The t(5;17) variant of acute promyelocytic leukemia expresses a nucleophosmin-retinoic acid receptor fusion

The classical action of the hormone 1,25-dihydroxyvitamin D3 (VD) is the regulation of calcium metabolism. In contrast, the peptide hormone atrial natriuretic factor (ANF) is one of the few known nonclassical VD responding genes. We screened the promoter of the rat ANF gene and identified a typical VD receptor (VDR) binding site formed by a direct repeat of two hexameric core binding motifs spaced by three nucleotides, between positions -907 and -891. Like most of the DR3-type VD response elements this sequence is bound with high affinity (Kd = 0.53 nM) by a heterodimer formed by VDR and retinoid X receptor. In a heterologous promoter context one copy of this sequence mediated an about fourfold gene activation by VD and a half-maximal activation (EC50) value of 0.48 nM VD. This characterizes the identified sequence as one of the most potent VD response elements.     

Scrotum exfoliative dermatitis with ulcers associated with treatment of acute promyelocytic leukemia with all-trans retinoic acid]

We present a case of leukemia cutis associated with a prominent giant cell component. This lesion was initially diagnosed as chronic granulomatous inflammation 1 year before the definitive diagnosis of leukemia cutis was made. Skin biopsy specimens showed numerous Langhans-type giant cells occurring singly and as poorly formed granulomas. However, the majority of the infiltrate consisted of immature myeloid cells, positive for chloroacetate esterase, lysozyme, and CD 68. Subsequent peripheral blood and bone marrow examinations confirmed the progression of the disease to acute myeloid leukemia.     

Treatment of newly diagnosed acute promyelocytic leukemia (APL) by all transretinoic acid (ATRA) combined with chemotherapy: The European experience. European APL Group

All transretinoic acid (ATRA) gives complete remission (CR) rates of 80 to 90% in newly diagnosed acute promyelocytic leukemia (APL). However, it has two major drawbacks (1) a rapid rise in WBC in some patients, with potentially fatal ATRA syndrome (2) rapid relapse with maintenance therapy using ATRA alone or low dose chemotherapy. The French APL group therefore designed a treatment approach with ATRA followed by intensive chemotherapy. The latter was administered after CR achievement with ATRA, or was rapidly added to ATRA in case of rapid rise in leukocyte counts. This combined approach, in a pilot study and in a randomized trial, proved superior to intensive chemotherapy alone, by slightly increasing the CR rate but more importantly by reducing the relapse rate. These results were confirmed by the Chinese, Japanese and New York groups. Our group (and other European groups) are now testing in a new randomized trial the better timing of ATRA and chemotherapy administration (ATRA followed by chemotherapy or ATRA plus chemotherapy) and the role (after an intensive consolidation) of maintenance treatment with intermittent ATRA, continuous low dose chemotherapy or both.     

Acute promyelocytic leukemia: all-trans retinoic acid (ATRA) along with chemotherapy is superior to ATRA alone

This study was conducted to compare the results of treatment of acute promyelocytic leukemia (APL) with all-trans retinoic acid alone (ATRA) or a combination therapy of ATRA followed by chemotherapy. Forty-three patients treated between February 1992 and February 1996 were included in this study. Eighteen patients were treated with ATRA alone and 25 patients were treated with ATRA followed by chemotherapy. The cytogenetic analysis was done in 41 patients at presentation, following treatment, and at follow-up. A complete response (CR) was achieved in 13 (72%) patients on ATRA and 19 (76%) on ATRA followed by chemotherapy. Eleven of 13 patients with response to ATRA alone relapsed with median survival of eight months (range, 1 to 28). One patient died of hepatitis in CR and one patient is alive 2 years after diagnosis. In the combination therapy arm, 10 patients are in CR with a median follow-up of 22 months (range, 6 to 56 months). After achieving a CR, four patients died due to infections during chemotherapy therapy, and only 5 of 19 patients have relapsed. Major cytogenetic response was seen in 8 of the 10 patients in whom cytogenetic data was available after treatment with ATRA at the time of remission. Similarly, 13 of 15 for whom data was available showed a major cytogenetic response after treatment with ATRA plus chemotherapy. Prior to relapse, 80% of the patients had an increase in the percentage of t(15;17) cells in the marrow. Patients with a complete hematological response but no cytogenetic response relapsed within six months. Ten patients died prior to response evaluation. Two patients who received ATRA died of retinoic acid syndrome, one of pneumonia, and one of intracranial hemorrhage. Of the six patients on ATRA and chemotherapy, four died of retinoic acid syndrome (RAS), one of intracranial hemorrhage, and one of left ventricular failure. Only one patient is alive at 24 months following treatment with ATRA alone. The relapse-free survival is 42% at four years for patients treated with ATRA followed by chemotherapy. This trial is a historical comparison of ATRA alone and ATRA with subsequent combination chemotherapy. Nonetheless, the trial shows a significant improvement in the event free survival of patients receiving chemotherapy as consolidation following ATRA.     

