EFFECT OF SHORT-COURSE, HIGH-DOSE STEROID THERAPY IN A CHILD WITH MYELODYSPLASTIC SYNDROME

High-dose methylprednisolone (HDMP) has been shown to induce differentiation of myeloid leukemic cells with a remarkable antileukemic effect in children with various subtypes of acute myeloblastic leukemia (AML). Here the beneficial effect of short-course HDMP therapy in a child with myelodysplastic syndrome (MDS) is reported. Oral methylprednisolone sodium succinate (Prednol-L) was administered at a single daily dose of 30 mg/kg for 5 days to a 4-year-old girl with refractory anemia with excess of blasts and hypocellular bone marrow before the initiation of chemotherapy. In addition to dramatic clinical improvement, the patient's white blood cell count increased from 2.3 ×10 9 /L to 5.0 ×10 9 /L, and peripheral blood blast cells disappeared 4 days after HDMP treatment. Repeated bone marrow aspirate 1 week after the initiation of HDMP disclosed increased cellularity with no blasts. Furthermore, short-course HDMP treatment stimulated the increase in the number of peripheral blood lymphocytes and CD3 + , CD4 + , CD8 + , CD19 + , CD34 + , and NK cells. Results obtained with HDMP from the previous studies and the present case suggest that high-dose methylprednisoloneis a promising agent in the treatment of MDS and it is recommended as an initial treatment especially for MDS children with hypocellular bone marrow at presentation.     

Myelodysplastic Syndrome with Partial Deletion of the Long Arm of Chromosome 5: First Report of a Case in a Child

A childhood case of myelodysplastic syndrome (MDS) with a deletion of the long arm of chromosome 5 (5q-) is reported. The patient was an 8 year old boy who has recurrent angina. Laboratory evaluation revealed the following: hemoglobin 8.1 gm/dl, white blood cell count 4.9 × 10³/l with 3% atypical lymphocytes, and platelet count 17.7 × 10⁴/l. A bone marrow aspirate revealed 20% blast cells and dysmyelopoietic changes involving all three marrow cell lines. Karyotype analysis of marrow cells revealed 46,XY,5q- in 100% of the metaphases.
These findings led to a diagnosis of MDS with 5q-, which is most commonly found in adult MDS. This case seems to represent an exceedingly rare childhood case of MDS with 5q-.     

Transient leukemia with extreme basophilia in a phenotypically normal infant with blast cells containing a pseudodiploid clone, 46,XY i(21)(q10)

PURPOSE: Transient leukemia and extreme basophilia occurred in a phenotypically normal newborn with expression of isochromosome (21)(q10) in the blast population. PATIENTS AND METHODS: A newborn boy was found to have an elevated white blood cell count of 120,800 with 33% blasts. The peripheral blood also contained elevated numbers of basophils and neutrophils with unusual staining properties. The blasts, evaluated by flow cytometry and light and electron microscopy, had the properties of megakaryoblasts. Cytogenetic studies revealed 46,XY karyotype in peripheral blood lymphocytes; however, analysis of the blast cells from the bone marrow showed an abnormal chromosome 21. RESULTS: The blast cells in the peripheral blood disappeared by day 42 without chemotherapy. The red blood cell count and platelet count normalized by 2 months. Chromosomal analysis of skin fibroblasts and bone marrow after the disappearance of the blast cells in the peripheral blood showed a 46,XY phenotype. CONCLUSIONS: The leukemic cell of transient leukemia has the potential of forming cells of basophil and megakaryocyte lineages. Trisomy of the q arm of chromosome 21 contains sufficient genetic information for the development of transient leukemia in a phenotypically normal newborn.     

Fatal aplastic anemia in a child with Down's syndrome

An infant with Down's syndrome developed severe persistent neutropenia at the age of 9 months and fluctuating anemia and thrombocytopenia at one year of age which terminated as full-blown aplastic anemia at 26 months of age. Immunological evaluation revealed increased peripheral and bone marrow lymphocytes and impaired blood OKT4: OKT8 ratio. Bone marrow granulocyte-macrophage colony forming cells (GM-CFC) were markedly increased, while peripheral blood mononuclear cells (PBMN) produced normal numbers of colonies. The patient's PBMN and serum were both somewhat inhibitory to normal bone marrow derived GM-CFC, suggesting the existence of a suppressor activity both in his serum and PBMN. This unusual course of aplastic anemia and the abnormalities in T-cells and hematopoiesis in Down's syndrome are discussed.     

