Immunohistochemical expression of blood group substances and related carbohydrate antigens in breast carcinoma

In forty-one carcinomas and sixteen benign lesions (fibroadenoma and mastopathy) of the human breast, immunohistochemical expression of sialylated and non-sialylated forms of both Lea and Lex, and the A, B, and H type 2 blood group substances were studied by using an indirect immunoperoxidase staining. In normal ductal epithelium and benign lesion of breast, Lewis-related antigens were mostly expressed. Breast carcinomas showed these antigens with the following frequencies: Lea, 31.7% (13/41); sialyl Lea, 56.1% (23/41); Lex, 46.3% (19/41); sialyl Lex, 68.3% (28/41); A/B/H type 2, 38.1% (16/41). Sialylated forms of Lea and Lex were observed more frequently than their respective non-sialylated forms in breast carcinomas. In both one normal epithelium and four carcinomas of breast with Le(a-b-) phenotype, the expressions of type 2 antigens were observed, while type 1 antigens were not consistently expressed. Although compatible expression was observed in all specimens of both normal epithelium and benign lesion of breast, twenty-four cases with the deletion of A and/or B antigens, six cases with H type 2 accumulation and one case with incompatible expression were demonstrated in breast carcinoma. Thirty-one breast carcinomas which showed the deletion of A/B/H type 2 expressed the Lewis-related antigens more frequently than nine cases which showed compatible expression. These results suggested that the activation of terminal fucosyltransferase and sialyltransferase as well as inactivation of some glycosyltransferases had occurred in cancer cell membrane, and sialyl Lex, defined by a new monoclonal antibody CSLEX1, may be useful as a tumor-associated antigen independent of Lewis blood group type in breast cancer.

[Infection prophylaxis in patients with hematological malignancies (II)--Successful prophylaxis of tuberculosis with isoniazid]

In a retrospective study to evaluate the efficacy of isoniazid (INH) for the prevention of tuberculosis, we studied 1760 patients with hematological malignancies over a twenty-year period (1970-1989). 759 patients received oral INH, most of all received 400 mg per day. Only one (0.1%) of the patients receiving INH developed tuberculosis, whereas nine (0.9%) of the 1001 patients who did not receive INH developed tuberculosis (p less than 0.05). We found that INH was very effective in the prevention of tuberculosis in patients with hematological malignancies, and was well tolerated.

IL-2-dependent ATL cell lines with phenotypes differing from the original leukemia cells

Adult T-cell leukemia (ATL) cells have been shown to express the receptor for IL-2 by studies using anti-CD25 monoclonal antibody, but these cells usually show no or only a weak proliferative response to IL-2. In the present study, we established thirteen IL-2-dependent T-cell lines from four ATL patients. Examination of the clonalities of these cell lines by the rearrangement profiles of the TCR beta-chain gene and the integration sites of the HTLV-I proviral genome, revealed that two cell lines (KK-1 and KK-5) were of real ATL cell origin. The others were of normal T-cell origin and had been established by infection with HTLV-I. The KK-1 and KK-5 cell lines were derived from a single ATL patient (KK). Interestingly, these cells showed different phenotypic features from the majority of original leukemia cells (CD3 +/- CD4+ CD8-). The KK-1 cell line acquired CD8 antigen expression and became double-positive (CD3 +/- CD4+ CD8+), while the KK-5 cell line prominently expressed CD3 antigen (CD3+ CD4+ CD8-). These results indicate that the phenotypic feature of ATL cells are not fixed, but can change in vitro as has occasionally been observed in vivo.

[Infection prophylaxis in patients with hematological malignancies (I)--Successful prophylaxis of Pneumocystis carinii pneumonitis with sulfamethoxazole-trimethoprim]

In a retrospective study to evaluate the efficacy of sulfamethoxazole-trimethoprim (SMX-TMP) for the prevention of Pneumocystis carinii pneumonitis, we studied 1760 patients wit hematological malignancies over a twenty-year period (1970-1989). 449 patients received oral SMX-TMP, most of all received 400 mg of SMX and 80 mg of TMP twice per day. None of the patients receiving SMX-TMP developed P carinii pneumonitis, whereas twenty-six (2.0%) of the 1311 patients who did not receive SMX-TMP developed P carinii pneumonitis (p less than 0.01). We found that the SMX-TMP was very effective in the prevention of P carinii pneumonitis in patients with hematological malignancies, and was well tolerated.

[Comparison of ciprofloxacin with polymyxin B for infection prophylaxis in neutropenic patients with acute non-lymphocytic leukemia]

Twenty-four neutropenic patients receiving intensive chemotherapy for acute non-lymphocytic leukemia were studied in a randomized trial comparing ciprofloxacin with polymyxin B for prevention of infections. Both groups (12 patients each group) received amphotericin B for antifungal prophylaxis. 20 febrile episodes occurred in 22 courses of oral prophylactic ciprofloxacin and 22 occurred in 24 courses of oral prophylactic polymyxin B. Patients receiving ciprofloxacin had a mean time to the first infection-related febrile episode of 7.2 days, compared with 4.3 days for the polymyxin B group (p less than 0.01). Patients receiving ciprofloxacin also had fewer days of fever (average 6.5 days versus 9.8 days for the polymyxin B group, p less than 0.02). Duration of administration of parental antibiotics were also shorter in the ciprofloxacin group (p less than 0.001). Although modifications of the empiric antibiotic regimen were required more frequent in patients receiving polymyxin B, this did not reach statistical significance. These results suggest that ciprofloxacin is a more efficacious oral antimicrobial agent than polymyxin B for the prevention of infections in neutropenic patients with acute non-lymphocytic leukemia.

Survey of anti-human T-cell leukemia virus type I antibody in family members of patients with adult T-cell leukemia

To evaluate the intrafamilial clustering of HTLV-I, we examined the sera or plasma of 296 healthy family members of patients with adult T-cell leukemia (ATL) for anti-HTLV-I antibodies. Of 296 subjects, 132 (44.6%) had anti-HTLV-I antibodies. Fifty-nine (41.0%) out of 144 males and 73 (48.0%) out of 152 females were seropositive. The positive rates of antibody to HTLV-I increased with age, especially between the 30-39 and the 40-49 age groups. Five out of 6 fathers, 3 out of 4 mothers, 31 (60.8%) out of 51 spouses, 40 (63.5%) out of 63 siblings and 46 (33.8%) out of 136 children of patients with ATL had anti-HTLV-I antibodies. Of 74 children with an ATL father, 14 (18.9%) were seropositive, while 32 (51.6%) out of 63 children with an ATL mother were seropositive. This difference was statistically significant (P less than 0.001). Of those children with an ATL father, 12 (26.1%) out of 46 whose mothers were HTLV-I carriers had antibodies to HTLV-I. In contrast, none of the 13 children whose mothers were not carriers were seropositive. These results supported the hypothesis that the mother-to-child transmission is one of the most important modes of HTLV-I transmission. In wives of male patients with ATL, the positive rate of antibody to HTLV-I was 65.6% (21/32), and in husbands of female patients, it was 52.6% (10/19). The high positive rate of antibody to HTLV-I not only in wives of male patients but also in husbands of female patients suggests that either HTLV-I is more frequently transmitted from wives to their husbands than we had originally expected, or that ATL may develop even in wives who acquire HTLV-I from their husbands after marriage.

[Serological evaluation of human T lymphotropic virus type-I infection in routine hospital samples, especially using serodia.HTLV-I]

Particle agglutination (PA; Serodia-ATLA) and ELISA (Ei-test ATL) assays have been used as routine anti-HTLV-I antibody detection in Japan. However, inconsistent results were obtained by the above methods. We wished to develop criteria for serological confirmation of HTLV-I infection in Hospital samples. Sera obtained in our Hospital from October, 1988 to September, 1989 were tested by five methods of PA (Serodia-ATLA), new PA (improved on the PA; Serodia.HTLV-I), ELISA-I (coated by HTLV-I infected cell lysates as antigens; Ei-test ATL), ELISA-II (coated by recombinant gag-env hybrid proteins as antigens) and IF. The HTLV-I seropositive rates using five methods were not different, ranged from 29.7 to 32.3% in 155 sera. However, PA assays appeared more false positive and rare false negative in some high titer sera. 13 sera as demonstrated negative for ELISA-I and positive for PA (ELISA-I(-)/PA(+] were reevaluated. As results, the antibody were confirmed in only 3 by new PA, 1 by ELISA-II and 2 cases by IF, respectively. On the other hand, 2 by new PA, 4 by ELISA-II and 2 by IF in 18 sera with ELISA-I(+)/PA(-) were interpreted as positive. Therefore, new PA is a remarkable improvement on the PA current model.

Antibodies against p40tax gene product of human T-lymphotropic virus type-I (HTLV-I) under various conditions of HTLV-I infection

We investigated antibodies against pX gene product, p40tax, by ELISA using recombinant p40tax protein in HTLV-I seropositive carriers as well as patients with adult T cell leukemia (ATL) and HTLV-I-associated myelopathy (HAM). Seventy (49.0%) out of 143 HTLV-I healthy carriers were found to be positive for antibody against p40tax antigen and the follow-up samples at two-year intervals revealed constant reactivity by ELISA in each carrier. The onset of antibody production was delayed 4 to 12 weeks as compared with anti-HTLV-I in primary infection cases. The anti-p40tax-positive rate (90%) in HAM patients was significantly higher than that of healthy carriers, acute and chronic ATL patients and their family members. Furthermore, HAM patients and a few healthy carriers showed high reactivities by ELISA. Children from mothers with anti-p40tax showed a higher anti-HTLV-I-positive rate than that of children from mothers without anti-p40tax (54.5% versus 12.5%). Two men without anti-p40tax and one female with low anti-p40tax developed ATL during follow-up studies. These results suggest that HTLV-I carriers could be divided into 2 or 3 sub-populations according to antibody response to p40tax. A smaller population with anti-p40tax, especially a high antibody reactivity, could have a high risk of developing HAM and of transmission from mother to child. In addition, ATL may occur in a population with low or absent anti-p40tax.

High risk of mother-to-child transmission of HTLV-I in p40tax antibody-positive mothers

A new enzyme-linked immunosorbent assay (ELISA) for detecting the antibody to a human T-lymphotropic virus type I (HTLV-I) tax gene product, p40tax, has been developed. By this ELISA method, we have investigated the relationship between the presence of p40tax antibody in HTLV-I-infected mothers and the virus transmission rate from mothers to their children. The rate of mother-to-child transmission of HTLV-I was higher in p40tax antibody-positive mothers than in antibody-negative ones. Thus, the presence of p40tax antibody may indicate an increased risk of vertical transmission of HTLV-I.

[Difference of antibody profile for human T-lymphotropic virus type-I (HTLV-I) among individuals]

Healthy carriers, patients with ATL and HTLV-I associated myelopathy (HAM) were examined for HTLV-I antibodies of IgG and IgM classes and anti-p 40x antibodies, using ELISA, western blot (WB) and particle agglutination (PA) techniques. IgG antibodies were almost always detectable in sera from all of patients with ATL and HAM and healthy carriers with high titer in the PA test (normal carriers), and the average value of OD 405 was 2.0 +/- 0.3, 1.6 +/- 0.6 and 1.3 +/- 0.7, respectively. In anti-p 40x antibodies, the detectable incidence of HAM, ATL, normal carriers and carriers with low titer of the PA (low-PA group) was 90%, 67%, 44%, and 3%; and, the average value of OD 405 of the antibodies was 2.3 +/- 1.0, 0.7 +/- 0.5, and 0.7 +/- 0.7, respectively. On the other hand, the incidence of IgM antibodies demonstrated in HAM, ATL, normal carriers and low-PA group was 90%, 41%, 33%, and 53%, respectively. Furthermore, the follow-up observation of these antibodies revealed that the antibody profile of individuals for a long time was constant, i.e. in each carrier the value with high OD remained high and the presence of anti-p 40x and/or IgM antibodies remained present. These data has demonstrated that there are considerably differences among individuals in responsivilities for HTLV-I. Then, the antibody profile is mainly classified into 3 groups; hyper-, common- and hypo-immune patterns.

Immunoglobulin classes of antibody for human T-lymphotropic virus type-I (HTLV-I) in healthy donors and HTLV-I-associated disorders

Healthy blood donors, patients with adult T-cell leukemia (ATL) and HTLV-I-associated myelopathy (HAM) and recipients of unscreened blood (SR) who had seroconverted and were followed-up for more than 2 years were examined for HTLV-I antibodies of immunoglobulin G (IgG) and M(IgM) classes. The overall infection rate in donors was 4.9%, as determined by screening with a particle agglutination method (PA). The rate increased with increasing age. Positive sera with a low titer in the PA test (1/16, 1/32 and 1/64) contained IgM antibodies in 32.5% (titer 1/16) to 36.1% (titer 1/64) of the cases, but IgG antibodies were detected in only 5.6% of the sera with a titer of 1/16 and in 36.1% of the sera with a titer of 1/64. Conversely, in high titer sera (1/128 or higher) IgG antibodies were almost always detectable (99.0%) and IgM antibodies less frequently (25.5%). Sera from acute, chronic and pre-ATL, HAM and SR patients contained IgG antibodies in high titer in all cases. The incidence of IgM antibodies was 7.7, 30.0, 53.3, 72.3, and 77.8%, respectively. IgM antibodies were demonstrated repeatedly in some cases who were followed up for a year. Only IgM antibodies from HAM patients occurred in high titers and had strong reactivity to the p24 antigens of HTLV-I in Western blot testing. It is concluded that it is important to detect IgM antibodies not only in primary infections but also in persistent infections of HTLV-I.

