Summary:vary from one study to another, they show generally a lower risk of relapse, and a longer disease-free survival (DFS) after AlloBMT and ABMT than after ICC. A cross-sectional study of quality of life (QOL) was performed in 98 patients in continued first complete From 1986 to 1992, the EORTC and GIMEMA Leukemia Cooperative Groups prospectively compared these remission (CR) for 1-7.4 years, after inclusion in the AML 8A trial which prospectively compared allogeneic three therapeutic options: patients with newly diagnosed AML were entered in the AML 8A trial, and, after the same bone marrow transplantation (AlloBMT), autologous BMT (ABMT) and intensive consolidation chemoinduction and intensive consolidation course, were assigned, according to availability of a family HLAtherapy. Several significant differences between the three treatment groups were observed, on the basis of matched donor or randomization, to AlloBMT, ABMT or a second ICC course. At a median follow-up time of 3.3 patient self-reports, with regard to somatic symptoms (mouth sores, cough, hair loss, headache), repeated years, there was a significantly longer DFS in the AlloBMT (55%) and ABMT (48%) arms than in the ICC arm (30%). 5 acute medical problems, physical functioning, role functioning, leisure activities and, above all, sexual funcHowever, the overall survival after CR was similar in the three arms, patients relapsing after ICC being more easily tioning. There were also significant differences for overall physical condition, and overall quality of life. For all salvaged and frequently receiving an ABMT during second CR. these parameters, the ranking was uniformly AlloBMT lower than ABMT lower than chemotherapy. These dif-The conclusions of this study were based on analyses made according to the intention-to-treat principle. In ferences remain significant after adjustment for time interval between CR and QOL evaluation, sex or age.addition, we have observed a significant difference with regard to the short-term toxicity of the treatment actually These results, confirming a higher risk of permanent impairment of QOL after BMT, may have an impact administered, the treatment-related mortality being 20, 10 and 6% after AlloBMT, ABMT and second ICC, respecton medical decisions and warrant further studies. Keywords: quality of life; acute myeloid leukemia; bone ively. Furthermore, the final results may also be hampered by long-term toxicity, especially due to the conditioning marrow transplantation regimens, with or without total body irradiation (TBI), for both BMT procedures, and to chronic graft-versus-host disease (GVHD) after AlloBMT. Such long-term somatic toxiAllogeneic bone marrow transplantation (AlloBMT), autocity is also likely to induce psychosocial sequelae. Indeed, logous bone marrow transplantation (ABMT), or intensive some previous studies have shown that quality of life consolidation chemotherapy (ICC) are currently proposed (QOL) might be more or less markedly impaired after for patients with acute myelogenous leukemia (AM...

Purpose:To assess the v a lu e o f granulocyte-m acro phage co lo n y-stim u la tin g fa c to r (GM-CSF) fo r induction tre a tm e n t o f acute m ye lo id le u ke m ia (AML)/ both fo r prim ing o f leukem ic cells a n d

Summary. Chronic myeloid leukaemia (CML) dendritic cells (DC) are possible candidates for inducing antileukaemic immunity. This study aimed to investigate the frequency, phenotype and function of blood-derived leukaemic DC in comparison with DC from healthy donors using flow cytometric assays and mixed leucocyte reaction (MLR). Immature leukaemic DC displayed a reduced endocytotic capacity as compared with healthy controls. Moreover, in vitro maturation of leukaemic DC was found to be deficient. Expression of CD80, CD83, CD86, and major histocompatibility complex class I and class II antigens were reduced on lipopolysaccharide (LPS)-matured leukaemic DC but were enhanced by a mixture of interleukin 1b (IL-1b), IL-6, tumour necrosis factor-a (TNF-a) and prostaglandin E2 (PGE 2 ). Upon stimulation with bacterial LPS, intracellular TNF-a and IL-8 production was diminished in maturing DC from CML patients. This distinct cytokine deficiency was overcome when leukaemic DC were stimulated with cytokines/PGE 2 . MLR showed fully functional leukaemic DC after TNF-a-induced maturation, but a reduced proliferative alloresponse of leukaemic peripheral blood mononuclear cells. Further, intracellular production of cytokines in CMLderived T cells was markedly reduced. These data indicated that, in CML, the maturation response of leukaemic monocyte-derived DC to a natural stimulus like LPS is abnormal and may be caused by an aberrant TNF-a response in these cells. Thus, TNF-a alone or in combination with pro-inflammatory and T-cell stimulatory cytokines should be considered as an adjuvant for DC-based immunotherapy in CML.

Cladribine (2-chlorodeoxyadenosine, 2-CdA) is a newer purine analog with specific toxicity to lymphocytes. As lymphocytes play a major role in rheumatoid arthritis (RA), we assessed the safety profile of low-dose 2-CdA in patients who were refractory to more than three disease-modifying drugs. Five patients were given a subcutaneous dosage of 0.05 mg/kg 2-CdA weekly over a period of 8 weeks. Of the lymphocyte subsets, both T and B cells decreased below the normal range, whereas natural killer cells remained stable. These changes were the only side-effects noted during treatment and 4 weeks afterwards. In one patient a pacemaker was implanted for reasons unlikely to be related to 2-CdA administration. We conclude that even low-dose 2-CdA (0.05 mg/kg) can decrease T and B cell populations in patients with refractory RA, but other side-effects are unlikely. For assessing the possible clinical efficacy of low-dose 2-CdA further studies are warranted.

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