Studies on the effect of various kinds of cytostatic therapy on the cellular immune reaction in children with acute lymphatic leukemia]

Clinical and experimental findings on possible changes of the lymphocyte function during an immunosuppressive or cytostatic therapy respectively caused investigations to be made for explaining the connections existing between the influence of cellular immunoreaction and the use of different cytostatic regimes. Earlier findings on the influence of cellular immunoreaction after adding cytostatics to cultivated cells and investigations on the influence of the lymphocyte function in dependence on cytostatic therapy were used for comparison. Transformation and mitosis rates as well as necrosis rates and the result of macrophage migration inhibition are comparable parameters for influencing the lymphocyte function in children treated with cytostatics. Antimetabolites, vincristine, asparaginase and daunomycin will have less influence on the transformation rate as an expression of an immunosuppressive effect on only those cells responding in accordance with their kinetic phase. Cyclophosphamide will inhibit the transformation reaction more significantly. Examinations in children with different therapeutic regimes reveal a certain validity of therapy after the first statistical evaluation of the clinical material.     

Effect of immunotherapy on lymphocyte function in acute lymphatic leukemia]

During the immunotherapy children suffered from acute leukaemias will have a significantly higher transformation rate than at the beginning of the immunotherapy. This may be explained by an increase of the immunological competence as well as by an enhanced mobilization of lymphatic cells. Leukaemic blasts used for immunoinduction-therapy will have no higher transformation rates as antigens than those cells never contacted by children. During the immunotherapy an increase of transformation rates may be observed after administering unspecific antigens and in mixed cultures. In a retrospective manner the indication for immunotherapy may be checked again in children with immunotherapy on the basis of the clinical course and evaluation of the cellular immunoreaction.     

Clinical and cytological differences in adult acute lymphatic and acute undifferentiated leukemia]

The usefulness for clinical purposes of the distinction of acute undifferentiated (AUL) and acute lymphocytic leukemia (ALL) is suggested by the following observations: 1. Maturation from AUL to ALL has not been observed. Transformation of ALL to AUL has been reported i.e. less of cytoplasmic polysaccharides; however this seems rather to be the effect of cytotoxic therapy and not a real change of the cytological type. 2. Significant differences among ALL and AUL can be noted as far as the therapeutic response is concerned: All of the 9 patients with ALL but only 2 out of 9 patients with AUL went into remission. The mean survival of the cases with ALL amounts to 34, that of AUL only to 4 months. Out of the patients with ALL 4 patients are still alive in persistant first remission after 77, 57, 36 and 28 months. 3. ALL occurs most frequently in young adults (mean age of 21 patients: 31.7 years): AUL is more frequent in elderly patients (Mean age of 18 patients: 57.6 years). 4. In our material ALL did never occur consequent to a typical preluekemic stage, which was followed either by myeloblastic, monocytic, erythroleukemic or undifferentiated leukemias.     

Thrombocytopenia after autologous bone marrow transplantation in in acute lymphatic leukemia]

There is reported about the treatment of refractory thrombocytopenia in a 9 years old boy following the autologous bone marrow transplantation for acute lymphoblastic leukaemia. The megakaryocytes were found diminished in the bone marrow smears. Controls of the thrombocyte count and the kinetics with radioactively labeled platelets of a donor spoke in favour of immunothrombocytopenia. Threatening bleeding complications challenged the use of all treatment possibilities. The irradiation of the spleen was without any success. After the splenectomy the thrombocyte count increased slowly, but after a remarkable lag phase, however. A diminished reproduction capacity of the bone marrow graft for special cell sorts has to be taken into account in such cases. The usual cytodynamics after splenectomy cannot be expected at all.     

Comparison of the cytomorphological classification with the cytochemical differentiation of acute lymphatic leukemia in children]

In 100 children with acute lymphatic leukaemia the cytomorphological subclassification of the pathological cell type was made according to Mathé and the French-American-British Co-operative group (FAB). In addition, all cases of leukaemia were differentiated according to their cytochemical type. Lymphoblasts from 10 cases of leukaemia could be subclassified immunologically. From 71 children will ALL the survival rates of those cases of leukaemia subclassified cytomorphologically and the cytochemical reactions were compiled and partially compared. Microlymphoblastic leukaemia could be found to be the most frequent type of ALL at children's age. Prolymphocytic leukaemias were characterized by a favourable survival rate and the highest percentage of ALL with the PAS type. Macrolymphoblastic and microlymphoblastic cases of leukaemia revealed no essential differences of survival rate, but significant differences of cytochemical reactions.     

