Plasma cell leukemia accompanied by polyclonal gammopathy and congenital tumor in the atrioventricular node

A 32-year-old man with plasma cell leukemia and congenital tumor of the atrioventricular node is described. Although M protein could not be detected by immunoelectrophoresis, the examination of bone marrow atypical plasma cells with immunofluorescent and immunoperoxidase showed that most of these plasma cells produced IgG or IgA. Also some plasma cells possessed concomitantly both IgG and IgA. An electrocardiogram revealed complete atrioventricular block. The patient died of aspergillosis and bleeding in the lung. Postmortem examination revealed the infiltration of atypical plasma cells in the bone marrow, spleen, liver and lungs, and infiltration of mesothelial tumor cells in the atrioventricular node.

Human bone marrow fibroblastic cells can inhibit clonogenic growth of K562 cells

The influence of human bone marrow fibroblastic cells (FC) on the proliferation of K562 leukemic colony-forming cells (LCF-C) was studied. FC derived from normal subjects and patients with acute leukemia were used. The growth of LCF-C was evaluated by colony-forming efficiency in soft agar. Inhibition of leukemic colony formation was produced by FC from normal subjects and patients with acute leukemia. While the degree of inhibition by FC from patients with acute lymphocytic leukemia was almost the same as that by those from the normal subjects, that by FC from patients with acute nonlymphocytic leukemia was lower than that by those from normal individuals. Both conditioned media obtained from FC and contact of their FC with LCF-C in dishes for four hr inhibited leukemic colony formation. These data show that leukemic stem cells are inhibited by bone marrow FC through cell-to-cell contact or humoral factors derived from FC.

Increased growth and collagen synthesis of bone marrow fibroblasts from patients with chronic myelocytic leukaemia

Growth and collagen synthesis were measured in human bone marrow fibroblasts derived from patients with chronic myelocytic leukaemia (CML) and normal individuals. The 3H-thymidine uptake, growth rate and collagen synthesis of fibroblasts from patients with CML were significantly greater than those from normal subjects. Thus, there is increased proliferation and collagen synthesis of fibroblasts in patients with CML. These findings show that CML fibroblasts may display a greater sensitivity to stimulator contained in the fetal calf serum used for the cultures, and they are relevant to the myelofibrosis by bone marrow fibroblasts in this disease.

T lymphocyte subsets of the infiltrating cells in the salivary gland and kidney of a patient with Sjögren's syndrome associated with interstitial nephritis

Lymphocyte subsets in the salivary gland and kidney were examined in a 38 years-old female patient with Sjögren's syndrome associated with interstitial nephritis by PAP immunoperoxidase method using monoclonal antibodies. Predominant cells of the infiltrating cells in both tissues were T lymphocytes and most of them were Ia+, OKT4+ cells (activated helper/inducer T lymphocytes). A small number of T lymphocytes were OKT8+ (suppressor/cytotoxic T lymphocytes). Moreover, we found the OKT8+ cells invading the salivary duct epithelial cells. There was no difference in the proportion of lymphocyte subsets of the infiltrating cells between the salivary gland and kidney. A similar pathologic mechanism of tissue damage, therefore, was suggested in both tissues.

Immunofluorescent staining of human leukemic cells with monoclonal antibody to phosphotyrosine

Peripheral blood cells and bone marrow cells from patients with various types of leukemia, but not those from healthy persons, were brightly immunofluorescent (IF) after staining with monoclonal antibody reactive to O-phosphotyrosine. All the IF-positive cells observed in peripheral blood were judged to be leukemic in morphology, and the IF-positive cells comprised 40-90% of total leukemic cells present in blood. Similar bright fluorescence was observed in the K562 human leukemic cell line. The results raise the possibility that leukemic cells can be distinguished from normal hematologic cells by their increased contents of phosphorylated tyrosine residues.

Circulating natural killer cells in Sjögren's syndrome

Reduced natural killer (NK) cell activity of peripheral blood lymphocytes (PBL) has been reported in a number of diseases including Sjögren's syndrome (SS). In this study, we used 2 monoclonal antibodies directed toward NK cells (anti-Leu-7 and anti-Leu-11) for determining NK cell activity in 29 patients with SS (9 with primary SS and 20 with secondary SS). The NK activity of PBL was simultaneously determined by the 51Cr release method using K562 as target cells. Contrary to previous reports, we did not find reduced NK activity of PBL in our patients compared with sex- and age-matched healthy controls. Although the percentage of Leu-7+ cells was significantly higher in the patients than in the controls (P less than 0.05), the absolute number of circulating Leu-7+ cells was not different between the groups. The percentage of Leu-11+ cells, however, was not significantly different between the patients and the controls, but the number of circulating Leu-11+ cells was significantly fewer in the patients than in the controls (P less than 0.05). Between the primary and secondary SS groups, no significant differences were found in NK cell activity or in the percentage of Leu-7+ or Leu-11+ cells. Furthermore, we found a significant correlation of NK activity with the percentage of Leu-11+ cells (P less than 0.05) in the controls as well as the SS patients, although a significant correlation was not identified between NK activity and the percentage of Leu-7+ cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant histiocytosis with marked cellular atypia--an autopsy case with an immunohistochemical study on neoplastic histiocytes

