To determine the clinicohematological factors predictive for the appearance of major vascular complications (MVC) in patients with essential thrombocythemia (ET), 148 consecutive such patients were retrospectively assessed for the development of MVC during a median follow-up of 58.5 months. Seventy-seven patients had vascular risk factors, and 37 a history of MVC at ET diagnosis. Forty-nine MVC were registered in 33 patients during the follow-up period. The actuarial probability of MVC was 27% at 6 years in the whole series, 35.6% for patients above 60 years, and 21.4% for patients younger than 60 years, whereas only one of the 36 patients younger than 45 years had MVC. At multivariate analysis, age Ͼ60 years, history of major ischemia and hypercholesterolemia were the variables associated with an increased MVC risk. These results suggest that all ET patients above 60 years should be treated, whereas in younger patients treatment decisions should be primarily based on the existence of risk factors for MVC.

Ischemic stroke as a presenting manifestation of essential thrombocythemia is probably underrecognized. The diagnosis of thrombocythemia should not be excluded on the basis of platelet counts lower than 600 x 10(9)/L. The availability of in vitro culture of hematopoietic progenitors from peripheral blood makes it possible to diagnose early and atypical cases.

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We studied the association between myelodysplastic syndromes (MDS) and malignancies in a cohort of 155 patients with MDS, 21 of whom presented malignant solid tumors. Myelodysplasia was present after the diagnosis of cancer in eight patients (interval between the diagnosis of both conditions 18 months, median survival 49.5 months), simultaneously with diagnosis in 11 (median survival 8 months), and before malignancy in two patients (interval between the diagnosis of both conditions 47 and 7 months). One patient was given chemotherapy for lung cancer, and three patients received radiotherapy for adenocarcinoma of the kidney and cancer of the prostate. At the time of diagnosis of MDS, nine patients already presented metastatic spread. Fourteen patients died, ten as a result of tumor-related complications and four because of transformation to acute nonlymphocytic leukemia. The analysis of the incidence of malignancy in patients with MDS was statistically significant for males, and the relative risk was significant in both sexes. The results of this study show that MDS patients present a higher incidence of malignant tumors than the general population, that MDS may be of real paraneoplastic significance, and that the occurrence of MDS in cancer patients may be considered to be related to the malignancy rather than an independent phenomenon.

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Recently., Raz and associates [l] and Haznedar [2] reported in this journal five cases of pancytopenia with hyperplastic marrow, which preceded the development of lung and prostate carcinomas suggesting that pancytopenia resulting from myelodysplasia is a possible paraneoplastic manifestation in solid tumors.In our experience, five of 18 patients with chronic myelomonocytic leukemia diagnosed according to the FAB criteria [3] presented with an associated epithelial solid tumor. The following abnormalities were found in all cases: an absolute monocytosis in the peripheral blood (> 1 x lO'/liter), high levels of serum lysozyme, splenomegaly, bone marrow infiltration made up of atypical promyelocytes and especially of promonocytes, and a percentage of type I blast cells of less than 10%. In four of the five cases, the in vitro culture of CFU-GM from bone marrow and peripheral blood samples showed a characteristic growth pattern of chronic myelomonocytic leukemia (increased number of colonies and aggregates).Two patients had a carcinoma of the stomach, one patient a carcinoma of the colon, one patient an epidermoid bronchogenic carcinoma, and the remaining patient an epidermoid tumor of unknown origin. Malignancy was confirmed by histologic study in all cases. In three of the five patients, the diagnosis of the leukemic process and that of the epithelial tumor was established simultaneously, but in two cases (epidermoid mletastatic carcinoma and carcinoma of the colon) the neoplasm developed 5 months, and 2 years, respectively, before chronic myelomonocytic leukemia. This last patient was the only one who died as a consequence of the blastic crisis; in the remaining four patients, the cause of the death was metastatic dissemination of the neoplasm. One of the five patients (epidermoid metastatic carcinoma) was given

We investigated the expression of the lymphocyte function associated (LFA)-1 adhesion molecule, recognized by the CD11a and CD18 monoclonal antibodies, in 53 patients with B-cell chronic lymphocytic leukemia (B-CLL) and in 37 controls. The mean percentage of control lymphocytes expressing CD11a and CD18 positivity was 92 +/- 5.5 and 90 +/- 8.7, respectively and, in patients with B-CLL, 14.2 +/- 10.3 and 14.8 +/- 10.3 respectively (p < 0.001). No statistical difference was found between CD11a and CD18 expression and the Rai clinical stages. In our experience a decrease of LFA-1 is a constant finding in B-CLL, in the early stages of the disease. It may, therefore, be useful to differentiate between slight increases of neoplastic cells and reactive blood lymphocytosis.

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