Management of Adult Acute Myelogenous Leukaemia

Crowther, Derek; Powles, R; Bateman, Chris; Beard, Michael; Gauci, Christopher; Wrigley, P. F. M.; Malpas, J. S.; Fairley, G. Hamilton; Scott, Ronald Bodley

doi:10.1136/bmj.1.5846.131

Cited by 147 publications

(38 citation statements)

References 5 publications

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“…In addition, many of the so-called acute myelogenous leukaemias (32%) have quite large proportions of adherent cells (the + + + and + + groups). Cultural characteristics and response to treatment.-The patients in this study received standard chemotherapy induction using protocols which have been reported in detail elsewhere (Crowther et al, 1973). Table IV found by other workers (Golde and Cline, 1973;Aye et al, 1974a and b;Osgood et al, 1951).…”

Section: Aiaterials And) Methodsmentioning

confidence: 98%

Diagnostic and prognostic significance of peripheral blood cultural characteristics in adult acute leukaemia

Balkwill¹,

Oliver²

1976

Br J Cancer

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Summary.-A simple liquid culture technique has been used to study peripheral blood from patients with acute myelogenous leukaemia. Evidence is presented that cells from morphologically identical types of leukaemia have differing capacity for " differentiation " from free floating blast cells into plastic-adherent, phagocytic, trypsin-resistant macrophage-like cells with Fc and C 3 receptors. Preliminary analysis suggests that patients whose cells have the greatest capacity for " differentiation " have a better chance of achieving complete remission.

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Section: Aiaterials And) Methodsmentioning

confidence: 98%

Diagnostic and prognostic significance of peripheral blood cultural characteristics in adult acute leukaemia

Balkwill¹,

Oliver²

1976

Br J Cancer

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“…Criteria for the diagnosis of acute myelogenous leukemia and therapeutic protocols used have been reported in detail elsewhere (9,10). All the patients studied were in complete remission and received either chemoinimunotherapy with BCG plus irradiated allogeneic leukemic myeloblasts according to the protocol reported by Powles et al (11,12) or the same chemotherapy plus BCG alone (2).…”

Section: Methodsmentioning

confidence: 99%

Autologous leukemia-specific T-cell-mediated lymphocytotoxicity in patients with acute myelogenous leukemia.

Lee¹,

Oliver²

1978

The Journal of Experimental Medicine

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It is more than 80 years since the first attempts were made to immunize human cancer patients against their own tumors (for review see reference 1). As yet, there are no immunological manipulations of proven value in terms of ensuring long-term cure, though there are randomized control studies demonstrating short-term prolongation of survival in patients with acute myelogenous leukemia receiving bacille Calmette-Guerin (BCG) 1 with or without aUogeneic leukemic blasts (for review see reference 2). In experimental animals, particularly inbred mice, it has been considerably easier to demonstrate tumor-specific antigens, both by serological and cell-mediated techniques and to prolong survival by immunizing against these antigens (3). Despite a welter of publications, there are few studies in human tumor systems where the concept of tumorspecific antigens has been clearly established and universally confirmed. In particular, though many authors have demonstrated lymphocyte-mediated cytotoxicity against tumor lines in both normal individuals and patients with tumors (4, 5), evidence for Tlymphocyte-mediated autologous tumor cytotoxicity has been very difficult to establish.In vitro assays of transplantation rejection using the mixed lymphocyte culture and cell-mediated lympholysis tests, have provided clear insight into the nature of antigenic determinants necessary for generation of cytotoxic T cells. The pioneering studies of Eijsvoogel et al. (6) on HLA recombinant families demonstrated the need for two types of antigens, the first type coded for by genes closely associated with those of the HLA D locus cause lymphocyte activation, whereas the second class of determinants, closely associated with the serologically defined HLA A, B, and C locus antigens, acts as the target for the cytotoxic T lymphocytes. Eijsvoogel et al. (7) also showed that production of cytotoxic T lymphocytes was possible even if the lymphocyte-activating determinant and serologically defined antigens were present on different cells. Zarling et al. (8) applied this principal to study leukemia patients and then reported one patient where stimulation of remission lymphocytes by mitomycin C inactivated autologous myeloblasts and a third party inactivated allogeneic lymphocytes in short-term culture led to the production of cytotoxic cells against autologous blasts but not the remission lymphocytes.We report and confirm this observation in a series of 14 patients with acute myelogenous leukemia and investigate the nature of the effector cell, the helper * Present address:

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“…We found that second remissions were the rule (6/7 patients), while third and subsequent remissions commonly occurred (Freeman et al, 1973), in contrast to the general experience that relativelv few patients achieved second remission in adult AML (Wiernik and Serpick, 1970;Bailey et al, 1971;Crowther et al, 1973;Powles, 1973;Powles et al, 1973Powles et al, , 1977. There are few reports of third remissions (Whittaker and Slater, 1977 examination was repeated within 2 weeks.…”

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confidence: 53%

Active immunotherapy in acute myelogenous leukaemia and the induction of second and subsequent remissions

Harris¹,

Zuhrie²,

Freeman³

et al. 1978

Br J Cancer

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Summary.-One hundred and ninety-one adults with acute myelogenous leukaemia were treated with combination chemotherapy consisting of daunorubicin and cytosine arabinoside (Barts III). Sixty-three patients achieved remission and were admitted to one of 3 trials of active immunotherapy: immunotherapy alone, immunotherapy and maintenance chemotherapy or neither of these. All patients had weekly clinical and blood examination and monthly marrow examination. Reinduction chemotherapy was given as soon as relapse was diagnosed in the marrow. The most striking observation was that immunotherapy was associated with easy and repeated reinduction of remission and marked prolongation of survival after first relapse when compared with immunotherapy plus chemotherapy. The possible reasons for this and the value of immunotherapy are discussed in relation to the third trial still in progress which includes 2 maintenance arms, immunotherapy alone and surveillance only. The present communication describes our experience over a 6-year period of 3 trials of active immunotherapy in AML in which immunotherapy has been associated with relatively short first remissions but easy second and subsequent remission with long post-relapse survival and an excellent quality of life. PATIENTS AND METHODSPatients entered into 3 Manchester AML trials since 1971 and followed up to 15 March 1977, have received one of the therapeutic protocols summarized in Table I. Patients were not selected, and all who were referred to Manchester Royal Infirmary were treated.The diagnosis of AML was confirmed by blood examination and by marrow examination carried out by sternal or iliac-crest puncture. The aspirated material was fixed,

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Management of Adult Acute Myelogenous Leukaemia

Cited by 147 publications

References 5 publications

Diagnostic and prognostic significance of peripheral blood cultural characteristics in adult acute leukaemia

Diagnostic and prognostic significance of peripheral blood cultural characteristics in adult acute leukaemia

Autologous leukemia-specific T-cell-mediated lymphocytotoxicity in patients with acute myelogenous leukemia.

Active immunotherapy in acute myelogenous leukaemia and the induction of second and subsequent remissions

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