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A female patient in whom acute nonlymphocytic leukemia (ANLL, FAB-M6) developed during treatment of hepatocellular carcinoma (HCC) is described. Two years after partial hepatectomy and subsequent chemotherapy, leukemia developed following a 2 month preleukemic stage. Chromosomal analysis revealed an abnormal karyotype, 46,XX,-5, + der(5)t(3;5)(q25;q31). The balanced translocation t(3;5) has been observed in all types of ANLL and MDS except for ANLL M3 subtype. We summarize patients with ANLL M6 and t(3;5).

We studied the effects of recombinant human interleukin-4 (IL-4) on colony formation by enriched hematopoietic progenitors. IL-4 alone did not support colony formation at all. When IL-4 was combined with granulocyte colony-stimulating factor (G-CSF), the number of pure neutrophil colonies increased three times over that supported by G-CSF alone. IL-4 added 5 days after the addition of G-CSF failed to exert this synergistic effect, indicating that IL-4 acts on the early stage of proliferation. The mapping experiments (sequential observation of colony formation) have clearly shown that IL-4 did not initiate progenitor cell proliferation. Based on these data, IL-4 may possess a direct action on progenitor cells; however, it can only act as a costimulant with G-CSF. In contrast, IL-4 had possible inhibitory effects on macrophage colony formation supported by interleukin-3 (IL-3) and macrophage colony-stimulating factor (M-CSF). In other words, IL-4 may induce progenitor cells to become sensitive to G-CSF and thereby induce neutrophil differentiation. Delayed addition experiments demonstrated that human IL-4, unlike murine IL-4, could support neither proliferation nor survival of erythroid burst or mixed colony forming cells. Neutrophil colony forming cells only survived and recovered after addition of G-CSF and erythropoietin on day 5 of incubation. On the other hand, IL-3 supported neutrophil, erythroid burst, and mixed colony forming cells as reported previously (Sonoda et al, Proc Natl Acad Sci USA, 85:4360, 1988). These results led us to propose that IL-4 possibly acts with more mature progenitor cells than those of IL-3 or granulocyte-macrophage (GM)-CSF.

A review of 65 patients with multiple myeloma (MM) and 10 patients with primary macroglobulinemia (PM) seen at our clinic from 1972 through 1988 revealed further cancers that were found in 11 patients with MM and in 2 patients with PM. In 4 of 13 patients with multiple primary neoplasms, either MM or PM was an antecedent. In 6 patients, MM or PM was coincident with the cancers. In 3 patients, the cancer was antecedent. Only one patient with multiple myeloma developed secondary leukemia following treatment with alkylating agents.

On June 22, 1984, a 69-year-old man was admitted to hospital because of high fever and weight loss. On admission, laboratory data revealed the following: ICG R15 17%, and an AFP of 14 X 10(4) ng/ml. Celiac angiogram revealed a hypervascular tumor, a prominent A-P shunt, and an obstruction of the main portal trunk. After three sessions of one shot chemotherapy using ADM, MMC, and CDDP during the first admission, the AFP serum level decreased to 17,400 ng/ml, and tumor size regressed. Subsequently, the patient has received eighteen sessions of one-shot chemotherapy every two to four months and is still alive as of December 1987.

In April, 1985, a 60-year-old Japanese male was diagnosed as having refractory anemia with an excess of blasts (RAEB). He thus was treated solely with blood transfusions until June, 1986, when a new diagnosis revealed that his illness had been transformed into acute myelogenous leukemia (M2). Chromosome analysis at the initial diagnosis had revealed a normal male karyotype. When the subsequent diagnosis of AML was made, however, a chromosomal abnormality [46, XY, -20, +der (20) t (?8;20) (q22;p13)] was detected. Myelodysplastic syndrome (MDS) in patients evidencing a karyotypic alteration from the initial karyotypic findings progresses in severity that includes overt leukemia, and results in a shorter survival than in patients who show no further karyotypic changes. Therefore, the prognosis of patients with MDS can be predicted more accurately by subsequently reanalyzing their chromosomes after the initial analysis, as well as by examining their peripheral blood/counts, and by monitoring bone marrow cytology.

TAEs were performed for 14 cases of nodular type hepatocellular carcinomas. The tumor size in 10 of the 14 cases was less than 5.0 cm in diameter. After 2 to 3 TAEs for each of the cases, tumor regression was noted in 11 cases and a decrease in the serum AFP in every case. The 1-year survival rate (1 YSR) was 79%, the 2YSR was 42%, and 3YSR was 10%, Re-growth of the tumors was observed in 45% of the cases 1-year after, and in all cases 2-year after. In cases which had multiple nodules or an incomplete capsule or a poor accumulation of Lipiodol, re-growth occurred even earlier.