Leukocyte Alkaline Phosphatase Score Research Articles

Leukocyte Alkaline Phosphatase and Carcinoembryonic Antigen in Metastatic Colorectal Cancer Patients

Peripheral blood leukocyte alkaline phosphatase scores and plasma carcinoembryonic antigen levels in 26 patients with metastatic colorectal cancer were compared to those in 30 healthy controls. Patients had metastases to the liver and abdomen. The mean leukocyte alkaline phosphatase score in the metastatic colorectal cancer patients was significantly higher than in the control group (246 +/- 65 vs, 52 +/- 26, p less than 0.001); and the mean carcinoembryonic antigen level in the patients was also significantly higher than in the controls (110 +/- 100 vs, 4.9 +/- 3 ng/ml, p less than 0.001). One hundred percent of the metastatic cancer patients had elevated LAP scores and 73% of these patients had elevated CEA levels. There was a difference between the mean CEA levels in the patients with liver metastases and those with abdominal metastases (162 +/- 135 vs, 39 +/- 53 ng/ml, p less than 0.04). The results suggest that although both markers were elevated in metastatic colorectal cancer, the LAP score seems to be more useful in detecting metastatic disease, since we found 11% false negatives with the CEA level and 0% false negatives with the LAP score.

Leukocyte Alkaline Phosphatase and Carcinoembryonic Antigen in Colorectal Cancer Patients

Leukocyte alkaline phosphatase (LAP) scores in peripheral blood, and plasma carcinoembryonic antigen (CEA) levels were determined in 122 colorectal cancer patients, and compared to 30 healthy persons, who served as controls. Both markers are gradually elevated according to the severity of tumor penetration. LAP scores in Dukes'C and D (157 +/- 79) were significantly higher than in Dukes'A, B1 and B2 (81 +/- 43), p less than 0.001. CEA levels were also higher in Dukes'C and D (50 +/- 95) than in patients with Dukes'A, B1 and B2 (25 +/- 54), p less than 0.07, but less significantly. The LAP score has at least the same reliability as the CEA values as a marker of stage in colorectal cancer patients.

Leukocyte alkaline phosphatase score in patients with cerebrovascular disease and in patients with primary and metastatic brain tumors

Leukocyte alkaline phosphatase (LAP) activity in peripheral blood was determined in 54 patients with cerebrovascular disease (CVD), 11 patients with primary brain tumor, and 23 patients with metastatic brain tumor. The LAP score of the primary brain tumor patients (155 +/- 40) was significantly higher (P less than 0.03) than the LAP score for cerebrovascular disease patients (96 +/- 87). The LAP score levels of the metastatic brain tumor patients (251 +/- 55) was significantly higher as compared with both the cerebrovascular disease (P less than 0.001) and primary brain tumor groups (P less than 0.001). The LAP score could serve as an additional, although non-specific, marker to assist in the differentiation between cerebrovascular disease and brain tumors.

Recombinant Gamma-Interferon Has Activity in Chronic Myeloid Leukemia

We demonstrated the clinical effectiveness of recombinant interferon-gamma (rIFN gamma) (Biogen) in 18 patients with Philadelphia-positive chronic myeloid leukemia. Sequential cytogenetic studies and molecular analyses of the breakpoint cluster region and for immunoglobulin and T cell rearrangements were performed every 3-4 months. In 13 patients who received treatment for a minimum of 3 months, the majority were treated with 1.5 mg/m2, t.i.w., i.v. Nonhematologic effects--particularly chills, rigors, myalgia, fatigue, headaches, and nausea--were significant. Complete or partial hematologic responses were observed in six patients, two of whom had approximately 20% normal metaphases after an average of 74 weeks of treatment. However, reversion to 100% Ph+ cells occurred 30 weeks later. In these two patients, in whom normal metaphases were found, no changes were observed in the presence of rearrangements of the breakpoint cluster region. In addition, the marrows remained hypercellular, and the leukocyte alkaline phosphatase score and B12 levels remained abnormal. No immunoglobulin or T cell beta-chain gene rearrangements were found. These data indicate the clinical effectiveness of rIFN gamma in some patients with chronic myeloid leukemia, although the fundamental nature of the disease is unaltered by this form of treatment.

