Prognostic factors for survival of 194 patients with low infiltrate leukemia

Evaluation of Aspergillus IgG, IgM antibody for diagnosing in chronic pulmonary aspergillosis: A prospective study from a single center in China

Chronic pulmonary aspergillosis (CPA) is a slowly progressing pulmonary fungal infectious disease caused by Aspergillus. Aspergillus IgG, IgM are now considered to be valuable biomarkers in CPA diagnosing.Our research attempts to evaluate the effectiveness of Aspergillus IgG, IgM in diagnosing CPA.In our study, CPA patients were younger than the patients who suffered other pulmonary disease. The most common underlying disease in CPA patients was pulmonary tuberculosis. And the most common clinical symptom was hemoptysis. The comparison among the groups indicated statistical significance with regard to Aspergillus IgG and IgM between the CPA and other pulmonary disease groups (P < .01). The Aspergillus-specific IgG and IgM in infectious group exhibited higher levels than those in colonization group (P < .01). The area under the receiver operating characteristic curve of Aspergillus IgG was 0.762 (95% confidence interval: 0.664-0.860) (P < .01).Aspergillus-specific IgG offers great diagnostic value with regard to CPA.

High-dose chemotherapy in high-risk myelodysplastic syndrome: covariate-adjusted comparison of five regimens

BACKGROUND

Antileukemic chemotherapy has been used for two decades to treat high-risk myelodysplastic syndrome (refractory anemia with excess of blasts [RAEB] and RAEB in transformation into acute leukemia [RAEB-t]) patients. Because the results of standard regimens have been disappointing, high-dose chemotherapeutic regimens were investigated recently. In the absence of randomized trials, the relative merits of various treatment regimens are unknown.

METHODS

The authors analyzed the outcome for 394 newly diagnosed patients treated between 1991 and 1999 with five regimens consisting of intermediate- or high-dose cytosine arabinoside (A) in combination with idarubicin (I), and introduced cyclophosphamide (C) and the new agents fludarabine (F) and topotecan (T) into new combinations with A. In addition to defining the role of high-intensity chemotherapy in the overall outcome for patients with RAEB-t and RAEB, the authors determined the relative merits of the five regimens (IA, FA, FAI, TA, and CAT), accounting for the nonrandom distribution of the prognostic covariates.

RESULTS

The overall complete response (CR) rate of 58% was significantly associated with karyotype, performance status (PS), treatment in the laminar air flow room, duration of antecedent hematologic disorder and age, but not French-American-British or International Prognostic Scoring System risk categories. Multivariate analysis did not identify statistically significant differences in CR rates obtained with each regimen. Induction death rates increased with age with all but the TA regimen; they were lowest with TA (5.4%) and highest with FAI (20.7%), and these differences were significant in patients older than 65 years. The trend for time to death was the same as for time to recurrence in all groups. Multivariate analysis of time to death identified treatment regimen (FA, FAI, and CAT), cytogenetic status (-5/-7), increasing age, and PS greater than 2 as significant independent unfavorable prognostic factors. After prognostic variables were accounted for, survival with IA treatment remained superior to that of FA and FAI but comparable to TA, and CR duration was only marginally shorter with FA. Landmark analysis showed the overall survival of responders to be superior to that of nonresponders, the difference remaining significant after adjustment for prognostic covariates.

CONCLUSIONS

Although the newer regimens did not improve outcome, TA and CAT produced results comparable to those of IA and may be considered treatment alternatives. The TA regimen was particularly effective in RAEB patients and could be delivered safely, with low induction mortality. Our results indicated that although CR seemed associated with survival advantage, innovative post-remission managements represent a challenge because improvement in outcome is not likely to come from intensified therapy.

Quantitative, phenotypic, and functional evaluation of basophils in myelodysplastic syndromes

BACKGROUND

The myelodysplastic syndromes (MDS) are a group of clonal haematological disorders characterized by cytopenia(s), reduced differentiation-capacity of myeloid cells, and impaired leukocyte function. However, little is known so far about basophil granulocytes in MDS.

DESIGN

We have compared the numbers, phenotype and function of basophils in MDS patients with those in healthy subjects. A total numer of 23 patients with MDS (refractory anaemia, n = 8; refractory anaemia with ringsideroblasts, n = 7; refractory anaemia with excess of blasts/refractory anaemia with excess of blasts in transformation, n = 8) and 20 healthy donors were included.

RESULTS

The numbers of blood basophils in MDS patients (34.6 +/- 62.9 microL-1) was lower compared to healthy controls (58.6 +/- 64.9 microL-1). Correspondingly, whole blood histamine levels were lower in MDS patients (MDS 34.1 +/- 29.1 ng mL-1 vs. normal donors 72.0 +/- 36.9 ng mL-1). Like "normal" basophils, basophils in MDS expressed interleukin-3 receptor alpha (CD123), E-NPP3 (CD203c), CR1 (CD35), CR3 (CD11b), CR4 (CD11c), membrane co-factor protein (CD46), decay-accelerating factor (CD55) and membrane attack complex inhibitory factor (CD59), as well as receptors for C3a, C5a (CD88), and IgE. Recombinant human (rh) C5a and anti-IgE induced significant release of histamine from basophils in both groups of donors without significant differences between MDS and healthy controls.

