Isolation of HTLV-1 from an aggressive form of ATL in a Romanian patient not at risk of infection and with seronegative family members.

We present the clinical, virological and haematochemical data of a 22 year old patient from Romania with Adult T Cell Leukaemia (ATL). Viral isolation in peripheral mononuclear blood cells (PMBC), detection of DNA sequences of HTLV-1 by Polymerase Chain Reaction (PCR) and of antibodies by Elisa and Western blot were performed. The patient does not belong to any risk group and additionally all members of her family are seronegative for HTLV-1, the aetiological agent of ATL. The role of viral infection remains open.

The anti-beta2-glycoprotein I activity in human anti-phospholipid syndrome sera is due to monoreactive low-affinity autoantibodies directed to epitopes located on native beta2-glycoprotein I and preserved during species' evolution.

To characterize the reactivity pattern of Abs directed to beta2-glycoprotein I (anti-beta2GPI) in patients with anti-phospholipid syndrome, we have purified anti-beta2GPI Abs by affinity chromatography using the IgG fractions from sera of five different anti-phospholipid syndrome patients. Affinity-purified anti-beta2GPI were shown to be representative of Abs found in human sera because their activity could be virtually abolished from the IgG preparations after repeated absorptions on immobilized human beta2GPI column. Our results show that affinity-purified anti-beta2GPI: 1) do react with beta2GPI in the absence of any phospholipid, as demonstrated by the lack of phosphorus contaminant in the employed reagents, as well as by their comparable binding activity before and after extensive delipidation procedure; 2) can recognize beta2GPI regardless of its origin from different animal species; 3) are able to bind soluble beta2GPI with a mean Kd value of 4.65 x 10(-6) M (range 3, 4-7, 2 x 10(-6) M); 4) significantly enhance their binding avidity when beta2GPI is linked to a solid support; and 5) appear to be mainly monoreactive autoantibodies. In conclusion, we have shown that human polyclonal anti-beta2GPI are low affinity, mainly monoreactive autoantibodies directed to an epitope located on native beta2GPI, preserved along the species evolution.

Cerebral hemorrhage and thrombotic thrombocytopenic purpura during ticlopidine treatment: case report.

We report the second case of thrombotic thrombocytopenic purpura occurring during ticlopidine therapy. A cerebral hemorrhage was the first sign of the thrombocytopenia. Even if thrombocytopenia is a rare occurrence with ticlopidine therapy, we stress that platelets must be repeatedly monitored.

Late taste disorders in bone marrow transplantation: clinical evaluation with taste solutions in autologous and allogeneic bone marrow recipients.

The aim of this work was to determine the type and the significance of taste disorders in allogeneic bone marrow transplanted patients. In a retrospective study the taste threshold of a cohort of 15 allogeneic bone marrow transplanted patients, 4-51 months after transplantation (mean: 30.6 +/- 15.8), was compared to the taste threshold of 8 autologous bone marrow recipients, 4-48 months after transplantation (mean: 24.12 +/- 12.18), and to the taste threshold of a group of 20 consecutive normal subjects. Allogeneic bone marrow transplanted patients showed a significant hypogeusia for salt (Pearson's chi square p = 0.0002; Yates' correction p = 0.0007) and sour (Pearson's chi square p = 0.001; Yates' correction p = 0.008). No significant variations were observed for sweet and bitter. Autologous bone marrow recipients did not show any significant variation of taste acuity for sweet, salt or sour; a constant reduction of the taste threshold for bitter was observed, but the values were not significantly different from normal (Pearson's chi square p = 0.47; Yates' correction p = 0.83). So, late and selective taste disorders are observed in allogeneic bone marrow transplanted patients. Since the severity of the disorders is not strictly related to the severity of chronic oral G.V.H.D., taste analysis could discover the slightest, clinically undetectable cases of chronic oral G.V.H.D. The mechanism of immune aggression on the sensorial taste cells is poorly understood. Further trials are needed to define variations of taste acuity not only after allogeneic bone marrow transplantation, but also in systemic immune diseases.

[Aggressive ulcerous stomatitis due to the herpes simplex virus in an allogeneic bone marrow transplant. A clinical case]. / La stomatite ulcerosa aggressiva da herpes simplex virus nel trapianto midollare allogenico. Contributo clinico.

Aggressive ulcerative HSV stomatitis was observed in a patient 10 months after allogeneic bone marrow transplantation. The patient was affected by acute myeloid leukemia (LMA) in second remission and, after bone marrow transplantation, supported a severe graft versus host disease. Intravenous acyclovir was administered during 22 days and ulcerative stomatitis completely healed.

