Acute Myeloid Leukaemia Occurring in Untreated Chronic Lymphatic Leukaemia

A case of acute myeloid leukaemia (AML) occurring in a patient with untreated chronic lymphatic leukaemia (CLL) is presented. The diagnosis of two simultaneous leukaemic processes is based on morphological, cytochemical and immunological findings. The significance of the development of AML in patients with CLL is discussed.     

Acute Myelogenous Leukemia Concurrent With Untreated Chronic Lymphocytic Leukemia

We report a case of acute myelogenous leukemia (AML) concurrent with untreated chronic lymphocytic leukemia (CLL). An 84-year-old Japanese man was admitted to the Chihaya Hospital with persistent high-grade fever. Morphologic observation of peripheral blood and bone marrow smears revealed a proliferation of blasts and lymphocytosis with small and mature phenotypes. Immunophenotyping of the blast cells revealed CD13+, CD33+, CD34+, and HLA-DR+, and that of the lymphocytes revealed CD5+, CD19+, CD20+, and lambda+ on the cell surface. The peripheral lymphocytes revealed an IgH gene rearrangement. Chromosome analysis of 20 metaphase cells from bone marrow showed numerous abnormalities, containing +8,+11,+21. The patient's disease was diagnosed as AML with trilineage dysplasia concurrent with CLL. The simultaneous occurrence of AML and CLL is extremely rare but should not be overlooked as a possible underlying cause of lymphocyte abnormalities in AML patients.     

Expectancy for Life in Chronic Lymphatic Leukemia

Survival data were calculated for 125 patients with chronic lymphaticleukemia seen at the University of Minnesota Hospitals during the years 1945to 1957 and followed for another 4 years. An actuarial method and modifiedmaximum likelihood method were used for the statistical analyses.

The survival times in this study are significantly longer than those reportedpreviously in large reference series of chronic leukemia. They more nearlyapproximate the results reported by Osgood for patients treated by his methodof total body irradiation. It is suggested that in a disease with a wide clinicalspectrum such as chronic lymphatic leukemia, differences in survival may bemainly related to differences in the composition of the groups being studied.

Submitted on September 16, 1963 Accepted on April 24, 1964     

The Ultrastructure of Phytohemagglutinin (PHA) Stimulated Lymphocytes of Chronic Lymphatic Leukemia

Cultured lymphocytes of chronic lymphatic leukemia have been shownto have a delayed and diminished response to phytohemagglutinin (PHA)stimulation.

By electron microscopic examination, a morphologically distinct intermediate blastoid cell was identified in the stimulated cultures which showedminimal differences between those derived from normal and leukemic lymphocytes. It was distinguished by a large vesicular nucleus and relativelyscant cytoplasm with few organelles. This intermediate blastoid cell frequentlypredominated in cultures with a low total percentage of blastogenesis. It issuggested that this intermediate blastoid cell represents a premitotic phasein lymphocytic transformation, though the possibility of it’s being a nonmitotic blastoid cell cannot be excluded.

No morphologic differences were noted between the large blastoid cellstransformed from normal and leukemic lymphocytes.

Submitted on November 14, 1968 Accepted on April 21, 1969     

Case Report: Autoimmune Hemolytic Anemia in Chronic Granulocytic Leukemia

A patient with chronic granulocytic leukemia developed autoimmune hemolytic anemia. He was found to have a cold agglutinin and a nonspecific warmpanagglutinin. Therapy with prednisone appeared to control the hemolyticcrisis and did not affect the granulocytic process. The patient died of bronchopneumonia, and at autopsy no other neoplasm was found.

Submitted on March 2, 1967 Accepted on April 17, 1967     

Seronegative Lyme Neuroborreliosis in a Patient on Treatment for Chronic Lymphatic Leukemia

Abstract We report on a patient who developed seronegative Lyme neuroborreliosis complicating chemotherapy for chronic lymphatic leukemia. After the fifth cycle of chemotherapy (FCR: fludarabine, cyclophosphamide, rituximab and prednisone) the 63-year-old patient developed night sweat, arthralgia in elbows, wrists, proximal interphalangeal joints (PIPs) and strong neuropathic pain in both legs, followed by paresthesia and hypesthesia in the feet, arms and face. Laboratory analysis revealed an elevated C-reactive protein (CRP), a slight elevation of liver enzymes and decreased IgG levels. Cerebrospinal fluid (CSF) analysis showed a lymphomononuclear pleocytosis and an elevation of protein. A broad diagnostic work-up was negative including a negative Borrelia IgG and IgM ELISA. The patient did not remember recent tick bites, but after specific questioning he recollected a transient erythema on his leg developing just before the start of the last cycle of chemotherapy. As the combination of neuropathic pain and arthralgia, the transient erythema and the lymphomononuclear pleocytosis raised the suspicion of Lyme neuroborreliosis, the patient was treated for 3 weeks with ceftriaxone. On therapy all symptoms resolved and CRP normalized. Retrospective PCR analysis of a CSF sample confirmed the clinical diagnosis by detecting Borrelia garinii DNA. This case demonstrates that in immunosuppressed patients borrelial serology may be negative and that additional diagnostic approaches (including tests for direct Borrelia detection) may be needed to demonstrate borrelial infection.     

The Periodic Acid-Schiff Reaction in Neutrophil Leukocytes in Untreated and Myleran-Treated Chronic Myelocytic Leukemia: A Quantitative Microspectrophotometric Study

Microspectrophotometric quantification of the periodic acid-Schiff (PAS)reaction has been performed in about 3,000 individual mature neutrophilleukocytes from 20 normal subjects and 23 patients with chronic myelocyticleukemia (CML), of whom 10 were untreated or in relapse and 13 in partialremission or remission.

