Low plasma cell 3(H) thymidine incorporation in monoclonal gammopathy of undetermined significance (MGUS), smouldering myeloma and remission phase myeloma: a reliable indicator of patients not requiring therapy.

The kinetics of bone marrow plasma cells were evaluated by means of in vitro 3(H)thymidine incorporation in 143 patients with monoclonal gammopathies. Fifty-three patients had symptomatic multiple myeloma (MM) at diagnosis, nine were in stable remission, six in unstable remission, and 16 in the relapse phase. Thirty-seven patients were classified has having monoclonal gammopathy of undetermined significance (MGUS) and 22 as smouldering myeloma (SM). A thymidine labelling index (LI%) of greater than 3 at initial diagnosis predicted a very short survival. High LI% values (median 2.8 +/- 1.1) were also seen at relapse. However, the major new finding was that the LI% could be used to discriminate precisely between the SM-MGUS group and the MM patients including stage I disease (P less than 0.0001). Only one patient developed MM during follow up, that being 8 months after the initial diagnosis of SM. During the unmaintained stable remission (plateau) phase a low proliferative activity was also observed (LI% = 0.6 +/- 0.2). Thus the LI% was extremely useful in identification of both poor risk groups with a LI% greater than 3 and stable patients requiring no immediate therapy with a LI% less than 1. The ability to discriminate between MGUS and SM and stage I MM should prove particularly useful clinically.

Differences in the in vitro growth pattern of fresh and cryopreserved granulo-monopoietic precursors.

A study of the in vitro growth model of human granulo-monopoietic precursors (CFU-GM) before and after cryopreservation using both leukocyte feeder layers and GCT conditioned medium as the source of colony stimulating activity (CSA) is reported. The number of colonies produced with fresh cells was linearly related to the amount of marrow seeded with both CSA sources, whereas after cryopreservation this was true with feeder layers, and with GCT only at relatively high cell concentrations. This might indicate the production of granulopoietic stimulators on the part of a second population that is at least partly resistant to freezing. It seems more likely, however, that these results depend mainly on a sublethal damage to CFU-GM induced by freezing, thus making the cells hyporesponsive to some forms of CSA, such as those contained in GCT conditioned medium.

[Current clinical use of radioisotopes in the study of platelet kinetics]. / Attualità sull'utilizzazione clinica delle indagini radioisotopiche nello studio della cinetica piastrinica.

Radioisotopic study of platelet kinetics can provide a preliminary orientation in the diagnosis of thrombocytopenia. A study of the platelet kinetics in thrombocytopenic and normal subjects using the Cr51 isologous platelet labelling technique and subsequent in vivo injection of the labelled platelets was conducted. The results obtained confirm the reliability and usefulness of the technique. The identification of the limitations involved and the recognition of their significance in processing data allows the hematologist and the general practitioner to allow the right amount of room for the study of platelet kinetics in the diagnosis of thrombocytopenia.

[Critical considerations on the present approach to Hodgkin's disease]. / Considerazioni critiche sull'attuale approccio alla malattia di Hodgkin.

The report attempts to show why therapeutic success in the treatment of Hodgkin's disease levelled off at the start of the Eighties. The prospects of future treatment based on more accurate interpretation of clinical and histopathological data, further cytological and immunological research as well as improved therapeutic techniques more carefully adapted to the variety of prognoses are also discussed.

[Clinical and radiological considerations on a case of acquired idiopathic agammaglobulinemia]. / Considerazioni cliniche e radiologiche in un caso di agammaglobulinemia idiopatica acquisita.

A case of acquired idiopathic agammaglobulinaemia in a 23-yr-old woman is presented. The picture included frequent and recurrent lung, sinus and mastoid infections, and diarrhoea. The pathogenesis, radiological picture, and differential diagnosis of this immunological disorder are described.