What is the actual relationship between neutrophil extracellular traps and COVID-19 severity? A longitudinal study

BACKGROUND

Neutrophil extracellular traps (NETs) have repeatedly been related to COVID-19 severity and mortality. However, there is no consensus on their quantification, and there are scarce data on their evolution during the disease. We studied circulating NET markers in patients with COVID-19 throughout their hospitalization.

METHODS

We prospectively included 93 patients (201 blood samples), evaluating the disease severity in 3 evolutionary phases (viral, early, and late inflammation). Of these, 72 had 180 samples in various phases. We also evaluated 55 controls with similar age, sex and comorbidities. We measured 4 NET markers in serum: cfDNA, CitH3, and MPO-DNA and NE-DNA complexes; as well as neutrophil-related cytokines IL-8 and G-CSF.

RESULTS

The COVID-19 group had higher CitH3 (28.29 vs 20.29 pg/mL, p = 0.022), and cfDNA, MPO-DNA, and NE-DNA (7.87 vs 2.56 ng/mL; 0.80 vs 0.52 and 1.04 vs 0.72, respectively, p < 0.001 for all) than the controls throughout hospitalisation. cfDNA was the only NET marker clearly related to severity, and it remained higher in non-survivors during the 3 phases. Only cfDNA was an independent risk factor for mortality and need for intensive care. Neutrophil count, IL-8, and G-CSF were significantly related to severity. MPO-DNA and NE-DNA showed significant correlations (r: 0.483, p < 0.001), including all 3 phases and across all severity grades, and they only remained significantly higher on days 10-16 of evolution in those who died. Correlations among the other NET markers were lower than expected.

CONCLUSIONS

The circulating biomarkers of NETs were present in patients with COVID-19 throughout hospitalization. cfDNA was associated with severity and mortality, but the three other markers showed little or no association with these outcomes. Neutrophil activity and neutrophil count were also associated with severity. MPO-DNA and NE-DNA better reflected NET formation. cfDNA appeared to be more associated with overall tissue damage; previous widespread use of this marker could have overestimated the relationship between NETs and severity. Currently, there are limitations to accurate NET markers measurement that make it difficult to assess its true role in COVID-19 pathogenesis.

IL-6 and cfDNA monitoring throughout COVID-19 hospitalization are accurate markers of its outcomes

BACKGROUND

Severe COVID-19 entails a dysregulated immune response, most likely inflammation related to a lack of virus control. A better understanding of immune toxicity, immunosuppression balance, and COVID-19 assessments could help determine whether different clinical presentations are driven by specific types of immune responses. The progression of the immune response and tissular damage could predict outcomes and may help in the management of patients.

METHODS

We collected 201 serum samples from 93 hospitalised patients classified as moderately, severely, and critically ill. We differentiated the viral, early inflammatory, and late inflammatory phases and included 72 patients with 180 samples in separate stages for longitudinal study and 55 controls. We studied selected cytokines, P-selectin, and the tissue damage markers lactate dehydrogenase (LDH) and cell-free DNA (cfDNA).

RESULTS

TNF-α, IL-6, IL-8, and G-CSF were associated with severity and mortality, but only IL-6 increased since admission in the critical patients and non-survivors, correlating with damage markers. The lack of a significant decrease in IL-6 levels in the critical patients and non-survivors in the early inflammatory phase (a decreased presence in the other patients) suggests that these patients did not achieve viral control on days 10-16. For all patients, lactate dehydrogenase and cfDNA levels increased with severity, and cfDNA levels increased in the non-survivors from the first sample (p = 0.002) to the late inflammatory phase (p = 0.031). In the multivariate study, cfDNA was an independent risk factor for mortality and ICU admission.

CONCLUSIONS

The distinct progression of IL-6 levels in the course of the disease, especially on days 10-16, was a good marker of progression to critical status and mortality and could guide the start of IL-6 blockade. cfDNA was an accurate marker of severity and mortality from admission and throughout COVID-19 progression.