Fatal Aplastic Anemia in a Child with Down's Syndrome

ABSTRACT. An infant with Down's syndrome developed severe persistent neutropenia at the age of 9 months and fluctuating anemia and thrombocytopenia at one year of age which terminated as full-blown aplastic anemia at 26 months of age. Immunological evaluation revealed increased peripheral and bone marrow lymphocytes and impaired blood OKT4: OKT8 ratio. Bone marrow granulocyte-macrophage colony forming cells (GM-CFC) were markedly increased, while peripheral blood mononuclear cells (PBMN) produced normal numbers of colonies. The patient's PBMN and serum were both somewhat inhibitory to normal bone marrow derived GM-CFC, suggesting the existence of a suppressor activity both in his serum and PBMN. This unusual course of aplastic anemia and the abnormalities in T-cells and hematopoiesis in Down's syndrome are discussed.     

EFFECT OF SHORT-COURSE,HIGH-DOSE STEROID THERAPY IN A CHILD WITH MYELODYSPLASTIC SYNDROME

High-dose methylprednisolone (HDMP) has been shown to induce differentiation of myeloid leukemic cells with a remarkable antileukemic effect in children with various subtypes of acute myeloblastic leukemia (AML). Here the beneficial effect of short-course HDMP therapy in a child with myelodysplastic syndrome (MDS) is reported. Oral methylprednisolone sodium succinate (Prednol-L) was administered at a single daily dose of 30 mg/kg for 5 days to a 4-year-old girl with refractory anemia with excess of blasts and hypocellular bone marrow before the initiation of chemotherapy. In addition to dramatic clinical improvement, the patient's white blood cell count increased from 2.3 &#50 10 9 /L to 5.0 &#50 10 9 /L, and peripheral blood blast cells disappeared 4 days after HDMP treatment. Repeated bone marrow aspirate 1 week after the initiation of HDMP disclosed increased cellularity with no blasts. Furthermore, short-course HDMP treatment stimulated the increase in the number of peripheral blood lymphocytes and CD3 + , CD4 + , CD8 + , CD19 + , CD34 + , and NK cells. Results obtained with HDMP from the previous studies and the present case suggest that high-dose methylprednisoloneis a promising agent in the treatment of MDS and it is recommended as an initial treatment especially for MDS children with hypocellular bone marrow at presentation.     

Congenital amegakaryocytic thrombocytopenia: an intrinsic hematopoietic stem cell defect

Serial studies of bone marrow (BM) hematopoiesis using clonogenic assays were performed in an infant with congenital amegakaryocytic thrombocytopenia. Initially, when the only hematological abnormality was isolated thrombocytopenia, the number of clonogenic BM hematopoietic progenitors was comparable to controls, including the number of megakaryocyte precursors. As the disease evolved into aplastic anemia over an 11-month period, the peripheral blood counts declined, and colony numbers from four classes of BM progenitors--termed BFU-E, CFU-GM, CFU-Mix, and CFU-Meg--also declined in parallel. When added to the marrow cultures, patient's plasma was not inhibitory to either control or to patient's BM colony growth. Similarly, no cellular inhibition of hematopoiesis was observed when patient's BM was cultured after depleting the sample of T lymphocytes and after adding the T lymphocytes back. Furthermore, stromal cells established from short-term and long-term cultures of patient's BM showed normal proliferative activity and yielded a "fertile" marrow microenvironment for patient's and control BM colony growth. Our data suggest that the central problem in congenital amegakaryocytic thrombocytopenia is an intrinsic hematopoietic stem cell defect, rather than an abnormality of the marrow milieu. The findings are consistent with either a progressive, quantitative attrition of progenitors or their inability to proliferate into colonies in vitro and into differentiated, functional cells in vivo.     

