Positive Coombs test in acute leukaemia.

We present the results of the immunohaematological tests performed in an unselected group of patients with acute leukaemia at the time of diagnosis, and when possible the follow-up in remission and/or in relapse. Thirteen out of the 112 patients tested had a positive Coombs test at the time of diagnosis and, in six patients, the Coombs test became positive during remission. All the 19 positive Coombs test were of the complement type with, in 11 cases, an anti-I antibody eluted from the patient's RBC. There was no relationship between the FAB morphologic subtype, the presence of other immune abnormalities, the course of the leukaemia and the immunohaematological abnormalities. Several hypotheses on the possible relationships between the acute leukaemias and the immunohaematological abnormalities are discussed.

Chronic myelomonocytic leukemia according to FAB classification: analysis of 35 cases.

Thirty-five patients who fulfilled the FAB diagnosis criteria of chronic myelomonocytic leukemia (CMML), i.e., myelodysplastic features, monocytosis over 10(9)/liter, bone marrow monocyte infiltration, blast cells less than 5% in the peripheral blood and less than 30% in the bone marrow, are analyzed. CMML appears as an entity distinct from myelodysplastic and myeloproliferative disorders. Splenomegaly, anemia, thrombocytopenia, leukocytosis with monocytes and granulocytic cells in all stages of development, increased blood and urine lysozyme levels without renal failure, and polyclonal hyperimmunoglobulinemia are its main clinical and biologic features. With conventional cytotoxic drugs (6-mercaptopurine, hydroxyurea), the prognosis of CMML appears poor (median survival 475 days). None of the clinical hematologic or biologic parameters tested had a significant effect on prognosis. As other chemotherapy trials seemed necessary, we recently administered small doses of cytosine-arabinoside (ARA-C) to six patients over several consecutive days and obtained a complete remission in four. These preliminary results must be confirmed by larger series using the diagnostic criteria proposed by the FAB cooperative group.

Immune disorders in agnogenic myeloid metaplasia: relations to myelofibrosis.

Tests for a dysimmune state were done in an unselected group of 67 patients with agnogenic myeloid metaplasia (AMM). The results were compared to those of 56 patients with polycythaemia vera (PV). 75% of AMM patients versus 32% of PV patients had various abnormalities. The most frequent disorders among AMM patients were serum antinuclear and anti smooth muscle autoantibodies (10.3% each), a positive test for rheumatoid factor (21.7%), a polyclonal increase in serum immunoglobulin levels (46.8%) or a serum monoclonal component (9.7%), a positive direct Coombs' test (19%), an anti I autoantibody (30%). In AMM patients there was no relationship between age, sex, importance of splenic enlargement, time from diagnosis or treatment and the present of a dysimmunity. Furthermore, in AMM patients, but also in PV patients, it seems that the more frequent and numerous these abnormalities the more severe is the myelofibrosis. Like other previous studies, these results suggest a lymphoid cell involvement in AMM and a role for these immune disorders in the pathogenesis of myelofibrosis.

[Evans' syndrome during acute myelomonocytic leukemia. 2 cases]. / Syndrome d'Evans au cours de leucémies aiguës myélomonocytaires. Présentation de deux cas.

The immune abnormalities observed during acute myeloblastic leukemia often remain undiagnosed for they generally have no practical consequences. The association of peripheral thrombopenia and a positive direct Coomb's test, during two cases of acute myelo-monocytic leukemia should be recognised owing to the difficulty of interpretation and the therapeutic consequences.