A new combination chemotherapy for advanced chronic lymphocytic leukemia (vincristine, cyclophosphamide, melphalan, peptichemio, and prednisone protocol).

The MiNa protocol (vincristine, cyclophosphamide, melphalan, peptichemio, and prednisone) was given to 20 patients with advanced B-cell chronic lymphocytic leukemia. Complete remission (absence of all clinical and bone marrow evidence of leukemia) was obtained in 35% of cases; partial response (greater than 50% reduction in organ enlargement and decreasement of lymphocyte count to less than 15(9) X 10/l) was observed in 35% of patients. Of 12 patients (60%) previously treated with chlorambucil and corticosteroids, nine responded to treatment. Toxicity was mild and the relapse rate particularly low. It was concluded that the MiNa protocol represents an effective chemotherapy for advanced and/or progressive CLL.

An analysis of morphological, cytochemical, immunological and clinical features of adult T cell acute lymphoblastic leukemia.

Morphological, cytochemical, immunological and clinical features of 19 adult patients with T cell acute lymphoblastic leukemia (T-ALL) were investigated at the time of diagnosis and were compared with those of 34 adult patients affected by B cell acute lymphoblastic leukemia (B-ALL). Immunophenotypic studies employing a wide panel of monoclonal antibodies (mAbs) revealed a heterogeneous pattern of antigen expression in the five T-ALL groups that were identified on the basis of blast T cell differentiation levels. PAS (periodic acid Schiff) negativity and focal AP (acid phosphatase) positivity, as well as white blood cell count and serum lactic dehydrogenase levels, were significantly related to T-ALL when compared with B-ALL. On the contrary, no statistically significant difference was demonstrated in the clinical outcome.

[Analysis of a case of multiple myeloma with late dissemination of skin nodules]. / Analisi di un caso di mieloma multiplo con disseminazione nodosa cutanea tardiva.

A case of a 55 years old woman suffering from multiple myeloma with strong bone marrow proplasmocytic infiltration, several osteolytic and osteoporotic lesions and high seric M-component level and hypertensive heart failure is described. After 32 months of partial remission obtained with cyclic chemotherapy, large cutaneous tumors arose. Despite of a new therapeutic trial, in the last 8 months, an increase of bone marrow and seric signs was observed without involvement of the lungs or kidneys or expression of plasma-cell leukemia. Death occurred at 50th month because of sepsis and heart failure. A real cutaneous tropism, late occurred and without cytohistological changes, is stressed. The meaning of the rich vascularization of the skin over the tumors in absence of inflammation and necrosis remains unclear.

Polyamines as biological markers of the effectiveness of therapy in acute leukemia.

Urinary polyamine levels were determined in patients with acute leukemia, before and during chemotherapy, in order to confirm whether tumor cell death, due to successful chemotherapy, increases the release in urine and serum of polyamines from tumor tissues (12). Comparison between the polyamine test and cytological data indicated that a rise in urinary spermidine levels occurs during the first 3 days of therapy, both in the responsive and unresponsive patients. However, in the responsive patients the spermidine increase was higher (at 5% significant level) than in the unresponsive ones, and it was coincident with the fall of the blast cells and the revival of normal hematopoiesis. Increases in putrescine levels were also observed, but there were no significant differences (5% level) between the 2 groups of patients. When polyamine determinations were carried out following chemotherapy cycles, the relapse of the disease was always accompanied by an increase in putrescine.