亲体肝移植术后并发噬血细胞综合征的治疗

目的 总结儿童重型肝炎行儿童亲体肝移植术后并发噬血细胞综合征的治疗经验.方法 1例6岁女孩,因不明原因急性进行性黄疸、腹水及全身出血等住院,经化验、彩色多普勒、螺旋CT等确诊为亚急性重型肝炎,于2008年2月26日施行亲体肝移植术,供肝为患儿父亲的左外叶.术后3 d开始出现全血象进行性下降,13 d降至最低,血清铁蛋白升高,EB病毒DNA阳性,骨髓细胞学检查发现噬血细胞,确诊为儿童亲体肝移植术后EB病毒相关性噬血细胞综合征,用环孢素A、地塞米松和静脉注射丙种球蛋白等治疗,并进入层流病房,加强抗感染治疗.结果 术后患儿肝功能恢复顺利,各种酶学指标术后3d各种开始下降,7d接近正常,14d完全正常.术后20 d全血象开始逐渐上升,40 d升至正常水平,准予出院随访,至今无复发,情况良好.结论 儿童亲体肝移植手术后出现不明原因的全血象下降时应想到并发噬血细胞综合征的可能,早期诊断,及时正确的治疗能使患儿顺利康复.     

Agranulocytosis following infectious mononucleosis

A girl developed acute agranulocytosis (45/mm³), 37 days after the onset of infectious mononucleosis. The bone marrow showed myeloid hyperplasia with maturation arrest and erythroid hypoplasia. A normal amount of colony forming units of granulocytes and macrophages (CFU-GM) colonies with a relative high number of clusters was observed. Neither anti-neutrophil antibodies nor circulating inhibitors of colony growth were found in serum. Granulocyte and macrophage colony stimulating factor (GM-CSF) activity in the patient's serum rose at this time. The agranulocytosis lasted 5 days and her clinical state soon improved. These results suggested that agranulocytosis was presumably not due to serum factors, including auto-antibodies and/or suppressive substances, and that Epstein-Barr virus (EBV) had some direct or indirect effect on the marrow cells of the myeloid series.     

Clinical and in vitro antiproliferative properties of recombinant DNA-derived human interferon-alpha 2

The properties of the recombinant DNA-derived human leukocyte interferon, HuIFN alpha 2, were studied in patients with advanced leukemia or lymphoma. In vitro, HuIFN alpha 2 induced an increased activity of 2-5A synthetase in leukemic and in control cells indicating cellular responsiveness to IFN. HuIFN alpha 2 also produced a dose-responsive decline in marrow leukemia blast progenitor colony growth, and in normal hematopoietic colony formation in vitro, confirming its antiproliferative effect. A course of intravenous therapy given to a lymphoma patient produced a modest decline in peripheral white blood cell (WBC) and neutrophil counts; higher, more frequent doses in a second patient induced a profound drop in WBC's, neutrophils, and platelets. When the leukemia patients were given an intravenous course of HuIFN alpha 2 as a sole agent, blast cytoreduction was seen in peripheral blood in three patients, and in marrow of one patient with acute myeloblastic leukemia (AML). Elevated 2-5A synthetase levels could be detected after therapy. No modulation of leukemic cell markers was seen after in vitro or in vivo treatment with HuIFN alpha 2, implying that the cytoreduction was not linked to blast cell differentiation. These studies suggest that this subtype of recombinant DNA-derived IFN has antileukemic properties, and indicates the possibilities for IFN as an adjunctive form of therapy in leukemia.     

Pancytopenia in propionic acidemia: hematologic evaluation and studies of hematopoiesis in vitro

This study investigated the hematologic abnormalities of an infant with propionic acidemia and reversible pancytopenia. Light and electron microscopy of her bone marrow revealed severely disturbed cellular morphology with trilineage dysmyelopoiesis, hemophagocytosis, and numerous multinucleated histiocytes and megakaryocytes. The effects of her serum and of organic acids associated with propionic acidemia were studied on hematopoiesis in vitro. Mouse erythroid (CFU-E) and granulocyte-monocyte colonies (CFU-GM) were assayed by fibrin clot technique; human CFU-GM were grown in agar culture. The infant's serum reduced mouse CFU-E and CFU-GM by 43 and 32%, respectively, compared with normal human sera, but had no effect on human CFU-GM in our culture system. Buffered propionic acid caused concentration-dependent inhibition of mouse CFU-E and human CFU-GM over a range reported in sera of acutely ill infants with propionic acidemia. Neither cell viability nor subsequent colony formation was diminished by preincubation of bone marrow cells with propionic acid for 48 h. The three other organic acids studied, tiglic acid, 3-OH propionate, and glycine, did not inhibit growth of mouse CFU-E, CFU-GM, or human CFU-GM, and glycine significantly enhanced formation of the latter. Evaluation of the infant's hematologic abnormalities suggests that inhibition of bone marrow proliferation and maturation and, perhaps, shortened red blood cell survival were responsible for her pancytopenia. The studies performed in vitro implicate propionic acid in this hematopoietic dysfunction.     

