[Utility of the copper/zinc ratio in patients with lymphoma or acute or chronic leukemias]. / Utilidad de la relación cobre/zinc en pacientes con linfoma o leucemias aguda o crónica.

OBJECTIVE: To determine the diagnostic value of serum levels of copper, zinc and the Cu/Zn ratio in patients with hematological malignancies compared to gender- and age-matched control subjects. METHODS: A total of 44 patients with recently diagnosed and non-treated hematological malignancies were included: 17 lymphoma (11 non-Hodgkin), 15 acute leukemia (10 myeloblastic), and 12 with chronic leukemia (8 granulocytic); 95 healthy subjects were included. Copper and zinc serum levels were measured with a Perkin Elmer (model 2380) atomic absorption spectrophotometer. RESULTS: Serum copper levels (microgram/dL) were significantly lower in healthy subjects (54.4 +/- 8.9, p < 0.05) compared to patients with lymphoma (93.7 +/- 37.5), acute leukemia (80.6 +/- 44.6) or chronic leukemia (95.7 +/- 28.9) while serum zinc levels (microgram/dL) were significantly higher in healthy control subjects (100.4 +/- 14, p < 0.05) compared to patients with lymphoma (77.2 +/- 22.6), acute leukemia (66 +/- 15.6), or chronic leukemia (74.8 +/- 14.7). The Cu/Zn ratio was significantly lower in healthy subjects (0.54 +/- 0.13, p < 0.05) than in patients with lymphoma (1.21 +/- 0.5), acute leukemia (1.22 +/- 0.7), or chronic leukemia (1.28 +/- 0.4). Twenty three patients died during a mean follow-up period of 13 months and their serum zinc levels were significantly lower (68 +/- 21) than in the living patients (76 +/- 15, p < 0.05). CONCLUSION: Cu/Zn ratio is significantly higher in patients with lymphoma or acute and chronic leukemias compared to gender- and age-matched control subjects.

rHuGM-CSF after high-dose chemotherapy in post-remission acute leukemia.

Post-remission high-dose chemotherapy has been an important advance in the treatment of adult acute leukemia (AAL). Without the use of colony-stimulating factors (CSFs) in this program, the mortality rate varies from 5 to 17%, and infectious complications arise in more than 50%. These findings limit the widespread use of such forms of therapy. The use of high-dose ara-C (HIDAC) alone or in combination with other drugs is the most common regimen studied, however neither other drug combinations nor the addition of supporting CSFs have been extensively explored. For this reason we studied the effect of high-dose cyclosphosphamide-etoposide (CECY) plus recombinant human granulocyte-macrophage (rHuGM)-CSF with the intention of decreasing morbimortality and prolonging disease-free survival (DFS). Since 1992 we have included 51 complete remission patients with AAL in the CECY plus rHuGM-CSF protocol. The maximal myelosuppression occurred in a mean of 6.4 days, and the mean days required for absolute neutrophil count recovery was 13 days and for platelets 21 days (p < 0.0001). No toxic deaths occurred and only two serious infectious complications were seen. After two years of follow-up, 50% of de novo acute myelogenous leukemia patients had relapsed at 13 months, and 50% of de novo adult acute lymphocytic leukemia patients had relapsed at 15 months. In a recent update, we have not seen a significant difference when compared to historic groups. The CECY protocol does not appear to be superior in prolonging DFS compared to HIDAC as a post-remission strategy for newly diagnosed AAL. The main difference was the absence of toxic deaths and minimal serious infectious complications in the CECY protocol. Therefore, we suggest that the use of rHuGM-CSF in post-remission programs should be included in future studies.

[Cost-benefit of the Schilling test using cobalt-57]. / Costo-beneficio de la prueba de Schilling con cobalto-57.

Our purpose in the present publication is to determine the cost-benefit relation of the Schilling test used to measure the intestinal absorption of radioactive vitamin B12. The 60Co-B12 urinary excretion Schilling test was first reported in 1953, and five years later it was being performed at the National Institute of Nutrition (INNSZ) in Mexico City. It was performed in its original version until 1969 and from 1970 to 1980, the direct absorption was measured with a whole-body counter. For the last nine years we have used the Schilling test with 57Co labeled cyanocobalamin. From January 1981 through March 1990, 240 of these tests were carried out in 120 patients. The results were tabulated and compared with their clinical diagnosis. We analyzed our laboratory and labor costs. An oral dose of 0.5 micrograms of vitamin B12 labelled with 18.5 Bq of 57Co is taken by the fasting patients and two hours later one mg of standard B12 vitamin is injected. Urine is collected for 48 hours and the radioactivity is measured in a scintillation counter. Three days later the test is repeated with an additional oral dose of intrinsic factor (IF). The total expense is calculated using the following factors: the cost of the imported radioactive vitamin, IF capsules, parenteral B12 vitamin, syringes, equipment use and its depreciation, laboratory material, and salaries for the professional and administrative personnel.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular differentiation of two different translocations producing two apparent Ph chromosomes in a patient with CML.

