Comparison of outcomes and prognostic factors for two groups of patients with acute myeloblastic leukemia.
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Biomedical subjects
Publications and source records attributed to J E Till.
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A colony assay available for a subpopulation of acute myeloblastic leukemia blasts with proliferative potential was used to measure adriamycin (adria) and daunorubicin (dauno) dose-response curves following brief exposure to either drug and washing. The dose-response curves were simple negative exponentials that might be characterized by D10 (dose required to reduce survival to 10%) values. The D10 values ranged from 0.47 to 20.8 microgram/ml for adria (8 patients) and from 0.06 to 0.34 microgram/ml for dauno (3 patients). Controls consisted of committed granulopoietic and T-lymphocyte progenitors. Four measurements of granulopoietic progenitors yielded D10 values from 2.5 to 11.5 mug/ml for adria and from 0.44 to 1.2 microgram/ml for dauno. T-lymphocyte precursors from 4 normal individuals were resistant. However, following incubation of normal leukocytes with phytohemagglutinin, DNA synthesis commenced in T-lymphocyte precursors for 3 additional normal controls, which was associated with an increased data sensitivity with D10 values ranging from 4.4 to 6.2 microgram/ml.
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Using colony assays for human erythropoietic (BFU-E, CFU-E) and granulopoietic (CFU-C) progenitors, normal and leukemic myelopoietic differentiation were compared; similar patterns were found in both. However, the origin of blast cells characteristic of the disease could not be established indicating the need for a direct approach to these cells. A colony assay for blast cells in acute myeloblastic leukemia is described. Blast cell colony-formation is significantly correlated with blast cell number, and the colonies contain cells of blast like morphology without differentiation markers. It is proposed that this method, taken in conjunction with results from assays of myelopoiesis and lymphopoiesis, may provide a more complete picture of leukemic differentiation. It is anticipated that such a model will be useful in devising new therapies.
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Correlation analysis of numbers of colony-forming progenitor cells was used as an approach to the quantitation of human pluripotent stem cells. Marrow specimens were obtained from 24 patients with untreated acute myeloblastic leukemia, 22 patients under treatment, and 29 patients with no hematologic malignant disease. Three classes of progenitor cells were assayed: burst-forming units dependent on erythropoietin (BFU-E), colony-forming units dependent on erythropoietin (CFU-E), and granulopoietic progenitors (CFU-C). Significant positive correlations between numbers of BFU-E, CFU-E, and CFU-C were found in all 3 groups of patients. In contrast, no such positive correlations were seen between marrow blasts and any of the classes of colony-forming progenitors. These results were compatible with a shared relationship of the colony-forming progenitors to a pluripotent cell of origin and raised the possibility that the immediate progenitors of the blasts may not be any of the myelopoietic progenitor cells monitored in these studies.
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Mice made tolerant to allogeneic tissues in neonatal life have been examined at different times for their ability to respond to the tolerizing determinants in a variety of assays (in vitro CML, MCL and in vivo GvH assays). All animals were tolerant in terms of their inability to produce CTL to the relevant determinants, and to induce GvH in lethally irradiated F1 recipients. Nevertheless, some mice also showed a normal MLC proliferative response and contained antigen-specific serum inhibitory factors, while other mice contained apparently antigen-specific suppressor cells. The pool of the latter, futhermore, was expanded considerably upon adoptive transfer of tolerant cells (with tolerizing antigens) to lethally irradiated syngeneic recipients. The data are compatible with the notion that suppression of clonal expansion represents the primary mechanism of tolerance maintenance (induction), and that the infrequently observed serum reactivity in such tolerant mice represents a vestige of the means whereby-cell mediated suppression was induced.
Peripheral blood from patients with acute myeloblastic leukemia (AML) contains cells capable of giving rise to colonies in culture when stimulated by media conditioned by leukocytes (LCM) in the presence of phytohemagglutinin (PHA). Two types of colonies are recognized with high frequency: The first grows in the presence of low concentrations of PHA LCM, have a blast-like morphology, and are numerically correlated with morphologically identified blast cells. The second requires either high PHA LCM concentrations or PHA alone with or without 2-mercaptoethanol and consists of cells capable of forming rossettes with sheep erythrocytes and resembles. T-lymphocyte colonies from normal blood. Precursors of blast cell colonies from 15 leukemic patients were tested for cycle state, using either the 3H-thymidine or hydroxyurea techniques. All were found to have a high proportion of cells in the S phase of the cycle. In contrast, T lymphocyte precursors from three normal individual were quiescent. The data are consistent with the maintenance of the leukemic blast cell populations by the proliferative activity of a small subpopulation of blasts.
Conditioned medium from cultures of phytohemagglutinin-stimulated leukocytes has been assessed for its content of factors able to stimulate either colony formation by human granulopoietic progenitor cells, or 3H-thymidine incorporation by peripheral leukocytes from leukemic patients. The cell concentration, concentration of phytohemagglutinin and time required for optimal production of factors were investigated. Production of both classes of factors was found to be insensitive to inhibitors of cell proliferation and DNA synthesis, but sensitive to inhibition of protein synthesis by cycloheximide. The production of colony stimulating activity showed a markedly greater sensitivity to cycloheximide than did production of thymidine-incorporating activity. For cycloheximide and most of the other inhibitors studied, factor production by leukemic cell populations was affected to a somewhat greater extent than production by normal leukocytes. Separation by velocity sedimentation of the cells responsible for production provided no evidence for distinct classes of cells producing these two classes of factors.
