39 AML patients and in 2 (29%) of 7 AMLL patients, whereas in ALL, the expression of IL-6 was almost negligible. IL-6R was expressed in all patients with AML and AMLL, whereas only half of ALL patients expressed low levels of IL-6R as compared with those with AML and AMLL. However, gp130 was ubiquitously expressed in all the leukemia patients, and there was no significant difference in gp130 expression among AML, ALL, and AMLL. Significant correlation was observed between the expression of IL-6R and gp130 in AML. When tested for in vitro response to IL-6, the leukemic cells from 3 of 7 AML, none of 3 ALL, and both of 2 AMLL patients significantly responded to IL-6, showing the correlation between the expression levels of IL-6R and gp130 and the responsiveness of leukemic cells to IL-6. These results showed that quantitation of IL-6R and gp130 expression by reverse transcriptase-polymerase chain reaction is useful for the rapid prediction of the responsiveness of leukemic cells to IL-6, especially in cases of administration of IL-6.

Treatment of adult T-cell leukaemia-lymphoma with irinotecan hydrochloride (CPT-11). CPT-11 Study Group on Hematological Malignancy

A late phase II study of a new camptothecin analogue, irinotecan hydrochloride (CPT-11), was conducted to evaluate the anti-tumour effect and toxicity in patients with refractory leukaemia and lymphoma including adult T-cell leukaemia (ATL)-lymphoma, in a multi-institutional cooperative study. All the patients with ATL had been previously treated with various conventional combination chemotherapies and were refractory to these therapies or had relapsed. CPT-11 was administered at a dose of 40 mg m-2 day-1 for three consecutive days repeated weekly until evidence of disease progression. One complete remission and four partial remissions were achieved in 13 assessable patients with ATL. The median total dose to achieve remission was 240 mg m-2 and the median duration of response was 31 days. The major toxicities were leucopenia (83%), diarrhoea (62%) and nausea/vomiting (69%). These were relatively severe, but they were generally tolerable and reversible. However, one patient died probably as a result of this therapy. No effective chemotherapy for adult T-cell leukaemia-lymphoma has yet been established, and the prognosis for patients with this disease is very poor. Our results suggest that CPT-11 may be a promising agent for this disease. Further combination therapy with CPT-11 is needed to improve the therapy for ATL.

A calcium channel blocker verapamil inhibits the spontaneous closure of the ductus arteriosus in newborn rats

Newborn rats delivered by caesarean section were given subcutaneously verapamil hydrochloride (VER), a Ca-channel blocker, (1) immediately or (2) 180 min after delivery. The diameter of the ductus arteriosus (DA) of the newborn pups was calibrated at 30, 60 and 90 min after the VER-administration. (1) The DA calibers of the pups given 0.1, 1.0 mg/kg VER immediately after delivery remained significantly larger than those of control pups in a dose-dependent manner for 30 min after treatment. In the 1 mg/kg group, the enlargement of the DA was prolonged until 90 min after treatment. (2) In untreated pups, the DA completely closed by 180 min after caesarean delivery. The closed DA was not affected after 1 mg/kg VER was given at 3 hours after delivery. It was concluded that, VER inhibits the spontaneous constriction of the DA, suggesting that the increase of intracellular Ca2+ concentration may play an important role on the spontaneous closure of the DA in newborn rats.

Constrictive effects of paraquat on the ductus arteriosus in fetal rats

Rats on day 21 of pregnancy received a subcutaneous injection of paraquat (2, 7 or 25 mg/kg). The inner diameter of the ductus arteriosus (DA) of their fetuses was measured using the whole-body freezing method 1, 3, 6 and 24 hours after injection. The 7 mg/kg dose group showed a significant constriction of the DA 3 hours after paraquat treatment. The 25 mg/kg dose group showed a significant constriction 3 and 6 hours after treatment. The constrictive effect was dose-dependent, that is, the magnitude of constriction observed 3 hours after paraquat injection was greater in the 25 mg/kg dose group than in the 7 mg/kg dose group. The 2 mg/kg dose group showed no significant change in the inner diameter of the DA at any point of measurement (1, 3, 6 and 24 hours after injection), compared to the saline treated controls. These results indicate that paraquat induces constriction of the fetal rat DA in a dose-dependent manner when administered in late stages of gestation, and that this effect of paraquat is not seen at a dose level of 2 mg/kg.

