A 23-year-old male patient developed aplastic anemia and was treated with cyclosporin A and rhG-CSF. Bone marrow biopsy showed an improvement in cellularity with a recovery of all hematopoietic precursors after nine weeks of therapy. WBC increased after two weeks of treatment, mostly due to an increase in the absolute granulocyte cell count. Hb, RBC, Plts and reticulocytes showed an increase six weeks after the beginning of therapy. Of the serum cytokines, EPO levels progressively decreased, while sTfR increased in peripheral blood. A reverse correlation between blood neutrophil count and serum levels of G-CSF was observed, indicating an increased clearance of G-CSF. Finally, sIL-2R showed a rapid increase in the first week of treatment and prior to the increase in PMN cells. Thus, the use of cyclosporin A and rhG-CSF in our patient induced a complete recovery of hemopoiesis, and this may be explained by a synergic effect induced by the capacity of cyclosporin A to remove inhibitory factors and the stimulatory activity of rhG-CSF.

Adult↗

PubMedDate not supplied

Acute promyelocytic leukemia: morphological and clinical features.

BACKGROUND AND METHODS: Acute promyelocytic leukemia (APL) is not a morphologically homogeneous entity: to verify whether there is any relationship between this heterogeneity and other biological and clinical aspects, we studied 43 cases of APL with morphological, cytochemical, cytogenetic and immunological methods. RESULTS: Three morphological categories were present: a classic hypergranular type (30 cases), a microgranular type (6 cases) and a form with basophilic granules (M3b) that stained metachromatically with toluidine blue (7 cases). In all these groups there were cases with cytochemical features of both myeloid and monocytic type (alpha-naphthyl-acetate esterase positive). No immunological and cytogenetic differences were observed; the morphological variant with basophilic granules was more frequent in females; age distribution was not related to the morphological subtype; organomegaly was extremely rare in M3b. A low white blood cell count was constant in M3b, whereas no differences were observed in hemoglobin and platelet values. Severity of bleeding was worst in the group with toluidine blue metachromasia; this and the microgranular type had poor prognosis. CONCLUSIONS: Our study confirms the importance of identifying different cytologic categories in APL. In particular we focused our attention on a new variant with basophilic granules.

Adolescent↗