Disappearance of Ph1-positive cells in four patients with chronic granulocytic leukemia after chemotherapy, irradiation and marrow transplantation from an identical twin

Four patients (21, 41, 13 and 38 years of age) with a history of chronic granulocytic leukemia for 12, 10, 11, and 106 months, respectively, were treated with dimethyl busulfan, cyclophosphamide, 920 rads of total-body irradiation and intravenous marrow infusion from normal, genetically identical twins. Serial chromosome analyses were performed on marrow aspirates cultured without mitotic stimulants. No Ph1-positive cells were detected in the marrows from the normal twins, whereas just before therapy, all 100 metaphases examined from each patient were Ph1-positive. Chromosome analyses were performed three to five times per patient after transplantation, and not a single Ph1-positive cell was detected. The patients remain hematologically normal 22, 23, 26 and 31 months after transplantation. The results show that the Ph1-positive clone can be eradicated by vigorous therapy and that the marrow in chronic granulocytic leukemia can be repopulated by stem cells from normal twins.

Treatment of chronic granulocytic leukemia by chemotherapy, total body irradiation and allogeneic bone marrow transplantation

Fourteen patients with chronic granulocytic leukemia received bone marrow grafts from HLA identical siblings. Ten patients were in blast crisis prior to grafting, three were in an accelerated phase of their disease, and one was aplastic secondary to chemotherapy. Prior to transplant all patients were conditioned with chemotherapy including cyclophosphamide plus 1,000 rad of total body irradiation. Ten patients achieved engraftment while four died 1 to 26 days after marrow infusion without functioning grafts. Two patients received a second infusion of donor marrow because of delayed engraftment. Neither marrow cell dose nor presence of myelofibrosis correlated with successful engraftment. Three out of ten engrafted patients developed graft-versus-host disease. Interstitial pneumonia occurred in seven patients. The immediate cause of death was bacterial septicemia in six patients. All evidence of leukemia disappeared in nine out of ten evaluable patients. The median survival was 43 days. One patient had a complete remission of 16 months duration.

Improving continuity of care through a state hospital-CMHC liaison program

After several abortive attempts, a state hospital and a community mental health center located in the same county made a more successful attempt to improve continuity of care. A study of 78 discharged hospital patients identified several problems in the continuity-of-care system. A liaison team made up of a social worker from the hospital and a psychiatric nurse from the center was set up to carry out such tasks as contacting county residents admitted to the hospital, participating in treatment and discharge planning, and contacting patients who did not keep aftercare appointments. The program had several positive results; the authors believe they were related to such factors as an objective definition of the problems, administrative cooperation, and strong linkage, through a middle-management team, between the liaison team and top-level management and between the hospital and the center.

Copper content and exchange in mammalian hearts

Determination of the copper (Cu) content of rat, rabbit, and mouse hearts proved to be a sensitive microassay for mitochondrial content and membrane area of mitochondrial cristae per unit myocardial cell volume. The direction of variations in Cu content correlated well with variations in membrane area of mitochondrial cristae determined by morphometry of electron micrographs during normal postnatal growth, ventricular hypertrophy after aortic constriction, and thyroxin-stimulated myocardial cell growth. Right and left ventricular and interventricular septal Cu contents per unit dry weight were the same, did not vary during postnatal growth, and significantly exceeded atrial Cu content. Among different mammalian species, ventricular Cu content per unit dry weight tended to vary inversely with adult animal size and thus with adult resting heart rate. The existence of mechanisms for transport of 67 Cu across the myocardial cell plasma membrane and for incorporation of 67 Cu into mitochondrial cristae from an intracellular precursor pool was demonstrated by injecting 67 Cu-labeled blood serum into rats.