Karyotype analysis during development of chronic myelocytic leukemia

We report cytogenetic data concerning 9 patients with chronica granulocytic leukemia and eosinophilia at the onset and during the chronic phase of the disease before the blastic crisis. The cariotype analises in the intermediate phases allowed to determine the first changes which could be involved in the evolutionary events of the disease up to the moment in which the typical markers of the blastic crisis can be found.     

Identification of a melanoma antigen, PRAME, as a BCR/ABL-inducible gene

In order to elucidate molecular events in BCR/ABL-induced transformation, we adopted a polymerase chain reaction (PCR)-based technique of differential display and compared mRNA expression in human factor-dependent cells, TF-1, with that in factor-independent cells, ID-1, which were established from TF-1 cells by transfection of BCR/ABL. Cloning and sequencing of a gene which was upregulated in ID-1 cells revealed that the gene was identical to a melanoma antigen, PRAME. Our present study demonstrated that PRAME was markedly expressed in primary leukemic cells with chronic myeloid leukemia (CML) in blastic crisis and Philadelphia (Ph)+-acute lymphoblastic leukemia (ALL), in which BCR/ABL played an important role as a pathogenic gene. Moreover, comparison of PRAME expression among CD34+ cells with CML in blastic, accelerated, and chronic phases revealed a higher expression in CML in advanced phases. Thus PRAME was considered to be a good candidate for a marker of Ph+-leukemic blast cells as well as a new target antigen of leukemic blast cells that cytotoxic T cells can recognize.     

Detection of B-cell antigen on the blast cells in chronic myeloid leukemia]

The presence of the common antigen on B lymphocytes of healthy donors and myeloblasts of patients with chronic myeloid leukemia in blastic crisis was observed with antimyeloblastic serum in the indirect surface immunofluorescence test. The cytotoxic test showed this antigen in the blastic cells in 27 out of 57 patients with CML BC, in 3 of 11 patients with acute lymphoid leukemia, in 1 of 8 patients with chronic lymphoid leukemia and in 2 of 2 patients with undifferentiated leukemia. The antigen was not found in the peripheral blood cells of healthy donors.     

Non-blastic meningeal leukemia during the myelofibrotic phase of chronic myeloid leukemia

Myeloblastic involvement of the central nervous system has been noted in the course of chronic myeloid leukemia in the blastic phase; meningeal leukemia in the chronic phase of CML is almost unknown. We report on a case of CML in which meningeal infiltration by cells of the granulocytes series in all stage of cellular maturation developed 15 years after initial diagnosis and seven months after a myelofibrotic transformation of the systemic disease.     

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.     

A new case of chronic myelogenous leukemia with 14q+ marker and review of the literature

We report a new case of Ph 1 positive chronic myelogenous leukemia (CML) with 14q+ marker shown during chronic phase (CP) and subsequently in blastic crisis (BC). After a review of the literature, we discuss the biological significance of 14q+ marker in developing lymphoid cellular differentiation, during evolution of CML, that remains still unclear. Besides, we also discuss the prognostic value of this change, concluding that a larger number of cases may clarify this question, as also the unresponsivity to chemotherapy of the patient studies so far, may not be related to 14q+ marker.     

Modulation of chronic lymphocytic leukemia cells by phorbol ester: increase in Ia expression, IgM secretion and MLR stimulatory capacity

When cultured with 12-O-tetradecanoylphorbol 13-acetate (TPA) at a concentration of 1.6 X 10(-7) M, chronic lymphocytic leukemia (CLL) cells differentiated into mature cells of B lineage and increased their expression of surface Ia antigens when compared with cells cultured in the absence of TPA. Concurrently, TPA enhanced the ability of CLL cells to stimulate in a mixed lymphocyte reaction (MLR). The events induced in vitro by TPA that are characteristic of B cell maturation included morphologic changes, reduction in surface immunoglobulin (Ig), appearance of cytoplasmic Ig, and secretion of IgM. The increase in Ia expression and the enhanced capacity to stimulate in an MLR after incubation with TPA might also be associated with maturation of the CLL cells. The changes induced in vitro by TPA in neoplastic B cells provide new information concerning the terminal events in normal B cell differentiation.     

Single cilium in human leukemic cells heterotransplanted into hamsters

Single cilium formation was studied in two human hematopoietic cell lines, KCL-22 and MT-2, KCL-22, established from a patient with chronic myelogenous leukemia in blastic crisis, and MT-2, a human cord T cell line carrying human T-lymphotropic virus type I, were transplanted into hamsters. Ciliogenesis was observed in both cell lines, only after transplantation into hamsters.     

