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La infiltración ocular diferente del sarcoma mieloide en la leucemia no linfoblástica aguda (LNLA) es un hallazgo inusual.Se revisa el caso de una niña de 9 meses de edad con LNLA M5 e infiltración del sistema nervioso central (SNC), que presentó afectación de la cámara anterior del ojo intratratamiento, coincidiendo con la remisión complete del SNC.Se trató con esteroides tópicos, quimioterapia sistémica y radioterapia ocular bilateral (dosis total de 1.000 cGy) con buena respuesta, aunque falleció a los 2 meses al no conseguirse la remisión hematológica de su enfermedad.Cualquier manifestación ocular en niños con leukemia debe ser evaluada y tratada de forma precoz. La radioterapia tiene un papel importante en el tratamiento de la infiltración de la cámara anterior del ojo.La infiltración ocular junto a la medular y del SNC es un signo de mal pronóstico en niños afectados de leucemia. : Unlike myeloid sarcoma, ocular involvement is unusual in acute non-lymphoblastic leukemia. A 9-month-old female infant with acute non-lympho-blastic leukemia M5 and evidence of active central nervous system (CNS) disease showed infiltration of the anterior chamber during therapy. At that time, the CNS disease was in completed remission.She was treated with topical corticosteroids, chemotherapy and bilateral ocular radiotherapy (total dose 1,000 cGy). The ocular manifestations responded well to treatment but hematologic response was poor. The patient died a few months later.Any ophthalmic manifestation in children with leukemia should be detected and treated early. Radiotherapy is warranted in infiltration of the anterior chamber of the eye.The presence of ocular, central CNS or bone marrow involvement indicates poor prognosis in acute childhood leukemia.

The relation between the quantified French-American-British cooperative study (FAB) classification and presenting features was studied in 123 adult patients (greater than or equal to 15 years) with acute myeloid leukemia. Myeloblastic leukemia with maturation (M2) patients with a high maturation index (M2a) were older, compared to the other myeloblastic subgroups, while promyelocytic leukemia (M3) patients were younger than those with M2 or M2a. Differences between various leukemia types were found in the occurrence of a preceding myelodysplastic syndrome, leukocyte count, and platelet count. In both monoblastic leukemia (M5) and myeloblastic leukemia (M1-3) a smaller degree of maturation seemed to be related to a larger tumor mass. The effect of chemotherapy was analyzed in a group of 64 patients. Comparison between immature (M1) and more mature (M2) myeloblastic leukemia suggested a longer duration of first complete remission and a longer survival in M2. The findings of this study may imply that the degree of maturation determines tumor mass and the success of chemotherapy.

A large dose of equine antilymphocytic globulin (ALG, 120 mg/kg/day) was given intravenously to four patients with myeloblastic leukemia. Leukemic myeloblasts from each patient were lysed by the ALG in vitro, in the presence of the same patient's serum complement. In each patient, ALG infusion was followed by a reduction in the count of circulating leukemic myeloblasts, and a fall in the serum levels of C3 and C4 complement. It is likely that complement-mediated lysis of circulating leukemic myeloblasts occurred in these patients, as a result of ALG administration.

We refer to 48 adult patients suffering from acute myeloblastic leukemia, whose leukemic cells showed a typical cytochemical pattern: i.e. weak staining for peroxydase and with sudanblack B and lacking or only weak staining for nonspecific esterase. In 8 patients the leukemic myeloblasts additionally showed distinct granular staining for polysaccharides using the PAS-reaction. The therapeutic response, the remission rate and the survival time of these 8 cases have been compared to those of 40 patients, whose leukemic myeloblasts differed exclusively in the absence of granular PAS-positive materials. Out of the latter PAS-negative cases 7 patients (18%) went into a complete remission (M1, P1), 5 patients achieved partial remission (M2, P1-2), the 50%-survival time was 4.9 months. Out of the 8 granular PAS-positive cases 4 patients (50%) went into complete (M1, P1), and 1 reached partial remission (M2, P1-2). The 50%-survival time of the cases now lasts 10.1 months and three patients are still alive and in persisting complete remission 19, 12.5 and 12 months after diagnosis. These results suggest a better prognosis and an improved therapeutic response in those myeloblastic leukemias which additionally contain cytoplasmic granular PAS-positive materials.

