Consolidation therapy without maintenance for acute non-lymphoblastic leukaemia.

The most effective therapy to prolong remission and to increase cure rates in patients with acute non-lymphoblastic leukaemia is uncertain, and approaches vary from one course of consolidation to two years of maintenance and intensification therapy. We report the results of brief intensive therapy with daunorubicin, cytosine arabinoside and thioguanine, and no maintenance therapy, in 72 patients with a minimum follow-up period of two years. The complete remission rate was 67%, the median duration of remission was 11 months, and 23% of patients whose leukaemias went into remission, have remained in remission for three years and longer. These results are equivalent to those that have been reported with long-term chemotherapy.

Cancer of the breast and beta 2 microglobulin.

In carcinoma of the breast the disease stage at diagnosis determines therapy and is closely related to prognosis. To date no single biochemical marker of disseminated breast cancer has been described although beta 2 microglobulin values in the serum have been suggested as a discriminant between localized and systemic disease. Using a new method of beta 2 microglobulin estimation, we carried out a prospective study of levels in 53 patients with breast cancer who were studied repetitively over a 2 yr period. No relationship could be determined between beta 2 microglobulin values and the stage of the disease. Moreover beta 2 microglobulin levels, even when elevated, did not predict early metastasis. Repeated beta 2 microglobulin estimations during treatment of metastatic disease had limited usefulness in that patients with responsive disease usually showed a fall in beta 2 microglobulin, whereas there was generally no change in non-responsive patients. These changes were, however, often within the normal range and seemed to offer a marginal improvement in assessment.

Changes in serum ferritin levels after intravenous iron.

The effect of intravenous iron dextran on serum ferritin levels was observed in two patients with iron deficiency anaemia. Serum ferritin levels rose sharply and reached peak levels seven to nine days after infusion when at least 90% of the infused iron had been removed from the plasma. A linear relation was shown for each patient between the logarithm of the serum ferritin levels and the logarithm of the calculated cellular non-haem iron levels.

The relationship of hookworm infection, anaemia and iron status in a Papua New Guinea highland population and the response to treatment with iron and mebendazole.

In 345 apparently healthy Papua New Guinea male subjects, predominantly highlanders, 89% of whom were infected with hookworm (Necator americanus), there was a statistically significant inverse correlation of hookworm egg count with haemoglobin and serum ferritin level, but no significant correlation with serum albumin, folate or B12 values. A sub-group of 128 was chosen for a six-month study on the effect of treatment with the anthelmintic mebendazole and/or parenteral iron on haemoglobin and serum ferritin levels. Mebendazole-treated subjects remained worm-free and the hookworm egg counts of the controls decreased during the study period. Parenteral iron treatment had the expected effect of raising haemoglobin to a normal level. There was a statistically significant improvement in haemoglobin level in all treated groups but not in the control. Serum ferritin levels decreased significantly in all groups, but more in the control than in the treated groups, although treatment groups were not significantly different. Although probable inadequate uptake of iron by the subjects and blood donation by some subjects was apparently more detrimental to iron status than hookworm infection, the results of this study support the view that hookworm infection in this country contributes to lowered haemoglobin levels and iron status.

Some haematological and physical characteristics of a group of Papua New Guinea highlanders.

Full blood counts and some serum biochemistry were carried out on 349 male and 22 female apparently healthy Papua New Guinea subjects, most of whom were highlanders. In males, RBC, Hb, PCV, MCH, MCHC, serum albumin, ferritin, iron, per cent transferrin saturation and folate means were significantly lower than the Australian normal means; WBC and MCV means were similar to Australian values; and eosinophil and reticulocyte counts and serum transferrin and vitamin B12 means were higher than Australian means. In females, WBC, RBC, Hb, PCV, MCV, MHC, MCHC and serum ferritin means were lower than Australian means; eosinophil counts, serum iron, per cent transferrin saturation, and folate means were similar to Australian means; and serum transferrin and B12 means were higher than the Australian means. Hepatomegaly and mild splenomegaly were common. beta-Thalassemia was present in three subjects two of whom were from Simbu Province.

A report on two interlaboratory surveys of serum ferritin estimation.

Two surveys of the proficiency of performance of serum ferritin estimation in Australia have been conducted, one in 1978 and one in 1979. The majority of participants in both surveys used assay kits supplied by Clinical Assays, Roche Diagnostics and Ramco. The first survey showed a median intrabatch variation 9% and median interbatch variation of 17%. The overall assay variation had a median level of 22%. Assays by the various kits gave values which were not significantly different for each specimen (including purified liver and spleen ferritin solutions). The second survey showed an improvement in the overall precision of the participants with a median coefficient of variation of 15%. Contrary to the first survey, significant differences were evident between the results in 4 of the 5 specimens assayed. Some participants returned results for the high ferritin serum that differed substantially depending on the dilution of the sample used. The surveys showed a need for improvement in the assay performance of some participants, the need for ferritin levels to be assayed at least in two dilutions, and the need for standardization of assays, reference ranges and reporting units. Recommendation are made on all these points.

Urinary ferritin protein in subjects with prosthetic heart valves and other disorders.

Twenty-four-hour urine ferritin protein excretion (UFPE) was elevated in the great majority of patients with prosthetic cardiac valves. In this group, there was a positive correlation with the presence of haemosiderin in the urine and with another indirect measure of reduced red-cell survival, namely, serum lactic dehydrogenase. In a number of hospital patients with various disorders, UFPE was also increased. In this latter group, however, there was no constant accompanying haemosiderinuria or elevation of lactic dehydrogenase. The measurement of UFPE can be added to the list of screening tests for intravascular haemolysis, but analysis of the different isoferritins in urine is necessary to fully understand the mechanism of excretion in the different groups.