Characteristics and prognosis of KI-1 positive anaplastic large cell lymphoma in Asians

BACKGROUND

Ki-1 positive anaplastic large cell lymphoma is a rare type of non-Hodgkin's lymphoma (NHL), and has not been extensively described in Asian patients.

AIM

To evaluate the clinical characteristics, prognostic factors and treatment outcome of Ki-1 positive lymphoma in an Asian community.

METHODS

A retrospective analysis of all patients with CD30 antigen positive anaplastic large cell lymphoma from 1987 to 1996 in a single institution.

RESULTS

Of 218 patients with NHL, ten (5%) were identified with Ki-1 positive anaplastic large cell lymphoma. Eight were Chinese, two Indians. The male:female ratio was 1.5:1, and the median age was 32 years. Seven patients presented with B-symptoms, and five had stage III/IV disease. The majority (seven of ten) was low- or low-intermediate risk according to the International Prognostic Index (IPI). Four out of five cases immunophenotyped showed a T-cell origin. Five out of eight patients who received first-line combination chemotherapy achieved a complete remission. Two relapsed, with one being re-induced into a durable second remission. One patient with recurrent cutaneous lymphoma received solely radiotherapy and was disease-free at 20+ years from diagnosis. At analysis, two patients had died, five were disease-free at four, 27, 78, 89 months and 20 years respectively, and three were alive with disease. The IPI appears to have prognostic significance.

CONCLUSION

Incidence and clinical characteristics in our Asian patients were similar to those described in Western populations. The IPI appears to have prognostic relevance. In approximately one-third of patients, long term survival can be achieved with standard treatment.

Treatment of acute promyelocytic leukaemia in first relapse with all-trans retinoic acid

A 27-year-old Chinese woman with acute promyelocytic leukaemia in first relapse after the initial conventional induction chemotherapy 18 months earlier was treated with all-trans retinoic acid (ATRA) at an initial dose of 45 mg/m2 and subsequently increased to 65 mg/m2 on day 15. Complete remission was achieved after a total of 40 days of ATRA alone. Serial marrow examinations during induction showed progressive maturation of myelopoiesis without bone marrow hypoplasia. There was a significant reduction in number of cells with the t(15;17) translocation when complete remission was achieved. ATRA was very well-tolerated. The symptoms of dry skin and intermittent headache were self-limiting.

Multiple myeloma: the National University Hospital (NUH) experience

The aim of this retrospective study was to define the characteristics of local patients with multiple myeloma. Twenty-nine de novo cases were accrued from October 1986 to January 1992 at the National University Hospital of Singapore. Features like median age of presentation, sex distribution, the incidence of IgG, IgA and light chain subtypes were similar to published data. However IgD myeloma appeared to be more common here and it tended to be more advanced at presentation. Objective response rate to treatment with the melphalan-prednisolone combination was about 40% with a median survival of 18 months.

Acute deep vein thrombosis in hospital practice

A recent cross sectional study on symptomatic acute deep vein thrombosis at the National University Hospital (NUH) in Singapore found a frequency rate of 0.79 per 1000 patient admissions. A total of 39 patients were accrued over 18 months, 36 with deep vein thrombosis alone and three complicated by pulmonary embolism. No sex or ethnic predilection was observed in this cohort of hospitalised patients. Twenty-eight (71.8%) patients were 40 years or older. Majority (89.7%) of patients had at least two predisposing factors. While prolonged bedrest and operative procedures featured equally frequently in patients above and below 40 years, neoplasms were predominantly associated with the former and protein C or S deficiency primarily with the latter. The exhaustive laboratory confirmation of an inherent thrombotic tendency is recommended only for patients below 40 years of age.