ATM-dependent DNA damage-response pathway as a determinant in chronic myelogenous leukemia

Chronic myelogenous leukemia (CML) begins with an indolent chronic phase, and subsequently progresses to an accelerated or blastic phase. Although several genes are known to be involved in the progression to blastic phase, molecular mechanisms for the evolution toward blast crisis have not been fully identified. Oncogenic stimuli enforce cell proliferation, which requires DNA replication. Unscheduled DNA replication enforced by oncogenic stimuli leads to double strand breaks on DNA. We found the DNA damage-response pathway is activated in bone marrow of chronic-phase CML patients possibly due to an enforced proliferation signal by BCR-ABL expression. Since ataxia telangiectasia mutated (ATM) is a central player of the DNA damage-response pathway, we studied whether loss of this pathway accelerates blast crisis. We crossed Atm-knockout mice with BCR-ABL transgenic mice to test this hypothesis. Interestingly, the loss of one of the Atm alleles was shown to be enough for the acceleration of the blast crisis, which is supported by the finding of increased genomic instability as assayed by breakage–fusion–bridge (BFB) cycle formation. In light of these findings, the DNA damage-response pathway plays a vital role for determination of susceptibility to blast crisis in CML.     

Chromosome abnormalities associated with Phl and acturial survivorship curve in chronic myeloid leukemia. Probabilistic interpretation of blastic transformation of CML

Sixty-six patients with chronic myelogenous leukemia, all with Philadelphia chromosome, have been studied for chromosomic abnormalities associated (CAA) to Ph', as well as for actuarial curve of survivorship. Patients dying from another disease were excluded from this study. Frequency of cells with CAA was measured and appeared strongly higher after blastic transformation than during myelocytic state; probability to be a blastic transformation is closely correlated with this frequency. On the other hand, actuarial curve of survivorship is very well represented by an exponential curve. This suggests a constant rate of death during disease evolution, for these patients without intercurrent disease. As a mean survivance after blastic transformation is very shorter than myelocytic duration, a constant rate of blastic transformation could be advanced: it explains possible occurrence of transformation as soon as preclinic state of a chronic myelogenous leukemia. Even if CAA frequency increases after blastic transformation, CAA can occur a long time before it and do not explain it: submicroscopic origin should be searched for the constant rate of blastic transformation would express the risk of a genic transformation at a constant rate during myelocytic state.     

Correlations between the clinical course,characteristics of blast cells,and karyotype patterns in chronic myeloid leukemia

Summary Results of chromosome studies of blood and bone marrow cells from 101 patients with Ph¹ positive chronic myeloid leukemia (CML) confirm the assumption that clinical and morphologic manifestations of the disease correlate with karyotype peculiarities of leukemic cells. Several variants of the clinical course of CML may be distinguished. One is the variant with a short chronic phase and a comparatively long terminal phase. In blastic crisis the blast cells are peroxidase negative and do not possess cytoplasmic inclusions. Acute transformation occurs without any additional chromosome damage. The second, more common form is less severe because of longer chronic phase but it has a short and grave acute stage. The blast cells present definite signs of myeloid differentiation, they have basophilic or neutrophilic cytoplasmic granules and are peroxidase positive. Marker i(17q) often combined with trisomy 8 is a characteristic chromosome abnormality in the terminal stage of this variant. The third type has an extremely long chronic phase but ends in a rapidly progressing severe and resistant to therapy lymphoid blastic crisis. Blast cells have typical lymphoid morphology, they are peroxidase negative and contain granular PAS positive substance. Various additional chromosome changes appear in the terminal stage. Future studies of a larger series of patients may possibly reveal more CML variants.     

Cytoenzymochemical changes in acute leukemia cells under cytostatic treatment

Cytomorphologic and cytoenzymochemical changes occurring in leukemic blastic cells of bone marrow and peripheral blood were studied concomitantly in 180 cases of acute leukemia treated with one or more cytostatics, in various association related to the main cytologic type. Cellular effects due to monochemotherapy in various types of acute leukemia varied depending on the cytostatic dose, duration of treatment, and sensitivity of blastic cells to the cytostat. The expression of cellular sensitivity was marked by megaloblastosis of myeloid elements, cell gigantism and intranuclear and cytoplasmic vacuolization. Resistance to cytostatics was demonstrated both by the morphologic aspect of blastic cells which remained unchanged and by their overloading with glycogen, lipids and peroxidases. The relationships between posttherapeutic cellular changes and clinical parameters are discussed.     

