Incidence, clinical markers and prognostic significance of immunologic subtypes of acute lymphoblastic leukemia (ALL) in children: experiences of the ALL-BFM 83 and 86 studies

In the therapy studies ALL-BFM 83 and 86, immunophenotyping of ALL by monoclonal antibodies was performed in a total of 1162 protocol patients (ALL-BFM 83 n = 578; ALL-BFM 86 n = 584). Both studies yielded similar results with respect to the incidence of immunological subtypes: CD10-negative pre-pre-B ALL (ALL-BFM 83: 3.6%; ALL-BFM 86: 5.3%), common ALL (80.1%; 77.9%), B-ALL (1.9%; 2.8%), pre-T/T-ALL (13.9%; 13.5%). Leukemic cells of 3 patients in the ALL-BFM 83 study lacked lymphoid and myeloid antigens (acute unclassifiable leukemia, 0.5%), and 3 patients in the ALL-BFM 86 study exhibited different blast populations with expression of either myeloid or lymphoid features (acute mixed-lineage leukemia, 0.5%). Coexpression of myeloid antigens (CD13 and/or CD33 and/or CDw65) on lymphoblasts (My-positive ALL) was identified in 35 of the 570 (6.1%) protocol patients prospectively analyzed in the ALL-BFM 86 study. The following associations were observed between the immunological subtype and the clinical risk factors: median age (years)-pre-pre-B 3.0, common 4.3, B- 7.9, pre-T/T-ALL 8.5 (pre-pre-B, common vs. pre-T/T-ALL p = 0.05); median leukocyte counts (x 10(9)/l)-pre-pre-B 80, common 9.1, B- 12.3, pre-T/T-ALL 68.1 (common, B- vs. pre-pre-B, pre-T/T-ALL p less than 0.05). The prognostic relevance of the immunophenotype was evaluated on the basis of the therapeutic results obtained in the ALL-BFM 83 study. A significant difference in the remission rate was only recognizable between patients with common ALL (99.1%) and those with pre-T/T-ALL (93.7%, p less than 0.001). After a median follow-up of 54 months, the probability of event-free survival is 71% for pre-pre-B ALL, 67% for common ALL, 56% for pre-T/T-ALL and 27% for B-ALL (common vs. B-, pre-T/T-ALL p less than 0.001), the prognosis in patients with pre-pre-B and common ALL being markedly influenced by the initial leukocyte counts and the age.     

Acromioclavicular dislocations treated by coracoacromial ligament transfer

Summary Forty-seven patients with acute Allman type-III acromioclavicular dislocations were treated with open reduction and coracoacromial ligament transfer. At follow-up 1.6–10 years (mean 6) postoperatively 44 patients (94%) had excellent or good functional results. Two of the three patients with unsatisfactory results had degenerative joint changes. No late dislocation was found but there were three subluxations (3–5 mm). Two of the three patients with subluxation in the acromioclavicular joint at follow-up had unsatisfactory results. Complications were infrequent and cosmetic results satisfactory.     

Ueber die Resorption verdauter Nährstoffe (Eiweisskörper und Fette) im Dünndarm

Ohne ZusammenfassungHierzu Taf. IX. Fig. I–V.     

Ueber die Morphiumwirkung

Ohne Zusammenfassung     

Über Myatonia congenita (Oppenheim)

Ohne ZusammenfassungMeinem hochverehrten Chef, Herrn Professor Dr. H. Oppenheim, bin ich für die Anregung zu der Arbeit und die gütige überlassung des Materials zu grossem Danke verpflichtet.