Three-hundred and ninety-nine patients with acute leukemia examined during the period 1947-1964 were divided into three sequential series and their survival, from diagnosis to death, was compared. A statistically significant increase in duration of survival for myeloblastic leukemia from a median of 2 to 5 months occurred between series I and series III. This is the first convincing evidence that 6-mercaptopurine therapy influences survival in myeloblastic leukemia. A steady increase in median survival of patients with lymphoblastic leukemia from 4 to 8 to 12 months was found in the three series. The results of analysis of these series are compared to other reported series. The hypothesis —that the longer survivals reported for patients treated in hematology clinics compared to that of patients selected from population areas reflects patient selection—was examined and appeared unlikely.

The longevity, reckoned from the symptomatic onset of acute leukemia as well as from the initiation of treatment, of a group of 89 cases including children and adults, treated in this clinic since March, 1954, was found to exceed that of a similar group of 78 patients treated in preceding years in the same clinic. The median survival of all cases considered as a unit was increased from three to six months, as measured from the date treatment was begun. The change was found to be statistically significant as well as clinically important. The longer survival found in the 1954-57 series correlated with the greater use of three, rather than only two, chemotherapeutic agents. On analysis, improved survival was statistically proven only for individuals with lymphoblastic leukemia; for these, the median survival was 10 months after the symptomatic onset of leukemia and 7½ months after the start of treatment. Within this group, there was an even greater improvement for those whose leukocyte values immediately prior to the initiation of therapy were less than 10,000 per cu.mm.; half of these patients lived more than 12 months after treatment was begun. The reason for the exceptional longevity of patients with the lower pre-treatment leukocyte values is unknown. It appears that one can attribute at least part of the improvement to therapy. The type of statistical analysis used presents the minimum figures for improvement in median survival. When the ultimate longevity is known for the 17 per cent of the cases surviving at the closing date of the study an additional small increment may be found. The relative inefficacy of chemotherapy in myeloblastic leukemia should be a signal for greater screening of new agents in this type of tumor.

The apparent protein content of a single spherical lymphocyte or a similar cell, as well as its diameter, can be measured by a modified and stabilized AO-Baker interference microscope which is either fitted with an AO half-shade eyepiece or connected to a photomultiplier. This paper gives results for the apparent protein content and the diameter of normal mouse lymphocytes and thymocytes; these do not differ significantly from each other. It also gives values for the apparent protein concentration and the diameter of the lymphocytes of mice of the same strain which have developed leukemia or lymphoma; these values are significantly different from those of normal mice. Related data are given for the apparent protein content and for the diameter of normal human lymphocytes and the white cells found in myeloblastic leukemia and in stem cell leukemia in man; here the values differ significantly from those of the normal human lymphocyte. The rule seems to be that the abnormal white cells become more watery and larger as the disease advances.

A case with a prolonged period of blood disorder preceding the terminal development of myeloblastic leukemia is reported in some detail. The preleukemic period was characterized by anemia, neutropenia and thrombocytopenia. It extended over a period of almost nine years but was punctuated by a period of remission lasting four and one half years. In the initial phase, the marrow was hypoplastic but during the later stages, it was hyperplastic. Brief reference is made to somewhat similar cases that have been recorded and to the ideas expressed by the authors of these reports. It is suggested that further investigation is needed to determine whether the initial blood disease occurring in such cases is irrevocably linked to the subsequent leukemia.

A case of a patient is presented, who suffered from acute leukemia, showing predominantly atypical myeloblasts in the bone marrow. In contrast, a high amount of atypical “neutrophils” were present in the peripheral blood, as well as there was a conspicuous number of monocyte-like intermediate forms between the myeloblasts and the atypical segmented “neutrophils.” The cytochemical pattern of the “Neutrophils” was highly atypical, the main part being devoid of sudanblack B-positive lipids, as well as of peroxidase and chloroacylesterase activity, which characteristically are present in large amounts in the neutrophil granulocytes. Moreover, atypical distribution of alkaline phosphatase and naphthylamidase activities were encountered in these cells. The intermediate or transitional cells exhibited a cytochemical pattern different from that of normal blood monocytes, but corresponding to that of the atypical neutrophils. Thus, the assumption of a direct maturation way from myeloblasts to “paraneutrophils” with mononuclear, monocyte-like intermediate stages was supported by the results of cytochemical investigations. In contrast to the elevated number of neutrophils in the peripheral blood (10 350/mm3) very rare normal neutrophil precursors with typical cytochemical pattern were encountered in the haematopoietic organs.