A case of chronic myelogenous leukemia (CML) is described whose leukemic cells appeared to contain two Philadelphia (Ph) chromosomes originating from different translocations involving the two chromosomes 22. The karyotype of the affected cells, established on two different occasions, was: 46,XY,t(9;22)(q34;q11),t(15;22)(p11;q11) with no normal chromosomes 22 and only one 9q+ in each of 115 marrow cells examined. The same findings were present in 50 peripheral blood cells cultured without phytohemagglutinin (PHA) stimulation. When stimulated with PHA, a normal male karyotype was present in the 11 cells examined. There were no additional chromosomal abnormalities and no indication of a blastic crisis after nearly 1 year following the original study. Analysis of the breakpoint cluster region (bcr) on chromosome 22 in the DNA of the affected cells (marrow) revealed evidence for one rearranged chromosome 22 and one normal chromosome 22, indicating that the t(15;22) was not due to the usual Ph translocation seen in CML. The results point to the crucial usefulness of molecular analysis in confirming cytogenetic results related to Ph translocations in CML.

Alteraciones pulmonares en padecimientos hematologicos malignos. / Pulmonary involvement in malignant hematological diseases

Se revisaron los estudios de necropsia del Archivio del Departamento de Patologia del Instituto Nacional de la Nutricion Salvador Zubiran, de enero de 1971 a diciembre de 1980. Se encontraron 103 casos con padecimientos hamatologicos malignos cuyas caracteristicas clinicas se correlacionaron con los hallazgos anatomicos haciendo enfasis en las alteraciones pulmonares desde los puntos de vista clinico y radiologico. De los 103 casos, 63 tuvieron alteracion pulmonar; las entidades responsables mas frecuentes fueron leucemia y linfoma. Los datos clinicos atribuibles a la enfermedad respiratoria fueron poco aparentes y fue raro integrar algun sindrome.De los 63 casos, 24 (38%) tenian telerradiografia de torax normal. Por tanto, la normalidad de esta no elimina al pulmon como el organo responsable del proceso infeccioso. No se observo correlacion entre neutropenia y/o trombocitopenia acentuadas y alteracion pulmonar; en cambio, si la hubo con las aplicaciones de quimioterapia El enfoque diagnostico de un paciente con padecimiento hematologico maligno y alteracion pulmonar debe ser individual y oportuno y en ocasiones debe llegarse a la realizacion de biopsia, que en general se prefiere a "cielo abierto"

Leucemia aguda y embarazo. / Acute leukemia and pregnancy

Los casos de leucemia aguda em cuya evolucion se presenta un embarazo no han sido frecuentes hasta el momento. Se informan 2 casos con leucemia aguda mieloblastica y uno con linfoblastica que se embarazon estando en remision completa y en tratamiento de mantenimiento con 6-mercaptopurina, ciclofosfamida y methotrexate. En dos casos el producto murio en utero; uno de ellos con grandes malformaciones. El tercero tuvo gemelos univitelinos, uno con minimas malformaciones, pero estudios de medula osea y cromosomico normales y ambos en buenas condiciones despues de 2 anos.El embarazo no influyo en la evolucion de la leucemia. Se propone utilizar metodos anticonceptivos en las pacientes leucemicas en edad fertil

Late-appearing Philadelphia chromosome in two patients with chronic myelogenous leukemia.

We describe two patients with typical myelogenous leukemia, who at the beginning of the disease lacked the Philadelphia chromosome in bone marrow cells, and 90 and 42 days later, respectively, its presence was shown in all cells analyzed from that tissue. These findings are compatible with the possibility that at least occasionally Ph1 occurs secondarily in already leukemic cells. The rapid change form Ph1- to Ph1+ CML in one of the patients (42 days), suggests the possibility that in addition to Ph1+ cells enjoying marked selective advantage, this change is induced simultaneously in multiple bone marrow cells.