A noninvasive technique for monitoring response to chemotherapy in human acute leukemia

Evaluation of leukocyte arylsulfatase-A activity in patients with breast cancer and benign breast disease

This study was planned to evaluate the feasibility of using the assay of leukocyte arylsulfatase-A (AS-A) activity as a non-invasive diagnostic tool in patients with benign and malignant breast disease. The leukocyte AS-A activity of a total of 81 women was analyzed, including 28 healthy women, 29 women with benign breast disease (BBD) and 24 patients with primary breast cancer (BC). The mean leukocyte AS-A activity in patients with BBD was slightly higher (14.3%) that observed in the healthy subjects, but the difference was not statistically significant. In patients with BC the enzyme activity was significantly higher than in the healthy subjects (60.3%, P<0.05) and in the benign group (40.2%, P<0.05). In addition, since no significant differences have been observed between premenopausal patients and their controls, it is suggested that the measurement of leukocyte AS-A activity may not be a reliable test for differential diagnosis of benign and malignant proliferation in mammary glands due to the possible interfering effect of gonadal hormones on AS-A activity. In contrast, since peri- and postmenopausal BC patients have negligible or no gonadal activity function, the elevation in the activity of leukocyte AS-A in these age groups of patients may only be expected to originate from malignant proliferation. Based on our results, it is concluded that in patients in whom high leukocyte AS-A activities were observed the possibility of the presence of malignancy might also be high. Therefore, this test might be valuable as a non-invasive biochemical technique in combination with other established markers for the identification of masses in the breast.

Lack of prognostic value of T-, B- and null-lymphocytes in adult acute leukemia

The distribution of T-, B- and null-lymphocytes was studied in the peripheral blood of 38 adult patients with acute nonlymphocytic leukemia (ANLL) and 15 with acute lymphocytic leukemia (ALL) at first diagnosis, during induction treatment, and in remission. Thirteen ANLL and 9 ALL patients were followed until relapse and during reinduction therapy. T- and B-cells were detected by specific membrane marker. The pre- and posttreatment pattern of lymphocyte subpopulations was analyzed to determine their prognostic significance for remission incidence, remission duration, and survival. It was observed that in both types of leukemia, T-cells are more affected by the leukemic process and cytostatic drugs than B-cells. Nonresponding patients possibly have a reduced potential for recruiting precursor T- and B-cells. At first diagnosis, no significant correlation was found between pre- or posttreatment variables and prognosis. At relapse, ANLL patients had a longer second remission when a high proportion of B-cells was found; ALL patients with a high lymphocyte count before and after treatment, experienced longer survival.

Kinetics of colony-forming cells (CFU-c) in adult acute leukemia and their prognostic relevance

The in vitro growth pattern of bone marrow and peripheral blood in soft-agar cultures was studied in 50 previously untreated patients with adult acute leukemia. Patients were followed from time of first diagnosis, during induction treatment, in remission at various time intervals, at relapse and during subsequent re-induction therapy. The distribution of granulopoietic progenitor cells was analysed to determine their prognostic significance for remission incidence, remission duration and survival. All patients revealed an abnormal growth. ANLL patients showing a decreased clone number in the marrow but an increased number of clones in the peripheral blood, had a significant higher probability to enter remission and a significant longer remission than those having clones within normal range at first presentation. On the contrary, ALL patients responding to induction treatment, had a better colony and cluster growth in the bone marrow than those failing to respond. No significant correlation was found between in vitro growth and survival. It is concluded that colony-forming cells of both bone marrow and peripheral blood seems to be of some value in predicting the response rate and length of remission in ANLL and ALL, and in possibly selecting patients with a high chance to respond to current cytostatic regimens.

Urinary 6-hydroxymethylpterin levels accurately monitor response to chemotherapy in acute myeloblastic leukemia

In our earlier study it was shown that patients with various types of cancer excrete three- to 20-fold higher levels of urinary 6-hydroxymethylpterin as compared to patients with nonmalignant diseases or normal volunteers. In the present study urinary 6-hydroxymethylpterin levels have been measured as an index of disease status in acute myeloblastic leukemic patients on antileukemic drugs. The daily excretory pterin levels and the values of respective blast counts have been graphically presented for four cases with the chemotherapeutic regimens. Remission of the disease was marked by a rapid drop in the urinary 6-hydroxymethylpterin levels and correlated very well with the percentage of blasts. In another study the percentage of blasts and the urinary 6-hydroxymethylpterin were determined simultaneously in four patients undergoing chemotherapy. The data conclusively show that the simple noninvasive determination of urinary 6-hydroxymethylpterin levels accurately and rapidly reflects the status of the disease under treatment and could conveniently be employed as a suitable index for monitoring the effect of chemotherapy as well as the condition of the residual extramedullary leukemic infiltration.

Aryl sulfatase A in acute nonlymphocytic leukemia

To ascertain whether estimation of urinary aryl sulfatase A (ASA) is a reliable noninvasive technique for monitoring disease activity in adult acute nonlymphocytic leukemia, we studied the excretion pattern of this enzyme during active disease, partial remission, and complete remission in ten patients and compared the results with those of ten healthy volunteers. There was no significant difference in enzyme excretion between complete remission cases and the control group. Patients with partial remission and active disease had significantly different urinary enzyme levels from each other and from the control and complete remission groups. Estimation of urinary ASA is a useful noninvasive method of monitoring disease activity in adult acute nonlymphocytic leukemia.