6 28

Correspondence

Saito. H., Oshimi, K., Akahoshi, M., Yamauchi. K., Yamada. 0. & Mimguchi, H. (1991) ContrasuppressorT cell leukaemia: clonal proliferation of contrasuppressorT cells in a patient with granular lymphocyte proliferative disorder. British Iournal of Haernatology, 78, 5-13.

Smith. J.L.. Oscier. D.G.. Haegart, D.G.. Jones, D.B., Howell, M.. Hodges, E.. Stevenson,F.K. & Hamblin, T.J. (1988)CD3 +CD8 + T cell lymphocytosis masking B cell leukaemia. Journal of Clinical Pat'athologu,41, 746-752. Snowden, N.. Bhavnani. M.. Swinson. D.R., Kendra. J.R.. Dennett,C., Carrington. P.. Walsh. S. & Pumphrey. R.S.H. (19911 Large granular T lymphocytes. neutropenia and polyarthropathy: an underdiagnosed syndrome?QuarterlyIournal of Medicine. 78, 6576.

We welcome the opportunity to comment on the letter of Drs Snowden and Bhavnani about granular T lymphocyte proliferation and B-cell dysfunction. As they and other researchers (Loughran & Starkebaum, 1987; Semenzatoet al, 1987; Bassanet al, 1989)pointedout. granular lymphocyte-proliferative disorders (GLPD) (Oshimi, 1988) are frequently associated with B-cell dysfunctions including polyclonal hypergammaglobulinaemia, autoantibody production, autoimmune diseases, M-proteinaemia and B-cell neoplasms. The fundamental question to be answered is whether GLPD induce B-cell dysfunction or B-cell dysfunction induces GLPD. Both possibilities are likely. When GLPD cells do not possess suppressor function, or when GLPD cells have contrasuppressor function (Saito et al. 1991). gammaglobulin level may be elevated, though the function of GLPD cells does not always correlate with the serum immunoglobulin level (Semenzato et al, 1987; Saito et al, 1991). B-cell neoplasms may induce GLPD. T-lineage GLPD cells are considered to be in vivo-primed cytotoxic T lymphocytes (CTL) (Kaneko et al. 1992). and therefore these CTL may have been

primed in vivo by tumour antigens, or CTL that have been generated in vivo by other stimulants, such as viruses, may have been expanded by cytokines produced by B-cell neoplasms. Tokyo Womens' Medical College,

8-1 Kauada-Cho,

TAKAKO KANEKO U z u o OSHIMI

Shimjuka-ku. Tokyo 162,Japan REFERENCES Bassan, R.. Pronesti, M.. Buzzeti, M..Allavena. P., Rambaldi, A., Mantovani, A. & Barbui, T. (1989) Autoimmunity and B cell dysfunction in chronic proliferative disorders of large granular lymphocytes/naturaI killer cells. Cancer. 63, 90-9 5. Kaneko, T., Oshimi, K., Seto, T., Okumura. K. &Mizoguchi.H. (1992) A bispeciec antibody detects cytotoxic T lymphocytes of unknown antigen specificity in patients with granular lymphocyte-proliferative disorders. British Iournd of Haematologu. 80, 151-1 56. Loughran. T. 81 Starkebaum,G. ( 1 987) Large granular lymphocyte leukaemia. Report of 38 cases and review of the literature. Medicine, 66, 397-405. Oshimi, K. ( 1988) Granular lymphocyte proliferative disorders: report of 12 cases and review of the literature. Leukaernia, 2,61762 7.

Saito. H.. Oshimi. K.. Akahoshi. M.. Yamauchi. K.. Yamada. 0. & Mizoguchi, H. (1991) Contrasuppressor T cell leukaernia: clonal proliferation of contrasuppressor T cells in a patient with granular lymphocyte-proliferative disorder. British Journal of Haernatology, 78. 5-13.

Semenzato. G., PandolA, F., Chisesi, T.. De Rossi, G.. P m l o . G.. Zambello, R.. Tretin, L., Agostini. C., Dini. E., Vespignani, M., Cafaro, A., Pasqualetti. D.. Giubellino, M.C., Migone, N. & Foa, R. (1 98 7) The lymphoproliferative disease of granular lymphocytes. A heterogeneous disorder ranging from indolent to aggressive conditions. Cancer. 60, 2971-2978.

THERAPY WITH HUMAN RECOMBINANT ERYTHROPOIETIN IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES Bowen and co-workers recently reported that two out of 10 patients with myelodysplastic syndrome (MDS) treated with human recombinant erythropoietin (EPO)had a steady state rise in haemoglobin concentration. Both responders were recently diagnosed, never transfused and showed relatively low concentrations of serum immunoreactive EPO (Bowen et al, 1991). Serum Epo inappropriately low for the degree of anaemia has been confirmed in other MDS patients successfully treated with Epo (Kurzrock et al, 1991) but not in others (Schouten et al, 1991: Stein et al. 1991). In a monocentric. non-randomized open trial we treated 19 patients with primary MDS with increasing doses of rh-Epo (Eritrogen'"', Boehringer Mannheim. Germany) administered subcutaneously three times a week. The starting dose was 6000 U: after 4 weeks the dose was increased to 10000 U and after further 4 weeks to the maximum dose of 20 000 U.Eligibility criteria were bone marrow blasts

Therapy with human recombinant erythropoietin in patients with myelodysplastic syndromes.

6 28 Correspondence Saito. H., Oshimi, K., Akahoshi, M., Yamauchi. K., Yamada. 0. & Mimguchi, H. (1991) ContrasuppressorT cell leukaemia: clonal pro...
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