Fusarium verticillioides and maize interaction in vitro: relationship between oxylipin cross-talk and fumonisin synthesis

Fusarium verticillioides is one of the most important fungal pathogens causing ear and stalk rot in maize. Even if frequently asymptomatic, it can produce a harmful series of compounds named fumonisins. Plant and fungal oxylipins play a crucial role in determining the outcome of the interaction between the pathogen and its host. Moreover, oxylipins are factors able to modulate the secondary metabolism in fungi. To uncover the existence of the relationship between oxylipin production and fumonisin synthesis in F. verticillioides, we analysed some molecular and physiological parameters, such as the expression of genes whose products are related to oxylipin synthesis (i.e. lipoxygenase, diol synthases and fatty acid oxidase), the oxylipin profile of both cracked maize and the pathogen by using a lipidomic approach (i.e. combining LC-TOF and LC-MS/MS approaches with a robust statistical analysis) and the synthesis of fumonisin B1. The results suggested a close relationship between the modification of the pathogen oxylipin profile with the fumonisin synthesis. Notably, a modification of the oxylipin profile of the pathogen during its growth on cracked maize can be demonstrated. The switch in oxylipin synthesis could indicate that the ‘presence’ of maize determinants (e.g. plant cell wall fragments and/or lipids) was able to promote the modification of the pathogen lifestyle, also by adapting the secondary metabolism, notably fumonisin synthesis.

Evolution and predictive factors of relapse in ulcerative colitis patients treated with mesalazine after a first course of corticosteroids

INTRODUCTION

Mesalazine remains the first line treatment for the induction and the maintenance of remission in mild to moderate ulcerative colitis (UC). Its efficacy as a maintenance treatment after a first flare treated with corticosteroids has not been specifically studied. The aims of our work were to study a cohort of UC patients treated with mesalazine after a course of oral systemic corticosteroids and to identify predictive factors of relapse and of colectomy.

MATERIAL AND METHOD

We studied retrospectively a cohort of 143 UC patients, who never received immunosuppressive drugs, and treated for the first time with oral corticosteroids for a flare. Among patients responding to corticosteroids, we studied the group treated by mesalazine after the flare.

RESULTS

Fifty% (n=52) achieved a complete clinical remission with steroid weaning. In this group, 67% (n=35) received oral mesalazine. Seventy-five % of patients treated by mesalazine relapsed (median 29 months, range: 1-156). Fourteen % required a colectomy (median 11 months, range: 1-24). Kaplan Meier curve showed a relapse rate and a colectomy rate over one year of 26% and 11% respectively. In multivariate analysis, male gender and short duration of disease were predictive factors of the time-to-relapse. No factor was predictive of time-to-colectomy.

CONCLUSION

Maintenance efficacy of mesalazine over one year after a first course of corticosteroids for a disease flare is reasonably high. The longer-term relapse rate becomes higher in male patients with a short disease duration. An immunosuppressive treatment could be discussed in case of further relapse despite improved medication-adherence. Medication-adherence should first be assessed and promoted. An immunosuppressive treatment could be discussed in case of further relapse despite improved medication-adherence.

Preliminary evidence of clinical activity in a phase I study of CAL-101, a selective inhibitor of the p1108 isoform of phosphatidylinositol 3-kinase (P13K), in patients with select hematologic malignancies

3543

Background: The class I PI3Ks regulate a variety of cellular functions relevant to oncogenesis, including metabolism, proliferation and survival. The PI3K p110δ isoform is highly expressed in cells of hematopoietic origin and plays a key role in B cell maturation and function. CAL-101 is a potent inhibitor of PI3K p110δ (IC50=65 nM) with 40 to 300-fold selectivity compared to other PI3K isoforms. In vitro studies of 0.1 to 10 μM CAL-101 showed inhibition of pAKT expression and/or apoptotic effects against primary chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) cells and against a range of leukemia and lymphoma cell lines. Methods: In an ongoing phase 1 dose escalation study in sequential cohorts of 3 patients with relapsed/refractory CLL or select B-cell non-Hodgkin's lymphoma, CAL-101 is administered orally twice daily for 28 days per cycle. Clinical response is evaluated according to NCI criteria at the end of Cycles 1 and 2 and every 2 cycles thereafter. Results: To date, 6 patients have been treated in the first 2 cohorts at dose levels of 50 mg and 100 mg and the 200 mg cohort is currently enrolling. No treatment-related adverse events greater than grade 1 have been seen, with 2 patients treated for >5 cycles. Mean trough drug levels in the 50 and 100 mg cohorts were 0.3 and 1 μM, respectively, which are in the range required to inhibit PI3K p110δ in vitro. Two of 6 patients attained partial response and 4 have stable disease. Partial responses were observed after 2 cycles of 50 mg in a patient with mantle cell lymphoma with 6 prior therapies, and after 1 cycle of 100 mg in a patient with follicular lymphoma with 6 prior therapies, including autologous stem cell transplant. Disease specific cohort expansion will occur at the maximally tolerated dose, and patients with AML will be added. Updated data will be presented at the meeting. Conclusions: Early results from a phase 1 study of the oral PI3K p110δ inhibitor CAL-101 show that it is well tolerated and has preliminary clinical activity in patients with B-cell malignancies.