Cisplatin and 5-fluorouracil continuous infusion for metastatic nasopharyngeal carcinoma

The activity of cisplatin and a 120-hour continuous infusion of 5-fluorouracil (5-FU) was evaluated in 25 patients with metastatic nasopharyngeal carcinoma. Cisplatin 100 mg/m2 and 5-FU 1000 mg/m2/day by continuous infusion for 120 hours were given via an implanted venous access device and ambulatory infusion pump. Eighteen (72%) patients had multiple sites of metastases and seven (28%) patients had only bony metastases. Subjective responses in terms of pain relief and improvement in performance status were seen in 21 (84%) patients. Overall objective response was seen in 19 (76%) patients with two complete remissions (CR) and 17 partial remissions (PR). Locoregional disease responded more completely and rapidly than bony or visceral metastases. Toxicities included nausea, vomiting, neuropathy and one septic death. Cisplatin and 5-FU by continuous infusion represent an effective treatment for metastatic nasopharyngeal carcinoma.

Prognostic usefulness of cytogenetic analysis for haematological malignancies--two case reports on acute myeloid leukaemia

Since the setup of marrow cytogenetic analysis at the National University Hospital (NUH) of Singapore in 1988, we have systematically examined all patients with haematological neoplasia for clonal abnormalities. In most patients, diagnosis was unequivocal on clinical and morphological grounds so that karyotyping was undertaken for prognostic purposes. Two patients are described who illustrate the prognostic implications of nonrandom chromosomal derangements. They highlight the increasing appreciation of the importance of cytogenetic analysis as an independent and reliable prognostic tool in the management of haematological malignancies.

Hepatocellular carcinoma--a case series of 104 patients

The records of one hundred and four patients with confirmed hepatocellular carcinoma seen over a two year period at the National University Hospital were analysed to elucidate the clinical features of our local patients and to assess their response to various therapeutic modalities. Chinese males were over-represented with a peak frequency in the sixth to eighth decade of life. Seventy-five percent of the patients were HBsAg positive and at least 88% had evidence of previous Hepatitis B infection. Ninety-one percent were symptomatic at presentation with pain being the most common symptom. Hepatomegaly with features of cirrhosis were the main physical findings. Seventy percent of the patients presented within three months after the onset of symptoms. The majority of patients had stage II or III disease at diagnosis. Twenty percent of patients had normal alpha-fetoprotein levels. Chemotherapy did not appear to show a survival benefit. Curative surgical resection was feasible in about 10% of patients and it remains the only chance for long term survival. There is an urgent need to identify more effective drugs or other modalities to treat this common and rapidly fatal malignancy. Identification of high risk patients should prompt screening with both serum alpha-fetoprotein and ultrasonography of the liver.

Malignant glandular triton tumor

A case of left brachial plexus-related malignant peripheral nerve sheath tumor showing neoplastic, glandular, and rhabdomyoblastic elements in a 39-year-old Chinese man is reported. The authors suggested that this tumor be termed a malignant glandular triton tumor in view of the presence of the adenocarcinomatous component. The patient had extensive local recurrence comprising mainly the Schwann spindle cells within a year after complete piecemeal removal and died 15 months later after the initial presentation. The natural behavior of this tumor, as in other reported cases of malignant triton tumor, is extremely aggressive, unlike malignant schwannoma or glandular malignant schwannoma. The histogenesis of this tumor is likely to be from primitive neural crest cells, Schwann's cell precursors, or metaplastic malignant Schwann's cells.

Cytogenetic analysis in myeloid malignancies

Forty-one patients with myeloid malignancies, majority newly diagnosed and previously untreated, were systematically karyotyped between January 1988 and December 1989 using fluorodeoxyuridine (FdU) synchronisation and Giemsa banding techniques. Eighteen patients had acute myeloid leukaemia (AML), 13 had one form or other of a myeloproliferative disorder and 10 fulfilled the clinical and morphological criteria for the myelodysplastic syndrome (MDS). Ten AML patients had cytogenetic abnormalities. All 6 chronic myeloid leukaemia (CML) patients carried the Philadelphia chromosome with 2 having additional abnormal clones. Only four MDS patients showed involvement of either chromosome 5 or 7.

Treatment of adrenal cortical carcinoma with mitotane: outcome and complications

Adrenal cortical carcinoma is a rare tumour with a poor prognosis. We report a patient with metastatic adrenal cortical carcinoma who responded dramatically to Mitotane (o,p'-DDD). Unlike previous reports of metastatic adrenal cortical carcinoma in which complete remission was obtained with high dose Mitotane treatment, the dose of Mitotane used in this patient was low. However, she developed unusual side-effects such as hyperpigmentation, low plasma cortisol and high adrenocorticotropic (ACTH) levels. The side effects closely resemble those in Nelson's syndrome and were reversed by cortisone replacement. The mechanism of actions of Mitotane is discussed with emphasis on its effect on corticosteroid metabolism.

Chemotherapy of adult acute myeloid leukaemia

Great strides have been made in the chemotherapy of adult acute myeloid leukaemia in the last two decades. This paper describes our experience in the treatment of adult acute myeloid leukaemia from 1980-88. About two thirds of patients achieve remission with a standard chemotherapy protocol. Early disease relapse and measures to prevent it are major problems. The majority of patients with adult myeloid leukaemia, presently, are not cured with chemotherapy alone.

Extensive bone marrow necrosis in cancer

Extensive bone marrow necrosis is an uncommon finding in patients with cancer. This paper presents the clinical details of two patients in whom this condition was the presenting feature. The diagnostic criteria, pathogenesis and prognosis of this poorly understood problem are then discussed. Although prognosis is usually grave, prompt recognition and proper management of this condition may result in remission of the disease and regeneration of the marrow.

Non-surgical management of liver metastases

The liver represents the most common site of visceral metastasis for primary gastrointestinal neoplasms, but it is also a common site of metastasis for extra-abdominal tumours including breast cancer, lung cancer as well as other cancers. Metastatic liver disease is often the cause of death for cancer patients. Metastatic liver disease is a heterogenous entity depending upon histologic type, site of primary tumour and other extrahepatic involvement. Surgical resection is feasible only in highly selected patients with no extrahepatic metastasis. The nonsurgical modalities of management of liver metastases include radiotherapy, chemotherapy, biologicals or a combination of these modalities. Hepatic irradiation can produce satisfactory palliation but has dose limiting toxicity of radiation hepatitis. The systemic chemotherapy of liver metastases has evolved over the past decades from single agent systemic treatment to regional infusion chemotherapy. The drugs employed in treatment depend on the site of primary tumour. 5-fluorouracil remains the mainstay of chemotherapy in most gastrointestinal cancers. Recent technological advances in drug delivery system and genetic engineering have given new vistas to nonsurgical management of liver metastases. Ambulatory or implantable pumps have enabled drugs to be delivered by continuous infusion via an implantable vascular access system. Monoclonal antibodies conjugated to toxins or radioisotopes offer exciting prospects for targeted therapy.

Totally implantable central venous access for cancer patients in Singapore

Sustained venous access is assuming increasing importance in clinical medical practice for the infusion of antibiotics, cytotoxic drugs, blood products and parenteral nutrition. The limitation of peripheral venous access in patients receiving cancer chemotherapy can be a major problem. Many antineoplastic drugs are vesicant and may cause chemical ulcers when infiltrated or phlebitis and thrombosis. Recent technological advances in development of non-thrombogenic silastic catheters have facilitated in-dwelling catheters to be implanted for long periods. Port-A-Cath is a totally implantable vascular access system which allows for blood to be sampled and also infusion of drugs and blood products. Between March 1985 to October 1987, 20 devices were implanted on 19 patients (14 males and 5 females). Criteria were drawn up to select these patients. The quality of life was significantly improved for these patients who receive long term chemotherapy or blood products through this device. There were 6 episodes of transitory occlusion of catheter and 1 episode of infection. Continuous infusion of drugs given through this device does not produce chemical phlebitis. It has also facilitated new methods of delivering cytotoxic drugs and analgesia.