A nine-year chronic toxicity study of cadmium in monkeys. II. Effects of dietary cadmium on circulatory function, plasma cholesterol and triglyceride

The effects of long-term (9 y) po administration of daily low doses of cadmium on blood pressure, heart rate, electrocardiogram and plasma cholesterol and triglyceride concentrations were examined in rhesus monkeys. Thirty-five male rhesus monkeys were divided into 5 groups and fed pelleted food containing cadmium chloride at dosages of 0, 3, 10, 30 or 100 micrograms cadmium/g food (= ppm). The 100 ppm group had increased blood pressure during the initial 1 1/2 y. Thereafter, the expected increase in blood pressure that occurred due to aging in the control and 3 ppm groups was not evident in the 100 ppm group. No changes attributable to cadmium were detected in pulse rates or in electrocardiograms. Plasma cholesterol in the 2 highest dosage groups and triglyceride in the 100 ppm group were slightly lower than in controls after 2 1/2 y. Long-term exposure to cadmium contributed to the development of elevated blood pressure during the first and second years and then inhibited the hypertension expected due to aging.

Recombinant human non-glycosylated granulocyte-macrophage colony-stimulating factor in allogeneic bone marrow transplantation: double-blind placebo-controlled phase III clinical trial

In a randomized double-blind placebo-controlled phase III clinical trial, the effects of a non-glycosylated recombinant human granulocyte-macrophage colony-stimulating factor (CSF 39-300) were investigated in patients who had received allogeneic bone marrow transplantation. CSF 39-300 was administered at a daily dose of 10 micrograms/kg (maximum dose, 300 micrograms/body) via three-hour intravenous infusions from days 1 to 21 following reinfusion of the marrow. Twenty-eight patients received CSF 39-300 and 25, placebo. The median number of days to recovery for leucocytes (> or = 1000/mm3), neutrophils (> or = 500/mm3), lymphocytes (> or = 300/mm3) and reticulocytes (> or = 20/1000) were significantly shortened (16 vs 20, 17 vs 21 and 22 vs 28, respectively) with CSF 39-300. The duration of stay in laminar-air-flow room after transplantation was also significantly shortened in the CSF 39-300 group (21 vs 30 days). There was no significant difference in the incidence of acute or chronic graft-versus-host disease between the two groups. A follow-up during the year after transplantation revealed there to be no significant difference in either survival rate or leukemia relapse rate between the two groups. CSF 39-300 is therefore considered useful after allogeneic bone marrow transplantation, especially in the early period.

Development of an ELISA assay for soluble CD35 (C3b/C4b receptor): high levels of soluble CD35 in LE-positive patients with hematological malignancies

Malignant cells usually lack CD35 (complement receptor type 1, C3b/C4b receptor), a differentiation surface antigen. We measured soluble forms of CD35 in the plasma of normal subjects and patients with various malignant diseases. A microassay for the determination of CD35 was established based on a sandwich enzyme immunoassay using 2 monoclonal antibodies that recognize different epitopes. Soluble CD35 was not detected in any plasma samples from normal subjects or from patients with a variety of solid cancers: i.e., levels were below 20 ng/ml. On the other hand, 3 of 70 patients with hematological malignancies showed high levels of plasma CD35. The molecular mass of the soluble form was about 200 kDa, which is similar in size to membrane forms of CD35. Although the clinical conditions differed in these patients, they had high transaminase titers and detectable autoantibody. Complement titers (CH50) and the levels of membrane complement regulatory proteins were within the normal range in these patients. Although the mechanism by which it is produced remains unknown, soluble CD35 is present in significant amounts in association with immunological disorders secondary to hematological malignancies.

