摘要:

AbstractThe proliferative effect of tumor necrosis factor‐α (TNF‐α) and lymphotoxin on B cells from patients with B‐chronic lymphocytic leukemia (B‐CLL) was studied. Fresh purified B‐CLL lymphocytes showed no proliferative response to either recombinant (r) TNF‐α or r‐lymphotoxin. However, after 'in vitro' activation of B‐CLL lymphocytes for 2 days withStaphylococcus aureusCowan 1 (SAC), four of seven patients showed enhanced blastogenic response in the presence of either rTNF‐α or r‐Iymphotoxin. We also found that the proliferative response of SAC‐activated B‐CLL lymphocytes to the two cytokines was independent of that found in the presence of interleukin‐2. These results demonstrate that TNF‐α and lymphotoxin can heterogeneously support the proliferation of in vitro activated B cells from B‐CLL patients and may reflect the biologi

ISSN:0361-8609    

DOI:10.1002/ajh.2830430202

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractWe observed increased hemoglobin A2(HbA2) levels in an asymptomatic human immunodeficiency virus‐1 (HIV1) patient with no previous history of β‐thalassemia. He was treated only with zidovudine (AZT). In an attempt to understand this observation, a retrospective study was initiated to determine whether mean HbA2levels are higher in AZT‐treated patients than in subjects not receiving this drug and to assess if other hematologic alterations are associated with elevated HbA2. One hundred fifty‐one HIV‐positive cases were investigated; AZT was administered to 81 of them. The mean value of HbA2was 0.032 (SD ±0.005) for the treated group vs. 0.027 (SD ±0.004) for the controls. This difference was highly significant (P<0.001). Twenty‐four patients (31%) in the treated group had elevated HbA2levels vs. none in the controls. Bone marrow toxicity seemed to be more significant in patients with heightened HbA2values, and HbA2levels did not increase with CDC clinical stage. We conclude that AZT may be linked to high HbA2levels in

ISSN:0361-8609    

DOI:10.1002/ajh.2830430203

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractThe aim of the present study was to document coagulation system activation and basal fibrinolysis in peripheral arterial occlusive disease (PAOD) at stage II of Fontaine's classification. In 34 patients, prothrombin fragment (F1 + 2), thrombin‐antithrombin III complexes (TAT), and D‐dimer concentrations were evaluated before and after a standard treadmill test. Basal levels in PAOD of F1 + 2 (1.25 ± 0.19 nmol/liter) and of TAT (3.34 ± 0.35 μg/liter) were significantly increased compared to those obtained in age‐ and sex‐matched healthy controls (0.68 ± 0.06 nmol/liter and 2.30 ± 0.33 μg/liter, respectively), showing baseline activation of the clotting cascade. A secondary activation of the fibrinolytic system was evidenced by the highly significant increase of basal D‐dimers (719 ± 99 ng/dl in PAOD vs. 229 ± 37 ng/dl in controls). Treadmill exercise failed to increase the study parameters significantly further. Walking distance (583 ± 40 m) was correlated with the preexercise ankle to brachial systolic blood pressure ratio (r = 0.485,P<0.005) and inversely with the level of D‐dimers (r = −0.425,P<0.02). Under baseline conditions, the latter parameter was correlated as well with the antigen concentration of urokinase‐type plasminogen activator (u‐PA; r = 0.503,P<0.002). These results indicate that stage II PAOD is characterized by an activation of the clotting cascade in baseline conditions evidenced by increased F1 + 2 and TAT. A secondary activation of the fibrinolytic system with increased u‐PA antigen levels accounts for the elevated D‐dimers. Treadmill exercise was unable to inc

ISSN:0361-8609    

DOI:10.1002/ajh.2830430204

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractProlonged exposure to low concentrations of cytarabine preferentially inhibits in vitro growth of neoplastic myeloid progenitors from patients with chronic myelogenous leukemia (CML) compared to that of normal myeloid progenitors. Continuous infusions of cytarabine in doses of 15–30 mg/m2/day were therefore administered for extended periods to patients with CML in stable phase to determine if this treatment could achieve selective cytoreduction of Philadelphia chromosome (Ph)‐positive cells. Five patients demonstrating>90% Ph‐positive metaphases before treatment received a total of 43 cycles of cytarabine infusional therapy. Cytarabine was administered on an outpatient basis using a portable, battery‐operated syringe pump until the total leukocyte count reached 2500/μl or the platelet count reached 75,000/μl. A new cycle was begun when the total leukocyte count exceeded 4,000/μl and the platelet count exceeded 100,000/μl. The median duration of cytarabine administration per cycle was 29 days (range 15–72 days). Leukocytosis was readily controlled by low‐dose cytarabine therapy in all patients. All five patients experienced complete hematologic responses during cytarabine therapy. The fraction of Phpositive metaphases in the marrow of the five patients was reduced to 0, 10%, 43%, 72%, and 84%, respectively, during therapy. The median time to achieve optimal cytogenetic response was 4.8 months (range 2.8–8.6 months). One patient demonstrated a complete cytogenetic response after three cycles of cytarabine. Another patient demonstrated persistent cytogenetic improvement during 20 cycles of cytarabine, with a median 38% Ph‐positive marrow metaphases (range 10–53%) over 32 months. Cytarabine therapy was generally well‐tolerated, but was discontinued in one patient because of persistent asymptomatic elevations in hepatic enzymes, which resolved within 2 months after discontinuing therapy. There were no episodes of fever during neutropenia, and platelet transfusions were not required. However, symptomatic anemia requiring transfusion of red cells occurred during most cycles of treatment. In summary, treatment of CML with low‐dose cytarabine can induce prolonged cytogenetic improvement in some patients with acceptable toxicity. Further evaluation is needed to ascertain the effects of this treatment on duration of stable p