4'-Epidoxorubicin (Epirubicin) as a single agent in advanced primary hepatocellular carcinoma--a preliminary experience

41Epidoxorubicin (Epirubicin) is a new anthracycline analogue which has activity in a variety of cancers. Advanced primary hepatocellular carcinoma is a rapidly fatal neoplasm. Studies with doxorubicin (Adriamycin) in Africa and Asia have shown a response rate around 30-50% with modes gains in median survivals in patients who responded. We report here our preliminary experience with epirubicin in advanced primary hepatocellular carcinoma. We treated 13 patients with advanced primary hepatocellular carcinoma with epirubicin using a dose of schedule of 60 mg/m +/- at the beginning and gradually escalated to 90 mg/m +/- as tolerated. All patients had no prior chemotherapy. Median age was 51 years with range of 31 to 70 years. Cardiotoxicity was serially monitored with radionuclide multigated left ventriculogram. Objective responses were observed in 3 (23%) patients of the 13 evaluable patients. The median duration of these responders was 30 weeks (range 20 to 42). The overall median survival was 11 weeks. Two patients had cardiotoxicity as measured by a significant fall in left ventricular ejection fraction. The toxicities are much less than doxorubicin and better tolerated. We feel that epirubicin has definite activity in primary hepatocellular carcinoma even in patients with advanced disease.

New perspectives in therapy of small cell lung cancer

Small cell lung cancer (SCLC) displays many unique features which are not present in the other subtypes of lung cancer. The clinical presentation with its unique paraneoplastic syndrome and early metastatic spread make SCLC a protean diagnostic problem. Until recently, SCLC was considered to have the worst prognosis in lung cancer. However the natural history of this cancer has been altered substantially over the past ten years with the application of combined modality therapy using combination chemotherapy and radiation therapy. Numerous clinical trials have demonstrated the four to five fold improvement in survival for patients with limited disease treated with combination chemotherapy and radiation therapy. There are several active chemotherapeutic agents such as cyclophosphamide, doxorubicin, etoposide, vincristine, methotrexate and cisplatinum which are currently used in various combination regimens. The role of radiation therapy is undergoing changes with an improvement in results when used in combination with chemotherapy. It no longer plays a primary role but remains a valuable adjunct in the management of small cell lung cancer. There is a diminishing role for surgery in this type of lung cancer. The therapeutic progress in SCLC has reached a plateau in the past four to five years. However much progress has been made in understanding the biology of SCLC. Armed with a better understanding of the biology of SCLC, we can hopefully formulate better treatment regimens and ultimately further improve therapeutic results.

Suppressor cell function in renal failure and transplant patients

Suppressor cell function was assessed in 13 patients with chronic renal failure not on dialysis, 10 patients on regular hemodialysis and 11 renal transplant patients by means of the Concanavalin A inducible Suppressor Cell Assay. The mean Suppression Index (S.I.) in the undialysed patients (0.76 +/- 0.39) and those of the dialysed patients (0.72 +/- 0.18) were not significantly different from the 25 healthy controls (0.68 +/- 0.22). However the S.I. in the renal transplant patients (1.11 +/- 0.41) was significantly different from the normal controls as well as the undialysed and dialysed patients. Although there was no correlation between S.I. and age, post transplant follow up period, serum creatinine concentration, prednisolone or azathioprine dosage it is likely that the cause of the impaired suppressor cell function was due to the immunosuppressive agents used.

