Polyerga,a biological response modifier enhancing T-lymphocyte-dependent responses

Cancer patients are often treated with biological response modifiers to enhance immunological functions. However, little is known about the actual mechanism of action of many of these substances. Therefore, we were interested in the effect of i.p. treatment with porcine low-molecular-weight spleen peptides, which are used during supportive cancer therapy, on lymphoid cell populations and function in mice. After treatment with 0.5 μg peptides/kg body weight for 14 consecutive days, lymphokine secretion and the generation of cytotoxic T-cells were significantly enhanced as compared with controls. However, there was no effect on the number of cells or the percentage of cells expressing functional surface markers in secondary lymphoid organs.     

Transformation of a myelodysplastic to a myeloproliferative syndrome (chronic granulocytic leukemia)

A report is presented of the course of a case of the myelodysplastic syndrome which transformed after 16 months into Philadelphia chromosome-negative chronic granulocytic leukaemia. Such a transformation into the myeloproliferative syndrome is considered to be a rare event and some views on the mechanism of this metamorphosis are discussed.     

Therapy-related myelodysplastic syndrome and acute myeloid leukemia in patients with chronic lymphocytic leukemia treated with fludarabine and cyclophosphamide

We retrospectively studied four cases of t-MDS/AML among 210 (1.9%) consecutive patients with CLL treated at a single center with fludarabine and cyclophosphamide (FC) either as the first- or second-line therapy. The median follow-up of the whole cohort of patients was 46 months (range: 7-60). Two of these patients (2/130, 1.7%) had been treated with FC only, and two more (2/80, 2.3%) with CHOP and CHOP + FND, respectively, prior to FC. The median age was 61.5 years (range: 49-71); three were male. They developed t-MDS/AML after a median latency period of 41 months (range: 7-56) from the FC completion. Chromosomal aberrations with an adverse prognostic impact were present in the karyotype of all four patients, including abnormalities of chromosome 5 in three of them, and a rare chromosomal translocation in one patient. Median survival after t-MDS/AML diagnosis was 4 months (range: 2-8). Although the agents administered prior to FC make it difficult to assess the risk of t-MDS/AML attributable to FC, this report might be a valuable addition to the literature.     

Competitive action of a biological response modifier, PSK, on a humoral immunosuppressive factor produced in tumor-bearing hosts

We investigated the effect of PSK, a protein-bound polysaccharide obtained from the basidiomycetes Coriolus versicolor, on an immunosuppressive factor produced in tumor-bearing animals. Oral administration of PSK suppressed the growth of the tumor in C3H/He mice bearing X5563 plasmacytoma or MH134 hepatoma, but affected mice bearing MM102 mammary tumor little. PSK prevented the reduction in splenic lymphocyte blastogenesis caused by phytohemagglutinin that occurs in mice bearing X5563 tumors or MH134 hepatoma. The lymphocyte blastogenesis affected little by tumor or PSK in mice bearing MM102 tumors. The effect of sera on the blastogenesis of lymphocytes caused by phytohemagglutinin was different with different tumors in the C3H/He mice. Serum of mice bearing X5563 tumors inhibited blastogenesis, but serum of mice bearing MH134 hepatoma or MM102 tumors promoted it. The sera of mice bearing MH134 hepatoma contained both inhibitory and promotive factors; those of mice bearing X5563 tumors contained an inhibitory factor, and those of mice bearing MM102 tumors contained a promotive factor. The oral administration of PSK reduced the inhibition caused by the sera of mice bearing X5563 tumors. The promotive activity of sera from mice bearing MH134 hepatoma was augmented by PSK; that of sera in mice bearing MM102 tumors was not affected by PSK. Living Bacillus Calmette-Guérin did not have such effects in any of these mice. Serum immunosuppressive activity was also reduced by PSK in various tumor lines of rodents. These results suggest that PSK acts by reducing the activity of immunosuppressive factors produced in tumor-bearing hosts.     

Mini-transplant for acute myeloblastic leukemia and myelodysplastic syndrome

The application of allogeneic hematopoietic stem cell transplantation (HSCT) has been limited to younger patients without organ dysfunctions due to transplant-related toxicities. Recently, non-myeloablative stem cell transplantation(NST) or reduced-intensity stem cell transplantation(RIST) has been developed as a less toxic HSCT, which enables the application of HSCT to patients of advanced age or with organ dysfunction by the use of mild conditioning regimen. The anti-leukemia effect mainly depends on the graft-versus-leukemia (GVL) effect. Several studies showed promising results of NST/RIST for acute myeloblastic leukemia(AML) and myelodysplastic syndrome(MDS). However, this novel treatment is still very toxic compared to conventional chemotherapy. We should continue clinical trials of NST/RIST to evaluate its efficacy and toxicity in patients with AML/MDS.     

Bestatin treatment of myelodysplastic syndromes and chronic myelogenous leukemia

A high remission rate (56%) was achieved in a preliminary study using Bestatin in patients with myelodysplastic syndromes. In particular, 9 out of 13 patients (69%) in the high blast group achieved hematologic remission. After Bestatin treatment, intrinsic hematopoietic stem cell abnormalities as well as hematologic findings were markedly improved. The success of Bestatin therapy in MDS led us to investigate the clinical activity of Bestatin in CML. In the current study the busulfan and Bestatin combination therapy resulted in complete hematologic remission in all of the patients. The most exciting result was the suppression of the Philadelphia chromosomes among the responding patients. Complete cytogenetic response was obtained in 3 patients (21%), partial cytogenetic response in 1 (7%), and minor cytogenetic response in 5 (36%). In particular, the majority of early chronic phase CML patients achieved significant cytogenetic response with sustained Ph1 negativity. The results are very encouraging and warrant further studies.     

多参数流式细胞术在慢性粒单核细胞白血病、骨髓增生异常综合症及急性单核细胞白血病免疫表型鉴别中的应用及其意义

本研究应用多参数流式细胞术分析慢性粒单核细胞白血病(CMML),骨髓增生异常综合症(DMS)以及急性单核细胞白血病(AML-M5b)的免疫表型特点,探究其在诊断及鉴别诊断上述疾病中的意义和价值。应用多参数流式细胞术比较分析14例CMML患者、48例MDS患者、46例AML-M5b患者及18例正常人骨髓标本的免疫分型特点。结果表明,CMML患者单核细胞比例明显高于MDS、AML-M5b患者及正常人骨髓(P<0.05),后3者之间无显著差别。MDS患者骨髓原始细胞比例明显高于正常骨髓标本(P<0.05),但与CMML患者无明显差别。AML-M5b患者骨髓成熟粒细胞比例较CMML、MDS患者及正常骨髓标本明显减低(P<0.05)。MDS、AML-M5b及CMML患者骨髓CD45/SSC特点与正常骨髓标本均存在一定差异。CMML患者骨髓具有CD2、CD56异常表达及CD14拖尾现象,与MDS、AML-M5b及正常骨髓标本相比差异显著(P<0.05)。MDS与CMML患者骨髓单核细胞CD15表达缺失或减低现象较正常骨髓标本及AML-M 5b患者显著,且CMML患者异常率高于MDS患者(P<0.05),两者粒细胞群均有显著CD13/CD11b/CD16表达规律异常现象,但两者间无显著差异。其他抗原表达呈不同程度异常,无统计学差异。结论 MDS、CMML及AML-M5b骨髓细胞免疫表型均具有各自的特点及不同程度的相似处。多参数流式细胞术综合分析其免疫表型,对于区分CMML、MDS以及AML-M5b具有重要鉴别意义。其中单核细胞比例增高,伴有CD2、CD56异常表达,CD14拖尾现象,CD15缺失或减低及成熟粒细胞CD13-CD11b-CD16表达规律异常,对CMML诊断具有重要意义。     

