Search

Autologous bone marrow or peripheral blood stem cell transplantation may carry an increased risk of secondary myelodysplasia (MDS) and acute myeloid leukaemia (AML), which are already recognized as complications of conventional treatment for lymphoid malignancies. In order to ascertain whether it is possible to detect the evolution of such a clone at an early stage in its development we have studied X-chromosome inactivation patterns (XCIPs) in three informative females who developed abnormal myelopoiesis after high-dose chemotherapy and ABMT. In one patient transplanted for relapsed Hodgkin's disease a leukaemic clone comprising approximately 50% of the patient's myeloid cells was detectable by comparison of peripheral blood granulocyte and T-cell XCIPs when the full blood count and morphology were normal. She presented with AML 7 months later. In two patients transplanted for AML, XCIP analysis was complicated by constitutively skewed Lyonization patterns, nevertheless a progressive alteration could be demonstrated by serial analyses. In one patient a difference was detectable 28 months before presentation with MDS. In the other patient, despite evident mild pancytopenia and alterations in her XCIPs over the past 4 years, she has developed no definitive myelodysplastic features and oligoclonality due to stem cell failure cannot be excluded. These studies show that XCIPs can be used to predict development of MDS/AML in some patients, but the technique is limited by technical variability and frequent constitutional skewing in the haemopoietic system.

This paper describes the use of immunoenzymatic techniques (and in particular a recently developed immuno-alkaline phosphatase procedure) for labelling haematological samples with monoclonal antibodies. Since cells are smeared and fixed before staining it is possible to combine optimal preservation of cellular detail with visualization of positive labelling. Additional advantages over conventional immunofluorescent procedures for detecting cellular antigens include the fact that samples may be stored for long periods both before and after staining, and that double labelling may readily be performed (either by combining immunoenzymatic staining with T cell rosetting or by performing immunoperoxidase and immuno-alkaline phosphatase techniques sequentially). Furthermore, these methods may be applied to samples containing too few cells for conventional examination (e.g. samples of cerebrospinal fluid). A total of 16 different antigens (including HLA-DR, common ALL antigen and antigens associated with T cells, B cells, erythroid cells and megakaryocytes) were demonstrated by immuno-enzymatic staining on a range of normal and neoplastic haematological samples. It is concluded that this approach to cellular antigen labelling is of potential value not only in routine haematological diagnosis, but also for research in many immunological and haematological fields.

An unusual case of acute myelomonocytic leukemia, with marked bone marrow eosinophilia and basophilia, is described in which there was cytogenetic evidence at presentation of acute promyelocytic transformation, with acquisition of the standard 15;17 translocation.

This paper describes the use of a recently developed immuno-alkaline phosphatase method (the 'APAAP' technique) for labelling frozen sections of undecalcified bone marrow biopsies with monoclonal antibodies, including reagents reactive with T cells and their subsets, B cells, glycophorin, HLA-DR antigen, common ALL antigen, epithelial cells and megakaryocytes. Use of an immuno-alkaline phosphatase technique avoids problems due to endogenous enzyme activity encountered when staining bone marrow by immunoperoxidase procedures. Immunohistological labelling of frozen trephine biopsies is of particular value when it is impossible to aspirate marrow particles and for identifying cells which do not readily enter suspension (e.g. dendritic reticulum cells or stromal cells). Details are given of cases in which immunohistological analysis was used for the phenotyping of acute leukaemias, for the differential diagnosis of intramedullary T and B cell proliferations, and for identifying bone marrow metastases.

Extracolonic manifestations of inflammatory bowel disease are common and diverse. However, cardiac complications are unusual and we therefore wish to report two cases in which pericarditis occurred. The first was a patient with Crohn's disease of the colon, in whom the pericarditis developed postoperatively. In the second case an acute pericarditis came on simultaneously with the initial presentation of ulcerative colitis.