No abstract

For the last 13 years, 47 patients with ALL over 15 years old (range 15-72; median 21) entered a 'total-therapy' programme. All cases received a 6-8 week induction course of PRD, VCR, DRB and/or L-ASN. Prophylaxis of CNS was done by cranial radiotherapy plus i.t. MTX in 32/45 patients who attained complete remission (CR). After CR, subsequent therapy involved a programme of maintenance with 6MP and MTX at full doses. Pulses of intermittent reinforcement (PRD, VCR and DRB) were done for 2 weeks, every 3 months, for at least 3 years. CR was achieved in 42/47 patients (89.3%). The median relapse-free survival of the patients who attained CR was 57 months, with an 8-year estimated disease-free survival rate of 43% for those cases. If actuarial assumptions were to be sustained, it would indicate an encouraging cure rate of 38% of all our adult ALL patients (mainly in those cases between 15 and 30 years old).

No abstract

Kinetic studies of marrow dividing granulocytic precursors (mitotic index and flash labeling index with ³H-TDR) were carried out in 11 patients with oligoblastic leukemia (OBL). The results were compared with similar data from cases of conventional acute non-lymphocytic leukemia (ANLL). The cytokinetic results were as follows: MI (%) in OBL, mean = 0.75; MI (%) in ANLL, mean = 0.66; p > 0.7; LI (%) in OBL, mean= 15.0; LI (%) in ANLL, mean= 15.4, p > 0.7. The lack of cytokinetic differences between these two groups of patients stands in favor of the hypothesis that OBL might represent a special type of smoldering leukemia with a ‘plateau’ of blast cell accumulation established at a subleukemic level.

Kinetic studies of leukemic blast cells (LBC) and erythroblasts were carried out in 20 cases of acute myeloblasts leukemia (AML), and the results were compared with those observed in dividing granulocytic precursors (DGP) and erythroblasts in a control group of 16 normal subjects. The parameters studied were: mitotic index (MI), labelling index (LI-³HTDR), MI/LI ratio and mitotic time (MT). The results showed that (1) LBC of AML do not proliferate more quickly than normal DGP, on the contrary, they replicate more slowly; (2) LBC obey some ‘ecological laws’ of normal hemopoiesis as a response to the control of the proliferative activity and release through the ‘marrow-blood barrier’; (3) the difference between hyperleukocytemic and subleukemic AML is not related to the multiplicative activity of marrow LBC, but rather to other unknown biological factors; and (4) the kinetic behavior of erythroblastic population in AML is consistent, at least in some cases, with its ‘leukemic origin’.