Red blood cell alloimmunization in transfused patients with myelodysplastic syndrome or chronic myelomonocytic leukemia

BACKGROUND: Red blood cell (RBC) alloimmunization is a major problem in chronically transfused patients because of the risk of hemolytic reactions and limited availability of compatible blood. This study was aimed at determining the characteristics of RBC alloimmunization in transfusion‐dependent patients with myelodysplastic syndrome or chronic myelomonocytic leukemia (MDS/CMML). STUDY DESIGN AND METHODS: The transfusion and clinical records of all patients with MDS/CMML seen at our hospital from 1990 to 2009 were reviewed. The cumulative incidence of RBC alloimmunization was calculated by taking death as a competing risk. Incidence rates were compared by Poisson multivariate regression. RESULTS: A total of 272 patients were included. Median age was 74 years; 55% were men and had received a median of 33 (range, 4‐421) RBC units. Forty‐two (15%) patients formed 81 alloantibodies and seven autoantibodies. Three additional patients developed autoantibodies without alloantibodies. The incidence rate of RBC alloimmunization was 1 per 10.5 person‐years and was independent of sex, age, and MDS diagnostic category. The cumulative incidence of alloimmunization increased with the number of RBC transfusions, reaching a plateau at 19.5% after 130 RBC units. The most common antibody specificities were Kell (26 cases), E (19), c (5), and Jk^a (5). In 26 (62%) of the 42 alloimmunized patients, only the Rh system and Kell were involved. CONCLUSION: RBC alloimmunization occurs in 15% of MDS/CMML patients on chronic transfusion support and mostly involves the Rh system and Kell. Transfusing these patients with extended antigen‐matched blood, including Kell and CcEe antigens, would presumably reduce the RBC immunization rate.     

A new high-throughput screening method for the detection of chronic lymphatic leukemia and myelodysplastic syndrome.

BACKGROUND: The VCS technology of Beckman Coulter differentiates white blood cells based on measures of their volume, conductivity and light scatter. The current study investigated the predictive value of index measures, known as research population data, for the detection of chronic lymphatic leukemia and myelodysplastic syndrome. METHODS: Blood cell counts were performed in samples from 44 patients with chronic lymphatic leukemia, 19 patients with myelodysplastic syndrome and 199 healthy blood donors using the Beckman Coulter LH750. Means and standard deviations of volume, conductivity and scatter of lymphocytes and neutrophils were evaluated as predictors for both diseases. Their specificity and selectivity were evaluated by logistic regression and receiver operating characteristic curve analysis. RESULTS: Research population data were significantly different among groups. For chronic lymphatic leukemia, standard deviations of lymphocytes scatter and volume showed most relevant differences in comparison to healthy blood donors (sensitivity 88.6%, specificity 84.4%). For myelodysplastic syndrome, standard deviations of neutrophils conductivity were most predictive (sensitivity 73.7%, specificity 93.0%). Areas under corresponding receiver operating characteristic curves were 0.941 and 0.951, respectively. CONCLUSIONS: Based on their high predictive value, research population data could be routinely used to screen for chronic lymphatic leukemia and myelodysplastic syndrome.     

急性髓系白血病及骨髓增生异常综合征的研究进展

美国第55届血液学年会于2013年12月7～10日在路易斯安那州新奥尔良市召开.根据继续教育资料,对有关急性髓系白血病基因组变化及预后,高危急性髓系白血病的治疗,骨髓增生异常综合征临床预后积分系统及治疗等一些问题做一简介.     