[Table: see text]

Surrogate biomarkers in evaluating response to anti-angiogenic agents: focus on sunitinib

Conventional methods to assess the clinical activity of new agents that target specific biological pathways involved in tumour pathology may not provide correlation with clinically relevant outcomes such as patient survival or progression-free disease, and new and alternative methods should be explored. Biomarkers can assist in evaluation, and once validated, serve as a surrogate for clinical activity. Angiogenesis, a process well known to be involved in tumour growth and metastasis, is the target of several agents available today in the treatment of cancer. Laboratory assays used to detect proteins involved in angiogenesis and emerging imaging approaches have provided the bulk of the biomarker data to date in this area, and have already corroborated aspects of the biochemical basis of anti-angiogenic strategy. This symposium article will provide a brief overview of biomarker data in several different tumour types and discuss the effect that sunitinib and other anti-angiogenic agents have on these biomarkers. Surrogate biomarkers discussed include soluble proteins found in the blood or urine, circulating endothelial cells and their progenitors, and non-invasive imaging techniques.

Staphylococcus lugdunensis endometritis: a case report

BACKGROUND

Staphylococcus lugdunensis has been reported to cause several localized and blood stream infections, but not endometritis.

OBJECTIVE

To desribe a case of Staphylococcus lugdunensis endometritis associated with premature rupture of membranes. CASE REPORT.A 39-year old woman presented with premature rupture of membrane (PROM) and underwent an emergency caesarean section at 40 weeks of gestation. Her endometritis was characterized by a foul odour and was so extensive that the baby was adherent to the endometrium and had to be separated by a gentle pull. In spite of these, neither the mother nor her baby suffered any adverse effect. The organism exhibited several unusual characteristics that are atypical ofstaphylococci. The baby did not develop any sepsis. The mother responded well to antibiotics and both were discharged home on the 4th postoperative day.

CONCLUSION

To the best of our knowledge, this is the first report of this organism causing endometritis.

Analysis of circulating biomarkers of sunitinib malate in patients with unresectable neuroendocrine tumors (NET): VEGF, IL-8, and soluble VEGF receptors 2 and 3

4045

Background: Sunitinib malate (SU11248) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenic activity that specifically inhibits VEGFR, PDGFR, KIT, RET, and FLT3. In a phase II trial of 109 patients with metastatic neuroendocrine tumors (NET), sunitinib treatment was associated with ORR and high rates of SD in patients with carcinoid and pancreatic islet cell tumors (Kulke et al, ASCO 2005). To characterize potential biomarkers of biological response to sunitinib, we analyzed plasma levels of a panel of soluble proteins from patients in this trial. Methods: Patients received sunitinib in 6-week cycles comprised of 50 mg/day for 4 weeks followed by 2 weeks off treatment. Pre-dose plasma samples from 106 patients were obtained on days 1 and 28 of multiple cycles. Plasma levels of VEGF, soluble VEGF receptor 2 (sVEGFR-2), interleukin-8 (IL-8), and a novel biomarker, sVEGFR-3, were measured via ELISA analysis. Results: Plasma levels of each protein were frequently modulated during the course of treatment. At the end of cycle 1, VEGF levels were increased more than 3-fold over baseline in ∼50% of all patients. Average baseline VEGF levels were higher in the islet cell group (62 vs. 40 pg/ml, P = 0.06). In cycle 1, sVEGFR-2 and sVEGFR-3 levels were significantly decreased by ≥30% in ∼60% and 70% of all patients, respectively (P < 0.0001). Levels tended to return to near-baseline after 2 weeks off treatment. The reduction in sVEGFR-3 levels in cycle 1 was, on average, greater in the subset of patients with PR (n=11) compared to others (45% vs. 38%). Overall, there was a 2.2-fold average increase in IL-8 levels by the end of cycle 1, and a larger proportional increase in IL-8 levels in patients exhibiting decreases in tumor size, patients who also tended to have lower baseline IL-8 levels. Further analysis of correlations with pharmacokinetic and clinical parameters is ongoing. Conclusions: Our results suggest that this panel of circulating proteins may be of utility as pharmacodynamic biomarkers of sunitinib activity in patients with advanced NET. sVEGFR-3 may be a novel biomarker of the biological activity of sunitinib in NET, and IL-8 may be of particular interest as a potential predictor of response.