The PAS reaction was taken as a quantitative measure of the cellularamount of PAS reactive material (PASMa), most probably equivalent toglycogen. The mean amount of PASMa in neutrophils from untreated andrelapse cases of CML was 43 per cent less than in normal neutrophils. Thefrequency distribution of PASMa per cell was normal in individual cases.In clinical remission after Myleran treatment, the neutrophils contained normalamounts of PASMa.

Submitted on November 1, 1965 Accepted on February 6, 1966     

Binding of Concanavalin A to Rat, Normal Human, and Chronic Lymphatic Leukemia Lymphocytes

This study was aimed to find a correlation between the extent of concanavalin A (Con A) binding to lymphocytesand the blastogenic effect of the lectinon these cells. ⁶³Ni-labeled Con A wasused in the lectin-binding experiments.Binding of Con A to a small fraction(approximately 3%) of Con A bindingsites in rat lymphocytes is requiredfor the maximal stimulation of RNAsynthesis. Binding of Con A to additional sites resulted in a less stimulatory effect. Lymphocytes from patients with chronic lymphatic leukemia(CLL) are impaired in their blastogenicresponse to Con A. Maximal stimulation of DNA synthesis induced by ConA in CLL lymphocytes is attained bytreatment of the cells with the lectinat concentrations that are smaller thanthose required for the induction ofmaximal DNA synthesis in normallymphocytes. The number of Con Abinding sites in CLL lymphocyte issmaller than in normal lymphocyte.

Submitted on March 6, 1972 Revised on April 18, 1972 Accepted on April 27, 1972     

Hypercalcaemia in Chronic Lymphatic Leukaemia

Hypercalcaemia developed in a patient with chronic lymphatic leukaemia. The hypercalcaemia did not respond to conventional treatment. At bone biopsy osteoclastic resorption was found (a photomicrograph is presented). 7 cases from the literature of hypercalcaemia and chronic lymphatic leukaemia are briefly reviewed. Possible mechanisms are discussed and it is suggested that osteoclast-stimulating factors may be of importance in the development of the hypercalcaemia.     

The Analysis of Anemia in Chronic Heart Failure

objectives To demonstrate the phenomena and explore the causes of anemia in patients with chronic heart failure (CHF). Methods To observe the phenomena of anemia in patients with CHF, a total of 276 patients with CHF were included in this retrospective study. The clinical characteristics of the patients are; mean age 69.2±11.0 years; male 151, female 125; NYHAⅢandⅣ115(41.7%). Results①Among the 276 patients with CHF, 81 (29.4% )had anemia (Mean hemoglobulin concentration 101.5±13.0 g/L).②Patients with Anemia were more likely to be female and to have greater NYHA (ⅢorⅣ) (P < 0.05 ) , higher serum creatinine, as well as lower serum albumin and low-density lipoprotein levels (P < 0.01).③A weak negative correlation was also noted between the level of NYHA and hemoglobulin.④There was no significant difference in age, the primary cardiac etiology of the CHF, the history of diabetes, left ventricular end diastolic diameter, and left ventricular ejection fraction between CHF patient with and without anemia. Conclusions The prevalence of anemia is high among patients with CHF. The anemia patients with CHF tend to be female, have greater cardiac and renal functional impairment, but with lower serum albumin and LDL that suggests some degree of malnutrition.     

Hemolysis In Vitro and the Anemia of Leukemia

Autohemolysis occurs in vitro in the blood of some patients with leukemiaand other disseminated neoplastic diseases. It is known that patients with suchdiseases are frequently anemic and hemolytic disease frequently contributesto the anemia. The present study has demonstrated that the in vitro autohemolytic phenomenon is not necessarily associated with a short red celllife span. This suggests that the abnormality does not damage the red cellswhile they are in the circulation.

Submitted on November 7, 1960 Accepted on June 6, 1961     

Characteristics of Cell Proliferation in Four Patients with Untreated Acute Leukemia

The characteristics of proliferation of leukemic cells in four children withuntreated acute leukemia have been studied. In all four of these children apopulation of marrow leukemic cells was found which were dividing with ageneration time of about 15 to 20 hours. In two of these patients it waspossible to demonstrate that these dividing cells after one or more mitoticdivisions became smaller and stopped dividing. In all of these patients 70 percent or more of the leukemic cells of the marrow and almost all leukemic cellsof the blood were nonproliferative at the time of these studies. These nondividing cells would be relatively unaffected by chemotherapeutic agents designedto inhibit cell division.

Submitted on September 7, 1965 Accepted on January 31, 1965     

Autoimmune Antibodies in Chronic Lymphatic Leukaemia

In chronic lymphocytic leukaemia a factor in patients' serum enhances the in vitro viability of the abnormal cells and this has been identified as an antibody. The activity of this factor can be removed by interaction with anti-immunoglobulin and by ammonium sulphate precipitation with a degree of saturation in excess of 46%. Cohn fractionation and chromatography with A-50 Sephadex show that the factor is not a complex but an immunoglobulin. No activity is removed after reaction of sera with 2-mercapto-ethanol and di-thiothreitol. The evidence therefore suggests that a γ-G immunoglobulin is involved. Concentrated washings from the leukaemic cells behave in exactly the same way as patients' sera and activity is retained in the same fraction during precipitation and purification procedure.
The extensive cross-reactivity of the sera suggests a common chronic lymphatic leukaemic antibody and it is considered that an active autoimmune response may be an integral part of the disease.     

慢性心力衰竭中的贫血

近年来研究发现,慢性心力衰竭患者中常常伴有贫血,而且贫血会加重心力衰竭患者的临床症状,使生存率下降。用促红细胞生成素治疗心力衰竭中的贫血,能够使心力衰竭患者的心功能和临床症状明显改善。