[Two cases of cardiac tamponade, complicated by malignant, effusive pericarditis and treated by creating a pericardial peritoneal window]

Reported are two cases of a cardiac tamponade complicated by a malignant, effusive pericarditis were treated by a pericardial, peritoneal window. In both cases, a reaccumulation of pericardial fluid was noticed, within a month after percutaneous, continuous pericardial drainage, and a tumor invasion was seen to the anterior mediastinum creating a pericardial, peritoneal window was considered useful for the treatment of the cardiac tamponade, secondary to the malignant, effusive pericarditis.

[Clinical study on the effect of natural alpha-interferon (HLBI) in the treatment of adult T-cell leukemia]

The phase II trial of natural interferon-alpha (HLBI) in treatment of adult T-cell leukemia was carried out as a cooperative study. Of the 24 cases which could be evaluated, 3 cases in crisis type and 5 cases in chronic type with lymphadenopathy and/or skin infiltration achieved PR, giving a response rate of 33.3%. The anti-tumor effect of HLBI for skin lesion could be assessed in 16 cases with skin infiltration, giving a response rate of 50.0% (5 CR and 3 PR) and demonstrating a high efficacy. Of the 31 eligible patients, side effects were recognised in 27 (87.1%). Major subjective and objective symptoms were fever (38.7%), fatigue (25.8%), anorexia (12.9%) and nausea (12.9%), and leukopenia (22.6%), granulocytopenia (38.7%), thrombocytopenia (38.7), elevation of GPT (12.9%) and GOT (12.9%) were observed.

Milk-borne transmission of HTLV-I from carrier mothers to their children

In order to clarify the natural transmission route of human T-cell leukemia virus type I (HTLV-I) from mother to child, we have followed two groups of children with ages of 1 to 3 years who were nourished either with HTLV-I-infected breast milk, or with non-infected milk from sero-positive, HTLV-I carrier mothers. Tests for the presence of antibody against HTLV-I revealed that 4 of 6 children in the former group developed HTLV-I infection, while only 1 of 14 children in the latter group became infected. The difference in HTLV-I infection rate for the children in the two groups was statistically significant (P less than 0.01 by chi-square). Furthermore, 2 of 4 elder siblings in the former group developed HTLV-I infection, whereas only one of 8 elder siblings in the latter group became infected. The overall rate of HTLV-I infection of breast-fed children born to HTLV-I-carrier mothers was 25% (8/32) by 3 years of age. Five of 6 mothers with HTLV-I-infected cells in the milk also possessed infected cells in their peripheral blood. Conversely 5 of 6 mothers without infected cells in the peripheral blood possessed no infected cells in their breast milk, suggesting that HTLV-I-infected cells in the peripheral blood can enter the breast milk. None of the 8 breast-fed children born to carrier mothers whose peripheral blood and breast milk-borne cells were negative, developed HTLV-I infection, suggesting that HTLV-I transmission from mother to child is dependent upon the number of HTLV-I-infected cells in carrier mothers.

Transmission of human T cell lymphotropic virus type I by blood transfusion before and after mass screening of sera from seropositive donors

The human T cell lymphotropic virus type I (HTLV-I) is transmitted by blood transfusions that contain cell components as one of the virus transmission modes. We carried out mass screening of sera from seropositive donors by a gelatin particle agglutination test to prevent the spread of HTLV-I by transfusion. Seroconversion rates were compared before and after screening. The results show a remarkable decrease in the rate of infection from 53.6 to 0.9%. Therefore, it is certain that screening by the agglutination method prevents the spread of HTLV-I transmission in blood transfusions.

Isochromosome 17q in a case of myelofibrosis with myeloid metaplasia terminating in blastic transformation

A case of myelofibrosis with myeloid metaplasia in a 61-year-old female patient is reported. Cytogenetic studies were performed using short-term culture without phytohemagglutinin. A chromosomal aberration of an isochromosome 17q, [i(17q)], was revealed in 88% of the metaphases of peripheral blood cells in the blastic phase. However, all metaphases of bone marrow cells in the chronic phase showed a normal karyotype. Furthermore, i(17q) was also observed in 10% of the metaphases of spleen cells examined 8 months before blastic transformation. In this case, therefore, the cells with i(17q) were associated with an abnormal clone of blastic transformation, with the abnormal clone originating in the spleen with myeloid metaplasia.