Recovery from aplastic anemia following attempted marrow transplantation.

A 23-year-old man with severe idiopathic aplastic anemia was prepared for marrow transplantation by the administration of cyclophosphamide (CY) 50 mg/kg on each of 4 days. He then received an intravenous infusion of 9.5 x 10(9) marrow cells from an HL-A matched and mixed leukocyte culture non-reactive sister. The graft was successfully established as shown by cytogenetic studies but was rejected after approximately 4 weeks. In preparation for a second transplant he was given procarbazine 12.5 mg/kg and goat antihuman thymocyte globulin (ATG) 7 mg/kg administered on alternate days for a total of 4 doses of each agent. At the end of this therapy his white blood cell count was noted to be going up and the second transplant was not carried out. Complete hematologic recovery of host type marrow ensued and persists now 20 months later. The various pathophysiologic mechanisms that may be involved are discussed.

Antithrombin III and Factor VIII in patients with neoplasms.

Possible increased activation of the coagulation pathway was measured in a group of patients with neoplastic diseases. In addition to standard tests, the thromboplastin generation test, thrombin generation test and immunologic and coagulant activities of both Factor VIII and antithrombin III were utilized in the evaluation. The correlation between immuno-Factor VIII (VIII-Ag) and its clotting activity (VIII-C1) was good (r = 0.83). In contrast, this was not the situation for antithrombin III-Ag and its clotting activity. Thromboplastin generation was accelerated in 60% and thrombin generation was accelerated in 40% of the patients. Fibrinogen was elevated in half the cases: in most of these patients, thrombin times were slightly prolonged. These results indicate that some patients who have cancer have abnormal clotting patterns and are often in a potentially hypercoagulable state that is reflected by the thromboplastin generation test, thrombin generation test, and high levels of Factor VIII (both VIII-Ag and VIII-C1).

[2 further cases of familial erythremia: association of erythremia and a malignant blood disease]. / Deux nouveaux cas d'érythrémie familiale: association de l'érythrémie et d'une hémopathie maligne.

The literature on benign familial erythremia is reviewed and two cases are reported. One of the patients developed acute leukemia. The author considers that this form of erythremia is not truly benign, although in the majority of cases it is compatible with a normal life-span.

[8;21 translocation and leukemia]. / Translocation 8;21 et leucémisation.

The authors report their observations on acute myeloid leukemias associated with the 8;21 translocation. Two cases have less than the required percentage of blasts for the cytological diagnosis of acute myeloid leukemia. In one case, the 8;21 translocation is superimposed on a constitutional trisomy 21. Conclusions from the 4th International Workshop on chromosomes in leukemia are highlighted, as well as certain new data relative to the biology of acute myeloid leukemias.

[Scleronodular type of Hodgkin's disease: experience at the Sherbrooke University Hospital Center]. / La forme scléronodulaire de la maladie de Hodgkin: expérience du CHU de Sherbrooke.

Scleronodular type of Hodgkin's disease: experience at the Centre hospitalier universitaire de SherbrookeThe nodular sclerosis type of Hodgkin's disease appears to be a distinct clinical entity. However, the incidence, the initial localization of the tumour and the survival of the patients are variable. The present study was carried out on a group of 17 patients, all French Canadians living in the province of Quebec, from a total of 31 with Hodgkin's disease, an incidence of 55%. There were more males (10) than females (7). The mean age of the group was 37 years, but that of the females was lower than that of the males. The mediastinum was involved at the onset in 47% of the patients. The initial staging (according to the classification of Rye) in 76% of the patients was I or II.Four patients showed disease below the diaphragm. The lungs were infiltrated three times, the spleen six times, and the liver five times. The duration of survival of the 17 patients was twice that of the patients with the three other types of the disease.

Levels of antithrombin III, alpha 2-macroglobulin, and alpha 1-antitrypsin in acute ischemic heart disease.

Since measurements of AT III and other possible coagulation inhibitors might provide an index of hypercoagulability, the goal was to measure over a 3-month period individual changes in blood levels of AT III, alpha 2-microglobulin, and alpha 1-antitrypsin in 51 patients with acute ischemic heart disease who were admitted to a Coronary Care Unit with the following diagnosis: unstable angina (26 patients), acute transmural myocardial infarction (20 patients), or subendocardial myocardial infarction (5 patients). Some patients received prophylactic antithrombotic therapy. AT III was measured by the von Kaulla, Owen, Thrombo-Screen, chromogenic, immunodiffusion, and immunoelectrophoretic methods. Alpha 2-macroglobulin and alpha 1-antitrypsin were measured by immunodiffusion. All inhibitors were measured on three different occasions: (1) on admission to hospital, (1) day of departure from hospital, and (3) at 3 months after hospitalization. Alpha 1-antitrypsin showed a significant increase compared to the control and remained elevated during the 3-month interval. Compared to normal control values, AT III was found to be significantly diminished when measured by one functional method (von Kaulla) in all three blood samples from patients with unstable angina and transmural myocardial infarction and by one immunological method (immunodiffusion) in patients with unstable angina, transmural myocardial infarction, and subendocardial myocardial infarction. Most methods determining functional AT III detected a significant increase 3 months after the acute ischemic episode; this rise was observed more often in patients with myocardial infarction than in those with unstable angina. Stepwise discriminant analysis separated the patients of the three groups. Subcutaneous heparin has no significant effect on AT III levels. Unexplained discrepancies still exist between the results obtained by various functional and immunological methods for determining AT III. It appears, however, that methods measuring functional AT III seem to be more suited than immunological methods to detect changes in AT III levels that might occur during and after an acute episode of ischemic heart disease.