[Late phase II clinical study of irinotecan hydrochloride (CPT-11) in the treatment of malignant lymphoma and acute leukemia. The CPT-11 Research Group for Hematological Malignancies]

A nationwide multi-center cooperative phase II clinical study of irinotecan hydrochloride (CPT-11) was conducted to evaluate its efficacy in intractable malignant lymphoma and acute leukemia. In malignant lymphoma, one course of CPT-11 consisted of intravenous drip infusion at a dose of 40 mg/m2 once daily for 3 consecutive days, performed once a week. In acute leukemia, one course of CPT-11 consisted of intravenous drip infusion at a dose of 15 to 20 mg/m2 a day twice daily for 7 consecutive days (1 cycle), performed every 2 to 4 weeks. Among the 79 patients with malignant lymphoma and 50 patients with acute leukemia enrolled in the study, 66 and 41 patients, respectively, completed treatment. These patients had all undergone chemotherapy prior to treatment. Among the malignant lymphomas, the response rate in non-Hodgkin's lymphoma (NHL), including 9 CRs, was 42% (26/62, 95% CI: 30-54%); of these there was a response rate of 39% (5/13), including 1 CR, in adult T-cell leukemia (ATL) as well. In Hodgkin's disease (HD), on the other hand, there were no cases in which efficacy was demonstrated (0/4). The overall response rate in malignant lymphoma was 39% (26/66), and the response rate even among the recurrent intransigent cases was 42% (16/38). The 50% survival time (MST) in the 74 eligible cases of malignant lymphoma was 153 days. In acute leukemia, on the other hand, partial remission was observed in 2 of 17 cases (12%) of acute lymphocytic leukemia (ALL), but no cases of remission were observed in the 24 patients with acute myelogenous leukemia (AML). The overall remission rate in acute leukemia was 5% (2/41, 95% CI: 1-14%). The principal adverse effects were myelosuppression in malignant lymphoma and gastrointestinal symptoms, including diarrhea, nausea/vomiting, anorexia and abdominal pain, in both malignant lymphoma and acute leukemia, and there was little organ damage to the heart, liver or kidney. Myelosuppression and gastrointestinal adverse effects were severe in some of the patients, so caution is required. Based on the above findings, CPT-11 appears to be efficacious in the treatment of non-Hodgkin's lymphoma.

[Clinical efficacy of arbekacin on MRSA infections with hematopoietic disorders. The Hanshin Study Group of Hematopoietic Disorders and Infections]

Arbekacin (ABK) was administered to 17 patients with MRSA infections that complicated underlying hematopoietic disorders, and the efficacy and safety were evaluated. The underlying diseases included acute myelocytic leukemia (8 cases), acute lymphocytic leukemia (1) myelodysplastic syndrome (3), chronic myelocytic leukemia (1), non-Hodgkin's lymphoma (2), Hodgkin's disease (1) and adult T cell leukemia (1). The infections consisted of septicemia (5 cases), pneumonia (4), upper respiratory tract infections (6) and urinary tract infections (2). ABK was administered by i.v. drip infusion in daily doses of 150-200 mg, given in two divided dosages. The therapeutic efficacies were: excellent in 2 (2 septicemias), good in 7 (1 septicemia, 4 upper respiratory infections, 2 urinary tract infections), fair in 2 (septicemia and pneumonia) and poor in 6 (1 septicemia, 3 pneumonias, 2 upper respiratory infections). As a side effect, reversible renal dysfunction was detected in four cases. Causative bacteria were isolated from six cases. They were all coagulase type II and MIC's of ABK were from 0.25 microgram/ml to 4.0 micrograms/ml. Arbekacin therapy was found to be effective even in patients with hematopoietic disorders accompanied by MRSA infections.

Allogeneic bone marrow transplantation in Japan

Allogeneic bone marrow transplantation (BMT) is being used increasingly to treat diverse diseases in Japan. The distinctive aspects of allogeneic BMT in Japan include the lower incidence of acute graft-versus-host disease, which may be attributable to less disparity in histocompatibility antigens in Japanese. Research in the field of allogeneic BMT in Japan has covered the use of recombinant hemopoietic growth factors, especially granulocyte colony-stimulating factor, and novel immunosuppressive agents.

