Hairy Cell Leukemia Pain Blood-1989-Vandermolen-2066!9!2

8/11/2019 Hairy Cell Leukemia Pain Blood-1989-Vandermolen-2066!9!2

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1989 74: 2066-2069

LA VanderMolen, WJ Urba, DL Longo, J Lawrence, H Gralnick and RG SteisDiffuse osteosclerosis in hairy cell leukemia

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2066

lood Vo l 74 . N o 6 N ovem ber 1 , 1 989 : pp 20 66-2069

iffu se O steo sc le rosis in H airy ell L euk em ia

B y Lou is A . V ande rM o le n , W a lte r J . U rba , D an L . Longo , Je ifry L aw re nce , H arv ey G ra ln ick , an d R ona ld G . S te is

W e desc rib e tw o p atien ts w ith a n ew clin ica l p a th o lo g ic

s yn drom e o f d iffu se o steo sc le ro s is in a ssoc ia tion w ith

h a iry c e ll le uk em ia . In bo th p atien ts b on e m a rrow b io ps ies

cou ld n o t be ob ta ined du e to ex trem e ly h ard bo nes an d

in ab ili ty to inse rt the b io ps y need le ; ne ith er p a tien t had a

h is to ry o f b on y p a in o r frac tu re . T he os te osc le ro t ic p ro ces s

in on e pa tie n t s ta b ilize d a fte r su cc es s fu l tre a tm en t o f h er

H

A IRY CELL LEUKEM IA is an ind o len t lym phopro-

lifera tive d iso rde r o f B -lym phocyte o rig in . T he dis -

ease typ ica lly invo lves the periph eral b loo d , bone m arrow ,

and sp leen and p atien ts usua lly p resen t w ith pancy topen ia

and sp lenom eg a ly .24 C lin ical invo lv em en t o f o th e r o rg an s

has been r epo r ted bu t is le ss comm on. B ony in filtration by

ha iry ce lls is particu la rly unusua l bu t w hen it occurs , it can

result in pa infu l ly t ic or m ix ed b la s tic /ly tic bone les ions

usua lly in the th orac ic o r lum bar sp ine , fem ora l n eck , o r

fem ora l head58 D iffuse bony sc lerosis in asso c ia tion w ith

ha i ry ce ll leukem ia has no t been rep orted p rev ious ly . In th is

report, w e desc ribe tw o p atien ts w ith ha iry ce ll leukem ia an d

d iffu se bo ny sc le ros is . The d isease process d id n o t ap pear to

be cau sed by d irec t in filtra tio n of the bon e by ha iry ce lls. T he

diffuse na ture of th e p roc ess su gg este d that a h um ora l facto r

w as respo nsib le fo r th e w id espread bony th icken ing .

CASE R EPO RTS

P atien t no . I

. A 39-year-o ld wh ite w om an presen ted in 1981

w ith p rog res siv e fatigue , sp le nom eg aly , and pan cy topen ia . A m ar-

row biop sy revea led a d iffuse ha iry ce ll in filtra te and a sp lenec tom y

w as per form ed 4 m onth s afte r p resen tatio n . T he sp leen w eig hed

900 g . T here w as a d iffuse in f iltra tio n o f the red pu lp w ith a u n ifo rm

popu la tion of sm all lym pho cy tes w ith prom in en t ce ll m em branes ,

cle ar cy to p lasm , roun d nuc lei, and occ asiona l sm all nu cleo li. Pe rip h-

era l b lo od co un ts norm a lized afte r sp lene ctom y . In m id - 1 9 84 he r

h em og lob in began to fa ll p rog ress iv ly an d she d eve lop ed recu rren t

F rom the B io log ica l R espon se M odifier s P rog ram . C lin ica l

R ese arc h B ranch , a nd P rogram Resou rce s, In c . N a tio na l C an cer

inst itu te , F rede ric k , M D . N ationa l Insti tu tes o f H ea lth C lin ica l

C en te r . C lin ica l P a tho logy D epar tm en t. B e thesd a . M D 20892 .

Subm itted M a rch 8 , 1 989 ; ac cep ted Ju ne 16 , 19 89 .

Th is p ro jec t has been fun ded a t lea st in par t w ith F edera l funds

from the D epa rtm en t o fH ea lth a nd H um an S erv ice s u nd er co n tract

n um ber N 01 -CO -7 410 2 . T he con ten t o f th is pu b lica t ion d oe s n o t

n ec essa rily re flec t th e v iew s orpo l ic ie s o fthe D epa rtm en t o f H ea l th

a nd H um an Serv ic es, no r d oes m en tio n o ftrade nam e s. c om m ercia l

produ cts . o r org an iza t ion s im p ly end or sem en t by th e U S gov ern -

men t .

