[Treatment of chronic myeloid leukemia using alpha-interferon and hydroxyurea. Study of 30 cases]. / Tratamiento de la leucemia mieloide crónica con alfa interferón e hidroxiurea. Estudio de 30 casos.

PURPOSE: To evaluate the efficacy of the combination, alpha-interferon (IFN)-hydroxyurea (HU) in the treatment of patients with Philadelphia positive chronic myelogenous leukaemia (Ph'-CML). PATIENTS AND METHODS: A prospective study was started in 1988 in which 30 patients with chronic phase, low-risk Ph'-CML, according to Kantarjian's staging system, were included. They were treated with IFN at a dose of 5 MU/m2 subcutaneously twice a week plus HU in doses between 0.5 and 3 g/m2/day. The clinic and biologic controls performed twice a month included granulocyte alkaline phosphatase, and cytogenetic studies of bone-marrow and peripheral blood were carry out every third month. The quality and duration of haematologic and cytogenetic remissions were evaluated, along with the untoward effect of the treatment. Survival was estimated in accordance to the Kaplan Meier method. RESULTS: The mean age was 49 years (range: 17-70) and the M/F ratio was 18/12. The median follow-up was 51 months (range: 8-89). Twenty patients were in early- and four late-chronic phase. Complete haematological remission (CHR) was achieved in 26 patients (87%) with a median of 52 months and an estimated global median survival of 81 months. Cytogenetic response was seen in 11 patients (52%) of the 21 who were evaluable after 11 months of treatment. Disappearance of Ph' (complete cytogenetic response) was seen in 6 cases (28%). The incidence of early blast crisis in the first three years was, respectively, 0%, 3% and 6%. The treatment toxicity was negligible in most cases, having to suppress the treatment only in one patient due to persistent fever. CONCLUSIONS: The association of IFN and HU is effective and well tolerated in patients with low-risk CML, and it improves survival in CHR and overall survival.

[Therapy of chronic myeloid leukemia with interferon, alone or combined. Preliminary experience]. / Terapéutica de la leucemia mieloide crónica con interferón, aislado o en asociación. Experiencia preliminar.

The value of low-dose interferon (IFN) on the evolution of chronic myelogenous leukaemia was assessed in this study. Eleven patients previously treated with busulphan were analysed. Seven of them, in the chronic phase, received IFN 2 x 10(6) U/m2 subcutaneously three times a week; four patients in accelerated phase and two unresponsive to IFN were given a combination of IFN and hydroxyurea. Low-dose IFN proved capable of prolonging the remission period induced by busulphan. In the accelerated phase, the association of IFN and hydroxyurea protracted the evolution of the disease, although no conclusions can yet be drawn regarding the patients' survival. Ph1-chromosome negativity was attained in 28% of the cases. Minimal untoward effects were observed. It was concluded that low doses of IFN may induce scarce toxicity while preserving the therapeutic value.

Leucemia megacarioblástica / Megakarioblastic leukemia

La Leucemia Megacarioblástica que describimos por primera vez en el Uruguay, es una variedad citológica excepcional. El carácter hipoploide de la población blástica, contrastando con la alta ploidia de esta línea en condiciones normales, ha hecho el diagnóstico difícil, llevando a incluir seguramente muchos de estos casos dentro del grupo de las leucemias indiferenciadas o linfoides. Sin embargo, la presencia de algunos hechos citológicos característicos, unidos a una fibrosis medular casi inconstante, la profusión de lesiones radiológicas esqueléticas y su curso rápidamente progresivo, permitieron sospechar el diagnóstico. Pero solamente la microscopía electrónica por medio de técnicas citoquímicas ultraestructurales, que ponen en evidencia una peroxidasa plaquetaria específica, hace el diagnóstico indiscutible y nos permitirá conocer en el futuro la verdadera incidencia de la enfermedad. Es posible que esta variante deba ser incorporada como un nuevo subgrupo dentro de las leucemias mieloblásticas

A proposito de un caso de pleuropericarditis purulenta. / Apropos of a case of purulent pleuropericarditis

Se presenta un caso de pleuropericarditis purulenta secundario a un empiema metaneumonico, en una paciente en la que no existian condicionantes locales, ni generales que favorecieran la localizacion del proceso. Se discuten la etiologia y los mecanismos patogenicos mas frecuentes