Chemotherapy of disseminated testicular cancer--a Singapore experience

Eighteen patients with bulky Stage II B or disseminated germinal neoplasms of the testis were treated with 4 months induction chemotherapy regimen of vinblastine, bleomycin and cis-diamminedichloroplatinum since July 1980. Subsequent maintenance therapy for responding patients consisted of monthly vinblastine and bleomycin. The duration of maintenance therapy was 10 months. Twelve patients (66%) entered into complete remission while 4 patients (22%) were partial responders. VP 16-213 (Etoposide) was added to the regimen for those partial and nonresponders. However there was a high percentage (66%) of relapse at 1 year. Major toxicities were severe gastrointestinal toxicities and mild myelosuppression. There was no drug related death. Problems encountered with this programme were compliance of patients, high costs of drugs and short-lived duration of complete remission. It can be concluded that disseminated germinal cells tumours of testis is highly responsive to combination chemotherapy containing cis-platinum, bleomycin and vinblastine.

Myelodysplastic syndromes: an analysis of clinical and haematological features

A retrospective analysis of 24 cases of myelodysplastic syndromes was performed between 1979-1984. There were 16 men and 8 women with a mean age of 69 years and 65 years respectively. The most common haematological features at initial presentation were refractory macrocytic anaemia, reticulocytopenia and associated with either bicytopenia or pancytopenia. The bone marrow was often cellular with megaloblastoid erythropoiesis and in 7 patients (29%), there were ring sideroblasts. Often there was associated dysgranulopoiesis and dysthrombopoiesis Myelodysplastic syndromes appear morphologically to be a heterogenous entity. An attempt to classify them according to the recent proposal of the French-American-British (FAB) Co-operative Group was made. Transformation into acute non-lymphocytic leukaemia occurred in 6 patients (25%). The mean interval between diagnosis and transformation to acute leukaemia was 13 months (range 3-30 months). Acute leukaemia in these patients were refractory to conventional chemotherapy. There were 14 deaths (58%) observed during the period and the common causes of deaths were acute leukaemia, infections and haemorrhage. At present there is no specific or generally effective therapy for this haematologic entity.

Beta-2-microglobulin in mesangial IgA nephropathy

This study measured plasma beta 2-microglobulin (beta 2-m) in patients with mesangial IgA nephritis. Plasma beta 2-m was measured in 51 patients with IgA mesangial nephritis and in 50 normal controls using a Phadebas beta 2-m RIA kit available from Pharmacia Diagnostics (Uppsala, Sweden). The mean plasma beta 2-m in IgA nephritic patients (1.92 +/- 0.67 mg/l) was significantly different from that of healthy controls (1.33 +/- 0.41 mg/l; p less than 0.001). The mean plasma beta 2-m in non-IgA nephritic patients (1.83 +/- 0.73 mg/l) was also significantly different (p less than 0.001). Patients with IgA nephritis with glomerular sclerosis (n = 33) had significantly higher levels of beta 2-m (2.02 +/- 0.70 mg/l) than IgA nephritic patients without glomerular sclerosis (n = 18, 1.72 +/- 0.65 mg/l; p less than 0.025). In the group with IgA nephritis and glomerulosclerosis, raised beta 2-m levels were correlated with the severity of proteinuria (r = 0.41) (p less than 0.02) as well as the intensity of IgA staining on immunofluorescence (r = 0.34; p less than 0.05). Elevated beta 2-m levels in IgA nephritis may serve as a useful prognostic marker.

The clinical relevance of platelet aggregation study in myeloproliferative disorders

30 unselected patients with various entities of the myeloproliferative syndrome were entered into a prospective study to evaluate the relationship between platelet aggregation abnormalities and hemostatic complications and the role of aggregation study in myeloproliferative disorders. 21 patients showed impaired collagen-induced aggregation and absent second phase epinephrine-induced response. 6 of these patients had bleeding manifestations. 4 patients hyperaggregated with ADP, collagen, epinephrine and arachidonic acid. Of these, 3 had thrombotic complications as their initial presentation. In the 6-40 months follow-up no new cases of bleeding or thromboembolic phenomena were encountered among the remaining patients. In 3 patients aggregation abnormalities heralded the specific myeloproliferative disorder by months or years. We conclude from this study that routine platelet aggregation study in classical myeloproliferative disorders is unwarranted as it is costly and does not improve the diagnostic accuracy nor yield any predictive information concerning the tendency to bleed. It is useful as an accessory investigative tool in the atypical or early myeloproliferative patient whose clinical features, blood and marrow findings although suggestive are not diagnostic of a specific myeloproliferative entity.