Add ress repr in t requests to R ona ld G . S te is , M D . B io log ica l

R esponse M od ifie rs P rogram . C lin ica l R esearch B ranch , N a tio na l

Canc er In stitu te -FC RF , M ed ica l P avi lion -FMH , 335 Pa rk A ve .

F reder ick , M D 21 701 .

T he pub lica tion costs o fth is a rtic le w ere de frayed in pa rt b y page

c harge pa ym en t. Th is a rtic le m us t th ere for e b e he reb y m ark ed

adver t isement

in ac co rda nce w ith 1 8 U .S .C . s ec tion 1 734 so le ly to

in d ica te th is fa c t.

T h is is a U S gov ernm en t w ork . Th ere a re n o re stric tio ns o n its

use .

0006-4971 /89 /7406-0014 0 .00 /0

ha iry c e ll le uk em ia w ith in te r fe ron a lph a an d deoxyco fo r-

m yc in su gg es tin g tha t the o ste os c le ro s is o bserved w as

re la te d to the u nd er ly in g m a lig nan t d ise as e . P oss ib le e tio -

log ic m echan ism s are d is cussed .

T h is is a U g o v ern m en t w o rk T h e re a re n o re str ic t io n s o n

its u s e

fa tigu e. In Janua ry 19 86 , a bo ne m a rrow b iop sy w as a ttem pted bu t

c ou ld n ot b e o bt ai ne d

The p a tien t w as re fe rred to the N ationa l C ancer In stitu te in

Feb rua ry 1986 and w as fou nd to hav e a hem og lob in o f 8 .8 g /dL , a

g ran u lo cy te co unt of 6 60/mm 3, an d a p late le t co unt of I

71 ,000 /

mm3 . A sm all pe rcen tage of periphera l b lood cells had the m orpho-

lo g ic app earanc e of ha iry ce lls a nd w ere pos itiv e on stain in g fo r

ta rtra te resis tan t a cid ph osp ha tase (TRAP ). P oste rio r ilia c cre st

marrow bio psies cou ld not b e p erform ed bec au se of ou r inab il ity ,

de sp i te severa l a ttem pts, to pen etra te the cort ical b one . Th e bio psy

need le bro ke off in the b one an d could n ot b e retr ieved , even u nd er

d irec t v isua liz atio n in th e ope rat ing room . A n op en bone m a rrow

bio psy revea led m a rked ly th ic ken ed bony trabe cu lae . V ery little

m edullary sp ace w as o bse rved but that w hich w as pre sen t w a s filled

w ith d ense fib ro us t issu e co nta in ing large num be rs o f h airy cells

Fi g

I

V ery little norm al hem atopo ie tic tissue w as presen t. R ad iograp hs

(F ig 2) revea led d iffuse osteoscle rosis of the rib s, ve rte bra l bo d ies ,

pe lv is an d p rox im al fem ora . T re atm en t b egan on M arch 20 , 198 6

w ith al tern ating m onth ly cyc les o f deox yco form ycin (dCF ) and

recom b inan t in ter fero n-a lfa 2a (rIFN -a2 a) as d esc rib ed prev ious ly .9

W ith in 6 m on ths , th ere w a s no rm alization of p erip heral b loo d counts

and th e pa tien t com p lete d 1 4 m onths of therapy un ev en tfu lly . A

repea t

op en bon e m a rrow biopsy a fte r the com p letion o f th erapy

aga in rev ealed m a rked ly th ic ken ed bony trabe cu lae and litt le m edu l-

la ry spa ce fil led predom in an tly by fa t and hem o rrh age . N o hem ato-

p oie tic tiss ue was pre sen t. Serum levels o f so lub le IL -2 recep to r, a

re cen tly d esc rib ed tum or m a rke r in hairy ce ll le uk em ia, { 176 } no rm a l-

ized du rin g th e co urse of th erapy . T he pat ien t has

been

fo llow ed at

3-m onth in terv als sin ce th e com ple tion of therapy an d ha s don e w ell .

So lub le IL -2 recep to r leve ls have rem ained no rm al. Periph eral b lood

co un ts I 8 m onth s afte r the com ple tion o f the rap y rem a in norm a l bu t

t here h as b een no ch ang e in the x -ray app earanc e of her b on es since

th e com p let ion of therapy .

Pa tie n t no . 2 .