急性白血病、骨髓增生异常综合征诊断中若干问题的探讨

目的　探讨急性白血病、骨髓增生异常综合征(MDS)诊断中存在的问题。方法　按全国通用标准对急性非淋巴细胞性白血病、MDS及非血液系统疾病3组的骨髓片作粒、红、巨核三系细胞病态造血的观察。结果　发现各系病态造血的比率在急性非淋组为粒系>红系>巨核系,在 MDS组为红系>粒系>巨核系,对照组的少数病例也有病态造血表现,按 FAB标准诊断的 MDS,再用国内标准进行分型,23.3%的病例提高了一个分型级别。结论　认为原粒+早幼粒不能代替 I型原粒+Ⅱ型原粒,原始细胞增多是最具诊断价值的病态造血表现,单独计数原始细胞在本系统所占的比例优于按有核红细胞计数原始细胞比例,嗜碱性点彩和嗜多色性红细胞对 MDS诊断意义不大。本文还提出MDS诊断的最低标准问题、红血病的存在问题,希望引起深入的讨论。     

骨髓增生异常综合征和急性髓系白血病的基因突变比较

骨髓增生异常综合征(MDS)是一种起源于造血干细胞的异质性恶性克隆性疾病,以造血功能衰竭、病态造血、高风险向急性髓系白血病(AML)转化为特点.约30％的MDS会转化为AML,24％的患者死于白血病转化[1].MDS主要突变靶点是与DNA甲基化、染色质修饰、RNA剪接、转录因子、信号转导、黏连蛋白和DNA修复有关的基因...     

骨髓增生异常综合征和急性白血病患者骨髓巨核细胞质与量变化的探讨

本文对124例MDS和136例AL患者的骨髓象巨核细胞计数及形态改变观察结果进行了分析。结果表明，MDS巨核细胞以增多组为主，巨核细胞质的改变与预后有关，易发展成AL，而且多数为粒／单核细胞系统受累．ANLL巨核细胞质与量的异常明显高于ALL。初发时巨核细胞计数增高及出现病态变化者缓解率低，预后不良。     

Restoration of immune responsiveness by a biological response modifier, PSK, in aged mice bearing syngeneic transplantable tumor

PSK (Krestin) is a protein-bound polysaccharide isolated from cultured mycelia of Coriolus versicolor in basidiomycetes. PSK is a biological response modifier which possesses unique characteristics. We investigated the effects of PSK on the immune response of aged C57BL/6 mice bearing a syngeneic transplantable tumor adenocarcinoma 755. (a) In C57BL/6 mice, the delayed foot pad reaction against sheep erythrocytes and resistance to syngeneic tumor challenge reached a peak when the mice were at 30 weeks of age, and decreased at 50-60 weeks of age. The serum of normal mice exerts a modifying effect on blastogenesis of lymphocytes to phytohemagglutinin. The positive effect reached a peak at 30 weeks of age, and thereafter declined with age. (b) When adenocarcinoma 755 was inoculated to C57BL/6 mice at 10-, 30- and 60-weeks of age, immune responses were depressed in 10-week-old and 60-week-old mice. PSK prevented such depression. However, in 30-week-old mice, tumor-induced suppression was slight, and administration of PSK to them increased proportion of mice which did not develop a tumor. (c) In 60-week-old tumor-bearing mice, the antitumor effects was increased with a combination of PSK and adoptive transfer of spleen cells from 10-week-old normal mice. The immune responses of mice, which change with the progress of age, are depressed by tumor burden. The administration of PSK to aged mice is effective to restore immune responses from tumor-induced suppression.     

骨髓增生异常综合征转为急性嗜酸粒细胞白血病1例并文献复习

目的观察急性嗜酸粒细胞白血病(AEL)的形态特征、遗传特征、免疫表型及分子标记特征以提高对AEL的认识。方法对我院收治的1例难治性血细胞减少伴多系发育异常(MDS-RCMD)转为AEL患者的病历资料进行回顾性总结并复习相关文献。结果该例MDS-RCMD患者12个月后转为AEL;骨髓原始细胞占10.4%,嗜酸粒细胞占70.8%,其中嗜酸性早、中、晚幼粒细胞占69.6%;外周血嗜酸粒细胞占13.5%;骨髓原始细胞伴有复杂染色体异常、CD34、CD117、HLD-DR、CD33、CD38、CD13等阳性表达;FI1L1/PDGFRα和ETV6/PDGFRα融合基因阴性。按AML治疗2个月后患者死亡。结论该例AEL患者FI1L1/PDGFRα和ETV6/PDGFRα基因重排阴性,伊马替尼治疗无效。     