Familial Essential Thrombocyteemia

We report three siblings (2 F, 1 M) aged 9, 12, and 15 years with a thrombocytosis, above 650 X 10(9)/l for at least 18 months and a leukocyte alkaline phosphatase score below 37. The diagnosis of essential thrombocythemia was based upon the exclusion of a reactive thrombocytosis or another myeloproliferative disease. Cytogenetic examination of marrow cells was normal.

Leukocyte alkaline phosphatase and carcinoembryonic antigen in breast cancer patients: clinical correlation with the markers.

Leukocyte alkaline phosphatase (LAP) scores in peripheral blood and plasma carcinoembryonic antigen (CEA) levels were determined in 208 breast cancer patients with nonmetastatic disease. Patients were followed until clinical manifestations of metastases appeared. Then the LAP score and CEA level were analyzed in relation to the clinical appearance of metastases. Of the 208 patients studied, 58 developed metastases during the follow-up period. The LAP scores and CEA levels of this group of patients were compared to a control group of 60 breast cancer patients who did not develop metastases. Of the two markers, LAP score seems to be considerably more useful in detecting metastatic disease.

Significance and correlations of molecular analysis results in patients with philadelphia chromosome-negative chronic myelogenous leukemia and chronic myelomonocytic leukemia

Several investigators have documented a rearrangement of the breakpoint cluster region (bcr) in selected patients with a morphologic diagnosis of chronic myelogenous leukemia (CML) but no abnormality of the Philadelphia chromosome (Ph) by cytogenetic studies. Our intention was to systematically investigate the incidence of the bcr rearrangement in such patients, and to correlate the findings with patient characteristics, response to therapy (especially alpha interferon treatment), and overall prognosis. Molecular analysis studies were performed in 40 patients with Ph-negative CML (23 patients) and myelomonocytic leukemia (CMML; 17 patients). Rearrangement of the breakpoint cluster region (bcr) was detected in 11 of the 23 patients with Ph-negative CML (48 percent), indicating the presence of the abnormal molecular events in Ph-positive CML without documentation of the Ph cytogenetic abnormality. None of the 17 patients with CMML had the bcr rearrangement. Patients with Ph-negative CML and the bcr rearrangement had characteristics similar to those of patients with Ph-positive disease. These included a younger age, higher white blood cell counts, a higher incidence of thrombocytosis and basophilia, and a lower occurrence of thrombocytopenia. The leukocyte alkaline phosphatase score was not a helpful distinguishing feature. Among 21 patients receiving alpha interferon-based regimens, response to therapy was significantly better among patients with Ph-negative disease and the bcr rearrangement (seven of seven, 100 percent), compared with those without the bcr rearrangement (one of six, 17 percent), or patients with CMML (two of eight, 25 percent) (p less than 0.01). At this time of follow-up, only one of the 11 patients with Ph-negative CML and the bcr rearrangement had died from complications of allogeneic bone marrow transplantation, compared with three deaths among the 12 patients with Ph-negative CML and no bcr rearrangement, and 11 deaths among the 19 patients with CMML. We conclude that molecular studies help in better understanding the nosology of Ph-negative CML, and define a subgroup of patients with clinical, therapeutic, and prognostic correlations similar to those of patients with Ph-positive CML.

Chronic neutrophilic leukemia with marked myelodysplasia terminating in blast crisis.

A case of chronic neutrophilic leukemia (CNL) is reported. The patient had a history of bleeding, and showed sustained mature neutrophilic leukocytosis, hepatosplenomegaly, a high leukocyte-alkaline phosphatase score, elevated serum vitamin B12 and uric acid, and the presence of Döhle bodies in the neutrophils. In addition to the above typical features, marked myelodysplastic changes in the erythroid and megakaryocytic series were observed in the bone marrow. Three months after the diagnosis of CNL had been established, the hematological picture evolved into a blast crisis of monocytic type. Such findings give support to the statement of CNL as a distinct entity belonging to the spectrum of the myeloproliferative disorders.

