[Hematopoietic cell transplantation. Experience at the Western National Medical Center]. / Trasplante de células hematopoyéticas. Experiencia del Centro Médico Nacional de Occidente.

UNLABELLED: Bone marrow transplantation has recently reached an special place as a therapeutic tool, which was not available ten years ago. AIM AND SETTING: Descriptive information about the first fifteen cases transplanted at Centro Médico Nacional de Occidente, on a third level attention in Guadalajara, Jalisco, Mexico. MATERIAL AND METHODS: Fifteen patients were transplanted, were carried out autologous transplantation in ten patients and five have received allogeneic transplant; one allogeneic transplant was performed with bone marrow aspiration donor, all next donation were taken off from peripheral blood stem cell through apheresis procedures. From autologous transplant 3 with chronic myelogenous leukemia (CML), 3 with Hodgkin's disease, 2 with solid tumor, 1 with high risk acute myelogenous leukemia and 1 large and small cell lymphoma III-B stage. Received allogeneic transplant 4 patients with CML in chronic phase and one with acute lymphoblastic leukemia Ph+. RESULTS: All patients grafted, the median time to achieve > 0.5 x 10(9)/L granulocytes was 14 days (range: 11-18) from autologous and 16 (range: 14-18) days from allogeneic transplant, whereas the median time to achieve > 20 x 10(9)/L platelets was 18 days (range: 15-35) from autologous and 22 days from allogeneic, three patients died into 100 days postprocedure, two allogeneic, from graft versus host disease III-IV degree, and one autologous from interstitial pneumonia, surviving patients have showed +30 days to +1000 days survival. CONCLUSION: With these data we show that this procedure is inexpensive, is factible and possible if it does coexist with multidisciplinary and on time support, interest, dedication on care, and enough information and desire to do it, including official decisions to perform and sponsor its continuity to the people who participate in it.

Acute Promyelocytic Leukemia in Late Pregnancy. Successful Treatment with All-Trans-Retinoic Acid (ATRA) and Chemotherapy.

The use of all-transretinoic acid (ATRA) in APL is a great advance in the treatment of acute leukemia, driving the maturation steps until adult form. The effect of this medication in pregnant women with APL is being a safe and effective treatment only after the first trimester of pregnancy. If used in the first three months, it can cause fetus malformations due to its potent teratogenicity. The two patients we reported here, gave birth to normal children, yet they received ATRA. After a week with ATRA treatment, fibrinogen level improved and "D" dimers decreased, so as observed slowly maturation of leukemic leucocytes. ATRA used at the same time with chemotherapy; such as Cytarabine and Idarrubicine seems highly useful for induction and long term control of disease. One short discussion about the findings and compare with those found in the literature are presented.

Two different Philadelphia chromosomes in a cell line from an AML-M0 patient.

A second Philadelphia (Ph) chromosome is one of the most common nonrandom secondary chromosome changes in leukemias with 9;22 translocations. It has been suggested, and observed in two studies of masked t(9;22), that the second Ph chromosome is an exact duplication of the entire derivative chromosome 22. In a cytogenetic study of bone marrow cells from an acute myelogenous leukemia patient, a cell line carrying two different Ph chromosomes evidenced by a chromosome 22 centromeric heteromorphism was found. From this observation arose the question whether the second der(22) was a true Ph chromosome or whether it was a deleted chromosome derived from the normal chromosome 22 that did not contain the bcr-abl rearrangement. A fluorescent in situ hybridization (FISH) study with the t(9;22) probe revealed two bcr-abl positive signals on 60 of 100 interphase nuclei. The second Ph could have resulted from a mitotic crossing over; or, analogously to late-appearing Philadelphia chromosomes, it may be derived from a new chromatid translocation between the chromosomes 9 and 22 not involved in the initial t(9;22).