Clinical characteristics and treatment results of acute promyelocytic leukemia in children (Children's Cancer and Leukemia Study Group)

The clinical characteristics and treatment outcome in 40 children with acute promyelocytic leukemia (APL) treated at institutions participating in the Children's Cancer and Leukemia Study Group (CCLSG) were studied retrospectively. The median age at diagnosis was 8 years old. Bleeding diathesis was the predominant presenting symptom (90%), associated with laboratory findings of disseminated intravascular coagulation. Hepatomegaly, splenomegaly and lymphadenopathy were observed in 35%, 10%, and 15% of the cases, respectively. The median WBC count was 4.25 x 10(9)/l. Anemia (hemoglobin < 8 g/dl) and thrombocytopenia (< 30 x 10(9)/l) were present in more than half of the patients. Cytogenetic studies demonstrated the characteristic 15; 17 translocation in about 90% of the patients analyzed. Induction therapy consisted of cytosine arabinoside and an anthracycline, with or without other agents. Twenty-nine patients (73%) achieved complete remission (CR) while early fatal hemorrhage was the predominant cause of induction failure. The survival rates continued to decrease (28% at 3 years, 24% at 5 years, and 7.9% at 10 years) due to late marrow relapses. Anthracycline cardiotoxicity was fatal in three patients in remission. These clinical features of childhood APL should be taken into account in the development of new protocols.     

Acute and chronic arsenic poisoning associated with treatment of acute promyelocytic leukaemia

Seven relapsed and/or refractory acute promyelocytic leukaemia patients were treated by arsenic trioxide (As2O3). Four patients (4/7, 57%) achieved complete remission after one to three cycles of treatment and the most common acute side-effect was fluid retention (in six patients, 86%), including weight gains and pleuro-pericardial effusions. Evident polyneuropathy compatible with chronic arsenic toxicity was noted in two of the three patients who received As2O3 maintenance therapy and one of them had marked distal muscular atrophy. We suggest that As2O3 may be a useful salvage therapy for relapsed and refractory APL patients, but the acute or chronic arsenic toxicity should be carefully monitored.     

Bilateral osteonecrosis of the head of the femur complicating acute promyelocytic leukemia: a sequel to treatment of retinoic acid syndrome with dexamethasone

BACKGROUND: Isolating Helicobacter pylori on culture media and performing antibiotic susceptibility testing is potentially the most useful tool for guiding antibiotic therapy, especially when antimicrobial resistance is suspected. The aim of this study was to determine whether the yield of H. pylori culture was related to the site from which the gastric specimen was obtained either before or after therapy. METHODS: Gastric mucosal biopsies from the antrum and the corpus of the stomach were cultured. H. pylori status was determined by histological assessment using the Genta stain. RESULTS: Fifty-two patients with documented H. pylori infection were studied: Twenty-three were tested before antibiotic therapy and 29 after therapy had failed. In 47 patients (90%), both antral and corpus culture specimens were positive. In 5 patients (10%), only one site was positive, with three false-negative antral and two false negative corpus cultures. The overall sensitivity of culture in detecting H. pylori infection was 95% (95% confidence interval = 89-98%) and was not significantly different for the antrum or corpus, either before or after therapy. CONCLUSION: Culture of gastric biopsies from either the antrum or the corpus has an excellent diagnostic yield even in patients who failed antimicrobial therapy.     

A translocation t(8;14) and c-myc gene rearrangement associated with the histological transformation of B-cell acute lymphocytic leukemia (FAB-L2) into Burkitt''s type (FAB-L3) leukemia

During the late rainy season and winter season in 1990, outbreaks of suspected trypanosomiasis in native cattle (Bos indicus) occurred on 13 farms in Petchaboon province, Thailand. Forty-two cattle presented with nervous symptoms including circling, excitation, jumping, aggressive behavior, lateral recumbency, convulsion and finally death. Blood samples from 39 cattle on the two farms in which the outbreaks occurred were collected and examined for the presence of Trypanosoma evansi. It was found that all 16 blood samples from cattle on farm A were positive of T. evansi by mouse inoculation and indirect fluorescent antibody test (IFAT). In cattle from farm B, on the other hand only 37.5% and 39% of the samples were positive by mouse inoculation and IFAT, respectively. T. evansi was detected on impression smears of organs from the three cattle which died with nervous symptoms and also in smears made from their cerebrospinal fluid. In addition, trypanosomes were isolated from the cerebrum, cerebellum, pons and spinal cord by mouse inoculation.     