A nine-year chronic toxicity study of cadmium ingestion in monkeys. I. Effects of dietary cadmium on the general health of monkeys

Thirty-five male rhesus monkeys (Macaca mulatta) 2-5 y-of-age were separated into 5 groups and fed 200 g solid food daily which contained 0, 3, 10, 30 or 100 micrograms cadmium/g (ppm) as cadmium chloride for 462 w (9 y). The control feed (0 ppm) contained 0.27 micrograms cadmium/g. Dietary zinc intake was limited to the minimum requirement of 6 mg zinc/day (control food concentration was 3 mg zinc/100 g) to avoid impacting cadmium toxicity due to excessive zinc intake. Urine was collected at 3-w intervals. Decreased development (reduced body weight and body length) was observed in groups that received 10 ppm cadmium or more. The 100 ppm group had glucose in the urine after 48 w, elevated urine protein at 98 w, and markedly increased urine volume after the 102nd week. No abnormalities in renal functions were noted in the 3 or 10 ppm groups. Despite the development of these clinical signs of renal dysfunction, none of the 100 ppm group had aggravated renal dysfunction or renal failure during the 9 y of study.

[Anterior decompression of the thoracic spine through the posterior approach: its usefulness, indications, technique, and the preservation of postoperative spinal stability]

Three patients with thoracic myelopathy were operated on using a modified surgical approach, anterior decompression of the thoracic cord through the posterior approach. The usefulness of and indication for this approach were discussed. Operative technique is as follows. In the prone position, laminae are removed widely enough to include the medial half of the facets and pedicles. This creates cavities lateral to the dural sac as deep as the diameter of the spinal canal. Through these cavities the anterior wall of the spinal canal and the posterior portion of the intervertebral disc are drilled out to make a space into which lesions are pulled away from the dural sac. The lesions can be removed under direct vision with minimum retraction to the dural sac. Our technique preserves the integrity of the spinous processes and supra/inter spinal ligaments, which do not restrict access to the cord and have the potential to be one of the supports of the spine. Postoperative course was uneventful in all of the patients. This approach has several advantages. It can be applied to any levels of the thoracic spine and can be used for decompression all around the thoracic cord. The procedure is minimumly invasive. The indications for this operation are considered to be 1) lesions at the level of T3, 2) anterior lesions associated with OYL at the same or adjacent level, 3) multilevel lesions which need staged operations, 4) laterally protruded discs and 5) lesions in elderly or high risk patients.

Pediatric cerebellar infarction caused by atlantoaxial subluxation--case report

An 11-year-old girl developed cerebellar infarction presenting as a posterior fossa mass lesion after stretching and flexing her neck. Cerebral angiography demonstrated irregular narrowing of the right vertebral artery at the C2 level and x-rays of the upper cervical spine showed atlantoaxial subluxation with os odontoideum. She underwent surgical decompression with removal of infarcted tissue. The cerebellar infarction probably resulted from occlusion of the vertebral artery, followed by brain swelling due to recanalization.

Effect of maternal paraquat administration on the fetal ductus arteriosus in the rat

The ductus arteriosus (DA) in the fetal rat was calibrated using a whole-body freezing method, 3 hr after maternal treatment with paraquat at a dose of 25 mg/kg of body weight on days 19-21 of gestation. On days 20 and 21, the DA was significantly constricted. The DA was also significantly constricted on day 19 2/3 but not on day 19 1/2. It is concluded that paraquat has a constrictive effect on the DA and that the onset of this effect occurs in the first half of day 19 of gestation.

Confronting cisternae in canine testicular seminoma: special reference to appearance rate

A number of confronting cisternae (CC) were found in canine testicular seminomas (SEM). The CC consisted of two or three closely attached cisternae separated by an electron-dense layer, but occasionally four or more cisternae were stacked in a similar fashion. They showed a short, straight, and direct continuity with the rER or the nuclear envelope. They were found in SEM cells of both interphase and mitotic stages. We statistically examined 18 cases of canine SEM concerning the CC appearance rate in interphase cells (CCARI) and in mitotic cells (CCARM), and the tumor mitotic index (TMI). The SEM were classified into three groups (intratubular SEM without invasion, intratubular SEM with invasion, and diffuse type SEM) using Nielsen and Lein's classification (1974). The CCARI and TMI of the diffuse type SEM were significantly higher than those of the intratubular SEM with invasion, and those of the latter group were significantly higher than those of the intratubular SEM without invasion. On the other hand, the CCARM were similar between these three groups, and this parameter showed a non-significant correlation with the TMI. The present study suggests that the increase in the number of CC in interphase canine SEM cells might be correlated with the tumor progression.