Significance and correlations of molecular analysis results in patients with Philadelphia chromosome-negative chronic myelogenous leukemia and chronic myelomonocytic leukemia

<h3>Purpose</h3> Several investigators have documented a rearrangement of the breakpoint cluster region (<i>bcr</i>) in selected patients with a morphologic diagnosis of chronic myelogenous leukemia (CML) but no abnormality of the Philadelphia chromosome (Ph) by cytogenetic studies. Our intention was to systematically investigate the incidence of the <i>bcr</i> rearrangement in such patients, and to correlate the findings with patient characteristics, response to therapy (especially alpha interferon treatment), and overall prognosis. <h3>Patients and methods</h3> Molecular analysis studies were performed in 40 patients with Ph-negative CML (23 patients) and myelomonocytic leukemia (CMML; 17 patients). <h3>Results</h3> Rearrangement of the breakpoint cluster region (<i>bcr</i>) was detected in 11 of the 23 patients with Ph-negative CML (48 percent), indicating the presence of the abnormal molecular events in Ph-positive CML without documentation of the Ph cytogenetic abnormality. None of the 17 patients with CMML had the <i>bcr</i> rearrangement. Patients with Ph-negative CML and the <i>bcr</i> rearrangement had characteristics similar to those of patients with Ph-positive disease. These included a younger age, higher white blood cell counts, a higher incidence of thrombocytosis and basophilia, and a lower occurrence of thrombocytopenia. The leukocyte alkaline phosphatase score was not a helpful distinguishing feature. Among 21 patients receiving alpha interferon-based regimens, response to therapy was significantly better among patients with Ph-negative disease and the <i>bcr</i> rearrangement (seven of seven, 100 percent), compared with those without the <i>bcr</i> rearrangement (one of six, 17 percent), or patients with CMML (two of eight, 25 percent) (p < 0.01). At this time of follow-up, only one of the 11 patients with Ph-negative CML and the <i>bcr</i> rearrangement had died from complications of allogeneic bone marrow transplantation, compared with three deaths among the 12 patients with Ph-negative CML and no <i>bcr</i> rearrangement, and 11 deaths among the 19 patients with CMML. <h3>Conclusion</h3> We conclude that molecular studies help in better understanding the nosology of Ph-negative CML, and define a subgroup of patients with clinical, therapeutic, and prognostic correlations similar to those of patients with Ph-positive CML.

Hydroxyurea in the treatment of polycythemia vera: a prospective study of 100 patients over a 20-year period.

From 1963 to 1983, I treated 100 patients with polycythemia vera, using phlebotomy and the adjunctive agent hydroxyurea. These 78 male and 22 female patients ranged in age from 24 to 88 years (mean 55.7). Duration of therapy ranged from three to 216 months (mean 64.9). The mean daily dose was 0.72 gm, and the median dose was 0.64 gm. Hydroxyurea gave adequate control of red cells, platelets, and spleen size. Cytopenia was not observed. Phlebotomy requirements were markedly reduced. Leukocyte alkaline phosphatase scores were generally lowered and several blood chemistry values returned to normal. Side effects were minimal, and there were no drug-related deaths. Infections were not a problem. Hydroxyurea, a metabolic inhibitor of desoxyribonucleic acid, does not interfere with the synthesis of ribonucleic acid or protein and is thus probably less leukemogenic than radioactive phosphorus and alkylating agents. Acute myelogenous leukemia was seen in one patient after five years of continuous hydroxyurea therapy. He had received no other myelosuppressant agent. Because hydroxyurea is safe and effective in the treatment of polycythemia vera, it should be considered as first-line therapy. It probably offers practical and theoretic advantages over present therapy particularly when the disease is not well controlled by phlebotomy alone.

Leukocyte alkaline phosphatase (LAP). A useful marker of zinc status in beta-thalassemic patients.

Intensive desferrioxamine treatment may negatively affect zinc stores in thalassemic patients. Two groups of young thalassemic patients, with good and poor compliance to desferrioxamine treatment, and a control group were investigated. Leukocyte alkaline phosphatase (LAP), zinc content in neutrophils, plasma zinc levels, and urinary zinc excretion were determined. LAP score, and neutrophil zinc and plasma zinc levels of the good compliance patients were statistically lower than those seen in the controls and in the poor compliance patients. Urinary zinc excretion was statistically higher in good compliance patients than in controls and poor compliance patients only during high-dose intravenous desferrioxamine. On the contrary, poor compliance patients had LAP scores, neutrophil zinc, plasma zinc, and urinary zinc excretion values within the normal range. We conclude that high-dose desferrioxamine produces a reduction of zinc stores in thalassemic patients. LAP scores determinations, which are a reliable and inexpensive marker of body zinc, could become a routine test for monitoring thalassemic patients undergoing hypertransfusion programs.