CONCLUSIONS

The absolute numbers of basophils in MDS patients are lower than in normal donors. However, basophils in MDS do not differ from their "normal counterparts" in terms of complement receptor expression, IgE-receptor expression, or functional responses to respective ligands.

Prognostic value of lactate dehydrogenase activity in myelodysplastic syndromes

Several prognostic factors for patients with myelodysplastic syndromes (MDS) have been defined in the past. One of these factors appears to be the serum lactate dehydrogenase (LDH) activity. However, the precise predictive value of an elevated LDH level with regard to AML transformation remains uncertain. In this study, the prognostic value of the LDH activity was examined in a cohort of 180 patients with de novo MDS (median age 71 years [27-93]; f/m-ratio 1:1.2; RA: n=53; RARS: n=37; RAEB: n=50; RAEBT: n=19; CMML: n=21). Significant differences in LDH activities were found among FAB groups (P<0.05), and especially among IPSS groups (HIGH: 411+/-574; INT-2: 221+/-90; INT-1: 254+/-145; LOW: 192+/-47 U/l; P<0.05). An LDH level of >/=300 U/l was found to be associated with a significantly shorter median survival (10.3 months) when compared to <300 U/l (33.7 months; P<0.01). Moreover, an LDH activity of >/=300 U/l indicated a reduced AML-free survival in our MDS patients (P<0.01). As assessed by Cox regression, the inclusion of LDH as additional variable into the IPSS system resulted in an improved prediction concerning survival, but not with regard to AML evolution. Together, our data show that a serum LDH activity of >/=300 U/l in MDS is associated with a significantly shorter survival and higher risk to transform to AML. The LDH activity should be considered as an important prognostic factor in MDS.

The contribution of Auer rods to the classification and prognosis of myelodysplastic syndromes

Auer rods were first recognized at the beginning of this century. Their presence soon became considered to be an unequivocal manifestation of a leukemic process. Possibly influenced by this long-held assumption, in 1982 the French-American-British co-operative group (FAB) incorporated the presence of Auer rods into a classification system of the myelodysplastic syndromes that remains in widespread clinical usage today. Although unsubstantiated at the time, the presence of Auer rods was suggested to indicate a rapidly progressive disorder and a poor prognosis. In the absence of studies confirming the utility of Auer rods as a diagnostic criterion, the FAB classification system of myelodysplastic syndromes has been widely used to allocate therapy. In this review we examine the early descriptions of Auer rods and critically evaluate the studies examining the value their presence has in the classification and prognosis of patients with myelodysplastic syndromes.

The prognostic significance of auer rods in myelodysplasia

The category of refractory anaemia with excess blasts in transformation (RAEBt) of the French-American-British (FAB) classification system comprises a heterogeneous group of patients: those with any combination of 5% or more blood blast cells, more than 20% but no more than 30% marrow blast cells, or the presence of auer rods and 30% or less marrow blast cells. To determine the prognostic significance of auer rods in RAEBt, we classified the 208 patients with RAEBt seen between 1973 and 1992 as (1) those having RAEBt solely on the basis of auer rods (RAEBta, n = 29), (2) those meeting blood or marrow blast criteria for RAEBt and also having auer rods (RAEBtpos, n = 40) or (3) those meeting blood or marrow blast criteria for RAEBt without having auer rods (RAEBtneg, n = 139). The RAEBta group had a higher survival probability than either of the other two groups. Within RAEBta, those patients who, without auer rods, would be considered RAEB by the FAB system (n = 19) had a higher probability of survival than patients with RAEB as conventionally defined. Furthermore, patients with RAEBtpos were more likely to live longer than those with RAEBtneg. The RAEBta, RAEBtpos and RAEBtneg groups were similar with regard to the usual haematologic parameters. However, patients with auer rods were more likely to have a normal karyotype and less likely to have prognostically unfavourable cytogenetic abnormalities. When analysis was performed within cytogenetic groups, the favourable prognostic impact of auer rods was still evident. Similarly, the favourable prognostic significance of auer rods was discernible both among patients who did not receive intensive therapy and those who received induction chemotherapy. The complete remission rate in auer rod positive patients was 77%, compared to 27% in those without auer rods. There were no differences in remission duration. Our results suggest that: (1) patients with auer rods without blood or bone marrow blast criteria for RAEBt should not be grouped with those patients with such criteria, and (2) patients with auer rods and other criteria for RAEBt have a higher complete remission rate following induction therapy of the type frequently reserved for patients with acute myeloid leukaemia.

Exposure histories in acute nonlymphocytic leukemia patients with a prior preleukemic condition

A subset of patients with acute nonlymphocytic leukemia (ANLL) have evidence of a myelodysplastic syndrome (MDS), low infiltrate leukemia, or other preleukemic condition that may be present for several months before onset of disease. The hypothesis that these conditions act as markers for environmentally induced cancer was examined in 270 ANLL patients, 46 with a preleukemic phase and 224 with an acute onset. Although the effects of previously identified risk factors (male sex, age older than 50 years, prior cytotoxic therapy) were demonstrated, no associations with common environmental conditions (cigarette smoking, alcohol use, occupations with exposure to chemicals or radiation) were present with the exception of hobbies involving potential chemical exposure, odds ratio (OR) and 95% confidence intervals = 4.2 (1.4 to 12.3) and self-reported exposure to pesticides, OR = 10.2 (1.8 to 63.1). These may be chance associations although a previous case-control study of MDS reported similar findings.