A 48 -year-o ld w hite m an presen ted w ith fa tig ue

an d lethargy

in

A ugust 197 4 . E xam ina tio n reve aled sp lenom ega ly

an d the absenc e of lym ph adenopath y . H is hem og lob in w as 8 .7 g /dL ,

to ta l le uko cy te co un t 2 ,70 0 /m m 3 w ith 42 g ran u lo cy tes, 5 band

form s , 48 lym pho cytes, 2 eo sin oph ils , 2 b aso phils, an d 1 hairy

ce l l s . H is p late le t coun t w as 97 ,000 /mm 3 and a reticu locy te count

w a s I .9 . B uffy-coat cells w e re TRA P po sitive . A bone m arrow

bio psy show ed m yelo fib rosis an d ha iry c ell le ukem ia. R adio graph s

of the sk u ll , pe lv is, lum bar, a nd th ora cic sp ine reve aled d iffu se

os teo scle ros is. A bone scan show ed in cre ased u ptak e in bo th prox i-

m al fem o ra. In M arch 1975 , rep eat percu taneous bo ne m a rrow

bio psies w ere u nsu cce ssfu l be cau se th e bon es w ere so ha rd that tw o

n eed les w ere bro ken du ring the b io psy p roc edu re. O n Ap ril 21 , 1 97 5 ,

the pa tie n t u nde rw ent an open bon e m arrow biopsy , ax illa ry lym ph

nod e b iop sy , an d sp lene ctom y . M icroscopic ex am inat ion of all th ree

spec imens rev ealed invo lvem ent w ith ha iry ce ll leuk em ia. A fte r

sp lene ctom y , pe rip heral b loo d counts no rm a liz ed un til D ecem ber

1978 w hen th e hem oglo b in aga in beg an to prog ress ive ly d ecl ine . H e

b egan to req u ire red b lood cel l (R BC ) trans fus ion s in Jan ua ry 1979

and d ev elo ped hepatom ega ly . T rans fus ion dependency dev elo ped in

October 1979 . Ev alu atio n included liv er b io psy , lym ph node biopsy ,

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3/5

O S TE O S CLE RO SIS IN HA IR Y C E LL LE U KE M IA 2 067

Fig 1

H em a toxylin an d eosin stain of bo ne biop syof p atien t n o. 1 sho w ing osteosclerosis A an d h airy cell in filtration B original

m a gn ificatio ns: A . x 32; B , x 128 .

Fig 2. P lain radiographs of the pelvis A and chest B of patient no. 1 . d em o nstratin g d iffu se o steo sclero sis. A rro w in dicates b ro ken

b one m a rrow biop sy n eedle. inside circle. fro m previo us b on e m a rrow biop sy attem p t.



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R EF ER EN C ES

2068

V N ERMOLEN ET L

and open bone m arrow biopsy . The liver and lym ph nodes w ere

infiltrated w ith TR A P positive ly m phocytes. The open bo ne m arrow

biopsy rev ealed marke dly thickene d bony trabeculae , m ye lofibro sis ,

and an infiltrate o f hairy cells . In N ov em ber 197 9 , therapy beg an

w ith clorambucil but the patient co ntinue d to re quire frequent R B C

trans fusions . Lithium carbo nate w as added in June 1 98 1 w ithout

im prove me nt in periphe ral bloo d c ounts. Chloram buc il and lithium

carbo nate w ere both discontinued in D ecem ber 19 8 1 and oxym etha-

lo ne w as co mm enced in M arch 19 82 . In A pril 19 82 , the patient w as

ho spital ized fo r bilateral pne um onia and an open lung bio psy

revealed nonspec if ic pneum onitis and hairy ce ll infiltration into the

lung parenchym a. He died in M ay 1 982 of progressive pulm onary

inv o lv em ent w ith hairy ce ll leukem ia.

C O M M E N T S

B one invo lvem ent in hairy ce ll leukem ia is a rare com pli-

cation that usually m anifes ts itse lf c linically by pain in

i nv o lv ed ske le tal areas . Patho log ic fractures due to infiltra-

tion o f the

co rtic a l b o ne by hairy ce lls h ave been repo rted .

R adiog raphically these les io ns

have

been predom inate ly ly tic

in nature ; how ev er, bone scans are freque ntly po sitive sug -

gesting

tha t

som e osteoblastic activ ity is also present.5 8 This

is th e firs t rep o rt o f diffuse osteosc lero sis, w itho ut a ly tic

com ponen t, a s a m an ife s ta tion o f bo ne disease assoc iated

w ith ha iry ce ll le uk em ia . B oth cases reported here had

ex tens iv e bo ny s cle ro sis o n r ad io g ra p hs , w hich in bo th cases

w as co nfirm ed p ath olo gica lly .

