Bone marrow transplantation for chronic granulocytic leukemia.

Thirty-seven patients with chronic granulocytic leukemia have been treated with supralethal chemoradiotherapy followed by transplantation of bone marrow from HLA-identical donors. All patients showed engraftment, and the Philadelphia chromosome (PH1) disappeared in each case. Four patients had syngeneic grafts before blast crisis and are still alive; 2 are in remission not maintained by therapy, and 2 others are receiving chemotherapy after having relapsed in the chronic phase. Thirty-three patients had allogeneic grafts; only 2 received the grafts during blast crisis, and neither is a long-term survivor. Of the 13 patients who had grafts in the accelerated phase, 6 died of complications related to the transplantation, and 1 died after a myeloblastic relapse. Thus 6 patients are in unmaintained remission with a median follow-up of 13 months. Eighteen patients received grafts in the chronic phase. All 10 survivors are in unmaintained remission with a median follow-up of 14 months; in this group, no patient has relapsed. The granulocytic hyperplasia of the chronic phase can be more effectively ablated than established blastic leukemia. The mortality rate of transplant-related complications must be weighted against the typical rate of progression of chronic granulocytic leukemia. Although a longer follow-up period is needed for full evaluation, bone marrow transplantation may now be offered to patients in the chronic phase in an attempt to achieve long-term survival or cure of more than one-half of these patients.

[Specific antibodies against lymphocytes and monocytes in multiple-transfused uremic patients]. / Anticorpi specifici per i linfociti e monociti in soggetti uremici politrasfusi.

Kidney patients waiting for transplant usually undergo deliberate transfusion without clinical need in order to improve the outcome of the transplantation. Besides the beneficial transfusion effect on graft survival antibodies against the Major Histocompatibility Complex (MHC) can be detected after blood transfusions. Preliminary studies have shown antibodies against surface determinants of endothelial cells and monocytes too. Following that it is necessary to investigate how these different antibodies can affect the kidney allograft survival in politransfused uremic patients. We tested 171 sera from uremic patients to detect antibodies directed against T and B lymphocytes and monocytes by using long incubation standard NIH cytotoxicity technique. Antibodies against B cells have been tested at 20 degrees C and 4 degrees C. 54 patients (31,6%) showed anti-HLS antibodies: sera from 23 patients (13,5%) were positive against I and B cells (T+B+) and monocytes (M+) and that's probably due to anti-HLA-A,B,C and DR antibodies. 17 patients (9,9%) were T+B+ for the presence of anti HLA- A,B,C antibodies. 10 patients (5,8%) were T+. It is not yet clear why 18 patients (10,5%) showed anti B Lymphocytes antibodies tested at 20 degrees C. Probably the presence of anti HLA-DR antibodies caused the positivity of 4 B+M+ patients (2,33%). Sera from 5 patients (2,92%) showed anti B Lymphocytes antibodies tested at 4 degrees C. 21 patients (12,3%) were M+ only.