Transient blastemia in phenotypically normal newborns

Two normal appearing infants presented in the newborn period with elevated white blood cell counts and immature blast cells. Initial bone marrow karyotype analysis showed trisomy of chromosome 21 in all metaphases. In both patients blastemia spontaneously resolved and percentage of trisomy 21 cells decreased. One infant required multiple exchange transfusions and pericardiotomy. The other patient had undifferentiated blasts and continued to have subtle hematopoietic abnormalities greater than 2 years later. Both children have had normal growth and development. The clinical course of these patients emphasizes the need for aggressive supportive care without use of cytotoxic drugs in phenotypically normal newborns with blastemia showing trisomy 21.     

更昔洛韦和黄芪对巨细胞病毒感染所致造血祖细胞增殖抑制的影响

目的　探讨更昔洛韦 (GCV)和黄芪对巨细胞病毒 (CMV)感染所致脐血粒 巨噬系祖细胞 (CFU GM)、红系早、晚期祖细胞 (CFU E、BFU E)、多向造血祖细胞 (CFU Mix)及巨核系祖细胞(CFU Mk)体外增殖抑制的影响。方法　采用造血祖细胞培养技术 ,培养、观察、计数巨细胞病毒AD169株 (CMV AD169)感染CFU GM、CFU E、BFU E、CFU Mix和CFU Mk后各祖细胞集落、峰期及维持时间 ;用聚合酶链反应 (PCR)检测集落细胞内CMV DNA ;根据细胞毒性实验结果 ,将GCV和黄芪作用于CMV感染的CFU GM、CFU E、BFU E、CFU Mix及CFU Mk祖细胞 ,再分别计数集落、峰期及维持时间。结果 ( 1)CMV感染组CFU GM、CFU E、BFU E、CFU Mix及CFU Mk集落数较对照组明显减少 (P <0 0 1) ;集落维持时间CMV感染组较对照组明显缩短 ;( 2 )用PCR在感染组集落细胞内检测到CMV DNA的存在 ;( 3)黄芪和 (或 )GCV作用于CMV感染的祖细胞后 ,与病毒组比较集落维持时间明显延长 ,集落数和集落增殖率明显提高 (P <0 0 1) ,黄芪组集落增殖率分别为 2 7 2 %、4 5 2 %、4 9 1%、39 0 %、11 9% ;GCV组分别为 37 4 %、74 2 %、71 7%、6 7 4 %、38 9% ;GCV 黄芪组分别为 5 3 6 %、83 8%、88 7%、87 8%、6 1 5 %。结论　CMV AD169在体外能明显抑制CFU GM、CFU E、BFU     

Lack of correlation between blast cell size and length of first remission in acute lymphocytic leukemia in childhood.

The bone marrow from 55 children with acute lymphocytic leukemia diagnosed from April 1969 to June 1973 were evaluated for blast cell morphology and size. Sixteen marrows contained a predominance of macrolymphoblasts (greater than 12 mu), while the remainder contained mainly microlymphoblasts. There was no correlation between blast cell size and the known front-end prognostic indicators of age and initial white blood count, nor could blast cell size be used to predict the length of initial bone marrow remission.     

Lack of correlation between blast cell size and length of first remission in acute lymphocytic leukemia in childhood

The bone marrow from 55 children with acute lymphocytic leukemia diagnosed from April 1969 to June 1973 were evaluated for blast cell morphology and size. Sixteen marrows contained a predominance of macrolymphoblasts (> 12 μ), while the remainder contained mainly microlymphoblasts. There was no correlation between blast cell size and the known front-end prognostic indicators of age and initial white blood count, nor could blast cell size be used to predict the length of initial bone marrow remission.     

