[Acute myeloid leukemia in the adult. Results of the National Antineoplastic Drug Protocol at the Hospital del Salvador, 1990-1998]

BACKGROUND

The incidence of acute myeloid leukemia is 3 cases per 100,000 inhabitants/year and its five years event free survival is 15 to 20%. Since the incorporation of trans retinoic acid, event free survival of M3 acute myeloid leukemia is 80%.

AIM

To report the results of acute myeloid leukemia treatment at the Hospital del Salvador, between 1990 and 1998.

PATIENTS AND METHODS

The medical records of 117 patients (66 female, mean age 48.2 years), treated between 1990 and 1998 using PANDA protocol, were retrospectively reviewed. Immunophenotyping was done in 69 patients and cytogenetic studies were done in 65.

RESULTS

Sixteen percent of patients had M3 acute myeloid leukemia. The most frequent phenotype was the association of DR, CD34 plus a panmyeloid marker. DR and CD34 were negative in seven of nine patients with M3 acute myeloid leukemia. Cariotype was abnormal in 78% of patients. Complete remission was achieved in 65% of cases with a 13% of failures. Early mortality was 21.3% and decreased to 6.1% in the last three years. Infections and coagulation disorders were the main causes of death. Mean survival was 10.5 months. Five years event free survival was 11%. In M3 acute myeloid leukemia, the figure is 50%.

CONCLUSIONS

Treatment results are less effective than protocols that consider more aggressive chemotherapeutic protocols or bone marrow transplantation. The reduction in early mortality is due to a better management of febrile neutropenia.

[Human races and hemato-sero-anthropology. Origin of Chilean natives and natives from Easter Island in the context of human races]

Geographical hematology of Bernard and Ruffie, or Hemato-sero-anthropology, intends to establish relationships between hereditary genetic characters of the blood and human races. Blood groups, haptoglobins, abnormal hemoglobin and other biological traits such as color vision are related to the origin of human races, their geographical distribution, history, settlements, drifts, invasions, customs, religious beliefs, cult to ancestors, dead modifications, culture, language, writing, sculpture, painting and pottery. Our investigations are aimed to locale Chilean natives and natives from Easter Island in the context of human races.

[Sea-blue histiocyte syndrome]

The sea-blue histiocyte syndrome, similar to Niemann-Pick disease, is a congenital, hereditary histiolipidosis due to an inborn enzymatic error. Accumulation of non saturated, oxidated, polymerized lipids is observed; ceroids of lipofuscin, glycophospholipids and sphingomyelin, like bulky granules 1 to 3 u in diameter, turn blue with May Grunwald staining, orange reddish with PAS and black with Sudan III and osmic acid. The sea-blue histiocytes are preferably located at the bone marrow, liver and spleen and less frequently in lymph nodes, lungs and some other organs. The prognosis is variable: fatal in the central nervous system location, relatively mild in cases of spleen and bone marrow location. The possibility of complicating hepatic cirrhosis and/or pulmonary fibrosis is always present. Seven cases are described in this paper, 4 of them family related. Acute myelomonocytic leukemia in one case and histioimmunoblastic lymphoma in another were complications not yet reported in the literature.

[Subacute necrotizing lymphadenitis (Kikuchi and Fugimoto's disease)]

Subacute necrotizing lymphadenitis preferently or exclusively located in the cervical area is often unilateral, self-limited and of probable viral origin. Women under 30 years of age are affected in 80% of cases. Cure is produced in 2 to 3 months although sometimes a much longer course may be observed. Recurrence in the same or other areas may also occur. The histological pattern is characteristic with foci of necrosis with dust-like nuclear rests, absence of neutrophils, scarcity of plasma cells and a notorious proliferation of T4, lymphoimmune histiocytes that partially or completely erase the lymphoid structure. The aspect of a non Hodgkin large cell lymphoma may be stimulated.

[Ectopic or migrating spleen and supernumerary spleens: detection and identification with 99mTc, 51Cr and 113In radioisotopes]

Congenital malformations of the spleen are rare. We report a patient with an ectopic spleen located in the left iliac fossa, which was excised in order to prevent severe complications such as torsion of the pedicle, rupture or infection. A second patient with idiopathic thrombocytopenic purpura presented with an accessory spleen located retroperitoneally. Removal of this spleen following removal of the normotopic one resulted in cure of purpura. The clinical, radiological and radioisotopic studies used to locate and identify these malformations are described.