A phase II trial of ProMACE-CytaBOM in previously untreated non-Hodgkin's lymphoma of intermediate- or high-grade histology.

Between November 1985 and June 1989 the aggressive combination chemotherapy programme ProMACE-CytaBOM was used at a community-based hospital as primary treatment for non-Hodgkin's lymphoma (NHL) of intermediate or high-grade histology in Ann-Arbor stages IB-IV. The 53 patients entering the study represented 90 per cent of all consecutive eligible patients with NHL diagnosed during the time period considered. Their median age was 54 years and median observation time was 36 months. Of 50 patients evaluable for response, 35 (70 per cent) achieved complete remission (CR), seven (14 per cent) partial remission, and five (10 per cent) were refractory. Treatment was given on an outpatient basis. Actually delivered drug doses ranged from 88 per cent to 97 per cent of the theoretical doses. Life-threatening toxicity was experienced by four patients. Treatment was stopped in three cases (6 per cent) because of toxicity and there was one treatment-related death. Actuarial 2-year disease-free survival of patients in CR was 73 per cent. Overall actuarial 3-year survival and disease-free survival were 67 per cent and 51 per cent respectively. High LDH level was a significant adverse prognostic factor both for achievement of CR (P less than 0.005) and for survival (P less than 0.0002). Age was of no prognostic importance. We conclude that ProMACE-CytaBOM is an effective, easy to administer and well-tolerated regimen for patients with aggressive NHL.

Lymphocyte subpopulations in the neonate: high percentage of circulating B73.1+, HNK-1- cells.

The reactivity of B73.1 monoclonal antibody was evaluated on unseparated and on T cell-depleted and T cell-enriched fractions of both cord blood lymphocytes (CBL) and adult peripheral blood lymphocytes (a-PBL). The reactivity of this monoclonal antibody with the E-, OKT3-, OKT8+, HNK-1- subset of CBL, previously demonstrated to have NK activity, was also studied. The data show that B73.1+ cells were present in similar percentages in CBL and a-PBL while HNK-1+ cells were very low in CBL. In addition the B73.1 monoclonal antibody reacted with about 50% of the E-, OKT3-, OKT8+, HNK-1- CBL and within this subset the majority of the B73.1+ cells were PNA-. These data support the hypothesis that part of this neonatal subpopulation, belongs to the NK cell lineage. Moreover the results obtained by double-labelling with B73.1 monoclonal antibody and PNA suggest that the E-, OKT3-, OKT8+, HNK-1- CBL include either different subsets or various differentiation stages of the same subset.

Remission continuation therapy for adult acute lymphoblastic leukemia. Preliminary results with a multidrug treatment protocol.

Twenty-four adolescent and adult patients with newly diagnosed acute lymphoblastic leukemia (ALL) were treated with the multidrug therapeutic program called IGG-74(9). Seventeen patients (71%) obtained a complete remission (CR) after induction therapy. They subsequently underwent a consolidation course with cytosine arabinoside and a seven drug maintenance regimen, lasting three years, with cyclophosphamide, 6 mercaptopurine, methotrexate, BCNU, adriamycin, vincristine and prednisone. The remission continuation treatment was well tolerated and produced an actuarial three-year disease-free survival rate of 57% and an overall median survival of 19 months. The efficacy of multidrug programs for the prevention of relapse in adults with ALL is discussed.

Detection of circulating immune complexes in acute non-lymphatic leukaemia: is it reliable?

The in vivo and in vitro phagocytic ability of leukaemic cells and the serum levels of circulating immune complexes (CIC) have been evaluated in 11 patients affected by acute non-lymphatic leukaemia (ANLL). High levels of serum CIC were detected in 17% of the cases showing phagocytic ability and in 80% of the cases lacking phagocytic ability (p less than 0.05). In 3 patients serum CIC determinations were negative while immunoglobulins with complement-fixing ability were detected in the cytoplasm of leukaemic cells indicating in vivo phagocytosis of CIC. These results suggest that leukaemic cells may sometimes interfere through their phagocytic ability on the detection of CIC in the serum. Therefore, the clinical and prognostic value of serum CIC in ANLL seems questionable.

Circulating immune complexes in human acute leukaemia.

Circulating immune complexes (CIC) in the sera of 60 newly diagnosed leukaemic patients were investigated by two methods, 125I-C1q binding test (C1q-BA) and conglutinin binding assay (KgB-SP). Positivity percentages were respectively 20.0% (C1q-BA) and 28.3% (KgB-SP). The small overlap between the results of the two methods suggests the occurrence of different types of CIC. The presence of CIC was found to be related only to clinical haemorrhage and thrombocytopenia; it did not prove to affect the prognosis and the survival of leukaemic patient.