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In 1982 a randomized trial of either alternating or syncopated VMCP/VBAP regimens for the treatment of active multiple myeloma was begun (Southwest Oncology Group Study 8229/30). A concurrent investigation was undertaken to evaluate the clinical importance and significance of cytochemically stainable plasma cell acid phosphatase (AP) and beta-glucuronidase enzymes (BG). Pretreatment bone marrow aspirates were available for analysis from 399 patients for AP and 398 patients for BG. The AP scores ranged between 42 and 395, and the BG scores ranged between 1 and 346. There was a significant increase of AP (P = .001) and BG (P = .002) in multiple myeloma as compared with a set of patients with benign plasmacytosis. The enzyme scores did not significantly relate to Ig idiotype of myeloma or other prognostic variables except that the BG scores varied significantly with the level of albumin (P = .03) and hemoglobin (P = .01). Analysis of patient groups with different levels of enzyme scores showed that 61 of 398 patients with an AP score of less than 130 had a poorer median survival of 1.7 versus 2.8 years for patients with higher scores (P = .001). In the multivariate analysis of survival, low AP score was an important prognostic factor (P = .006), but BG did not contribute significantly. It is suggested that the subset of patients presenting with low AP should be considered for specialized or more aggressive therapy.

Platelet function and morphologic characteristics were evaluated in 43 patients with myeloproliferative disease (MPD), 5 patients with myelodysplastic syndrome (MDS), and 7 patients with secondary thrombocytosis (ST). Platelet Factor IV (PF4) and B-thromboglobulin (BTG) showed slight elevation in ST but significant elevation in all MPDs. They were either normal or slightly elevated in MDS. Defective platelet aggregation with one or more inducers was seen in 62% of all patients. An epinephrine-induced defect was the most consistent aggregation abnormality. Hyperaggregation and spontaneous aggregation were seen in 15% of patients. Of the eight patients who showed increased bleeding tendency, all eight showed defective aggregation with two or more inducers, five showed decreased surface activation response, as well as decreased or abnormal granules and dense tubular disarray in the transmission electron microscope (TEM) study. Seven patients had clinical evidence of recurrent arterial and venous thromboses. Five of these patients showed hyperaggregation response to adenosine diphosphate and collagen and abnormal Wu and Hoak platelet aggregate ratio. Four patients showed spontaneous aggregation on aggregometer. Surface activation response was significantly increased in five patients, and an increase in platelet granules by TEM study was seen in four patients. Primary thrombocythemia could be differentiated from secondary thrombocytosis (ST) by the presence of abnormal aggregation response and significantly increased PF4 and BTG in the former, and greatly elevated plasma fibrinogen and Factor VIII, as part of acute phase reactant response, in the latter.

The association between renal transplantation and malignancy, particularly histiocytic lymphoma, is well known. Hodgkin's disease also occurs in renal transplant recipients. We report such a case and also review three other reports in the literatures. The Hodgkin's disease was insensitive to conventional MOPP chemotherapy in two of two, and was sensitive to combined MOPP-Bleomycin in one patient. The disease was rapidly fatal in three of four cases.

A 53-year-old black woman was admitted in coma with a diagnosis of thrombotic thrombocytopenic purpura (TTP). Plasmapheresis was performed daily for five days. The patient responded completely to apheresis by regaining consciousness. Her platelet count rose from 16,000/mm 3 to 211,000/mm 3 . Apheresis was discontinued and she was maintained on antiplatelet medications and fresh frozen plasma (FFP). Within four days platelet count fell to 6000/mm 3 and the patient's mentation deteriorated. Apheresis was reinstituted with complete recovery. After years of investigation and study, the etiology of TTP is still not completely understood. Numerous experimental and clinical studies have been published in the literature to explain the pathogenesis of this disease. Therapy for TTP has also been variable. Multiple forms of treatment have been instituted simultaneously to combat the disease. Comparison of individual modalities of treatment has not been done in a proper controlled environment. FFP infusion and plasmapheresis have been known to be effective in TTP. One is preferred over the other by individual groups. We report a case of TTP where discontinuation of plasma exchange and maintenance with FFP resulted in relapse with dramatic response when apheresis was reinstituted.

A 37-year-old intravenous drug abuser with acquired immune deficiency syndrome showed elevated activated partial thromboplastin time (APTT) and prothrombin time, normal thrombin time and fibrinogen, and borderline low platelet counts. The patient subsequently had a fracture of the left zygomatic arch, which did not produce uncontrollable bleeding. The coagulogram repeated at this admission showed persistent elevation of APTT. Further coagulation workup showed the presence of a lupus anticoagulant with mild specific inhibition of Factor VII. Platelet aggregation and Factor II levels were normal.

A 57-year-old black man with sustained platelet count of 2 million/mm3 and evidence of intermittent gastrointestinal bleeding was diagnosed as having essential thrombocythemia. Studies of bone marrow morphology, platelet aggregation, and other variables were confirmatory of the disease. The patient was treated briefly with low doses of Myleran for less than three weeks. He was then lost to follow-up study. Approximately 16 months later he reappeared complaining of recurrent nose bleeds. He was found to be pancytopenic and diagnosis of acute leukemia was made on the basis of bone marrow aspiration.

A 51-year-old, black man presented with severe anemia and weakness. X-ray studies showed diffuse osteosclerosis involving most of his skeleton. He was documented to have similar bone changes on x-ray 5 years previously. Peripheral blood findings were suggestive of a myelophthisic anemia. Open biopsy of the iliac bone showed osteosclerotic myeloma. Secretion of abnormal protein could not be demonstrated through many examinations of serum or urine. A unique finding at the autopsy was the presence of extensive erythrophagocytosis by the neoplastic plasma cells and macrophages.

Dyserythropoietic anemias are extremely rare disorders which often are misdiagnosed as megaloblastic anemia, DiGuglielmo's syndrome, refractory sideroblastic anemia, paroxysmal nocturnal hemoglobinuria, or other hemolytic anemias. Dyserythropoietic anemia is now subclassified into four types, designated Types I through IV, depending upon light and ultrastructural morphology, erythrocyte immunology, and the course of the disease. This report details the findings in a case of Type I dyserythropoietic anemia that represented a puzzling case of anemia for over 30 years. Many modes of drug therapy, as well as splenectomy, were not helpful. Interestingly, the family history was non-contributory. A brief review of the literature dealing with dyserythropoietic anemia is included.