Pruritus is a major clinical problem in patients with polycythaemia vera (PV). Conventional symptomatic treatment is unsatisfactory. Recently, a favourable effect of interferon-alpha on pruritus in patients with PV has been reported. Also, interferon-alpha suppresses the increased haemopoiesis in PV. However, long-term treatment with interferon-alpha may be hampered by side-effects and the inconvenience of chronic subcutaneous injection therapy. We conducted a long-term study (median follow-up 13 months) of the efficacy and tolerability of interferon-alpha in 15 patients (mean age 68 years) with PV and severe pruritus. Six patients were evaluable after 1 year. Pruritus significantly improved in 12/15 patients. Haematological control improved, as evidenced by a decreased number of phlebotomies from a mean of 4.3 in the year before the study to 1.8 while on interferon-alpha. Leucocyte and platelet numbers also decreased significantly. Five patients (33%) did not tolerate interferon-alpha. The effects of interferon-alpha could not be ascribed to an inhibitive effect on histamine production or to the disappearance of the abnormal erythroid progenitor clone, because erythropoietin-independent erythroid colony formation persisted during interferon-alpha treatment. We conclude that long-term interferon-alpha treatment is feasible and effectively relieves pruritus in patients with PV, but side-effects are an important concern. The optimal dose regimen that is well tolerated, relieves pruritus, and offers satisfactory haematological control at the same time remains to be established.
Four patients with paroxysmal nocturnal haemoglobinuria (PNH) were treated with cyclosporine. The treatment with cyclosporine was based on the hypothesis that immune-mediated bone-marrow damage is the common pathogenetic mechanism of aplasia and PNH, with lack of GPI-linked ligands for an immune attack (i.e. LFA-3, CD58) rendering PNH cells a growth advantage over other bone marrow cells. In the first patient, presenting with a mixed AA/PNH syndrome, a gradual recovery from aplasia was seen after prolonged treatment with cyclosporine. In a second patient, with a mixed AA/PNH syndrome, no haematological improvement was noted during cyclosporine administration, but this patient became transfusion-independent with increasing neutrophil and platelet counts after a course of ATG in combination with androgen therapy. Both these patients showed an increment in the proportion of neutrophils with normal expression of GPI-linked proteins concurrently with the improvement of haematological characteristics. In the two other patients, presenting with typical PNH, cyclosporine treatment did not result in any change in haematological characteristics, nor in PNH parameters. No significant change in haemolytic parameters was seen in any of the patients. It is concluded that immunosuppressive therapy may be of benefit in patients with a mixed AA/PNH syndrome. This effect became apparent after prolonged treatment with cyclosporine in one patient, and after a subsequent course of ATG with concomitant androgen therapy in another.
Summary:concluded that treatment with standard melphalan and prednisolone (M/P) was ineffective, with a median survival of 2.0 months, but more intensive chemotherapy induced Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by a malignant proliferresponses in approximately one half of patients, with a median survival of 20.0 months. [6][7][8][9][10][11] Patients with secondary ation of plasma cells in blood and bone marrow. Treatment of primary PCL has been mostly disappointing.PCL have usually received extensive chemotherapy for MM. These patients generally also have a reduced performThree patients with primary PCL are described who received high-dose melphalan with autologous PBSC ance status and reduced bone marrow function. As a consequence intensive chemotherapy is not well tolerated and support after vincristine, doxorubicine and dexamethasone (VAD), high-dose cyclophosphamide, and etomedian survival is 5 months. [12][13][14] In the present study we analyzed the results of intensive chemotherapy followed by poside, cisplatinum, dexamethasone and cytosine arabinoside (EDAP) courses. All patients were in CR posthigh-dose melphalan and stem cell support in three PCL patients and compared the results with the literature. transplantation. One patient relapsed after 3 months; the other patients are still in CR, after 14 and 26 months, respectively. These results in conjunction with data from the literature suggest that intensive chemotherapy for PCL is promising.
Human recombinant interleukin-4 (IL-4) was studied for its effects on the expression of granulocyte-colony stimulating factor (G-CSF) mRNA in human adherent monocytes in the absence and presence of endotoxin and interleukin 1 (IL-1). IL-4 (15 ng/ml) did not induce G-CSF transcripts in monocytes but suppressed the endotoxin-induced G-CSF expression when added simultaneously. Sequential treatment of monocytes with IL-4 followed by endotoxin suppressed G-CSF mRNA induction totally. This effect was independent of the presence of fetal bovine serum but dependent of the IL-4 dose. Comparable results were obtained with IL-1. IL-1 (50 U/ml) induced G-CSF expression in human adherent monocytes which could be counteracted by IL-4 pretreatment. In addition, it was shown that the induction of G-CSF mRNA by the calcium-ionophore A23187 or by c-AMP elevating agents could be blocked by IL-4. These suppressive effects of IL-4 were not related to changes in the half-life of G-CSF mRNA and were independent of protein synthesis. Finally it was demonstrated that IL-4 had comparable effects on the G-CSF secretion of endotoxin and IL-1 stimulated human monocytes by using a murine bone marrow assay. These results indicate that IL-4 down-regulates the expression of G-CSF gene and secretion of proteins in human activated monocytes.
Human recombinant interleukin 4 (IL-4) was studied for its effects on the erythroid burst forming unit (BFU-E) from human bone marrow cells. IL-4 alone neither supports nor suppresses the erythropoietin (Epo)-dependent colony formation. Different results were obtained when IL-4 was combined with interleukin-3 (IL-3) in the presence of Epo. IL-4 suppressed the IL-3 supported erythroid colony formation in all cases (an increase of 58 +/- 8% with IL-3 versus an increase of 14 +/- 7% with IL-3 plus IL-4, n = 8). This antagonizing effect was dependent on the continuous presence of IL-4 in the culture medium, but was independent of adherent cells, B-, T-cells, or the presence of serum in the culture medium. Finally, the effects of IL-4 and IL-3 were studied on the 'Epo-independent' BFU-E by adding Epo on day 3. A decline of the IL-3 supported BFU-E was observed in the presence of IL-4 but the degree of reduction was equivalent to the results obtained when Epo was supplied at day 0. These findings indicate that IL-4 acts as suppressive growth factor for the IL-3 supported erythroid colony formation from human bone marrow cells.
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