WT1基因在骨髓增生异常综合征中的表达及其与疾病进展的关系

目的 :观察 WT1基因在骨髓增生异常综合征 (MDS)不同亚型中的表达程度 ,探讨 WT1基因在MDS进展为急性白血病 (AL)进程中的表达规律。方法 :应用逆转录聚合酶链反应 (RT PCR)对 49例不同类型的 MDS患者外周血 WT1基因 (4种剪接变体 )表达情况进行测定。同时检测 66例 AL 患者〔其中包括由MDS转变而来的急性白血病 (post MDS AL)患者 8例〕及 16例健康对照者 WT1基因的表达。结果 :49例MDS患者 WT1阳性表达率为 2 2 .4% (11/4 9) ;难治性贫血 (RA) 13例 ,WT1阳性率为 0 (0 /13 ) ;原始细胞增多性难治性贫血 (RAEB) 2 4例 ,WT1阳性率为 2 5 .0 % (6/2 4) ;转化型原始细胞增多性难治性贫血 (RAEB t)12例 ,WT1阳性率为 41.7% (5 /12 )。 RA与 RAEB和 RAEB t比较差异有显著及非常显著性 (P<0 .0 5和P<0 .0 1)。 AL患者 66例 ,WT1阳性率为 48.5 % (3 2 /66) ,与 MDS组比较差异有非常显著性 (P<0 .0 1)。 postMDS AL 8例 ,WT1阳性率为 5 0 .0 % (4 /8)。 16例正常健康对照者 WT1阳性率为 0 (0 /16)。结论 :WT1基因在 MDS中呈较高表达 ;WT1基因在 MDS的 RAEB、RAEB t中表达率较高 ,在 RA中表达率较低。RT PCR方法灵敏度高 ,特异性强 ,可作为监测 MDS疾病进程及向 AL演变的可靠检测方法     

第二代测序技术及其在急性髓系白血病和骨髓增生异常综合征中的运用

第2代测序技术（next-generation sequencing,NGS）悄然取代经典的Sanger测序技术,成为科研人员发掘人类肿瘤疾病遗传学秘密的最实用、最可靠的方法。随着技术的不断更新及完善,进行全基因组测序不再遥不可及。近年来,部分科学家将此项技术运用于血液系统恶性肿瘤的研究,积极推动急性髓系白血病、骨髓增生异常综合征的全基因组测序的进程,期待从源头上找出部分血液系统恶性肿瘤的致病机理。本文就第2代测序技术及全基因组测序、外显子基因组测序和转录基因组测序在急性髓系白血病、骨髓增生异常综合征两种疾病中的运用进行综述。     

Enhancement of effector cell activities in mice bearing syngeneic plasmacytoma X5563 by a biological response modifier, PSK.

We investigated the effect of PSK, a protein-bound polysaccharide obtained from Coriolus versicolor of basidiomycetes, on antitumor immunity in tumor-bearing mice. PSK prolonged significantly the life span of C3H/He mice bearing syngeneic plasmacytoma X5563 in a schedule- and dose-dependent manner. PSK was most effective when administered at 100 mg/kg every other day ten times starting from the day after tumor inoculation. The administration of PSK enhanced significantly the cytostatic activity of peritoneal exudate plastic-adherent cells and the cytolytic activity of spleen cells after in vitro incubation with mitomycin C-treated tumor cells. In addition, PSK restored the cytokine-producing capacity of spleen cells suppressed in tumor-bearing mice after in vitro incubation with mitogen. Sera from tumor-bearing mice suppressed the activity of such effector cells as well as the interleukin 2-producing capacity of spleen cells, but sera from PSK-treated tumor-bearing mice prevented this suppression. These results suggest that PSK enhances antitumor immunity by reducing immunosuppressive activity of serum from tumor-bearing mice.