We have previously reported that the uptake of colchicine and other drugs in Chinese hamster ovary (CHO) cells can be greatly enhanced by the addition of metabolic inhibitors such as cyanide (See, Y.P., Carlsen, S.A., Till, J.E. and Ling, V. (1974) Biochim. Biophys. Acta 373, 242-252). This has led us to postulate the presence of an active drug permeability barrier in these cells. In this paper we provide evidence for the dependence of this permeability barrier on intracellular ATP levels. Colchicine-resistant mutants of CHO cells exhibiting a reduced drug permeability, however, can maintain this drug permeability barrier at much lower ATP levels, suggesting that they possess an altered active drug permeability barrier. We have also observed a membrane-associated protein kinase-phosphoprotein phosphatase system in the isolated membranes of mutant and wild-type cells. Differences in the intrinsic protein phosphorylation patterns between the membranes of these cells have led us to conclude that the control of the drug permeability barrier may be mediated via the phosphorylation of at least two high molecular weight surface glycoproteins.
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Normal adult hemopoiesis orginates in pluripotent stem cells; among the early differentiated descendents of such cells are progenitors committed to the erythropoietic, granulopoietic, or megakaryocytic pathways of myeloid differentiation. These may be detected in cell culture by developmental techniques, in which progenitors form colonies in viscid or semisolid media in response to appropriate stimulation. Certain diseases of hemopoiesis also originate in pluripotent stem cells; these include chronic myeloblastic leukemia, acute myeloblastic leukemia, polycythemia vera, and idiopathic myelofibrosis-the clonal hemopathies. The hypothesis is advanced that the distribution of cell classes among patients with clonal hemopathies is determined both by the differentiation potential of each pluripotent stem cell maintaining an abnormal clone and by random events occurring during clonal expansion. The latter process may account for the large variations observed between patients when committed progenitors are assayed in cultures of marrow from patients with acute myeloblastic leukemia (AML). This variation may also be used to estimate lineage relationships in the clonal hemopathies. When applied to myelopoiesis in AML, obvious differences from the normal are not detected. The analysis is consistent with the view that the blast cell population in AML is distinct from the leukemic myelopoiesis occurring within an abnormal clone. A new assay procedure is described for progenitor cells related to blast cell proliferation. Finally, these concepts are used to develop a model for the pathogenesis and cellular characteristics of AML.
The kinetics of colchicine uptake into Chinese hamster ovary cells have been investigated and found to be consistent with an unmediated diffusion mode. A variety of compounds such as local anesthetics and non-ionic detergents as well as drugs such as vinblastine, vincristine, daunomycin and actinomycin D potentiate the rate of colchicine uptake into these cells and into colchicine resistant mutants. In all cases, higher concentrations of these compounds were required to stimulate colchicine uptake in the colchicine resistant mutants than in the cells of the parental line. This stimulation was observed also in the uptake of puromycin, a structurally and functionally different drug. These stimulatory agents did not, however, cause the cells to become nonspecifically leaky since the uptake of 2-deoxy-D-glucose was unaffected. In addition, the activation energy of colchicine uptake was unaltered in the presence of stimulating agents, implying that they were not causing colchicine to enter the cells via a different mechanism. The results are compatible with the view that these compounds are membrane-active, and are able to stimulate an increased rate of unmediated diffusion of colchicine into the cells. It appears that a mechanism for the regulation of passive permeability is modified in the resistant mutants.
Some human marrows in culture release particles with oncornavirus-like properties. This study was designed to examine the immunological properties of similar particles in human marrow culture supernates. Leukemic and nonleukemic marrows were cultured for 5-7 days in the presence of [14C]uridine and [3H]leucine or [3H]glucosamine. Labeled supernatant components banding in sucrose gradient densities of 1.20-1.24 g/ml were used as antigen in a double antibody immunoprecipitation assay. The assay was validated by end point titrations and competition with unlabeled antigen; purified myeloma proteins were used as negative controls. Cross-reactivity with mammalian oncornaviruses, as judged by competitive inhibition of precipitation by these viruses, was slight and at the border of the sensitivity of the method. Precipitated antigens analyzed by SDS polyacrylamide gel electrophoresis contained three distinct polypeptides of about 70,000, 45,000 and 30,000 mol wt; these comigrated with the gp 70, pg 45, and p 30 of a murine leukemia virus. Similar polypeptides were obtained from both leukemic and nonleukemic marrow culture supernates. As determined by the radioimmunoprecipitation assay, 32 of 45 leukemic sera (71%), 36 of 45 normal sera (80%), 15 of 19 sera from family contacts of leukemic patients (79%), 14 of 21 cord blood specimens (67%), and 21 of 23 sera (91%) from patients with systemic lupus erythematosus had detectable antibody activity.