Multicentre study on intensified remission induction therapy for acute myeloid leukemia.

In a cooperative study at 13 centres in the Federal Republic of Germany, 213 adult patients with AML were treated for remission induction by a 9-day regimen consisting of cytosine arabinoside, daunorubicin and thioguanine (TAD) according to previously described sequencing. Complete remission was achieved in 70% of all patients. Complete remission rate was 57% in the 49 patients 60 years of age and older and 74% in the 164 patients under 60 years. Sixty-eight per cent of all complete remissions and 75% of those in the higher age group were induced by one induction course. Median survival was 10 months for all patients treated and 16 months for responders. Median remission duration was 13 months with 72 patients still in continuous remission for 1-31 months. Remission duration was not significantly different for patients treated either by monthly maintenance therapy or induction type consolidation without further therapy. However, patients completing two consolidation courses had a significantly longer remission duration of 22 months. Compared to similar multicentre studies on AML therapy the intensified induction regimen applied in this study shows an improvement even in older patients.

Maturation and proliferation capacity of blood cells from untreated acute myeloid leukemia and its prognostic significance.

Blood cells from 68 patients with untreated acute myeloid luekemia were cultured in RPMI-medium without stimulating factors up to ten days. The cultures showed in part maturation and proliferation to monocytes-macrophages, in part to promyelocytes, myelocytes and Pelger-like cells, in part we did not find any differentiation or the cultures were degenerated during the first days. Retrospectively we found that in the 16 blood cell cultures with capacity to differentiation into the monocyte-macrophages-system 5 patients had a smouldering leukemia. Our preliminary evidences suggest that the diagnosis "smouldering leukemia" is to be found with out in vitro culture system. Further analysis suggest that patients with acute leukemia whose blood cells have the capacity for maturation to monocytes-macrophages or to promyelocytes, myelocytes and Pelger-like cells have a better chance of achieving a complete remission and a longer median survival time.

[PHA- and PWM-stimulation in acute leukaemia (author's transl)]. / Antigenstimulation peripherer Leukozyten von Patienten mit akuten Leukämien.

Peripheral blood cells from patients with acute leukaemia were stimulated in RPMI-medium with Phytohaemagglutinin (PHA) and/or Pokeweed-Mitogen (PWM). Samples of the cultures were taken at 3, 5 and 7 day intervals for cytological characterization. From 119 cultures from 65 patients 76 cultures from 47 patients could be analysed. Cultures stimulated with PHA and/or PWM showed in 43,4% a higher stimulation rate in comparison with cultures from normal persons. These findings are discussed in relation to the increased agar-colony growth growth of leukaemic cells after in vitro PHA-stimulation and transformation of blast cells.

[Characteristic features of infections in hemoblastoses under cytostatic treatment (author's transl)]. / Besonderheiten der Infektionen bei Hämoblastosen unter zytostatischer Therapie

Infections and/or severe hemorrhages are the reasons for the unfavorable prognosis in patients with myeloid insufficiency. Hemorrhagic complications may be reduced by thrombocyte transfusions and substitution of coagulation factors; the prevention and treatment of infections represents great problems in spite of newly developed broad spectrum antibiotics. A comparison is made between the therapeutic results of 11 patients treated in sterile units and 22 patients treated under conventional conditions. The rate of remission was seen to be 64% in the first group and 28% in the second.

[Aplastic anemia-a preleukemic stage (author's transl)]. / Panmyelopathie - ein präleukämisches Stadium?

In a group of 44 patients with primary and secondary aplastic anemia, four (9%) developed an acute leukemia. Cytological changes that pointed to a preleukemia were not observed during the preleukemic stage. The possibility is discussed whether a aplastic anemia and a preleukemia can be distinguished by cytological, cytochemical and cytogenetic tests, by agar-culture technique, liquid-culture and determination of reverse transcriptase.

Adjuvant specific immunotherapy in maintenance treatment of adult acute non-lymphocytic leukemia.

From 1976 until 1978, 136 adult patients with acute leukemia were treated in four hospitals in Berlin. A complete remission was achieved in 47 patients (35%). Twenty-six patients with non-lymphocytic acute leukemia, who had achieved a complete remission with induction chemotherapy consisting of daunorubicin (45 mg/m2/day, day 1, 2 and 3) and cytosine-arabinoside (100 mg/m2/day, continuous infusion, day 1 to day 7) were entered into a randomized trial. Thirteen patients were treated with an intermittent combination chemotherapy at 4-week intervals; the other group of patients received in addition a specific immunotherapy consisting of neuraminidase-modified allogeneic blast cells. The results revealed that the addition of this kind of immunotherapy did not increase the duration of first remission or survival.

Germinal center cell lymphomas: prognostic significance of their histopathological differentiation.

Clinical data of 48 patients with centrocytic, 83 patients with centroblastic/centrocytic and 64 patients with centroblastic lymphoma who had entered a prospective multicenter study of the Kiel Lymphoma Study Group since October 1975 were compared. Advanced (stage IV) disease at time of diagnosis, predominantly due to bone marrow infiltration, was most frequent in centrocytic (69% of patients) and in centroblastic/centrocytic (51% of patients) lymphomas as compared to only 28% of patients with centroblastic lymphoma. High survival probability of patients with localized centrocytic and centroblastic/centrocytic lymphomas after radiotherapy, contrasting with a worse prognosis of corresponding patients with centroblastic lymphoma, is compatible with the classification of these lymphoma entities as neoplasias of low-grade malignancy. However, as shown by this prospective and previous retrospective trials overall survival probability of patients with advanced centrocytic lymphoma was inferior to that observed in corresponding patients with centroblastic/centrocytic lymphoma. These findings suggest the possibility that patients with advanced centrocytic lymphoma occupy an intermediate position between typical low-grade and typical high-grade malignant non-Hodgkin lymphomas.