The association of OKT4 epitope deficiency and acute myeloblastic leukemia (M1 by FAB) in a 12-year-old girl is reported. The patient's peripheral lymphocytes lacked the antigen identified by the OKT4 monoclonal antibody, but showed normal OKT4A and Leu-3a reactivity. Functional studies of the lymphocytes revealed normal responses to mitogens, but slightly reduced helper T cell function. The patient responded well to antileukemia chemotherapy and has been in remission for 30 months. The possible link between OKT4 epitope deficiency and the pathogenesis of AML is discussed.
Serum ferritin is known to be one of the tumor markers for neuroblastoma. Serum ferritin is elevated in most children with neuroblastoma who are in stages III or IV, but it is not elevated in those in stage I or II. It has also been observed that iron load caused by blood transfusion shows a greater effect on serum ferritin levels than tumor activity due to neuroblastoma. Thus, serum ferritin increases in a linear fashion in children given repeated blood transfusions but the levels increase exponentially in children who have bulky neuroblastomas. Thus, serum ferritin values must be interpreted with caution in patients with advanced stages of neuroblastoma who inevitably require blood transfusions. The authors propose that the pretransfusion and posttransfusion serum ferritin values be in comparison with other tumor markers such as urinary VMA, urinary HVA, and neuron specific enolase. The serum ferritin level should not be used as a sole indicator of tumor activity in neuroblastoma.
Acute megakaryoblastic leukemia (AMkL) is a newly defined acute leukemia in which the differentiation of proliferating blasts is arrested at the megakaryocytic precursor stage. In order to clarify whether a target cell of leukemic transformation in AMkL is a cell committed to megakaryocytic lineage, or a multipotential stem cell, we examined AMkL patients with regard to: a) the presence of myelodyplastic features in residual erythroid and granulocytic cells, b) coexistence of myeloperoxidase (MPO)-positive blasts with megakaryoblasts, and c) the presence of the same chromosomal abnormality in erythroid and granuloid colony-forming cells as seen in megakaryoblasts. Regarding the former two items, results were compared with those from megakaryoblastic crisis of chronic myelocytic leukemia (CML-MkBC) and transient myeloproliferative disorder in Down syndrome (DS-TMD), which are thought to be multipotential stem cell disorders. Among 18 patients with AMkL, three, all complicating myelofibrosis, had marked myelodysplastic changes of erythroid series and/or granulocytic series. In 4 out of 7 patients with CML-MkBC, 5 out of 8 patients with DS-TMD, and 7 out of 18 patients with AMkL, MPO-positive blasts, even though rare, were observed in addition to PPO-positive blasts. All except one of these patients with AMkL also showed complicating myelofibrosis. In one case of AMkL with myelofibrosis, chromosomal analysis of cultured cells of individual colonies revealed that all the analysable metaphases from both CFU-GM and BFU-E had the same chromosomal abnormality as megakaryoblasts. This study has clarified that a considerable proportion of AMkL cases, particularly those with complicating myelofibrosis or showing acute myelofibrosis, arise against the background of a multipotential stem cell disorder, even if blasts are exclusively megakaryocytic in phenotype.
A 6-month-old boy with familial erythrophagocytic lymphohistiocytosis (FEL) received allogeneic bone marrow transplantation (BMT) from an HLA-identical brother, after first achieving remission with Etoposide (VP16) and prednisone. The conditioning regimen for BMT consisted of high dose busulfan (16 mg/kg), cyclophosphamide (120 mg/kg), high dose VP16 (60 mg/kg) and intrathecal methotrexate and was well tolerated. Engraftment was achieved, and grade II GVHD was controlled with prednisone. Impaired NK activity present on admission gradually improved after BMT. The patient continues to be in complete remission more than 10 months after BMT.
A 1-month-old boy with familial erythrophagocytic lymphohistiocytosis (FEL) had a barely detectable natural killer (NK) activity of 0% to 7% (median, 0.5%) with an effector/target ratio of 20:1. The number of Leu7+ and Leu11+ cells was within normal range. In terms of interleukin-2 (IL-2) receptor antigens, IL-2R/p55 (Tac) was marginally expressed whereas IL-2R/p75 related antigen recognized by YTA-1 monoclonal antibody (MAb),i.e., YTA-1 antigen, was moderately expressed on the patient's mononuclear cells. Since the NK activity was restored in vitro by IL-2 stimulation, insufficient in vivo IL-2 production or altered cooperation of IL-2R/p75 and IL-2R/p55 (Tac) in the IL-2 mediated immune response was suspected to be present. The induction of IL-2R/p55 (Tac) in vitro was found to be imparied after stimulation with IL-2, or YTA-1MAb. When the patient attained remission the IL-2R/p55 (Tac) induction had normalized, but low NK activity persisted. The results indicate that the IL-2/IL-2R system may play an important role in the etiology and pathogenesis of FEL.
Severe hypercalcemia (serum calcium, 4.25-5.25 mmol/l), in association with osteolytic bone lesions, was found in a girl aged 2 yr 7 mo with common acute lymphoblastic leukemia (ALL). Hormonal studies excluded the possibility of the hypercalcemia being caused by primary hyperparathyroidism or ectopic parathyroid hormone secretion. Increased plasma prostaglandin E2 (PGE2) levels (130 ng/l), probably produced by leukemic cells, were considered to be one of the pathogenic mechanisms responsible for the occurrence of hypercalcemia in this patient. Both the hypercalcemia and the abnormal plasma PGE2 level returned to normal after chemotherapy.
Nine cases of childhood malignant histiocytosis (MH) showed an abnormally high serum phenylalanine (Phe)/tyrosine (Tyr) ratio (3.47 +/- 1.32) coincident with hyperferritinemia (50,800 +/- 33,600 ng/ml). Lactate dehydrogenase activity was also increased in these patients. These values were compared with data on sera from two groups of patients, acute leukemia cases (n = 14) and measles cases (n = 13), and with control values from normal healthy children (n = 38). The Phe/Tyr ratio was 1.57 +/- 0.54 for the acute leukemia (p less than 0.01) and 2.58 +/- 1.46 for the measles cases (NS), serum ferritin was 245 +/- 124 ng/ml for acute leukemia (p less than 0.01) and 167 +/- 117 ng/ml for measles (p less than 0.01). Accordingly, the concurrence of both abnormalities is considered to be characteristic for MH. It was also found that both serum Phe/Tyr ratio and ferritin levels reflect the disease activity, indicating that these two factors are useful prognostic indicators in the treatment of patients with MH.
Abstract After the acute onset of primary atypical pneumonia, a 4‐year‐old girl suddenly developed a widespread, sterile, pustular eruption with predilection toward the distal parts of the extremities. There was no involvement of the muco‐ocular area. Histological and electron microscopical examinations revealed intraepidermal pustule formation containing neutrophils and eosinophils, and perivascular infiltration of lymphocytes, histiocytes, neutrophils and eosinophils. These clinical findings are similar to those of Tan's “acute generalized pustular bacterid” and Teisch's “vesiculopustular eruption with mycoplasma infection”. Serological examinations, including complement fixation test, cold agglutination test, and passive hemagglutination test, confirmed a Mycoplasma pneumoniae infection. It is concluded that Mycoplasma pneumoniae infection should be considered in patients with bacterid‐like rashes who do not have streptococcal infections.