A 71-year-old male presenting high fever, pancytopenia, liver dysfunction and jaundice died without a confirmed diagnosis. Microscopically, histiocytes with marked atypia and erythrophagocytosis had infiltrated the spleen, enlarged lymph nodes, liver, and bone marrow. From the above features this case was diagnosed as malignant histiocytosis. The infiltrating histiocytes were classified into three categories: 1) phagocytic cells, 2) atypical, mostly non-phagocytic cells, and 3) bizarre cells including multinucleated giant cells. An immunohistochemical study of histiocyte markers demonstrated that lysozyme was positive in the atypical cells and some phagocytic cells, whereas alpha-l-antitrypsin tended to be localized in the phagocytic cells. Bizarre cells were negative for both markers. No S-100 protein was demonstrated in the neoplastic cells. These immunohistochemical features suggested monocyte-phagocytic origin of the tumor in this case.

Kinetics of indium-111-labeled leukemic cells in patients with acute nonlymphocytic leukemia

The distribution within the body of autologous leukemic cells labeled with indium-111 oxine was studied in seven patients with acute nonlymphocytic leukemia. The leukemic blood cells initially entered the spleen and liver, and the major site of localization was the former rather than the latter. The majority of the leukemic cells had not left the spleen and liver within 48 hr. Liver radioactivity fell transitorily up to the third hr after the initial rise. The clearance curve of radioactivity from the blood showed a plateau or the appearance of a "hump" from 1 to 5 hr after injection of labeled leukemic cells. These results might reflect recirculation of a portion of the leukemic cells between these organs and the bloodstream. In a patient with acute monoblastic leukemia. OKM1 monoclonal-antibody-treated monoblasts showed the lowest recovery into the blood and a greater increase of liver than splenic radioactivity at 30 min after injection. These results suggest the removal of damaged cells by the cytotoxic effects of antibody mediated by reticuloendothelial clearance mainly of the liver and others. In one patient with acute promyelocytic leukemia, leukemic cells accumulated in both kidneys, indicating the possible infiltration of these cells. Since indium-111 oxine stays firmly attached to the cells in spite of the possibility of radiation damaged in a long-term survey, it seems an ideal label for studying leukemic cell kinetics.

A study of correlation between histological, staging classification and prognosis of malignant lymphoma

In order to study the relationship between histological staging classification and prognosis, 62 cases of malignant lymphoma were analyzed retrospectively according to each histological type and staging classification during the last eight years (1976-1983). The findings obtained from this study were as follows: The incidence of malignant lymphoma in this department (Fourth Department of Internal Medicine, Tokai University) almost coincided with that reported before. Patients with Hodgkin's disease had almost the same results as that reported before even in the advanced stage. The prognosis of patients with non-Hodgkin's lymphoma was almost the same as that previously reported.

Prognostic factors in adult patients with acute leukemia

An analysis of prognostic factors was performed on a series of 50 adult patients with acute leukemia, treated in our department in the Tokai university Hospital between July, 1975 and June, 1980. The diagnosis was made in all cases on the basis of May-Grünwald-Giemsa-stained smears of peripheral blood and bone marrow. The patients were treated with two successive protocols. One course of induction chemotherapy consisted of 40 units/kg/day of neocarzinostatin, 1.2-1.6 mg/kg/day of cytosine arabinoside, 0.6-0.8 mg/kg/day of daunorubicin and 0.8-1.6 mg/kg/day of prednisolone on days 1-4 for acute nonlymphocytic leukemia, and the other consisted of 0.04 mg/kg/day of vincristine on day 1, 0.6-0.8 mg/kg/day of daunorubicin on days 1-4, 0.8-1.6 mg/kg/day of prednisolone on days 1-4 for acute lymphocytic leukemia. Consolidation and intensification therapies were given every 1-2 months after complete remission, and the protocols were basically the same as those of the induction therapy. Maintenance therapy consisted of 1.2-1.6 mg/kg/day of cytosine arabinoside, twice a week or 2 mg/kg/day of 6 MP orally. Risk factor leading to poor prognosis of acute leukemia were considered to be (1) advanced age (older than 50 years, P less than 0.05), (2) M5 (monocytic leukemia), (3) thrombocytopenia (less than 50,000 cmm-1), and (4) chromosome abnormalities of blast cells.