[Table: see text]

Crystallographic rearrangement of platinum induced by square wave potentials

This paper provides experimental evidences of crystalline rearrangements on platinum surfaces by applying square wave potential perturbations. The phenomenon was followed by differential ex situ X-ray diffraction patterns and in situ cyclic voltammetry in sulfuric acid solutions. Various upper and lower potential limits were employed covering anion, hydrogen, and/or oxygen adsorption ranges. When the -0.05 to 1.50 V (vs. reversible hydrogen) potential region is covered an increase in the distribution of (200) planes is observed. However, when the 0.65 to 1.50 V region is used, (220), (311), and (420) planes developed. The development of a longitudinal propagation mode is responsible for this rearrangement. The new equilibrium position of the platinum surface atoms in the lattice was calculated from the minimization of the potential energy expression.

Are patients with hyperlipidemia being treated? Investigation of cholesterol treatment practices in an HMO primary care setting

BACKGROUND

The main study objective was to investigate cholesterol treatment practices of primary care physicians in a managed care setting.

METHODS

The study was a retrospective review of data with a quasiexperimental design. The National Cholesterol Education Program-Adult Treatment Panel II (NCEP-ATP II) guidelines were used as the reference for conducting a measurement model in the study. Data were randomly selected via a systematic probability sampling method from a health maintenance organization (HMO) capitated risk-based contracting medical clinic in southern Florida.

RESULTS

Of the 348 patients selected for the study, 224 (65%) needed either dietary therapy (n = 106) or drug therapy (n = 118). However, only 16 patients (13.6%) had ever had cholesterol-lowering drug regimens prescribed during the 5-year study period.

CONCLUSIONS

Our findings indicate that (1) primary care physicians have poorly adopted the cholesterol management practice recommended by NCEP guidelines and need to improve their recognition and treatment of hypercholesterolemia; and (2) the problem of underutilizing prescription medications may be associated with risk-sharing capitation arrangements between physicians and third-party insurers.

The re-emergence of American visceral leishmaniasis in an old focus in Venezuela: present situation of human and canine infections

The report of a new autochthonous case of human American Visceral Leishmaniasis (AVL) in 1992 in the village of Guayabita, Aragua State, Venezuela (10 degrees 16'N, 67 degrees 28'W; 500 m asl), led us to undertake an epidemiological study in this locality. A demographic survey was conducted using a structured questionnaire in which data was collected regarding sex, age, occupation, length of residence in the area and migratory history. A leishmanin skin test (LST) was applied and samples of venous blood for counter immunoelectrophoresis (CIEP) and immunofluorescent antibodies (IFAT) tests were drawn. The prevalence of positive LST was 11.4%. The positivity was highest among males and increased with age. Young males seemed to be more exposed to infection than females. Since occupation per se did not seem to account for this association, it may be explained as a gender-associated behavior, leading to different degrees of exposure to sand flies. The canine population was also screened for leishmanial infection. One dog was shown to be parasitologically infected with Leishmania sp. Four out of 71 dogs (5.6%) were positive for FG, CIEP, IFAT and Western Blot and 11 (15.5%) were positive for CIEP. These results suggest that after almost 30 years of epidemiological silence, American visceral leishmaniasis has re-emerged in this focus.

IL-2 infusion abrogates humoral immune responses in humans

Although IL-2 infusion enhances cell-mediated cytotoxicity in patients with neoplastic disease, administration is paradoxically associated with a modest fall in total serum IgG and an increased risk of infection. We now show that the adverse effects of IL-2 infusion on the humoral immune system are substantial. Although IL-2 induces the B cell growth and differentiating factors IL-4 and IL-6, infusion abrogates primary antibody responses entirely and reduces secondary antibody responses 50-fold following antigen challenge. There is no evidence of the generation of cells with suppressive activity on B cells but IL-2 increases the ratio of circulating virgin:memory cells. These results may help to explain the increased rate of bacterial infection in patients receiving IL-2. As IL-2 plays a central role in the generation of an immune response, the finding that it is also sufficiently immunosuppressive to inhibit primary- and secondary-type antibody responses suggests that exploration of the underlying mechanisms may provide insights into immune system homeostasis and may offer new approaches to therapeutic immunosuppression.

