[A comparative clinico-morphological analysis of acute myelo- and myelomonoblastic leukemias in children and adults]. / Sravnitel'nyi kliniko-morfologicheskii analiz ostrogo mielo- i mielomonoblastnogo leikozov u detei i vzroslykh.

Previous morphocytochemical, immunological and cytogenetic analyses of blast cells in 174 children and 188 adults admitted to Cancer Research Center have shown that compared to adults in children leukemic precursors belong to earlier stage of differentiation similar to polypotent cell. The analysis covered 2 FAB-variants of ANLL comparable by the number of patients and intensity of the given chemotherapy (M2 and M4 ANLL FAB variants). The study included 65 children (50 with M2 and 15 with M4 FAB variants) and 43 adults (26 with M2 and 17 with M4 FAB variants) given therapy of standard intensity in the regimen 3+7 and 2+5. The children more frequently demonstrated involvement of the liver, spleen and peripheral lymph nodes. The percentage of complete remissions in both groups was not significantly different. 2- and 3-year recurrence-free survival was similar in two age groups with M2 FAB variants of ANLL. However, in M4 variant in adults this survival made up 18% against 0% in children. The differences may arise from lower peroxidase activity in children than in adults. It is suggested that M4 FAB variant in adults may indicate better prognosis than in children. Therefore, therapy in children with M4 FAB ANLL variant should be intensified.

[Acute nonlymphoblastic leukemias in children and adults]. / Ostrye nelimfoblastnye leikozy detei i vzroslykh.

Examinations of 174 children and 188 adult patients with acute nonlymphoblastic leukemia (ANLL) demonstrated a similar structure of distribution of ANLL FAB-variants in children and adults, although the incidence of M0 and M4 blasts was somewhat higher in infants aged under 2. In patients under 15 and over 60 peroxidase activity in myeloblasts was reliably lower than in the rest patients. HLA-Dr, Thy-1, CD11a, T-CD19, Gly-A, and Eb antigens were equally incident in the cells of children and adults. The expression of CD11b, CD38, and CD10 antigens on the blasts was higher in children than in adults. An abnormal blast karyotype was detected in 81.8% children and 73.7% adults. Translocation (8;21) was observed in patients with the M2 variant, as a rule (82%), and reliably more frequently in children; t(9;22) and t(11q23) occurred in children somewhat more frequently than in adults. A group of children with primary ANLL (n = 3) was distinguished for the first time, in whose cell karyotype a deletion of chromosome 5 was found. The findings indicate that the biological characteristics of blast cells differ in children and adults. Evidently, the level of hemopoiesis involvement in ANLL is earlier in infants under 2 and subjects over 60 than in the rest patients.

Blast cells in child and adult AML: comparative study of morphocytochemical, immunological and cytogenetic characteristics.

Bone marrow blast cells of 174 child and 188 adult patients with AML were examined and characterized in terms of their FAB type, immunological phenotype (102 children, 123 adults) and karyotype (69 children, 95 adults). The incidence of FAB variants of AML proved similar in children and adults. In patients under 15 and over 60, peroxidase activity in myeloblasts was lower than in middle-aged patients. Similar rates of HLA-Dr. Thy-1, CD11a, T-cell antigens, CD19, Gly-A and Eb antigens were found in cells of child and adult patients. The frequency of CD11b, CD38 and CD10 antigen expression on blast cells was higher in children than in adults. Abnormal blast karyotype was noted in 81.8% of children and 73.7% of adults. Translocation (8;21) was usually found in cases of M2 type (82%), significantly more frequently in children. predominantly in the group aged 6-10. t(15;17) was detected in all age groups only in M3 type of cells (86%). t(9;22) occurred more frequently in adults than in children; t(11q23) incidence rates were somewhat higher in children than in adults. Three cases of AML in children are described with deletion of chromosome 5 in their leukaemic cells. The data obtained indicate different biological characteristics of blast cells in children and adults. It is likely that haemopoietic cell involvement in children under 2 years and adult patients over 60 occurs at earlier stages than in middle-aged patients.

[Use of long-acting L-asparaginase (PEG-asparaginase) in acute lymphoblastic leukemia]. / Primenenie L-asparaginazy prolongirovannogo deistviia (PEG-asparaginazy) pri ostrom limfoblastnom leikoze.

Twenty-five patients with acute lymphoblastic leukemia [15 adults and 10 children] received standard treatment in which regular L-asparaginase was replaced for L-asparaginase of prolonged action [PEG-asparaginase]. The drug was administered once in two weeks in a dose 2500 IU/m2 for remission induction and consolidation or as a component of maintenance therapy. It was found that the response to primary PEG-asparaginase treatment or its use in the disease relapses produced the same response as regular L-asparaginase, being superior in convenience and feasibility of outpatient use. Side effects in the form of hypoproteinemia, hepatic toxicity and toxic pancreatitis [in children, 9 and 1 adults, respectively] were moderate and disappeared after 10-20-day discontinuation of the drug.

[Clinico-cytological parallels in acute myeloid leukemia in children]. / Kliniko-tsitologicheskie paralleli pri ostrom mieloidnom leikoze u detei.