[The clinical effects of a new antiviral 9-(2-hydroxyethoxymethyl) guanine (aciclovir) against herpes virus infections]

The clinical effects of a new anti-viral 9-(2-hydroxymethoxymethyl) guanine (Aciclovir) against Herpes virus infections have been investigated. The patients had malignant tumours or auto-immune disease complicated by shingles and chicken pox due to Vaicella zoster virus (VZV) (43 cases), Herpes simplex virus (HSV) (10 cases) and 9 cases which were clinically diagnosed as Herpes, though the virus was not confirmed as the causative agent. As a general principle the dosage of Aciclovir was 5 mg/kg, t. i. d. for 5 days by slow intravenous infusion. The clinically effective rate against VZV was 93%, being excellent in 42% and against HSV it was 80%, being excellent in 40% and when the results of the cases of unknown origin were included it was excellent in 40% and the cumulative effective rate was 88%. Concerning the efficacy in reduction of pain, swelling, disappearance of vesicles and new scab formation, the effect was most noticeable after the third day of treatment. Treatment given early in the disease is likely to provide better results. Concerning side effects, one of 62 patients had proteinuria and the other had a drug rash and an abnormal liver function test. It is likely that the combination of treatment and the primary disease had some influence, but the cause/effect relationship to Aciclovir treatment is not clear.

Trial of long-term leukapheresis in the treatment of adult T-cell leukemia

It is well known that adult T-cell leukemia (ATL) is usually refractory to chemotherapy, acute or subacute in clinical course and is accompanied by lethal infections, suggesting a deficiency in cellular immunity. Chemotherapy makes the deficiency in cellular immunity worse, and this is followed by lethal infections. Therefore, a patient with ATL underwent leukapheresis on an IBM 2997 cell separator. A total of 22.3 x 10(11) leukemic T cells was removed. Removal of a large number of leukemic T cells was not associated with improvements in clinical symptoms except for skin eruption, but was not complicated by lethal infections. The peripheral leukocyte count after the 14th procedure began to increase over the prepheresis levels. In the course of frequent leukapheresis, leukemic meningitis occurred. Intrathecal injections of a small dose of antileukemic agents resulted in a rapid reduction of the leukemic T cell count and improvements in clinical symptoms. However, the patient died from cryptococcal sepsis. The survival time was 10 months from clinical onset, 9 months from diagnosis, 9 months from leukapheresis and 5 months from chemotherapy. From this experience, it appears that long-term repeated leukapheresis can decrease lethal infections and extend the survival time.

Differences of microviscosity and lipid composition in normal human T and B lymphocytes

Human T and B lymphocytes differ morphologically and immunologically although little is known concerning their physiological parameters and biochemical constituents. In this study, microviscosity and lipid composition in normal human B and T lymphocytes were investigated. Microviscosity was examined using 1,6-diphenyl-1,3,5-hexatriene as a probe and lipid composition was analyzed by thin-layer chromatography with flame ionization detection. Microviscosity of T lymphocytes was higher than that of B lymphocytes throughout the temperature ranges tested, and microviscosity of whole lymphocytes was similar to that of B lymphocytes rather than that of T lymphocytes. There was no significant difference in lipid composition between B and T lymphocytes. However, it was postulated that the concentration of lipid per area of plasma membrane in B lymphocytes might be less than that in T lymphocytes. It was concluded that B lymphocytes show a less rigid membrane fluidity than T lymphocytes because of the lower concentration of lipid per area of plasma membrane.

[TAC-278. A new 5-FU derivative, by the oral route for its efficacy and safety in 36 patients with advanced cancers]

Tumor regression was observed in only one patient. Twelve (33%) of the 36 patients reported adverse effects: gastrointestinal symptoms in 8, CNS symptoms in 3, and others in 1. The antitumor efficacy of TAC-278 was insufficient while incidence of adverse effects was similar to other 5-FU derivatives in man and the clinical usefulness of the drug was hardly found. TAC-278 has been developed with an aim to give higher plasma concentrations of 5-FU in man. Even at a dose causing adverse effects, however, the clinical efficacy of TAC-278 was unsatisfactory. The study is a meaning tal eince the results suggest that there might be a more important factor than blood concentration of 5-FU to enhance an antitumor effect of 5-FU derivatives.