三氧化二砷联合全反式维甲酸治疗初发急性早幼粒细胞白血病50例疗效观察

目的 观察三氧化二砷(ATO)联合全反式维甲酸(ATRA)治疗初发急性早幼粒细胞白血病(APL)的疗效.方法 98例初发APL患者分为对照组和治疗组,对照组48例,治疗组50例.对照组采用常规ATRA+DA双诱导方案治疗;治疗组采用ATRA每天25 mg/m2,ATO每天0.15 mg/kg(ATRA后第10天开始)联合治疗,直至完全缓解(CR),CR后接受ATO和ATRA联合巩固治疗.比较两组CR率、PML-RAR α融合基因转阴时间及5年无病生存率.结果 对照组和治疗组CR率分别为89.5%(43/48)和90.0%(45/50),获得CR时间分别为(30.0±5.1)d和(28.1±4.4)d,两组CR率(x2=-0.068,P=0.946)及获得CR时间(t=1.757,P=0.083)相比差异均无统计学意义.在所有获得CR的患者中,3例分别在CR后第276、385和394天复发.所有患者发病时PML-RAR α融合基因均阳性,对照组和治疗组CR时分别有25.0%(5/20)和29.4%(5/17)转阴,巩固后分别有92.5%(37/40)和97.6%(41/42)转阴.对照组和治疗组5年无病生存率分别为(85.3±5.9)%和(87.6±5.6)%,差异无统计学意义(x2=0.232,P=0.630).结论 ATO联合ATRA能有效治疗初发APL患者,可以作为常规化疗方案外的另一选择.     

The t(14;18) in a patient with de novo acute lymphoblastic leukemia is associated with t(8;9)

Cytogenetic analysis of a bone marrow aspirate from a patient with acute lymphoblastic leukemia (ALL) revealed the presence of a complex karyotype containing the translocation, t(14;18)(q32;q21). Further investigations using fluorescence in situ hybridization (FISH) allowed the characterization of an additional translocation, t(8;9)(q24;p1?). The association of t(14;18)(q32;q21) and t(8;9)(q24;p13) has recently been described in two patients with de novo ALL (Nacheva et al. Blood 1993;82:231-240) and this report supports these findings.     

The neurotoxin, beta-N-methylamino-L-alanine (BMAA) interacts with the strychnine-insensitive glycine modulatory site of the N-methyl-D-aspartate receptor

Electrophysiological and receptor binding techniques were used to determine whether the neurotoxin beta-N-methylamino-L-alanine (BMAA), a monocarboxylic amino acid, can act at the strychnine-insensitive glycine modulatory site to modify the activity of N-methyl-D-aspartate receptors. DL-BMAA but not L-BMAA reversibly potentiated the amplitude of NMDA-activated currents. Neither DL-BMAA nor L-BMAA were able independently to active currents. The reversal potential and the potential-dependence of the amplitude were not affected by DL-BMAA. The DL-BMAA effect was reversibly antagonized by 7-chlorokynurenic acid. Concentration jump experiments showed that the time course of the "off" response of NMDA-activated currents in the presence of DL-BMAA is faster than in the presence of glycine, suggesting that DL-BMAA dissociates from the receptor more rapidly than glycine. DL-BMAA produced a concentration-dependent displacement of [3H]glycine binding which was additive with that of 7-chlorokynurenic acid. These data indicate that D-BMAA could act as a stereospecific modulator of NMDA receptor function by acting as an agonist at the strychnine-insensitive glycine modulatory site of the NMDA receptor.     

The human placenta and fetal membranes express the corticotropin-releasing hormone receptor 1alpha (CRH-1alpha) and the CRH-C variant receptor

Placentally derived CRH plays a major role in the mechanisms controlling human pregnancy and parturition. It has been suggested that there is a CRH placental clock that is active from the early stages of pregnancy and determines the length of gestation and the timing of parturition. CRH can influence human reproductive tissue function via specific CRH receptors. Two distinct CRH receptors have been cloned (R1 and R2) that share 70% homology at the amino acid level and exist as two alternatively spliced forms (alpha and beta). In this study we investigated the presence of CRH receptor subtypes in human fetal membranes derived from spontaneous rupture and placental biopsies at term. Using RT-PCR, we identified the full length of the CRH-R1alpha subtype in placental and fetal membranes. In both tissues we also identified a spliced variant of the CRH receptor (CRH-Rc). We were unable to detect any CRH-R2 messenger ribonucleic acid in any of the biopsies. Fluorescent in situ hybridization and immunofluorescence in both tissues demonstrated that syncytiotrophoblast cells and amniotic epithelium are the major cell types expressing CRH-1alpha and CRH-Rc receptor messenger ribonucleic acid. Further studies are necessary to give a better insight into the role of CRH and its receptors in these tissues.