Reversal of red cell aplasia and marrow fibrosis in non-Hodgkin's lymphoma

Red cell aplasia and marrow fibrosis occurred in a 34-year-old man with diffuse well differentiated lymphocytic lymphoma. Complete recovery of marrow function and histology with remission of the lymphoproliferative malignancy were observed following 6 courses of combination chemotherapy.

Loss of concanavalin A induced suppressor T-lymphocyte function in patients with mesangial IgA nephritis

Using the method of concanavalin A (Con a) inducible suppressor activity the peripheral mononuclear cells (PMC) of 17 patients with Mesangial IgA nephritis, 13 patients with idiopathic mesangial proliferative glomerulonephritis but with no IgA deposits on immunofluorescence (Non-IgA nephritis) and 18 healthy subjects were studied. DNA synthesis was measured by incorporation of 3H Thymidine. The mean suppression index (S.I.) of 0.94 +/- 0.08 (SEM) in the IgA nephritic patients was significantly different from that of the non-IgA nephritic patients (0.67 +/- 0.05) (P less than 0.01) as well as the group of normal healthy controls (0.64 +/- 0.05) (P less than 0.0025). The data show that patients with IgA nephritis have abnormal suppressor cell function and suggest an autoimmune basis in the pathogenesis of IgA nephritis.

Nephrotic syndrome associated with malignant tumours

The nephrotic syndrome complicating malignancy is an unusual occurrence. We report here four cases of nephrotic syndrome associated with malignant tumours. Three cases were associated with bronchogenic carcinoma and one with adenocarcinoma of colon. One of the four cases developed nephrotic syndrome before the discovery of bronchogenic carcinoma. All patients had renal biopsies with light microscopy, immunofluorescence and electron microscopy. The findings suggest an immune-complex disease complicating malignancy. The true incidence of nephrotic syndrome associated with malignant tumours is unknown. However it is clinically prudent to screen for malignancy in older patients presenting with nephrotic syndrome.

Cardiac amyloidosis--diagnosis by 2-dimensional echocardiography

In the past, the precise diagnosis of amyloid cardiomyopathy without resort to invasive techniques has been difficult. Recent experience with 2-dimensional echocardiography in cardiac amyloidosis has suggested that there are characteristic, and perhaps unique, features that are regularly imaged. We describe a case where usage of this non-invasive technique allowed accurate definition of cardiac involvement by amyloid.

Beta-thromboglobulin in mesangial IgA nephritis

Plasma beta-thromboglobulin (beta-TG) concentration were determined in 28 patients with mesangial IgA nephritis (17 with focal glomerular sclerosis and 11 without any glomerular sclerosis) and compared with those from 52 normal subjects and 24 patients controls with no evidence of renal disease. The mean beta-TG concentration in the patients with IgA nephritis [159 +/- 63 ng/ml (SD)] significantly different from the patients controls [32 +/- 25 ng/ml (SD)] (p less than 0.001) as well as the group of normal subjects [23 +/- 17 ng/ml (SD)] (p less than 0.001). In another group of 12 patients with diffuse mesangial proliferative glomerulonephritis with no IgA deposits (non IgA nephritis) the mean beta-TG concentration [126 +/- 86 ng/ml (SD)] though different from that of the normal as well as patient controls (p less than 0.001) was not significantly different from the IgA nephritis patients. The elevated beta-TG levels in the nephritic patients showed no correlation with serum creatinine, creatinine clearance or proteinuria but was significantly correlated with the degree of glomerular sclerosis (r = 0.44) (p less than 0.05). In vivo activation of the platelets is suggested by these findings of elevated beta-TG in patients with diffuse proliferative mesangial glomerulonephritis (IgA and non IgA).