Increased leucocyte alkaline phosphatase and transcobalamin III in chronic myeloid leukaemia associated with lithium therapy

A 38-year-old woman developed chronic myeloid leukaemia after 2 years of lithium carbonate therapy. A peculiar feature of her leukaemia, as well as of the 5 patients previously reported in whom CML has developed in the course of lithium therapy, was the unusually high degree of granulocyte maturation manifested in normal leucocyte alkaline phosphatase (LAP) score and, in 1 case, selective increase of transcobalamin III. Although a cause and effect relation between lithium therapy and CML has not yet been established, in view of the stimulatory effect of lithium on granulocyte proliferation, such treatment should be avoided in patients with established myeloproliferative disorders, or in patients at high risk of developing leukaemia.

Sustained post-transfusion granulocyte count increments following transfusion of leukocytes obtained from donors with chronic myelogenous leukemia.

Leukocyte transfusions from patients with chronic myelogenous leukemia (CML) and elevated WBC counts were given to 14 patients with acute leukemia for the treatment of 16 infectious episodes. The WBCs were not irradiated to determine if engraftment with production of granulocytes would occur following infusion of immature myeloid elements. No recipient was alloimmunized by clinical and serologic criteria. High leukocyte yields were obtained using a variety of differential centrifugation techniques with a mean WBC yield/transfusion of 95 X 10(9) (range 19-275). A mean of 2.5 transfusions (range 1-11) were administered/recipient with a mean total dose of 235 X 10(9) WBC/transfusion episode (range 50-590). Seven patients had granulocyte counts greater than 500/microliters for four or more days (range 4-11 days) following the last transfusion. Ph1 chromosomes were documented in 2 of 4 patients tested 2-8 days following transfusion. Leukocyte alkaline phosphatase scores were increased (greater than 150) in 5/5 recipients tested post-transfusion demonstrating that production of this enzyme can be induced in CML granulocytes. Except for one severe transfusion reaction, there were no significant side effects and no recipient developed signs of graft versus host disease. All patients with sustained increments demonstrated rapid clinical improvement including 3 severely infected, poor risk patients undergoing initial induction therapy. These 3 patients all achieved complete remission with no evidence of the Ph1 chromosome. Because of the high dose of WBC which can be collected and the salutary effect of continued leukocyte production, CML WBC may be the preparation of choice for selected, non-alloimmunized, severely infected patients.

Leukocyte alkaline phosphatase (LAP) activity in health and infections of infancy.

Leukocyte alkaline phosphatase (LAP) activity was determined in healthy neonates and 1–12 months old infants. As compared to the control values of 142±13.85 (range 118–163), in the neonatal infections of bacterial origin, the LAP score fell down to 115.92±35.91 (range 79–202) with p-value of 0.05. The diagnostic importance of the test was assessed.

Basophilic-Eosinophilic Meningitis in an Undifferentiated Myeloproliferative Disorder

BASOPHILIA and eosinophilia are common findings during an "accelerated phase" of chronic myeloproliferative disorders, particularly chronic myelogenous leukemia.^1,2When these diseases involve the meninges, it is invariably as "leukemic meningitis," usually during the blastic transformation to acute leukemia, and blasts are the primary cell found in the CSF.³A case of an undifferentiated myeloproliferative disorder (Philadelphia chromosome negative) occurred, in which the terminal event was characterized by a severe infiltration of the meninges with basophils and, to a lesser extent, eosinophils, without the presence of leukemic blasts. <h3>Report of a Case</h3> A 40-year-old woman was seen at the hospital 2 1/2 years before her present admission with vaginal bleeding, leukocytosis (116,000/cu mm, with 1% blast forms, 2% myelocytes, 9% metamyelocytes, 34% band forms, 38% polymorphonuclear leukocytes, 3% lymphocytes, 2% monocytes, 1% basophils, and 2% eosinophils), thrombocytosis (3,500,000/cu mm), a normal bone marrow karyotype, a leukocyte alkaline phosphatase score

Clinical, hematological, and biochemical features of Hb SC disease.