Cytomegalovirus infection in Gambian mothers and their babies

A 15 month longitudinal study of cytomegalovirus (CMV) infection in 178 Gambian mothers and their babies was undertaken. Twenty five (14%) of the babies were congenitally infected despite the fact that 87% of their mothers were antibody positive to the virus. Two of the 25 congenitally infected infants had evidence of severe neurological damage; skin sepsis was also a prominent feature in congenitally infected infants. The other children soon became infected. At 6 months of age, 53% of the infants were shedding virus either in urine or saliva. By the age of 12 months 86% of the infants had serological evidence of CMV infection. Preliminary evidence suggests that sibling to sibling infection in crowded compounds might be a major route of transmission.

Alternate-day prednisone treatment and treatment maintenance in Crohn's disease

We have reviewed our data from 55 patients with Crohn's disease (CD) treated with alternate-day prednisone (average dose: 25 mg every other morning) between 1966 and 1989 for a mean duration of 6.6 yr. Daily divided corticosteroid doses were given to all patients with active disease that had not been responsive to supportive measures and, in almost all cases, not responsive to sulfasalazine alone. After initial remission was achieved, patients were switched to alternate-day doses. Treatment evaluations utilized global assessment and the CD activity index of Harvey and Bradshaw (CDAI-HB) shown to correlate closely with the National Cooperative Crohn's Disease Study (NCCDS) activity index (CDAI). CDAI-HB scores of 0-1 indicated no or minimal activity, whereas scores of 2-15 indicated progressive activity. With the CDAI-HB and global assessments, in agreement in all cases, 33 patients (60%) showed favorable responses with 95% confidence intervals (CI) of 46.8 to 73.2. Comparing the results with a literature-based 20% spontaneous long-term remission rate, the data are significant at p less than 0.01. Serious complications were gratifyingly low, with no observed instances of osteonecrosis. It is concluded that alternate-day prednisone treatment and treatment maintenance, with or without concomitant sulfasalazine, after conventional induction of remission with daily steroid doses, is a reasonable treatment option for patients with CD not responsive to sulfasalazine alone.

Acquired von Willebrand disease in multiple myeloma secondary to absorption of von Willebrand factor by plasma cells

A case of acquired von Willebrand disease (AvWD) associated with an IgA lambda multiple myeloma is reported. No form of inhibitor could be detected. SDS-agarose gel electrophoresis patterns of von Willebrand factor (vWF) both in plasma and platelet lysates were normal but a decrease in all-sized multimers with a type IA pattern was seen. After 1-deamino-8-D arginine vasopressin (DDAVP) infusion, vWF multimers larger than those seen in the resting state appeared in patient plasma, which were progressively cleared. Indirect immunofluorescence studies with a monoclonal antibody to vWF showed that vWF was selectively absorbed into myelomatous cells. This is the first case of AvWD associated with multiple myeloma resulting from the selective absorption of vWF into abnormal plasma cells. This feature established a new pathophysiological mechanism of AvWD in multiple myeloma and probably in other lymphoproliferative diseases.

Acute reversal of flunitrazepam effects by Ro 15-1788 and Ro 15-3505: inverse agonism, tolerance, and rebound

A phase 1 double blind crossover comparison of a new benzodiazepine antagonist (Ro 15-3505) with Ro 15-1788 and placebo, in the reversal of sedative and psychophysiological effects of single IV doses of flunitrazepam (2 mg), was carried out in 12 normal volunteers. The antagonists were equally effective, leading to full reversal of all effects with a potency ratio of approximately 2.5 mg Ro 15-1788 for 1 mg Ro 15-3505. Inverse agonism, in the form of unpleasant feelings and symptoms, was reported by all subjects following Ro 15-3505 but none after Ro 15-1788. Adaptational phenomena such as acute tolerance and rebound of sedative effects of flunitrazepam were also detected and their potential implications are discussed.

[Prevention of acute graft versus host disease using 3 prophylactic schemes]

