Secondary acute myeloblastic leukaemia (AML) (expressing 11q23 mutation) occurring 11 months after chemotherapy/radiotherapy for paediatric non-Hodgkin lymphoma (NHL).

The occurrence of 11q23 cytogenetic abnormalities in drug-induced acute myeloid leukaemia (AML) is now well recognized. They are most frequently associated with topoisomerase II inhibitor administration. We here describe the case history of a 15-year-old child who presented with Stage III B-cell non-Hodgkin's lymphoma (NHL) and was treated with anthracyclines, alkylating agents and low-dose mediastinal radiotherapy. She developed an 11q23 mutation-related secondary AML at 11 months after therapy (15 months after her first exposure to drugs; 12 months after the first radiotherapy exposure), possibly the earliest yet reported in a paediatric patient. We discuss this newly recognized early form of refractory, secondary AML and its relationship to chemoradiotherapy.

Lipoperoxides as an index of free radical activity in bone marrow transplant recipients. Preliminary observations.

It has been previously demonstrated that the conditioning therapy given to bone marrow transplant (BMT) recipients creates a high oxidant stress, resulting in a measured reduction in antioxidants, such as glutathione peroxidase (GSH-Px), vitamin E, and cell peroxide fragilities. As part of a current intervention trial of antioxidant therapy in BMT recipients, plasma thiobarbituric acid reactive substances (TBARS) were measured to assess peroxidation and free radical activity. Measurements were performed before and after conditioning therapy, and then at weekly intervals for a period of 6 wk after transplantation in 20 patients (10 controls and 10 antioxidant therapy [AOT] recipients). The TBARS results were compared with concurrent measurements of more specific elements of the antioxidant pathways, such as red blood cell glutathione peroxidase (RBC-GSH-Px), plasma vitamin C, and serum vitamin E. In all cases, TBARS concentration was significantly increased after conditioning compared with baseline levels (p < 0.001), an increase that correlated inversely with RBC-GSH-Px (r = -0.81; p < 0.01). The TBARS concentration fell gradually after conditioning in all patients. The fall in the AOT group was more rapid than in the control group, and it paralleled the gradual return toward normal levels of the other antioxidants. The change in TBARS concentration occurred faster than changes in other indices, suggesting that TBARS might be a better index of overall free radical activity. Although the patient numbers are small, there is some evidence to suggest that MDA may act as a prognostic marker.(ABSTRACT TRUNCATED AT 250 WORDS)

3 cases of destructive facial granulocytic sarcoma in childhood - acute myeloid-leukemia expressing lymphoid associated antigens.

Three children, two from the Middle East and one from Greece, presented to this clinic for treatment of malignant facial tumours destroying bone. In each case biopsy histology led to an initial diagnosis of 'lymphoma'. Further characterisation of the tumour cells by cytochemistry and immunophenotyping established diagnoses of acute myeloid leukaemia, with myeloblasts in all three cases expressing lymphoid associated cell surface antigens. The possibility of granulocytic sarcoma should be considered in the differential diagnosis of facial tumours showing 'lymphomatous' morphology. The prognostic significance of this presentation 'syndrome' is discussed.

Bone marrow transplantation for acute myeloblastic leukaemia: an EBMT Leukaemia Working Party prospective analysis from HLA-typing.

The optimal post-remission therapy for patients with acute myeloblastic leukaemia remains controversial. Allogeneic bone marrow transplantation, autologous bone marrow transplantation, and consolidation chemotherapy are the major options. In order to evaluate their respective value the European Group for Bone Marrow Transplantation conducted a prospective registration study. Patients with newly diagnosed acute myeloblastic leukaemia were registered at the time of HLA-typing and intention to treat in case of presence or absence of an HLA-identical donor was recorded. 27/79 (34%) patients HLA-typed at diagnosis had an identical donor identified. The estimated survivals at 3 years from HLA-typing were 44% and 21% among patients with or without HLA-identical donor, respectively (P = 0.02). 22/26 (85%) patients for whom allogeneic bone marrow transplantation was intended were transplanted but only 15/47 (32%) patients for whom autologous bone marrow transplantation was intended were indeed transplanted (P < 0.001). The survival was 50%, 29% and 17% (P = 0.004) for patients treated with allogeneic bone marrow transplantation, autologous bone marrow transplantation, or chemotherapy, respectively. 40/68 patients HLA-typed in first complete remission had an HLA-identical donor. The estimated 3-year survival among patients typed in first remission with and without HLA-identical donors was 42% and 35% (n.s.), respectively. This technique of early patient registration illustrates the problems of patient selection during the course of the disease and might be used as a complement to randomized trials when comparing bone marrow transplantation and other treatment options.

Bone marrow transplantation for acute myeloid leukemia: the EBMT experience. A prospective analysis from HLA-typing. The EMBT Leukemia Working Party.

In 1990, 4,234 BMT were performed in Europe; 2,097 autologous BMT (388 AML) and 2,137 allogeneic BMT (494 AML). Although an established therapy with leukemia free survival (LFS) at five years of 41% +/- 5% (EBMT results) its value compared to alternative therapies remains controversial. During the year 1985, the EBMT conducted a prospective evaluation study. In 12 centres 168 patients with AML were registered at the time of HLA-typing. Basic patient data and treatment intention were recorded. 79 patients were HLA-typed at diagnosis. 68 patients in 1st CR and 21 at other stages. Follow-up of these patients was obtained as of January 1, 1991. Three-year LFS is 44% for patients with an HLA-identical donor and 21% for those without (p = 0.02). Of the 68 patients HLA-typed in first CR, 40 had an HLA-identical donor and 28 no donor. Three-year LFS is 42% and 35%. resp. (n.s.). The difference in results between patients typed at diagnosis and first CR patients illustrates the problem of selection. We conclude that patient registration early in the disease can give insight into the process of selection. Allogeneic BMT incorporated prospectively at diagnosis into therapy offers a survival advantage for patients in this age category compared to alternative therapies.

