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The cytogenetic features and the proliferative and differentiation capabilities of blast cell fractions purified on a density gradient were studied in one patient with chronic myeloid leukemia (CML) in blast crisis, both at the emergence and at relapse of the disease. The results show that relapse was due to the appearance of a new leukemic cell line that was characterized by peculiar chromosomal, growth, and differentiation features, which seemingly accounted for early refractoriness to therapy and disease progression.

Since April 1985, 82 patients with HCL entered a multicenter study using lymphoblastoid alpha-interferon; 51 (including 15 who failed splenectomy and 24 with substantial splenomegaly) enrolled before April 1986 are evaluated in this study. The patients were treated with 3 mega units daily subcutaneously until complete or partial response and were thereafter randomly allocated to a maintenance regime of 3 mega units/week or to observation only. Ten cases had a complete response, 18 a partial response, and 15 a minimal response. Two patients had no response, two interrupted therapy due to major toxicity (toxic hepatitis and thrombocytopenia), six died before completing 1 month of therapy of sepsis, and two died of myocardial infarction. In the two groups of splenectomized and nonsplenectomized patients the mean time to hemoglobin recovery was 8.5 and 6.5 weeks, respectively, the neutrophil count recovery was 6.5 and 9.3 weeks, and the time to platelet count recovery was 4.0 and 5.4 weeks, respectively. No significant differences in recovery time and response rate were observed between the two groups. In 31 out of 32 patients with substantial splenomegaly the spleen became either inpalpable (18) or significantly smaller (13). This study confirms the responsiveness of HCL to IFN in nonsplenectomized patients with high tumor burdens and is therefore recommended as a first-line therapy.

Cytogenetic studies were performed on the cells of bone marrow, peripheral blood, and skin tumor biopsies from a patient with mycosis fungoides at an early stage. Chromosome abnormalities were detected in 100% of the cells harvested from the cutaneous specimen, whereas the cells of the bone marrow and blood were karyotypically normal. Three related clones, showing increasing cytogenetic complexity, were found. Chromosome #12 was abnormal in all metaphases, and an abnormal 14q chromosome was present in a minority of cells belonging to the most complex emerging subclone. These data, along with the findings of important signs of chromosome imbalance, suggest a polyphasic evolution of this chronic T lymphoproliferative disease.

Eighty-nine patients who developed a secondary hematologic disorder and were studied with chromosome analysis were collected from nine institutions. The results of the study confirmed previous findings, in particular, -5/5q-, -7/7q-, -17, and +21 were the most frequently encountered aberrations. Moreover, a t(1;7)(p11;p11) was reported in four cases and consistent chromosome abnormalities were observed in a small group of patients who had been treated only with surgery, but not with chemo- or radiotherapy for a previous tumor.

Blast cells of 12 acute nonlymphoid leukemias have been investigated by consecutive application on the same preparation of three cytochemical reactions: alpha-naphthylacetate esterase, AS-D-choroacetate esterase and PAS. A fourth reaction (alpha-naphthylbutyrate esterase) was added in some preparations for a more detailed definition of the monocytoid-oriented cells. The cytochemical techniques were further combined with NaF inhibition and with the cytobacterial test for muramidase. The combined cytochemical approach allowed the identification of most of the blast cells, according to an empirically determined positivity to one or more reactions, and proved to be particularly valuable in classifying the cells after chemotherapy.

36 unrelated individuals with neutrophil MPO deficiency, (10 totally MPO deficient) were found on screening a population of 148,000 subjects. A further 2 subjects with total and 22 with partial MPO deficiency were identified through family studies. The assessment of neutrophil function, i.e., peroxidase activity, superoxide anion generation, microbicidal activity towards fungi and bacteria, and locomotor behaviour, was carried out in 10 subjects with total and 4 with partial MPO deficiency. We found that the enzyme defect is associated with a marked impairment in the killing of both S. aureus and C. albicans, without affecting microbicidal activity against S. faecalis. There appears to be a high incidence of malignancy in patients with complete MPO deficiency, suggesting a relationship between a defective MPO system and neutrophil-mediated tumor cell cytotoxicity.

We report a case of chronic myeloid leukemia in monoblastic blast crisis in which a deletion of chromosome 11 (11q-) was detected. Such a finding seems to provide further support to a relationship between this chromosome anomaly and monocytic proliferation.

Sixteen patients with paroxysmal nocturnal hemoglobinuria (PNH) from five European centers have been submitted to chromosome analysis. All of them had a normal bone marrow karyotype. The associations between some chromosomally abnormal cases reported in the literature and "typical" PNH or PNH phenomenon during the course of other hematological disorders are discussed.

Three patients affected by T helper chronic lymphocytic leukemia were treated with low dose interferon alpha-2b (3 MU/m2 3 times weekly). The disease presented different pathologic expressions with diffuse skin lesions in one patient, a mild clinical course and a prolymphocytic variant with aggressive features, respectively, in the other two cases. A consistent response was observed within 3-6 weeks; by that time a reduction of blood and marrow lymphocytosis in the three patients and a regression of the cutaneous lesions were documented. Therefore, it should be emphasized that the use of alpha IFN, whose effectiveness on cutaneous T cell lymphomas has been already demonstrated, may represent an active agent in the treatment of leukemic T helper phenotype chronic lymphocytic proliferations.

Blastic crisis in chronic myeloid leukemia is characterized by several cytological alterations which may represent some abortive attempts to differentiate along various cell lines as a consequence of a maturation defect of the myelopoietic cells. These changes of the hematological picture are associated with alterations of the karyotype and with cytochemical abnormalities of the blast cells, possibly related to their metabolic anomalies. In this regard 14 patients with blastic crisis were investigated to achieve an evaluation of the composition of the cell population during the acute phase. A sequence of three cytochemical reactions applied consecutively on the same slide (alpha-naphthyl-acetate esterase + AS D-chloro-acetate esterase + PAS) proved to be useful for the detection of differently oriented blast cells. During the acute phase of chronic myeloid leukemia only about one half of the blast cells were expressing granuloblastic differentiation. The data may be important for some clinical and prognostic factors, since the heterogeneity of the blastic population may be associated with a particular resistance to therapy.

Blood lymphocytes from 23 patients with B-cell chronic lymphocytic leukemia were stimulated with different mitogens (lipopolysaccharide from E coli, phorbol myristate acetate ester, Staphylococcus aureus, and phytohemagglutinin M form). Functional properties of stimulated cells (blastic transformation, mitotic index, cIg production, Ig secretion, and acid phosphatase positivity) were evaluated and correlated with the stage of disease and chromosomal findings. Early stages of the disease are characterized by a relatively homogeneous response to polyclonal B-cell and activators and by a restricted number of chromosomal aberrations. Advanced stages show a more heterogeneous pattern of response and a higher incidence of abnormal karyotypes suggesting an involvement of various subclonal lines.

The phagocytic activity of the blastic cells in the course of acute leukemias has been previously analyzed mainly by means of technical methods concerning the ingestion of inactive particles or foreign bodies. The spontaneous ingestion of cells (cytophagocytosis) has been studied to a minor extent, with reference to some occasional pictures, mainly in erythremic syndromes. The analysis of 104 cases of acute leukemias, classified according to cytochemical criteria, demonstrated the presence of cytophagocytosis pictures almost exclusively in non-lymphoid acute leukemia patients. The data are discussed with relation to similar findings in epithelial tumors as well as to the emperipolesis pictures.