During 7 years 81 patients received an allogeneic bone marrow transplant (BMT) for several diseases. The prevention of graft-versus-host disease (GVHD) was undertaken with methotrexate (MTX), MTX plus antilymphocytic gammaglobulin plus prednisone (MTX + ALT + P), and elimination of the T-lymphocytes of the donor's bone marrow with the monoclonal antibody CAMPATH-1. The actuarial survival of the patients who did not develop GVHD was significantly better than that of those who developed grade II-IV GVHD: 56% [95% confidence interval (CI) 39-71%] versus 10% (95% CI 3-25%) (p less than 0.0001). However, actuarial survival was similar in each of the three groups: MTX 35%, MTX + ALT + P 38%, and CAMPATH-1 43%. The incidence of GVH disease, when the sex of the donor and the receptor were different, was significantly higher than in cases where the donor and the receptor had the same sex: 45% (95% CI 31-58%) vs 15% (95% CI 8-28%) (p less than 0.005). By contrast, significant differences were not found between the three groups in the incidence of GVHD: MTX 36%, MTX + ALT + P 34%, and CAMPATH-1 20%. In patients with leukemia, a higher number of relapses occurred in the MTX group, because a higher number of patients in second or third complete remission (CR) or with active disease underwent transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapy of advanced myelodysplastic syndrome with aggressive chemotherapy

Nine patients with advanced stages of myelodysplastic syndrome (MDS) received aggressive chemotherapy with high-dose cytarabine or with a standard acute myeloid leukemic regimen. Six of them were in frank acute myeloid leukemic phase. The mean age was 57 years (range 32-71). Seven patients obtained remission, 6 complete remission (CR) and 1 partial remission. The induction remission rate was 77.7%. There were 2 deaths in the aplasia period because of infectious complications. The mean duration aplasia was 36 days (range 21-69). In spite of this all responders received further consolidation chemotherapy. The mean duration of CR was 10 months. We concluded that patients with MDS with excess of blasts and blastic transformation may be treated with aggressive chemotherapy with low toxicity and high remission rate, similarly to de novo acute myeloid leukemia.

Allogeneic bone marrow transplantation versus intensification chemotherapy for acute myelogenous leukaemia in first remission: a prospective controlled trial

In 1982 we began a prospective controlled trial to assess the effectiveness of allogeneic bone marrow transplantation and intensive post-remission chemotherapy for patients with acute myelogenous leukaemia in first complete remission. Fourteen patients, 3-45 years of age, who had an HLA-identical sibling donor, received bone marrow transplantation. Twenty-five patients who either lacked an HLA-identical sibling or were over 45 years of age received intensive consolidation chemotherapy including high-dose cytosine arabinoside with or without adriamycin. The actuarial rate of continued complete remission (CCR) at 3 years was significantly higher in the transplantation group than in the chemotherapy group: 70% (95% confidence interval 35-91%) compared with 10% (95% confidence interval 2-30%); P = 0.01. However, the actuarial rate of CCR was not significantly different between the transplantation group and patients under 45 years in the chemotherapy group: 70% (95% confidence interval 35-91%) compared with 17% (95% confidence interval 4-45%), 0.1 greater than P greater than 0.05. The actuarial probability of leukaemia relapse was significantly lower in the transplantation group than in the chemotherapy group: 10% (95% confidence interval 4-21%) compared with 88% (95% confidence interval 70-96%), 0.005 greater than P greater than 0.001. There was no significant difference between both groups if we compare only the patients who died of non-leukaemic causes: 22% (95% confidence interval 9-42%) versus 25% (95% confidence interval 7-59%), P = NS. In summary, this study shows that allogeneic bone marrow transplantation is a better anti-leukaemic treatment than is intensive consolidation chemotherapy in patients with AML in first complete remission.

Treatment of myelodysplastic syndrome with 1.25-dihydroxy-vitamin D3

1.25-dihydroxy-vitamin D3 (1.25 (OH)2D3) was tested in seven patients with myelodysplastic syndrome. The study was undertaken because 1.25 (OH)2D3 promotes differentiating myeloid cells in vitro and because of a prior report of potential benefit in a clinical study. The drug was given orally at a dose of 2.5 micrograms/day for a minimum of 8 weeks (range 8-28). After therapy, there were no significant changes in any of the parameters observed in peripheral blood or bone marrow. We did not observe any feature of granulocytic-monocytic differentiation. Treatment was well tolerated. One patient died because of bone marrow failure. Survivors have persisting myelodysplastic syndrome and continue to be transfusion dependent. 1.25 (OH)2D3 has no beneficial effect in patients with myelodysplastic syndrome with this dose regimen.

Hairy-cell leukaemia associated with auto-immune disorders in the form of a 'lupus-type' anticoagulant and a positive direct Coombs' test

An account is given of a case of hairy-cell leukaemia associated with a 'lupus-type' anticoagulant and a positive direct Coombs' test, both of which were clinically symptom free. This is yet another example of the coexistence of hairy-cell leukaemia and an auto-immune disorder, but the disorder in question has not been described previously.