A steady-state kinetic analysis of the reaction between arginine esterase E-I from Bitis gabonica venom and synthetic arginine substrates and the influence of pH, temperature and solvent deuterium isotope.

1. Using synthetic arginines as substrates, steady-state kinetic studies showed a deviation from Michaelis-Menten kinetics for esterase E-I purified from the venom of Bitis gabonica. Graphical analysis indicated a rate equation of at least a degree of 3:3. 2. pH variation of the kinetic parameters indicated the involvement of groups with pK values of approximately 7 and approximately 9 which had to be in the ionic form for activity. 3. Solvent isotope studies suggested transition states where proton transfer or reorganization was the rate-limiting step of proteolytic catalysis. A single protogenic site was postulated. 4. Temperature effects on the enzymic reaction showed a significant reduction in entropy loss upon formation of the transition state with both esters and extended tail polypeptide-anilides in comparison with the activation entropy for benzoyl-L-arginine p-nitroanilide.

Inactivation of arginine esterase E-I of Bitis gabonica venom by irreversible inhibitors including a water-soluble carbodiimide, a chloromethyl ketone and isatoic anhydride.

1. Esterase E-I from Bitis gabonica was inactivated with irreversible inhibitors which included studies with a water-soluble carbodiimide, an affinity labelling peptide and a mechanism-based inactivator. 2. The reaction with 1-ethyl-3(3-dimethylaminopropyl)-carbodiimide was biphasic and the dominant part followed saturation kinetics. At pH 5.5 a rate constant of 0.4 min-1 for inactive enzyme formation was calculated and a dissociation constant (Ki) of 0.2 M for the enzyme-inhibitor complex. 3. Inactivation with D-Phe-Pro-Arg-chloromethyl ketone indicated a two-step mechanism, for which the reaction parameters at pH 8.0 were determined. The Ki value was 0.2 microM and the inactivation rate was 2.5 min-1. 4. With isatoic anhydride pseudo-first-order kinetics was observed. At pH 8.0 a rate constant of 0.9 min-1 and a Ki of 2.0 mM were obtained. The inactivation of the enzyme was found to be governed by a group in the enzyme showing a pK value of 7.3.

Allogeneic bone marrow transplantation in patients with multiple myeloma.

50 patients with a median age of 41 years (range 29-54) underwent allogenic bone marrow transplantation for multiple myeloma. 35 patients were on second-line treatment, and 15 on first-line treatment. 24 patients were considered refractory to previous treatment. 45 patients received marrow from HLA-matched sibling donors (3 of these from twin donors), and 5 from unrelated or related non-sibling donors. 21 patients entered complete remission, while 15 had persistent disease following repopulation of the marrow. 14 patients were not evaluable for remission status because of early transplantation-related death. The overall median survival from bone marrow transplantation was 27 months, with a projected long-term survival of 34%. Patients who were 40 yr of age or older had a survival that was not different from that of patients between 29 and 40 yr of age. The median disease-free survival of patients who entered complete remissions was 41 months. These patients tended to have a longer survival than patients with persistent disease following repopulation of the marrow. Allogeneic bone marrow transplantation appears to be a promising method for treatment of certain patients with multiple myeloma.

Allogeneic bone marrow transplantation in 24 patients with multiple myeloma reported to the EBMT registry.

Twenty-four patients with multiple myeloma received an allogeneic bone-marrow graft from HLA-compatible sibling donors (n = 23), or a twin donor (n = 1). Eighteen patients are alive, 1-36 months post bone-marrow transplantation (median 14 months). Ten of these patients had no signs of multiple myeloma as judged by immunoglobulins in serum, light chains in urine, or the percentage of plasma-cells in bone-marrow aspirate. Bone lesions on X-ray were mainly unchanged. Six patients died from transplant-related complications 3 weeks to 5 months post transplantation. One of these patients had severe acute graft-versus-host disease (aGVHD). In other patients aGVHD was a minor problem. Allogeneic bone-marrow transplantation appears to be a promising method for treatment of a selected group of patients with multiple myeloma.

Bone marrow transplantation in multiple myeloma: report from the European Cooperative Group for Bone Marrow Transplantation.

Of 14 patients who received an allogeneic bone marrow graft from HLA-compatible sibling donors, 10 have survived for 6 to 34 months posttransplantation (median, 12 months). Four patients have died, two of relapse at extramedullary sites, one of severe acute GVHD, and one from GI bleeding and pericardial effusion. One patient is alive in relapse and four patients have signs of minimal persistent disease. Five patients are well without signs of active disease. Minor improvement in osteolytic lesions on X-ray were seen in three patients, but the X-ray bone structure was mainly unchanged in most patients. Bone marrow transplantation appears promising for treatment of certain patients with multiple myeloma.

Beta thromboglobulin and alcohol consumption.

Beta Thromboglobulin plasma levels were measured in three groups of hospital patients; a control group (n = 13) of non-drinkers, and test groups of patients who from their medical history regularly consumed either moderate amounts (80-200G/24 hours n = 31) or large amounts (200G/24 hours n = 10) of alcohol. Significant differences were detected between the control group, and both groups of drinkers. A correlation was demonstrated between the amount of alcohol consumed and the plasma Beta Thromboglobulin. It is necessary to consider a patient's drinking habits when interpreting Beta Thromboglobulin levels.