Malignant histiocytosis --- a case report

Malignant Histiocytosis (MH) is an uncommon disorder characterised by systemic tissue infiltration of atypical histiocytes and its precursors. The clinical features included fever with weight loss, hepatosplenomegaly and pancytopenia. The antemortem pathology of the lymph node and bone marrow were non-specific and non-diagnostic. However, at autopsy, there were florid pathological changes of malignant histiocytosis. This case illustrates the difficulty of making a definite antemortem diagnosis of this rare malignant condition and the terminology, aetiology and pathological features are discussed.

One year review of the blood cell separator programme

Using the Haemonetic Model 30 intermittent continuous flow centrifuge, 142 procedures, including 64 granulocytes and platelets, 68 platelet collection, 8 therapeutic leukapheresis and 2 plasmapheresis were performed. Granulocyte transfusions (mean collection 1.39 x 10(10) granulocytes) were given to 27 neutropenic patients for febrile episodes which were unresponsive to systemic antibiotics. Thirty-eight thrombocytopenic patients received a mean of 4.2 x 10(11) platelets per collection. Bleeding was controlled in most of the patients who received transfusion with a mean rise in platelet count of 30.6 x 10(9)/L. Therapeutic leukapheresis were performed on 3 patients with chronic leukaemias. A mean of 2.53 x 10(11) cells were collected per run with a mean fall of 58.2 x 10(9)/L in the patients' white blood cell count. Plasmapheresis was used to treat 1 patient with multiple myeloma. The authors' experience demonstrates that cell separator support is essential for patients with bone marrow depression and that the therapeutic leukapheresis is effective therapy for selected patients with chronic leukaemias. Plasmapheresis is effective in patients with hyperviscosity syndrome.

New concepts on the acute leukaemias: morphology, classification, cell biology, chemotherapy, supportive care, immunotherapy and bone marrow transplantation

The advances in chemotherapy, understanding of leukaemia cell biology and supportive care for acute leukaemia patients offer substantial prospect for cure in the future. Intensive treatment of acute leukaemia requires the resources of specialised unites for support of bone marrow failure. Where possible, patients should be referred to such units for diagnostic classification and intensive remission induction therapy. The understanding of leukaemia cell biology and the detection of colony stimulating activity in normal granulocytes and marrow has helped in predicting early relapses in leukaemia patients. Allogeneic sibling bone marrow transplantation for patients in remission offers a 70% chance of 3 years survival and disease-free state compared to 10% survival for the non-grafted patients treated on maintenance chemotherapy alone. Current evidence suggests that such transplanted patients do not require long term chemotherapy or anti-G.V.H. treated now that the problem of graft-versus-host disease in transplant recipients appears to be overcome by the use of Cyclosporin A.

The evaluation of tumour marker proteins in the diagnosis of primary hepatocellular carcinoma

The sera of 122 patients with biopsy confirmed primary hepatocellular carcinoma (PHC) were examined for the presence of alphafoetoprotein (AFP), alpha 1antitrypsin 1 (AAT), alpha 1acidglycoprotein (AGP) 1, gammaglutamyl transpeptidase (GGT), carcinoemryonic antigen (Roche) (CEA) and the "Hepatoma-Liver antigen" H-L Ag). 83% of patients had elevation of AFP of more than 18 ng/ml 7.4% and 15.5% had levels between 19--100 ng/ml and 100-500 ng/ml respectively. Raised AAT, AGP, GGT, CEA and HL Ag were found in many patients with PHC. Grossly elevated AFP were usually diagnostic of PHC. The combination of AAT, AGP, CEA and HL Ag were useful in the diagnosis of AFP negative cases.