Superoxide of neutrophils is one of the acitive oxygens related to intracellular bactericidal activities. In this study, superoxide production of neutrophils in both normal subjects and patients with acute leukemia was examined in order to evaluate the cause of the high susecptibility to infection. The results were as follows.
1. Superoxide production of neutrophils was significantly lower in the older subjects (70-89 y.o.) than in the younger ones (20-69 y.o.). No significant difference was shown between males and females.
2. Before antileukemic chemotherapy superoxide production was 4.09±1.43 nmol/min/10⁶ PMNs in patients with acute leukemia (normal subjects; 6.45±1.33 nmol/min/10⁶ PMNs). During induction chemotherapy it decreased to a level of 3.56±1.18 nmol/min/10⁶ PMNs and it increased up to normal or slightly higer levels in a complete remission. The changes in superoxide production did not relate to the types of acute leukemia.
3. An inverse correlation between superoxide production of neutrophils and the total number of leukemic cells in the bone marrow was recognized.
The results may suggest that the decrease in superoxide production of neutrophils contribute one of the causes of high susceptibility to infection in the elderly men and patints with acute leukemia.

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To elucidate possible association of silicosis with monoclonal gammopathy, serum protein was electrophoretically analized in 616 cases with silicosis. As reusults, monoclonal proteins (M-proteins) were shown in 15 cases (2.4%). One case was diagnosed IgA multiple myeloma, the other 14 cases, benign monoclonal gammopathy. The frequency of M-proteins among cases with silicosis at present study was significantly higher than those found in normal indivisual groups. The class of M-protein was IgA in 8 cases (53%), IgG in 5 cases (33%) and IgM in 2 cases (13%). The incidence of IgA M-proteins was relatively high. These clinical observations suggest that the protracted stimulation of immune system by silica containing adjuvant effect may be implicated in pathogenesis of monoclonal gammopathy.

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1) Fory-one patients with aplastic anemia were divided by the degree of damage to blood constituents at the time of initial diagnosis into 3 groups, severe (10), moderate (16) and mild (15). The prognosis was poorer in the severe group than 2 other groups but there was no significant difference between the latter 2 groups.
2) Although anabolic steroids (methenolone, oxymetholone, Fluoxymesterone) proved effective for aplastic anemia, the possibility of spontaneous recovery was undeniable in 2 cases.
3) The mean period required for a complete remission in 13 cases was 34 months with the maximum of a little longer than 8 years. The recovery of platelet counts was slower than that of other blood cells in many cases.
4) Secondary refractoriness developed in 3 of 12 methenolone-effective cases, 2 of 11 oxymetholone-effective cases and 1 of 9 fluoxymesterome-effective cases, totalling 6 cases. Refractoriness followed infection in 3 of them, suggesting involvement of infection in the mechanism of occurrence of the secondary refractoriness.
5) Other anabolic steroids administered to patients with secondary refractoriness produced an effect in only 1 of them. Splenctomy was performed in another case, in whom partial remission was obtained by readministration of the anabolic steroid.

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The prophylactic efficacy of Trimethoprim-Sulfamethoxazole (TMP-SMX) was evaluated for infections in randomized double blind controlled trial among 102 children with acute leukemia being treated with anticancer drugs. Children were divided into three groups; children with ALL under remission induction chemotherapy, under maintenance therapy, and children with relapsed ALL or AML. TMP-SMX was administered 0.02g/kg orally twice a day for 2 to 8 months.
As a result, the prophylactic effect of TMP-SMX was observed in group II. The average duration in days of infection was 4.86 days as compared to 11.44 days in placebo. The frequency of infectious episode lasting more than 7 days was 27.6% (8/29) in TMP-SMX and 60% (15/25) in placebo. It was also observed among children in group II, that the average duration in days of infection was 4.27 days in TMP-SMX and 7.89 days in placebo after intensification chemotherapy. Bacterial sepsis, lower respiratory tract infection, otitis media and tonsillitis occured less frequently among recipients of the drug. Stomatitis was main adverse effect of this drug. Blood chemistries were not significantly changed during and after administration of TMP-SMX. Rectal and pharyngeal bacterial flora was also unchanged.
We concluded that TMP-SMX could be used more effectively in patients with mild neutropenia during remission on maintenance and intensification chemotherapy.

