Changes in lymphocytes as an early sign of relapse in adult acute leukemia.

Abstract

This study was undertaken to find out some clue to detect early relapse of adult acute leukemia which had been in remission. Laboratory data such as LDH, erythrocyte sedimentation, or immunoglobulin level did not show any difference at the time of relapse from the remission period. Complete blood count with reticulocyte count was evaluated every two weeks retrospectively for 12 weeks before relapse. No significant change was observed at the time of relapse. However, both the percentage and absolute number of peripheral lymphocytes significantly increased, whereas percentages of both T and B cells markedly decreased at the time of relapse, suggesting some derangement of lymphocyte function. Results in bone marrow culture did not yield any remarkable difference. It was suggested from this study that it is the time of prerelapse of adult acute leukemia when lymphocytes show an increase in either percentage or absolute number in the patients who are followed under their maintenance therapy schedule. clinical sign; early relapse; adult acute leukemia; percentage of lymphocyte; T lymphocyte Nationwide studies on the remission induction therapy of adult acute leukemia have been performed, but the mechanism of relapse in acute leukemia remains to be elucidated. In our previous reports, we examined the factors of hosts, types and nature of leukemia, and the methods of therapy to discover the most influential factor for long survival of adult patients with acute leukemia. It was concluded that maintenance therapy in remission was the most important factor (Kawamura et al. 1977). This implies that elongation of remission is the most important for longer survival. Therefore, it is of clinical importance to predict the relapse and to resume the treatment as early as possible.In order to detect early signs of relapse in adult leukemia without frequent bone marrow punctures, hematological and immunological examinations and tissue culture studies of bone marrow cells were undertaken in the present study.It was found that the relapse of adult acute leukemia was indicated when lymphocyte counts exceeded 40 to 50% or T and B cells decreased significantly in the patients on maintenance therapy.

Prognostic evaluation of early detection of relapse in adult acute leukemia.

“…According to our previous case study (Kawamura et al 1981), the relapse was confirmed by bone marrow puncture in 10 of 12 cases (83%) in which the peripheral lymphocyte value was raised over 45%. The leukemic cells in the bone marrow were 10% or less at the time of relapse in 4 of the 10 cases and those in the peripheral blood were 0% in 9 cases.…”

“…In the previous study (Kawamura et al 1981), i.e., the criterion was established to detect the relapse of adult leukemia in its early stage, when the share of lymphocytes in peripheral blood increased over 45% of the leucocytes during the maintenance therapy, bone marrow puncture was immediatly performed to examine the appearance of leukemic cells. By this criterion, the relapse was detect earlier than by other criteria.…”