Nouvelle revue francaise d'hematologie最新文献

D-dimer assay was performed on 145 cerebrospinal fluid (CSF) samples from patients with or without neoplastic diseases. Levels of D-dimers were significantly higher in carcinoma and lymphoid malignancies with clinical or biological evidence of central nervous system (CNS) involvement than in diseases without such complications. In one patient, serial determinations of D-dimers were well correlated with the appearance and disappearance of CNS involvement. Although this test is not specific for neoplastic affections, our data suggest that the measurement of D-dimers in CSF may be useful in the diagnosis of CNS involvement of neoplastic cells and in monitoring intrathecal therapy in patients with lymphoma, acute lymphoblastic leukaemia or carcinoma. In this study, the D-dimer assay was also positive in some non neoplastic diseases, but failed to differentiate subarachnoid haemorrhage from traumatic lumbar puncture.

We have previously reported that the rate of haematopoietic recovery following Autologous Blood Stem Cell Transplantation (ABSCT) could be influenced by the type of conditioning regimen or by the underlying disease. Furthermore, Peripheral Blood Stem Cell (PBSC) growth was found to be sensitive to stimulation by irradiated allogeneic stromal layers. In the present study, we used the long term culture system (LTC) to investigate the quality of the bone marrow (BM) microenvironment from patients who had undergone ABSCT for either Malignant Lymphoma (ML, 13 patients) or Multiple Myeloma (MM, 8 patients) after conditioning regimens comporting myeloablative chemotherapy (CT) or Total Body Irradiation (TBI). Among the 13 ML patients, 10 received CT conditioning and 9 of the 10 BM samples developed a complete confluent stromal layer. The remaining 3 ML patients received TBI prior to ABSCT and 2 of the 3 samples developed confluent stroma. In contrast, when LTC were established with BM from the 8 MM patients, all of whom were treated with TBI prior to ABSCT, only 3 of the 8 marrow samples developed a complete confluent stromal layer. Thus BM from patients who had received CT conditioning therapy tended to form confluent stroma more often than BM from those who had received TBI (p = 0.08). CFU-GM production was also evaluated for the stromal layers derived from all transplanted patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative variations of blood cell progenitors were studied in thrombocytopenic post-chemotherapy patients and in healthy plateletpheresis donors with the aim of better understanding the reasons for their varying presence in peripheral blood. In 6 post-chemotherapy patients with severe thrombocytopenia on days 21-27 after initiation of chemotherapy when white blood cell counts were approximately 2.1-6.0 x 10(9)/l, a balance was observed between the most and least immature progenitors: levels of CFU-Meg were significantly lower than control values whereas levels of CFU-GEMM were 2-fold higher than in controls. Results suggest that an activator distinct from the known poietins may stimulate very immature progenitors. In 15 plateletpheresis donors, numbers of CFU-GEMM and CFU-Meg were greatly increased, respectively 5.5-fold and 10-fold, following plateletpheresis. Data once again indicate a major role of CFU-GEMM in the production of mature blood cells. As the most immature progenitors and thrombocytopoiesis stimulating factor(s) are both present in peripheral blood, such factors may be responsible for the initial engagement of these very early progenitors into a specific cell line.

The therapeutic potential of 2-chlorodeoxyadenosine (CdA) in patients with advanced chronic lymphocytic leukaemia (CLL) remains controversial with response rates in clinical trials ranging from 44 to 67%. This report describes our experience with CdA in 22 CLL patients having already undergone previous treatment. CdA was given by continuous intravenous infusion at a dose of 4 mg/m2/day for 7 days (4 patients) or as 2-h intravenous infusions at a dose of 5.6 mg/m2/day for 5 days (18 patients). Partial (n = 5) or complete (n = 2) response was obtained in 7 cases. As compared to unresponsive patients, responding subjects received CdA earlier in the course of their disease (mean interval between diagnosis and CdA therapy 58 vs 102 months), were less thrombocytopenic at initiation of CdA (mean platelet count 165 x 10(9)/L vs 81 x 10(9)/L) and experienced less severe neutropenia during the first course of therapy (mean minimal neutrophil count 1.55 x 10(9)/L vs 0.43 x 10(9)/L). None of 6 patients with CLL refractory to fludarabine responded to CdA. An evaluation of haematological toxicity during the first course of treatment showed grade 4 neutropenia (< 0.5 x 10(9)/L) in 7 cases and grade 4 thrombocytopenia (< 25 x 10(9)/L) in one of 19 cases where the platelet count was greater than 25 x 10(9)/L at initiation of CdA. In comparison with earlier reports, the present series of patients had received relatively heavy prior therapy, experienced more severe haematological toxicity and demonstrated a lower total response rate.

Despite some encouraging first results, experience with 2-chlorodeoxyadenosine (CdA) in the treatment of Waldenström's macroglobulinaemia (WM) has not as yet been very extensive. The present paper reports a clinical trial of the use of CdA in 18 patients having previously treated (n = 13) or untreated (n = 5) WM. CdA was administered by continuous intravenous infusion at a dose of 4 mg/m2/day for 7 days (5 patients) or as 2-h intravenous infusions at a dose of 5.6 mg/m2/day for 5 days (13 patients). Partial response was obtained in 7 cases. In this small series, no correlation could be found between response to CdA and patient characteristics at inclusion. During the first course of therapy, grade 4 neutropenia (< 0.5 x 10(9)/L) and thrombocytopenia (< 25 x 10(9)/L) developed in respectively 4 and 6 cases. In comparison with earlier reports haematological toxicity was more severe and the overall response rate lower in the present series of patients.

The Abbott Cell-Dyn (CD) 3000 is an automatic analyser, designed to give cell blood counts (CBC) and white blood differential (WBCD) by 4 angels diffraction analysis. Evaluation was performed by comparison between results obtained by CD and those obtained by Technicon H1 and by microscopic examination. Technical performances as reproducibility, linearity, carryover were quite well acceptable. On normal samples, neutrophils (NE), lymphocytes (LY) and eosinophils (EO) were found to correlate with optical method with coefficient (R) values higher than 0.9. Weaker R coefficients were found for monocytes (MO) and basophils (BA), however it didn't involve clinical consequences. Significant threshold for immature granulocytes (IG) and variant lymphocytes (VL) flags were built. By using those, a false positive rate of 7% was shown. In hematological diseases, no false negative was detected because all samples were flagged. However, no acute lymphoblastic leukemia (ALL) was studied, so the detection of lymphoblast, as known as a real difficulty for analyser, was not yet evaluated. Blasts in acute myeloblastic leukemia (AML) and hairy cells were both noticed by CD. Moreover, for chronic lymphocytic leukemia (CLL), three groups were described, according to the flags released. Knowing its performances and its limits, CD is a good analyser usable in an all round or a hematological laboratory with high number of WBCD per day.