Pericarditis in the course of acute leukemia

Among 140 patients with acute leukemia (AL) diagnosed according to FAB criteria, pericarditis was diagnosed clinically in 5 of them. They were 2 women and 3 men with different types of AL (L2-in one, M2-in one, M3-in one and M4-in two persons). It occurred in one patient at the onset of the disease and was associated with hyperuricemia, in another one--in complete remission, in the third--during partial remission, and in remaining two patients--during induction therapy. In all patients pericarditis was manifested by fever up to 38-40 degrees C, tachycardia and pericardial friction, in 3-heart silhouettes were enlarged. The ECG revealed mainly depression of ST segments. In 1 case only ECG pattern was typical of pericarditis. Clinically the symptoms of right ventricle failure predominated in 3 and of septic shock--in 2 patients. The etiologic factors were: Pseudomonas aeruginosa 2 X, Enterobacter cloacae 1 X, tuberculosis infection 1 X and hyperuricemia and Enterobacter sepsis 1 X. Pericarditis was favourably influenced by treatment with antibiotics, cardiaca and diuretics in 4 patients. One patient died of a sepsis. In no case the patient's death was attributable to pericarditis. The results of postmortem examinations in 79 cases of AL has revealed three additional cases of pericarditis due to tuberculosis infection, Staphylococcus aureus sepsis and aspergillosis.     

Leukemic chromosome clone. I. Risk factor in the acute lymphatic leukemia of children]

As long as the aetiology of acute lymphatic leukaemia of children is not known its therapy is based on clinical experience. Among the values of experience those factors will play a part, the evidence of which during the ALL initial stage will be a risk for successful therapy and survival rate. This results in a choice of more aggressive variants of modern therapy schemes. In a cytogenetic study made in 35 children with ALL it was tested, whether even leukaemic chromosome clones will be a risk for the course of acute leukaemia. The duration of the first remission and survival rate were considered as criteria. The evidence of a leukaemic chromosome clone could be shown to be followed by a short survival rate, irrespective of the stage of the disease where the clone had been observed first. Thus, cytostatic therapy in those ALL patients who are affected with luekaemic chromosome aberration of stem line character should be aimed at the complete annihilation of the clone, irrespective of other remission criteria. The failure of blood and bone-marrow cultures as early as during the untreated initial stage indicated a primary cellular immuno-insufficiency. This combination of cell immuno-depression with high peripheral leukocytes connts and a primary mediastinal tumour or a generalizing lymphosarcoma respectively, was the highest risk up till now for the course of the disease. Judging from the duration of the first remission and the survival rates, the consecutive schemes of therapy did not differ in their effect on leukaemia with pathological stem lines. On the basis of the present study the impression could not be excluded that up till now long term survival rates could be attributed rather to individual manners of response than to the modern therapy scheme.     

Study of circulating immune complexes in three hematologic diseases: Acute myeloid leukemia,acute lymphatic leukemia,and hematosarcoma

Summary Circulating immune complexes (CIC) were detected by means of the polyethylen glycol (PEG) precipitation method, in the serum of untreated patients with hematologic diseases including acute myeloid leukemia (AML), acute lymphatic leukemia (ALL) and hematosarcoma (HS). Immunoglobulins (Ig) and the C ₄ fraction of complement were quantitated in the precipitate dissociated by potassium cyanate (KCNO) and in the serum. When compared to control sera, the results showed a simultaneous increase of both precipitate and Ig component. The proportion of each Ig in the precipitate was stable for the controls but variable for the patients. On the whole precipitated proteins, 30% were systematically quantitated in patients and controls. In the remaining portion were noticed Clq and C ₃ fractions of complement as well as haptoglobin and albumin. The nature of the antigen was discussed.     

MLC-activation by acute lymphatic leukemia blasts.

The MLC-activating potential of 25 ALL blasts (16 "common" ALL, 6 T-ALL, 3 not identified) was investigated. Mitomycin-treated leukemic blasts or X-irradiated lymphocytes were cultured with heparinized whole blood from different healthy donors. MLC activation by blast cells was expressed as percentage of MLC activation by X-irradiated lymphocytes. Leukemic blasts showed a heterogeneous pattern of MLC activation, ranging from 2% to 245%. Eleven out of 25 cases of ALL poorly stimulated the MLC (2% to 33% response). Twelve ALL stimulated a normal response (50% to 120%); and 2/25 ALL stimulated a supranormal response (more than 200%). Four of six cases of T-ALL stimulated the MLC as efficiently as irradiated lymphocytes, 2/6 were among the poor stimulators. Most poor stimulator blasts had, however, normal MLC-activating properties if, instead of whole blood, isolated lymphocytes were used as the responding cells. The poor activation of lymphocytes by some leukemic blasts in whole blood appeared to be associated with impaired release of blastogenic factor(s) during the MLBC. No evidence for active suppressor mechanisms was found. The significance of the MLC-activating properties of leukemic blasts for the classification and immunotherapeutic use of ALL is discussed.     

Indices of the cellular reactions of the immune process in acute stress and its thymopentin correction]

The correlative analysis has determined the peculiarities of the integration of immune cells reactions under the acute stress. They are characterized by an increase in the role of polymorphonuclear leucocytes closely associated with blood superoxide dismutase activity. Thymopentin exerts an adaptive effect on the morphofunctional parameters of immune and antioxidant systems.     

Prognostic value of the reaction to steroids in the treatment of acute lymphoblastic leukemia in children]

Relationship between the result of therapy in 48 cases of the acute lymphoblastic leukemia in childhood and character of response to corticosteroids, classified according to BMF group, has been assessed. Follow up period ranged from 13 to 75 months (mean 36 months, median 39 months). In was found, that the probability of survival free from any events, probability of complete remission persistence, and probability of survival after diagnosis have been statistically significantly higher in the group of patients with positive response to corticosteroids in comparison with patients non-responding to these agents. However, there was no significant difference in the number of recurrencies with the involvement of CNS. Authors share the opinion that their results confirm an opinion of Riehm et al. that the response to corticosteroids is of prognostic value in the acute lymphoblastic leukemia in childhood.     

Interferon therapy in acute lymphatic leukemia and hepatitis B in childhood

1. The use of interferon in hepatitis B will bring about a favourable course of the disease, which is reflected in a normalisation of liver function tests. 2. The concentration of surface antigens is distinctly reduced, with a lower titre remaining for a longer period of time. 3. The level of the dosage chosen seems to be optimal. However, treatment has to be continued for a period of several months, probably for about 1 year. 4. In childhood the side-effects of interferon are minimal, they are restricted to febrile reactions. 5. In our investigations no sure hematological deviations could be identified in the treatment with interferon. 6. The study must be complemented by analysing further antigens, such as E antigen, allowing the course of disease to be characterised more distinctly. 7. In order to give a final assessment of the therapy the observation of patients must be continued after terminating the treatment, the histological improvement in the further course having to be confirmed by liver biopsies.     

The simultaneous occurrence of chronic lymphatic leukemia with malignant tumors and the lymphatic reaction caused by malignant growths

In 352 patients affected with chronic lymphatic leukemia (CLL) the authors simultaneously detected a solid second tumour 22 times (= 6.22%) (6 cancers of the prostrate, 5 cancers of the skin, 4 cancers of the uterus, 2 cancers of the stomach, 2 cancers of the lung, one case of rectal and mamma cancer each and one case of eye sarcoma). In one third of the cases the two malignomas were simultaneously detected, thus it was excluded that the second tumour was induced by the antimitotic treatment of the primary disease. In seven cases the solid tumour was identified after diagnosing CLL, without any cytostatic therapy having been made here before. In addition, a report is given on a patient showing symptoms of gastric cancer not radically removed and a lymphocytic reaction. Initially, the case was explained as gastric adenocancer with simultaneous CLL because even 5 years after surgical treatment there were 16-20 X 10(6)/l of leukocytes with 64% of lymphocytes in the peripheral blood and 85% of lympho-reticular cells in the bone marrow. Two years later, however, the blood picture was normal and remained to be unchanged further on. Thus, it seems that the healing of the gastric cancer has caused the lymphocytic reaction to have ceased. In addition, it should be noted that in 1974 the patient suffered from an epithelium after a scratch-mark on the nose tip, which was irradiated, however, without eliciting any lymphocytic reaction. The patient is still alive (June 1985).     

Calreticulin exposure on malignant blasts predicts a cellular anticancer immune response in patients with acute myeloid leukemia

Experiments performed in mice revealed that anthracyclines stimulate immunogenic cell death that is characterized by the pre-apoptotic exposure of calreticulin (CRT) on the surface of dying tumor cells. Here, we determined whether CRT exposure at the cell surface (ecto-CRT) occurs in human cancer in response to anthracyclines in vivo, focusing on acute myeloid leukemia (AML), which is currently treated with a combination of aracytine and anthracyclines. Most of the patients benefit from the induction chemotherapy but relapse within 1–12 months. In this study, we investigated ecto-CRT expression on malignant blasts before and after induction chemotherapy. We observed that leukemic cells from some patients exhibited ecto-CRT regardless of chemotherapy and that this parameter was not modulated by in vivo chemotherapy. Ecto-CRT correlated with the presence of phosphorylated eIF2α within the blasts, in line with the possibility that CRT exposure results from an endoplasmic reticulum stress response. Importantly, high levels of ecto-CRT on malignant myeloblasts positively correlated with the ability of autologous T cells to secrete interferon-γ on stimulation with blast-derived dendritic cell. We conclude that the presence of ecto-CRT on leukemia cells facilitates cellular anticancer immune responses in AML patients.