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Hemoglobin Pierre-Bénite [beta 90(F6)Glu---Asp] is a new high affinity variant (P50 = 21.5 mm Hg), with normal heme-heme interaction, found in a French family. It was difficult to detect by conventional electrophoretic methods. However, the high performance liquid chromatography profile of its tryptic peptides contained an additional peak. Amino acid analysis of the corresponding peptide and determination of its sequence allowed us to identify the mutation. No instability was found. Mutations previously recorded in position 90 of the beta-chain display a positive charge shift and a reduced affinity for oxygen, whereas Hb Pierre-Bénite shows no charge shift and increased affinity for oxygen.

Between november 1974 and august 1976, 100 acute myeloïd leukemias were treated by the same protocol L. 275. Induction treatment was daunorubicine, vincristine, cytosine arabinoside, in one intensive course for patients under 65 and cyclophosphamide (CPM), VCR and CAR in a less intensive and repetitive courses for patients over 65. In remission, there were three phases: consolidation, prevention of central nervous system leukemia, maintenance. All patients in remission received an androgenotherapy and two groups were randomised: chemotherapy and chemotherapy plus BCG. 68 patients were in complet remission (CR) 61 out of 80 patients under 65 and 7 out of 20 over 65. Median duration of first remission was 12 months. Median duration of survival was 13 months for all patients, 15 months for patients under 65, 3 months for patients over 65, and 22 months for 68 patients in CR. Survival of patients receiving BCG was slightly better than patients without BCG.

Splenectomies were performed on 142 patients (86 men and 56 women). The majority of them (117) were stages III or IV. The purpose of the laparotomy was therapeutic and not exploratory. Surgery was indicated, either due to evolution of the disease suggesting splenic involvement or to symptoms of hypersplenism. Splenic involvement was confirmed in 71% and hepatic involvement in 40%. Despite the risk of mortality during the first month after surgery, proportional to the extent of the disease, the overall results are encouraging provided that surgical intervention is followed by aggressive polychemotherapy. Serious infections were observed, however, in 9 patients; they did not occur for several months or even several years after splenectomy.

The authors emphasize the relative frequency of neurological symptoms in lymphatic leukaemia. Clinically, these cause more or less diffuse encephalitic or multineuritic syndromes, generally a combination of the two. Their pathogenesis is usually connected with lymphoid tissue infiltration into either the meninges or the vascular sheaths of the central nervous system or the sheaths of the roots or of the peripheral nerves. The authors stress the possible function of immunoglobulin abnormalities of the C.S.F. indicative of the presence of the leukaemic process within the nervous system. This pathogenesis prompts the use of therapeutic methods directly attacking leukaemic infiltration of the nervous system (focal cobalt therapy, intrathecal chemotherapy) and the authors have found that these give favourable results.