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Studies on abnormal polymorphonuclear neutrophils in acute myelogenous leukemia: clinical significance and changes
Abstract:
In patients with acute myelogenous leukemia (AML), 34 out of 35 patients (97%) had cytochemically abnormal polymorphonuclear neutrophils (PMN). Some interesting regularity was noted in the appearance of cytochemical abnormalities of the PMNs. When peroxidase (PO) activity was low, both alkaline phosphatase (AP) and chloroacetate esterase (CAE) activities were also low (group A). When PO activity was normal, if AP activity was low, CAE activity tended to be high (group B) and if AP activity was high, CAE activity tended to be low (group C). Complete remission rate of group B (65%) seemed to be better than that of group C (20%) and group A (25%) although the differences was not statistically significant. In these patients, the number of peripheral leukemic blasts and PMNs showed a significant positive correlation (r = 0.69, p less than 0.005). Furthermore, patients with higher circulating PMN counts (more than 2 X 10(9)/L) had a significantly worse prognosis than patients with lower counts (p less than 0.05). These rather unexpected findings strongly suggest that cytochemically abnormal PMNs are progeny of AML blasts. The change in the proportion of abnormal PMNs associated with chemotherapy were studied in 21 patients during the remission induction period. Abnormal PMNs disappeared from the circulation in patients who achieved complete remission. In contrast, abnormal PMNs persisted throughout the remission induction period in patients who failed to achieve complete remission.
Insights
Cytochemically abnormal polymorphonuclear neutrophils (PMNs) are common in acute myelogenous leukemia (AML). Their presence and specific activity patterns correlate with prognosis and treatment response, suggesting they originate from AML blasts.
Area of Science:
- Hematology
- Oncology
- Cell Biology
Background:
- Acute myelogenous leukemia (AML) is characterized by the proliferation of myeloid blasts.
- Polymorphonuclear neutrophils (PMNs) are a type of white blood cell.
- Cytochemical analysis can reveal abnormalities in cellular enzyme activity.
Purpose of the Study:
- To investigate the cytochemical characteristics of PMNs in AML patients.
- To determine the correlation between PMN abnormalities, leukemic blasts, and patient prognosis.
- To assess the utility of monitoring abnormal PMNs during chemotherapy.
Main Methods:
- Cytochemical staining for peroxidase (PO), alkaline phosphatase (AP), and chloroacetate esterase (CAE) in PMNs.
- Correlation analysis between PMN counts, leukemic blasts, and clinical outcomes.
- Monitoring of abnormal PMN proportions during remission induction therapy.
Main Results:
- 97% of AML patients exhibited cytochemically abnormal PMNs.
- Distinct patterns of PO, AP, and CAE activity were observed.
- Higher circulating PMN counts correlated with a worse prognosis.
- Abnormal PMNs disappeared in patients achieving complete remission and persisted in non-responders.
Conclusions:
- Cytochemically abnormal PMNs are likely progeny of AML blasts.
- PMN abnormalities serve as potential indicators of AML prognosis and treatment efficacy.
- Monitoring abnormal PMNs may aid in assessing remission status during AML therapy.