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Two cases of acute myeloblastic leukemia who developed meningeal infiltration with tumor formation in the brain after long term remisson are presented.
The first case is a 21-year-old male who was admitted because of right lower quadrantanopsia after 7.5 years of complete remission. Lumbar puncture revealed many myeloblasts in the cereblospinal fluid, and a mass lesion was found near the sella turcica on a CT-scan.
The second case is a 20-year-old female who was admitted with sensory disturbance of right upper and lower extremities after 3 years of complete remission. Many myleoblasts were documented in the CSF, and a CT-scan showed a mass lesion in the pons. Bone marrow was proved to be in complete remission in both cases.
CSF and roentogenographic findings were completely normalized in both cases after intrathecal chemotherapy (Methotrexate and Ara-C in the first case, Ara-C and Cyclo-C in the second case) and cranial irradiation. So far the first case remains in complete remission for 21 months and the second case 15 months.
Long term, close observation for CNS relapse is considered necessary not only in patients with acute lymphoblastic leukemia, but also those with acute myeloblastic leukemia.

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We studied a 48-year-old female patient with pernicious anemia who had anti-intrinsic factor and anti-parietal cell antibody in the serum. Immunological studies revealed that natural killer (NK) activity and antibody dependent cell-mediated cytotoxicity (ADCC) were depressed in spite of normal level of cell mediated cytotoxicity (CMC). Moreover, mitogen responeses to PHA, Con A and PWM were low. It has been know that patients with pernicious anemia are not infrequently associated with hypogammaglobulinemia as well as with other autoimmune diseases. But, her immunological abnormalities disappeared after the replacement of vitamin B₁₂. These observations suggest that her immunological abnormalities may be secondary to vitamin B₁₂ deficiency. It has been also known that patients with pernicious anemia have a higher incidence of malignancy than the general population. An altered immune response in pernicious anemia may provide an explanation for the high incidence of cancer.

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This report deals with 2 cases of acute myelogenous leukemia (AML) with eosinophilia which characteristically progressed to complete remission by a comibination chemotherapy of vindesine and prednisolone.
Case 1. A 42-year-old female had been in good health until a month before admission when she first noticed easy bruising. Laboratory data showed WBC count of 94,400/cmm with 14% leukemic cells and 20% mature eosinophils. Bone marrow aspiration revealed 27.6% leukemic cells, 11.1% eosinophils (3.9% My. 2.7% Meta. 2.4% St. 2.1% Seg.).
Cytogenetic examination revealed 46, XX.
Case 2. A 46-year-old male was admitted because of easy fatigability. Blood findings were 6,400/cmm leukocytes with 47% leukemic cells and 30.6% eosinophils (12.6 My. 12.9% Meta. 0.6% St. 4.5% seg.).
Cytogenetic examination revealed 47, XY, +8, inv (16) (p13 q22), t (4; 18) (q23?; q21?).
Leukemic cells from both cases were positive for peroxidase staining and mostly negative for α-naphthyl butyrate esterase and negative for PAS staining. Moreover they vere negative for terminal transferase. Both cases had neither lymphadenopathy nor marked hepatosplenomegaly. From cytochemical findings of increased eosinophils together with clinical signs they were diagnosed as having AML with eosinophilia rather than eosinophilic leukemia.
They had several common characteristics such as eosinophilia, high NAP score, high serum lysozyme and signs of DIC. The relationship between vindesine binding to leukemic cells and the effectiveness of vinca alkaloid prednisolone therapy will be disucssed.

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