Adhesion-mediated self-renewal abilities of Ph+ blastoma cells

The Philadelphia chromosome-positive blastoma, maintained by serial subcutaneous transplantation in nude mice, is a highly proliferating biological mass consisting of homogenous CD34⁺CD38⁻ myeloblastoid cells. These cells newly evolved from pluripotent leukemia stem cells of chronic myeloid leukemia in the chronic phase. Therefore, this mass may provide a unique tool for better understanding cellular and molecular mechanisms of self-renewal of leukemia stem cells. In this paper, we demonstrated that intravenously injected blastoma cells can cause Ph+ blastic leukemia with multiple invasive foci in NOD/SCID mice but not in nude mice. In addition, using an in vitro culture system, we clearly showed that blastoma cell adhesion to OP9 stromal cells accelerates blastoma cell proliferation that is associated with up-regulation of BMI1 gene expression; increased levels of β-catenin and the Notch1 intra-cellular domain; and changed the expression pattern of variant CD44 forms, which are constitutively expressed in these blastoma cells. These findings strongly suggest that adhesion of leukemic stem cells to stromal cells via CD44 might be indispensable for their cellular defense against attack by immune cells and for maintenance of their self-renewal ability.     

Cytochemical data in chronic monocytic leukemia]

4 cases of chronic monocytic leukemia were observed during several years. In 2 patients there was a final appearance of blastic crisis. During the course of the disease the activity of the naphthylacetate-esterase in the monocytes increased, but the PAS-reaction was lowered. By the help of two cases for comparison - one patient suffering from a chronic myeloid leukemia and intermediate monocytic phase, the other one from a panmyelopathia and monocytic reaction - the morphological resemblance of these phenomena is demonstrated, which cytochemically cannot be separated.     

Hypercalcemia associated with osteolytic lesions in the extramedullary blastic crisis of chronic myelogenous leukemia: report of a case

A 43-year-old male patient with hypercalcemia and osteolytic lesions complicating chronic myelogenous leukemia is presented. Extramedullary myeloid blastic crisis was diagnosed by the histological finding of the specimen biopsied from a osteolytic lesion in the right femur. As the serum levels of parathyroid hormone, 1,25 (OH)2 vitamin D, prostaglandin E2 and interleukin 1, and the urinary excretion of cyclic AMP were all normal, it was considered that the hypercalcemia was attributed to the bone destruction by the invasion of leukemic myeloblasts.     

Antileukemic Activity of Sulforaphane in Primary Blasts from Patients Affected by Myelo- and Lympho-Proliferative Disorders and in Hypoxic Conditions

Sulforaphane is a dietary isothiocyanate found in cruciferous vegetables showing antileukemic activity. With the purpose of extending the potential clinical impact of sulforaphane in the oncological field, we investigated the antileukemic effect of sulforaphane on blasts from patients affected by different types of leukemia and, taking into account the intrinsically hypoxic nature of bone marrow, on a leukemia cell line (REH) maintained in hypoxic conditions. In particular, we tested sulforaphane on patients with chronic lymphocytic leukemia, acute myeloid leukemia, T-cell acute lymphoblastic leukemia, B-cell acute lymphoblastic leukemia, and blastic NK cell leukemia. Sulforaphane caused a dose-dependent induction of apoptosis in blasts from patients diagnosed with acute lymphoblastic or myeloid leukemia. Moreover, it was able to cause apoptosis and to inhibit proliferation in hypoxic conditions on REH cells. As to its cytotoxic mechanism, we found that sulforaphane creates an oxidative cellular environment that induces DNA damage and Bax and p53 gene activation, which in turn helps trigger apoptosis. On the whole, our results raise hopes that sulforaphane might set the stage for a novel therapeutic principle complementing our growing armature against malignancies and advocate the exploration of sulforaphane in a broader population of leukemic patients.     

Clinical implications and utility of field cancerization

Cancer begins with multiple cumulative epigenetic and genetic alterations that sequencially transform a cell, or a group of cells in a particular organ. The early genetic events might lead to clonal expansion of pre-neoplastic daughter cells in a particular tumor field. Subsequent genomic changes in some of these cells drive them towards the malignant phenotype. These transformed cells are diagnosed histopathologically as cancers owing to changes in cell morphology. Conceivably, a population of daughter cells with early genetic changes (without histopathology) remain in the organ, demonstrating the concept of field cancerization. With present technological advancement, including laser capture microdisection and high-throughput genomic technologies, carefully designed studies using appropriate control tissue will enable identification of important molecular signatures in these genetically transformed but histologically normal cells. Such tumor-specific biomarkers should have excellent clinical utility. This review examines the concept of field cancerization in several cancers and its possible utility in four areas of oncology; risk assessment, early cancer detection, monitoring of tumor progression and definition of tumor margins.