Based on a comprehensive study of the morphofunctional parameters of blast cells by means of morphological, cytochemical, immunological and cytogenetic research methods, 8 types of blast cells and leukemic variants were identified in 200 children suffering from acute myeloid leukemia. In these children, the clinico-hematological parameters differed depending on the leukemic variant. Verification of the diagnosis of acute myeloid leukemia variants in children will favour further perfection of the individualized treatment programs.

[Differential diagnosis of acute leukemia and hematosarcoma in children]. / O differentsial'noi diagnostike ostrykh leikozov i gematosarkom u detei.

Comparative analysis of hemopoiesis and study of the morphofunctional characteristics of blast cells in 89 children with hematosarcomas and in 152 children afflicted with acute leukemia revealed significant differences both in the nature of blast metaplasia of bone marrow and in the degree of inhibiting erythro- and thrombocytopoiesis in acute leukemias and hematosarcomas in the stage of leukemization. Study of the function of blast cells allowed one to distinguish specific features of tumor elements similar in their cytological parameters. The differences in the character of hemopoiesis derangement in different forms of hemoblastoses can be used under clinical conditions for differential diagnosis of the leukemic stage of hematosarcomas and leukemias.

Clinical significance of standard CD assessment in acute leukemia.

The data of detailed studies of immunophenotype of blast cells in 426 patients with acute leukemias are presented. Diagnostic and prognostic significance of different marker expression has been evaluated in groups of patients with ALL and AML. Frequency distribution of T1, T2, T3, pre-B, B, common, Ia and null subvariants identified according to immunoclassification of Baryshinkov et al. was studied in 250 children with ALL. These subvariants differed both in duration of disease (p = 0.0015) and in duration of first complete remission (p = 0.0031). The use of monoclonal antibodies of VI-series in 90 patients with ALL allowed to describe an immunophenotype of the subvariants in detail. The mosaic expression of myeloid antigens CD11, CD14, CD15, CDw65 identified by MoAbs VIM-12, VIM-13, VIM-D5 and VIM-2, respectively, on blast cells of patients with AML was shown. The expression of CD11 (ICO-GM1) or CD15 (ICO-G2) was prognostically unfavorable in children with AML (p = 0.0028). The expression of T-cell markers (E-receptor, CD7, reactivity with anti-T-cell serum) on blasts was prognostically favorable in children with AML (p = 0.003). So the data of immunophenotyping are of great value for accurate diagnosis and prognosis of acute leukemias.

[Immunodiagnosis of acute nonlymphoblastic leukemia in children]. / Immunodiagnostika ostrogo nelimfoblastnogo leikoza u detei.

Seventy-two children with acute nonlymphoblastic leukemia (ANLL) have been studied for expression of different antigens on blast cells with the use of monoclonal antibodies. Myeloid antigens (C3bi; X-hapten) were identified on blast cells most frequently, 58.3%, Ia-like antigen was found in 55% and LFA-1 in 34% of cases. The expression of all antigens except that of LFA-1 was independent on FAB-subtype. It seems necessary in clinical practice to type ANLL cells for the expression of T-cell and myeloid antigens that are of prognostic significance.

[Comparative evaluation of blast cell proliferation and effectiveness of combined chemotherapy in children with different immunocytological subvariants of acute lymphoblastic and nonlymphoblastic leukemia]. / Sravnitel'naia otsenka proliferatsii blastnykh kletok i éffektivnosti kombinirovannoi khimioterapii u detei s razlichnymi immunotsitologicheskimi subvariantami ostrogo limfoblastnogo i nelimfoblastnogo leikoza.

It has been found that kinetic parameters of proliferation in a dominating clone of bone marrow blast cells with Ia-positive and Ia-negative phenotype, as well as with expression of myeloid differentiating antigens (ICO-GM1 and ICO-G2), or in the absence of these antigens, do not significantly differ in children with subvariants MO-M4 of acute nonlymphoblastic leukemia, sensitive and resistant to the therapy. A higher rate of the bone marrow blast cell population growth and a lower effectiveness of the combined chemotherapy have been recorded in children with T-cell and pre-B-cell acute lymphoblastic leukemia as compared to acute lymphoblastic leukemia with the phenotype of blast cells that have only Ia-like or "common" antigens.

Chromosomes in acute nonlymphocytic leukemia.

The karyotype of leukemic cells was studied in 88 acute nonlymphocytic leukemia (ANLL) patients. Chromosome abnormalities were discovered in 78.4% of all patients and in 72.5% of the 69 patients studied before treatment. Characteristic abnormalities: translocations 8;21, 15;17, 9;22 or 6;9, rearrangements of 11q, gain of chromosomes 8 or 21, and loss or deletion of chromosomes 5 or 7 were detected in 56 of 69 patients with abnormal karyotypes. Translocation 8;21 was revealed in 27 patients; 20 of them had M2 FAB-form, four had M1, and three had M4. In patients with t(8;21) the incidence of complete remission was higher and the duration of first remission and survival longer than in patients with other abnormalities or with a normal karyotype.