ISSN:0361-8609    

DOI:10.1002/ajh.2830430205

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractPatients with sickle cell disease (SCD) form immune alloantibodies more frequently than other transfused populations because red cells (RBCs) from white donors (with a higher incidence of certain Rh, Duffy, Kell, and Kidd blood group antigens) are transfused to black patients often lacking these antigens. We propose a model to reduce alloimmunization in patients with SCD by providing them with blood from only black random donors. Rationale is shown by examining calculations based on the phenotype E–, C–, Fy(a–), K–, and Jk(b–). There is a 7% probability that this phenotype belongs to a white donor, while there is a 93% probability that this phenotype belongs to a black donor. The probability of selecting blood from a black donor identical with the above phenotype for black recipients from an all black population and from a typical urban blood inventory population (90% white, 10% black) is 1/4 and 1/33, respectively. Therefore, an 8‐fold greater chance of selecting antigen non‐identical blood occurs if blood is obtained from a typical urban donor population as compared to a black population. Based on these calculations, alloimmunization can be reduced prospectively in patients with SCD by meeting their transfusion requirements with blood selected from random black

ISSN:0361-8609    

DOI:10.1002/ajh.2830430206

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractBone marrow differential and French, American, British (FAB) classification of buffy coat preparation (BCP) was compared to direct method (DM) in 69 pediatric patients with various hematologic and oncologic disorders. The marrow evaluation differed significantly in 12 of 69 patients (17.4%). The differential counts were discordant in 9 out of 69 patients (13%), and the FAB classifications were discordant in 3 out of 25 patients (12%) with acute lymphoblastic leukemia (ALL). Underestimation of the percent blasts occurred with buffy coat preparation in patients with acute non‐lymphoblastic leukemia (ANLL). While buffy coat preparations can facilitate morphologic evaluation in marrow malignancies, significant errors can occur in determination of the differential count. Direct smear should be used in conjunction with buffy coat smears in the evaluation of bone marrow aspirate

ISSN:0361-8609    

DOI:10.1002/ajh.2830430207

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractAt this time, the sole generally accepted use for DNA diagnosis in the hemoglobinopathies is for the prenatal detection of disease, which can be identified by these means early in the first trimester of pregnancy. By ascertaining genotype rather than phenotype, the confusion that results from diagnostic errors should be diminished. DNA diagnostics are the future of all genetic disease detection and this future will soon be upon us.

ISSN:0361-8609    

DOI:10.1002/ajh.2830430208

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractWe have investigated a case of lymphoproliferative disease of large granular lymphocytes (LDGL) occurring in association with celiac disease, anemia, neutropenia, and carcinomas of the endometrium, breast, and skin. The large granular lymphocyte (LGL) proliferation was monoclonal, T cell in origin, with T cell receptor β‐chain gene rearrangement, and a CD3+, CD8+, CD16±phenotype. In spite of the high frequency of LGL, natural killer (NK) cell activity was absent. Stimulation with interleukin‐2 in vitro, however, resulted in high lymphokine‐activated killer (LAK) cell activity against NK‐resistant targets. The T‐cell nature of the LAK precursor cells is in contrast to the majority seen in normal peripheral blood. Therapeutic trials of cyclosporin A, low‐dose cyclophosphamide, and levamisole were unsuccessful in reducing transfusion requirements. This case is unique in the association of LDGL with celiac disease. It is also unique in that the patient had been followed for several years prior to the onset of the LDGL. The case extends the list of lymphoproliferative disorders documented to be associated with celiac disease and, conversely, adds to our knowledge of lymphoproliferative disorder of LGL and its 'dysimmune' m

ISSN:0361-8609    

DOI:10.1002/ajh.2830430209

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractWe are reporting an unusual case of a 54‐year‐old woman with polycythemia vera (PV) who developed Ph chromosome positive chronic myelogenous leukemia (CML) 8 years after the initial diagnosis of PV, and terminating in acute lymphoblastic leukemia (ALL), 11 years after the initial diagnosis. Cytogenetic studies revealed a normal female karyotype at the time of diagnosis of PV and the presence of a Ph chromosome at the time of appearance of CML. Southern blot hybridization revealed a bcr rearrangement in both mononuclear cells and granulocytes. The diagnosis of ALL was established on the basis of morphology, positive TdT staining, and monoclonal antibody studies positive for I2, B4, and J5.This case demonstrates the transition of PV into CML, followed by a blastic transformation into acute lymphocytic leukemia. At termination of her disease there were findings compatible with bi‐phenotypic leukemia. These findings would suggest that the disease arose in a primitive multipotential stem

ISSN:0361-8609    

DOI:10.1002/ajh.2830430210

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractPatients presenting with Hodgkin's disease (HD) may show lung involvement characterized by contiguous spread from ipsilateral hilar lymph nodes. Lung consolidation or noncontiguous pulmonary involvement makes an alternative diagnosis more likely. This report describes a patient with HD in whom concurrent pulmonary blastomycosis was recognized only after chemotherapy had started and dissemination had occurred. Although Blastomyces dermatitidis may behave as an opportunitist pathogen, there are no previous reports of blastomycosis in patients with HD. Undiagnosed active opportunistic infection at the time of diagnosis of HD may complicate staging as well as treatment. Biopsy of lung lesions with stain and culture for opportunistic pathogens should be considered in patients with newly diagnosed HD disease and atypical patterns of lung involvement.

ISSN:0361-8609    

DOI:10.1002/ajh.2830430211

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY