Buffy coat autografts for patients with chronic granulocytic leukaemia in transformation

We have treated 20 patients with chronic granulocytic leukaemia (CGL) in transformation with cytotoxic drugs or with cytotoxic drugs and whole-body irradiation followed by transfusion of autologous blood cells collected at diagnosis and stored in liquid nitrogen. The mean number of nucleated cells autografted was 25.1 X 10(8)/kg (range: 12.5-40.1). Full myeloid engraftment occurred in 18 patients; it was partial in one patient and unassessable in another. The median survival for the 20 patients post-graft was 14 weeks. Two patients are alive, one now in recurrent transformation, and one in second chronic phase that has lasted 52 weeks. For the 18 patients who died the mean survival was 24 weeks (range: 2-125). Two patients with predominantly myelosclerotic transformation showed evidence of engraftment. One patient successfully autografted developed features consistent with graft-versus-host disease which proved fatal. We conclude that autografting may offer substantial palliation for some but not all patients with CGL in transformation.     

Cryopreserved peripheral blood cells functioning as autografts in patients with chronic granulocytic leukaemia in transformation.

Six patients with chronic granulocytic leukaemia (CGL) in transformation were treated with cytotoxic drugs or cytotoxic drugs plus total body irradiation, followed by infusion of reconstituted autologous peripheral blood cells that had been collected from them at diagnosis and stored in liquid nitrogen for up to 58 months. In four cases the blood and bone-marrow appearances were rapidly restored to those of typical chronic-phase disease. In three of these patients transformation recurred at 74, 32, and 26 weeks respectively. One patient was still in second chronic phase at eight weeks. One of the patients who entered a second transformation was restored to a third chronic phase by further treatment with cytotoxic drugs and a second autograft. Cryopreserved autologous blood cells may thus restore some patients with CGL in transformation to chronic-phase disease and so may help to prolong life.     

Lymphoblastic lymphoma in a female with chronic granulocytic leukaemia

In a 18 years old, Ph1 negative woman a lymphoblastic lymphoma developed after 16 months of treatment for juvenile form of CGL. In the course of the disease we observed twice the myeloblastic transformation and once the low differentiated transformation of CGL. Based on available methods we are not in a position to exclude a particular form of lymphoblastic transformation of CGL involving lymph nodes without leukaemic blood picture.     

Molecular biology of Philadelphia chromosome in chronic granulocytic leukaemia and acute lymphoblastic leukaemia

In classical t(9;22) translocation, as observed in chronic granulocytic leukemia (CGL), a hybrid DNA unit is produced, including a rearranged PHL gene, previously known as bcr (breakpoint cluster region) plus the translocated c-abl gene from chromosome 9: a hybrid bcr-abl protein, p210 is formed, with increased tyrosine kinase activity. Such DNA rearrangement, with a p210 protein synthesis, is also found in cases of Philadelphia-positive acute lymphoblastic leukemia (ALL), but in apparently similar cases the bcr gene is not rearranged, and a novel p190 abl-related protein can be found; c-abl rearrangement has also been observed.It is thus established that correlations between cytogenetic and molecular events can be found in CGL and ALL, as in other haemopoietic malignancies: translocation and possible rearrangement of the c-abl oncogene seem of particular importance in this case.     

Structural rearrangements associated with the Ph1 chromosome in chronic granulocytic leukaemia

Summary Four cases of C.G.L. in which banding of the Ph¹ chromosome was performed were found to have variation from the usual 9/22 translocation pattern. All 4 cases showed a rearrangement involving at least 3 chromosomes, 2 of which were a 9 and a 22. One of these cases had in addition an XYY karyotype in the bone marrow.     

Diagnostic and prognostic value of the terminal deoxynucleotidyl transferase (TdT) activity in treating the blastic phase (bp) of chronic granulocytic leukaemia (CGL)

The blastic cell phenotypes of 26 cases of CGL in blastic phase were estimated and the patients were treated with different schemes. The following methods of typisation of the blast cells were used: cytochemical stainings (POX, Sudan B, PAS, nonspecific esterase), estimation of TdT activity, and in 11 patients the testing with monoclonal antibodies of VI series. Using these methods 10 patients (38%) with lymphoid form of the blastic phase, 11 (43%) with the myeloid type and 5 patients (19%) with undifferentiated type were diagnosed. In the group of lymphoblastic type a longer survival time and complete remissions were observed. High TdT activity in blastic cells did correspond with favourable response to Vincristin and Prednison. The introduction of TdT assessment into the diagnosis of CGL allows the cells to be classified more precisely, thus helping in defining the prognosis and in the choice of treatment programme.     

Quantitative cytochemistry of blood neutrophils in myelodysplastic syndromes and chronic granulocytic leukaemia

Quantitative cytochemistry of components of blood neutrophil azurophilic granules (myeloperoxidase, chloroacetate esterase, beta-glucuronidase, and acid phosphatase) and specific granules (lactoferrin) has been performed by scanning and integrating microdensitometry in 13 patients with a myelodysplastic syndrome and 11 patients with chronic granulocytic leukaemia. Both patient groups showed a reduction of enzyme activity in azurophilic granules, and also of lactoferrin, consistent with abnormal development of neutrophil granules. These cytochemical changes in blood neutrophils are similar to those found in acute myeloid leukaemia, are consistent with a leukaemic maturation defect, and may be of diagnostic value.     

Elevation of an acid ribonuclease in serum of patients with chronic granulocytic leukaemia.

Ribonuclease (Ribonucleate nucleotide 2'-transferase E.C. 2.7.7.17) activity in serum of patients with chronic granulocytic leukaemia measured at pH 4.5-6.0 amounts to more than three times of that in serum of healthy subjects. At pH 6.0-8.0 the elevation of ribonuclease activity in serum of patients with chronic granulocytic leukaemia is less pronounced and amounts to about two times of that in normal ones. Using chromatography on CM Sephadex C-50 column, serum ribonuclease of both normal and chronic granulocytic leukaemia patients was separated into five distinct fractions. In serum of healthy subjects ribonuclease fractions denoted I-V contribute to 10; 21; 29; 22, and 18 percent of the total ribonuclease activity. In the serum of patients with chronic granulocytic leukaemia a decrease in ribonuclease fraction III to merely 17 percent and an increase in contribution of fraction IV to 32 percent of total ribonuclease activity could be observed. The comparison of each individual concentration of fraction in normal and leukaemia patients serum reveals, that ribonuclease fraction IV will increase about 3 times. A less pronounced increase could also be found for fractions I, II and V. However, ribonuclease fraction IV may be supposed to carry more than 50 percent of the whole extra load of ribonuclease present in the serum of chronic granulocytic leukaemia patients.     

Chronic monocytic leukemia terminating in blastic transformation

Chronic monocytic leukemia (CMoL) is a rare disorder, closely related to malignant histiocytosis, but a separate entity. The clinical course of the patient described in this case report was characterized by persistent monocytosis without response to cytotoxic therapy, and a large number of infections. On two occasions a clone of cells containing an extra chromosome 20 was observed. The disease terminated in a phase with rapidly increasing numbers of immature monocytoid cells, corresponding to blastic transformation.     

Cytochemical study of acute promyelocytic leukaemia.

Five cases of acute promyelocytic leukaemia (A.P.L.) are investigated for peroxidase, PAS, toluidine blue, astra blue, alpha-naphthyl esterase, double esterase incubation (naphthol-AS plus naphthol-AS-D chloroesterase), and cellular lysozyme activity. These cytochemical investigations may contribute further characterization of the morphologic type.     

Econometric analysis of phase duration for blood morphology and basophil count alterations in chronic granulocytic leukaemia

The retrospective analysis of 40 cases with chronic granulocytic leukemia revealed an average survival time of 39 months. Modal proportions between the chronic, accelerated and acute blastic crisis amounted to 25:6:8 months. The characteristic points and curves for peripheral white cell, blast cell, basophil cell and thrombocyte counts as well as haemoglobin levels were determined separately in 20 patients with long and in 20 with short survival time. Comparisons indicate among others that Busulphan sensitivity is an essential factor for a longer survival time of CGL patients.