Four cases of severe refractory anemia with an enormous increase of demonstrable free iron in the normoblasts are reported. Three cases were of unknown etiology and of benign course but in the fourth the anemia was probably related to rheumatoid arthritis or to the onset of myeloblastic leukemia. The significance of the sideroblastic bone marrow in these cases is discussed and the opinion expressed in the literature—that it indicates a defect in hemoglobin synthesis is subscribed to. Thus, it is believed that the anemia in these cases is due to degenerative changes in the bone marrow which also have some morphologic manifestations. The disturbance of marrow activity is probably best reflected in the reticulocyte counts.

A detailed study (phase contrast, bright field and electron microscopy) of the primitive leukemic cells from a patient with atypical myeloblastic leukemia has been presented. An unusual mucopolysaccharide-containing vacuole has been observed and characterized both morphologically and histochemically. In addition, this study has yielded considerable information concerning the structure and chemical composition of the fibrillar formations, fat droplets and the alterations in erythrocytes following their ingestion by the leukemic cells. Intramitochondrial structural alterations have been observed and characterized in many of the primitive myeloblasts. Changes in the mitochondria and endoplasmic reticulum may reflect impaired or altered metabolism in these abnormal leukemic cells.

The susceptibility of 12 mutant strains of Japanese quails to the R strain of avian erythroblastosis virus (AEV) was examined. Three strains, SBPP, PNN and CWE, showed high susceptibility and developed various types of tumors including erythroblastosis, hemangioma and myeloblastic leukemia. In relatively resistant WE strain, increased incidence and various types of tumors were observed by modification of host conditions. These results indicate pluripotential oncogenicity of AEV in quails as well as partial control of AEV-oncogenesis by genetical background of the host.

A patient with coexistent Gaucher disease and Philadelphia positive chronic granulocytic leukemia (CGL), who subsequently developed myeloblastic leukemia, is described. The diagnosis of CGL was established according to standard clinical, morphological, biochemical, and cytogenetic data, while the diagnosis of true Gaucher disease was based on biochemical data and the presence of Gaucher cells with typical ultrastructural features in the bone marrow and spleen. Enzyme studies showed low activity of ceramide-β-glucosidase in the patient's peripheral blood leukocytes, skin fibroblasts, and splenic tissue and the presence of increased amounts of ceramide-β-glucoside in the spleen. This case is reported in order to draw attention to the possible coexistence of these two diseases in the same patient, as opposed to the well-recognized finding of “Gaucher-like” cells in the bone marrow of patients with CGL. Enzyme studies enable distinction between these two situations.

Objective Leukemia is the most prevalent type of cancer in children. The aim of this study was to estimate the 5-year survival rates of Acute Lymphoblastic Leukemia (ALL) and Acute Myeloblastic Leukemia (AML) as well as factors influencing them. Methods This is a nonrandomized retrospective study conducted on 280 patients with ALL and AML. They were all below 15 years old children admitted to Shahid Faghihi hospital, Shiraz, Iran from 2004 to 2008.The survival rates were estimated by applying the Kaplan-Meier method. In addition, the log rank test was used to estimate the statistical significance of differences in the survival probability. Cox regression model was applied to conduct multivariate analysis for adjusting confounding variable. All analyses were performed in SPSS statistical software (version 16). P-values less than 0.05 were considered as statistically significant. Findings The mean (± standard deviation) of the observation period was 28.2±16.1 months. In this period, 60 (24.7%) patients (47 ALL and 15 AML) passed away. The cumulative rate of survival in this study was 53.3±0.1 percent. This probability was 56.6±0.1% and 44.2±0.1% for ALL and AML patients, respectively, which indicates no statistically significant difference between them (P=0.8). According to Cox model, there was a significant relationship among the variables of platelet count and relapse with the survival rate. Conclusion Platelet count was identified as a positive prognostic factor of the survival rate in ALL patients. However, on the base of our results and other studies, incidence of relapse and the number of relapses are significant factors of survival rates of leukemia.