Acute marrow folate deficiency during intensive care.
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Biomedical subjects
Publications and source records attributed to J W Hamer.
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Of 111 patients presenting with acute forms of leukemia, 44% had a chromosomally abnormal cell line in the bone marrow at diagnosis. In each of the acute leukemia forms (myeloid, lymphatic, stem-cell), patients with karyotypic abnormalities showed mean and median survival times like those with normal chromosomes. Both groups showed a wide range of survival times. The mean and median survival times of patients with mixed populations of chromosomally normal and abnormal cells did not differ from those of patients with exclusively abnormal cells in the bone marrow. The karyotypic abnormalities associated with acute leukemia, as well as having no etiologic significance, probably do not determine the subsequent course of the leukemia.
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Chronic lymphocytic leukaemia has developed in three siblings who are all carriers of the abnormal Ch(1) chromosome. (3)H-thymidine autoradiography showed Ch(1) to be a G(2) autosome, from which the short arm is absent, and not G(1), which is trisomic in Down's syndrome and which is believed to form the abnormal Ph(1) chromosome. Ch(1) is not of general significance in the aetiology of chronic lymphocytic leukaemia, but it must be considered as a possible predisposing factor to leukaemia in the present family.
Thirty consecutive patients with acute lymphoblastic leukaemia (ALL) who received treatment at Christchurch Hospital between 1972 and 1982 were reviewed. Complete remission (CR) was achieved in 80 per cent with a median survival of 65 weeks. Eleven of 30 patients had one or more of the following features--B cell ALL, a mediastinal mass, the Philadelphia chromosome (Ph1) and age 60 years or older at diagnosis. Although CR was obtained in 8 of these patients none survived three years. The remaining 19 patients were regarded as 'good risk' and treated by moderate intensity chemotherapy schedules. CR was obtained in 16 of these patients (84 per cent) and the estimated 5 year survival was 62 per cent with 6 patients remaining in remission from 5 to 9 years from diagnosis. These results demonstrate the value of objective and reproducible clinical and laboratory findings in defining a subset of ALL patients which may not require high intensity chemotherapy schedules.
The subdivision of the B lymphoid leukaemias by conventional techniques is subjective and poorly reproducible, with a range of cytological diagnoses available for cases which are not typical examples of chronic lymphatic leukaemia or acute lymphoblastic leukaemia. The monoclonal antibody FMC-7 recognizes a determinant on a subpopulation of B lymphoid cell and stains follicular B cells. Routiune FACS analysis of chronic lymphoid leukaemias with a panel of monoclonal antibodies identified a subset of lymphoproliferative disorders (20 of 88) which were FMC-7 positive. a careful 'blind' cytological assessment of this subset gave some support for the suggestion that they were examples of lymphoproliferative disease of follicular origin. Eight cases, however, were considered cytologically typical of CLL. The wider application of this antibody, particularly in sequential studies over a longer time scale may improve objectivity in the classification of this group of diseases.