Twenty-seven patients were seen and followed at our Sickle Cell Center over a period of seven years. Their clinical, hematological, and biochemical features were determined and compared to those of patients with sickle cell anemia who were concurrently investigated. The data indicate that the mild anemia of hemoglobin (Hb) SC disease is slightly microcytic and hyperchromatic. Parameters of hemolysis and the complications of chronic hemolytic anemia (cholelithiasis, leg ulcers, hepatomegaly, and cardiomegaly) are milder in Hb SC disease than in sickle cell anemia. Asplenia and its sequelae (increased platelet count and reduced serum IgM levels) are less frequent in Hb SC disease. Cerebrovascular accidents and the decreased leukocyte alkaline phosphatase scores are similar in both diseases. Thromboembolic complications, retinopathy, and renal papillary necrosis are more frequent in Hb SC disease.

Chronic Granulocytic Leukaemia with a raised Leukocyte Alkaline Phosphatase Score

International Journal of Clinical PracticeVolume 35, Issue 7-8 p. 277-280 Case Report Chronic Granulocytic Leukaemia with a raised Leukocyte Alkaline Phosphatase Score S. M. Crawford MB, MRCP(UK), S. M. Crawford MB, MRCP(UK) Registrar General Medicine Airedale General Hospital Steeton, Keighley, West Yorkshire, BD20 6TD Present address: Clinical Research Fellow In Oncology, Bradford Royal Infirmary Bradford BD9 6RJ.Search for more papers by this author S. M. Crawford MB, MRCP(UK), S. M. Crawford MB, MRCP(UK) Registrar General Medicine Airedale General Hospital Steeton, Keighley, West Yorkshire, BD20 6TD Present address: Clinical Research Fellow In Oncology, Bradford Royal Infirmary Bradford BD9 6RJ.Search for more papers by this author First published: 01 July 1981 https://doi.org/10.1111/j.1742-1241.1981.tb08286.x Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume35, Issue7-8July/August 1981Pages 277-280 RelatedInformation

Leukocyte alkaline phosphatase in cancer patient.

Leukocyte alkaline phosphatase (LAP) activity in peripheral blood was determined in 113 patients with non-metastatic malignancies, 36 patients with metastatic spread, and 22 individuals who served as controls. The LAP score of the non-metastatic cancer patients was significantly higher (p less than 0.001) than the controls, and the score of the metastatic group was further increased significantly as compared to both control (p less than 0.001) and non-metastatic groups (p less than 0.001). The results of this survey suggest that the level of LAP score in peripheral blood might be used to differentiate between non-metastatic and metastatic disease and might serve as an aid in prognosis of the patients.

Pituitary-adrenal axis function in sickle cell anemia and its relationship to leukocyte alkaline phosphatase.

The function of the pituitary-adrenal axis and leukocyte alkaline phosphatase activity were evaluated in eight patients with sickle cell disease during a painful crisis and when crisis-free. The leukocyte alkaline phosphatase (LAP) score did not increase during crisis; the scores were in the low-normal range during crisis and noncrisis periods. Insulin-induced hypoglycemia produced normal growth hormone responses during both crisis and crisis-free periods. Plasma cortisol concentrations were diminished in the crisis group. Also impaired was 11-deoxycortisol production in both groups after metyrapone. These findings indicate that a mild defect in the hypothalamic-pituitary-adrenal axis exists in sickle cell disease patients.

Significance of leukocyte alkaline phosphatase in hairy cell leukemia.

Peripheral blood samples of 23 patients who had hairy cell leukemia were examined for leukocyte alkaline phosphatase scores. Leukocyte alkaline phosphatase levels were elevated in seventeen patients (74%), were normal in six (26%), and were not decreased in any patient. The mean leukocyte alkaline phosphatase score was 166 (normal range, 11-95). High leukocyte alkaline phosphatase scores correlated inversely with the absolute number of neutrophils in peripheral blood and were unrelated to other clinical factors, including age and time since splenectomy. High leukocyte alkaline phosphatase scores were also associated with a shift to more immature forms of neutrophil differentiation. These findings are consistent with the view that high leukocyte alkaline phosphatase levels in hairy cell leukemia are secondary to decreased marrow granulocyte reserves and do not necessarily indicate the existence of primary abnormalities of multiple bone marrow cell lines, including the granulocytes, in hairy cell leukemia. The role of the leukocyte alkaline phosphatase assay in the differential diagnosis of hairy cell leukemia with respect to non-Hodgkin's lymphoma, chronic lymphocytic leukemia, and other lymphoid malignancies is discussed.