Search

The chromosomal data of 58 acute nonlymphocytic leukemia (ANLL) patients and of 32 acute lymphocytic leukemia (ALL) patients submitted to bone marrow transplantation and collected from nine institutions are reported. Chromosomal studies were available at diagnosis in 19 cases with ANLL: seven had a partially or completely abnormal pattern. Forty-one patients had a chromosome study before bone marrow transplantation and all had a normal pattern. Thirteen patients with ALL were studied at diagnosis: five had a partially or completely abnormal karyotype. Of 20 cases analyzed before bone marrow transplantation, only one has maintained the abnormal pattern of diagnosis in part of the cells. Karyotypes were available in nine ANLL patients relapsed after bone marrow transplantations. Two showed the same clonal abnormalities seen at diagnosis; in three other cases the leukemic clone of relapse carried an additional chromosome abnormality with respect to the pattern at diagnosis and four more cases presented at relapse complex abnormalities; two of them had a cytogenetically normal pattern at diagnosis. In four of ten relapsed ALL cases chromosomes analyses were available. A relapse in donor cells and a hyperdiploid pattern were observed in two cases, respectively, while a normal, recipient pattern was documented in the other two cases. Serial chromosome studies performed in acute leukemia patients after bone marrow transplantation may allow the detection of different chromosomal patterns of relapse. In those cases who relapsed with a cell clone cytogenetically different from the pattern at diagnosis, a direct role played by the conditioning treatment in the pathogenesis of the relapsing disease may be hypothesized.

The authors describe a case of Sweet's syndrome in a woman affected with chronic myeloid leukemia. They emphasize the association of the syndrome with a progression of the disease and the complete disappearance of it for 3 years until the present time after allogeneic bone marrow transplantation.

A pilot study was conducted in which 15 patients with small cell lung cancer (SCLC) with limited or extended disease were treated with high dose etoposide (600 mg/m2 daily for 3 consecutive days) followed by autologous bone marrow transplantation (ABMT). Twelve patients underwent a double graft. All had achieved complete or partial remission with conventional induction chemotherapy (adriamycin and etoposide, plus cisplatin in five cases). After ABMT six of the 15 patients did not receive radiotherapy to the chest; all but four patients received prophylactic brain irradiation. No toxic deaths were recorded during the period of aplasia. Eleven patients relapsed and died after ABMT. The median time to death was 18 months. One other patient died at 13 months of unknown cause. At the present time three patients are alive and free of disease at 54, 51 and 47 months respectively. This pilot study shows that high dose etoposide and ABMT is well tolerated as late intensification for responsive SCLC. Definite conclusions about its precise role in therapy cannot yet be drawn.

The karyotypes of 74 patients with Ph-positive chronic myeloid leukemia submitted to bone marrow transplantation collected from nine institutions were studied serially before and after transplantation. In 13 cases sporadic Ph-positive metaphases were detected without signs of relapsing disease at various intervals after transplantation. These data indicate that the leukemic clone may not be completely suppressed by the conditioning treatment and that other biological mechanisms may be involved in destroying this clone or controlling its expansion.