EFFECTS OF HYPERTRANSFUSION ON THE TREATMENT OF ADULT ACUTE NON-LYMPHOCYTIC LEUKEMIA

Abstract

We studied 33 previously untreated adult patients with acute non-lymphocytic leukemia (ANLL) who were treated with induction chemotherapy between January 1979 to December 1981.Seventeen adult patients with ANLL were treated with DCMP (daunorubicn, ara-c, 6-mercaptopurine, prednisolone) or BHAC-DMP regimen following hypertransfusion (hypertransfusion group) and changes in the peripheral blood and bone marrow cells including the labeling index of leukemic blasts (LI) were studied during the treatment. As controls, 16 adults with ANLL with background factors similar to those of the hypertransfusion group were treated with the same regimen without hypertransfusion (control group). The results were : (1) Both peripheral reticulocyte and marrow erythroblast counts decreased significantly after hypertransfusion, but there were no changes in the counts of peripheral leukocytes, leukemic blasts and platelets or the percentage of leukemic blasts among the nucleated marrow cells. (2) As a whole, no significant change was noted in the LI after hypertransfusion, while in 7 patients (increase group) the LI clearly increased after hypertransfusion due to the rise in the number of labeled large blasts. This suggests an increase in the number of blasts in the S phase. In the remaining 7 patients (non-increase group), the LI decreased or remained unchanged after hypertransfusion. (3) There were no significant differences between the hypertransfusion and control groups in complete remission (CR) rate, the remission duration or the survival period. But the latter two periods tended to be longer in the hypertransfusion group. The CR rate of the increase group tended to be higher than the non-increase group. (4) In the hypertransfusion group, the period from the start of remission induction chemotherapy to reaching the nadir of mature granulocyte and platelet counts tended to be longer than in the control group. (5) In patients achieving CR, the ratio of febrile days to days from the start of chemotherapy to reaching CR and the time period for recovery of platelet counts tended to be lower and shorter, respectively, in the hypertransfusion group than in the control group. This tendency was more evident is the increase group.From these results, it appears that so-called stem cell competition may exist in human beings. Further study is required to evaluate the significance of hypertransfusion in the treatment of ANLL.