An unusual case of T-cell lymphoproliferative disorder.

A 54-year-old woman with epigastric pain had leukocytosis of 73,000/microliter consisting mainly of atypical lymphoid cells with convoluted and cleaved nuclei resembling Sézary cells; the bone marrow aspirate was nondiagnostic. Skin biopsy was unremarkable. The patient also had hypercalcemia and hemolysis with a positive direct Coombs' test, both of short duration. The arterial oxygen tension was decreased, but there was no demonstrable lung pathology. The patient subsequently developed rapidly enlarging lymphadenopathy. Lymph node biopsy was interpreted as "undifferentiated pleomorphic lymphoma." Immunologic functional studies revealed that the majority of the peripheral blood atypical lymphoid cells from involved lymph nodes formed rosettes with sheep erythrocytes. The lymphadenopathy regressed transiently after the administration of chemotherapy and the white blood cell count decreased from a maximum of 385,000/microliter to 3,500/microleter, at which point the arterial oxygen tension returned to normal. The unusual features of this patient are discussed in light of the known characteristics of the various types of T-cell lymphorpoliferative disorders.     

Cell membrane fluidity in blast cells of children with acute leukaemia

Plasma membrane fluidity has been investigated by determining steady-state fluorescence polarization (FP) of the apolar stain 1,6-diphenyl-1,3,5,-hexatriene in intact blast cells, separated from peripheral blood and bone marrow of children with various types of acute leukaemia. FP-values of blast cells taken before antileukaemic therapy were compared with FP-values of peripheral blood and bone marrow mononuclear cells separated from patients in complete remission as well as from control patients and from healthy volunteers. Moreover, fluorescence polarization measurements were also performed using blast cells of leukaemic patients on short-term single-drug prednisolone pretreatment. The results have shown that untreated blast cells have significantly lower FP-values than normal mononuclear cells of peripheral blood or bone marrow. No compartment difference has been observed within blast cells, while normal mononuclear cells from peripheral blood have significantly higher FP-values than bone marrow cells. FP-values of cells separated in remission or during prednisolone treatment do not differ from control values.     

Effects of recombinant thrombopoietin on the growth of murine primitive and committed hematopoietic progenitors in serum-free culture

BACKGROUND: The aim of the present study was to determine the effect of thrombopoietin (Tpo) in combination with other cytokines on the growth of murine megakaryocytic, granulocyte-macrophage, erythroid and primitive hematopoietic progenitor cells, excluding possibilities of synergistic effects by serum factor(s). METHODS: Serum-free clonogenic assay systems were used for assay of colony forming units in megakaryocytes (CFU-Mk), colony forming units in granulocytes-macrophages (CFU-GM), burst-forming units in erythrocytes (BFU-E) in marrow of normal mice and of high proliferative potential colony forming cells in 5-fluorouracil-treated marrow. RESULTS: Serum-free culture enabled megakaryocyte colony growth by recombinant murine (rm) Tpo and this was synergistically supported with rm interleukin (IL)-3, rm stem cell factor (SCF) or recombinant human (rh) erythropoietin (Epo). Recombinant human IL-6, rhIL-11 and rm granulocyte-macrophage colony stimulating factor (GM-CSF) showed synergistic effects with rmTpo only in the presence of serum. Recombinant murine IL-3 or rmSCF increased the large colonies and mixed-type colonies containing other populations, suggesting that these cytokines promoted the proliferation of immature populations of CFU-Mk. The rmTpo enhanced the growth of granulocyte-macrophage (GM) colonies stimulated by rmGM-CSF or rmIL-3 and erythroid bursts by rhEpo, with or without rmIL-3. The rmTpo also significantly increased HPP colonies in synergy with rmIL-3 only in the presence of serum or rmSCF. CONCLUSION: Serum-free culture is valuable for evaluating synergistic effects of cytokines and Tpo acts not only on megakaryocytic progenitors but also on granulocyte-macrophage, erythroid and primitive progenitor cells in combination with other cytokines, such as rmIL-3 and rmSCF. However, serum or SCF was required for enhancement of the colony growth of primitive progenitors by Tpo.