B oth patients described here presented w ith hairy cell

l eukemia

and diffuse bony osteosc lero sis. Initially , it w as

possible to p e rfo rm pe rcu ta neous bo ne m arrow bio psies but

as th e ha iry

ce ll leukem ia pro gressed this becam e im poss ible

in both patients . This prog ress ive hardening o f the bo ne

sugg ests that the sc lerotic pro cess w as activ e and progressing

in th e ea rly yea rs o f the se pa tien ts d ise ase . T he sc le ro tic

pro cess in the second patient show ed radiographic w orsening

th at c orre late d

with

his progressive hairy cell leukem ia and

the first patient dem o nstrated radio graphic s tabilization

a fte r rem is s io n o f h a iry

c ell le uk em ia w ith effec tive therapy .

Thus , in both patients the o steosc lerotic process appears to

ha ve w orsen ed as the patients hairy ce ll leukem ia progressed

and in one patient has stabilized after rem ission of the hairy

ce ll leukem ia. This suggests a causal re lationship betw een

ha iry c e ll leukem ia and the osteo sc lerosis .

M ultiple m yelom a, ano ther B -ce ll neoplasm , c lass ically

results in osteo ly tic bo ne les io ns w ith o r w itho u t o s teo sc le ro -

s is .2 3 T he neop la s tic ce lls o f m u ltip le m yelom a are arrested

at a m ore m ature stage of differentiation than hairy ce lls,

w hich are m alignant counterparts o f pre-plasm a ce lls.45

B one invo lv em ent has no t been reported in chro nic lym pho-

cy tic leu kem ia , a

B-ce l l

neoplasm characterized by a pro lif-

era tio n o f ce lls a rre s te d at a stag e o f differentiation that is

less m ature than in hairy ce ll leukem ia.4 6 Thus, the degree

1 K orsm ey er S i, Greene W C , W aldm ann TA : C ellular orig in o f

hairy ce ll leukem ia: M alignant B ce lls that express receptors for 1

ce ll grow th factor. S em in Onco l 1 1:3 94 , 1984

2 . C atovsky D , Pettit JE, G alton D A G , S piers A S D , Harrison

C V : Leukaem ic reticuloendothe lio sis (Hairy ce ll leukaem ia): A

dis tinc t clinico patho log ical entity . B r J H aem ato l 2 6:9 , 197 4

o f ce llular m aturity m ay be an im por ta n t va r ia b le in the

dev elopm ent of bony com plications in these B -ce ll diso rders .

The deve lo pm ent of bo ne disease in hairy ce ll leukem ia

m ay be re lated to the platele t dy sfunction know n to ex is t in

this dis eas e. 72 { 1 7 6 } T he a -g ra nu le s o f plate le ts contain, am ong

o the r things , platele t-de riv ed grow th fac tor (PD GF) and

trans forming g row th facto r-f3 (TG F-/3).2 2 3 PD G F stimu-

lates both D N A and protein synthe sis in o rgan cultures o f rat

ca lvar iae and has also been show n to s tim u la te bone re so rp -

tion.2223 TG F-f3 enhances bone D NA synthes is and th e cells

of th e os te ob la s tic line age appear to be the m ost sensitive to

its mitoge nic activ ity .24 2 5 Thu s , both PD G F and TGF-fl are

gro w th factors that by them se lves or in conjunctio n w ith

o ther grow th factors ex ert a m ajor effec t on bo ne rem odel-

ing .23 26 The a-g ranules o f plate le ts in ha iry ce ll le ukem ia

have been show n to be decreased in num ber and to hav e

low er c onc entrations of these grow th facto rs.72 { 176 } The plate-

lets in hairy ce ll leukem ia appear to be intrins ically no rm al in

that the storage poo l defic iency -like abnorm ality has been

observed to reso lv e w ith effec tive hairy ce ll le ukem ia tre a t-

ment . 92 {176}hese

data are cons istent w ith the notio n that in

hairy ce ll leu kem ia an e xhau s te d -p la te le t o r s to rag e pool

d efic ie nc y -like s ta te oc cu rs w h ic h le ad s to ab erran t re le as e

o f th e se g row th

fac tors . These locally re leased fa c to rs co u ld

resu l t in the sc lerotic o r ly tic b o ne les io ns obse rv ed in o u r

pat ients .

The diffuse o te os c le ro s is s een in o u r pa tie n ts

in c lu ded bony s ites no t usua lly th ough t to

be ac tive in

hem a to po ies is in ad u lts

and is certainly m ore ex tens ive than

the bone invo lvem ent prev ious ly repo rted in hairy ce ll leuke-

m ia . T he re fo re , it se em s like ly tha t th e pathogenes is o f

osteosc le ros is

in hairy ce ll leu kem ia in vo lv es a hum o ra l

mechanism.

Treatm ent o f the ly tic bo ne c om pl ic atio ns in ha iry ce ll

leukem ia c an be ac com plished by sy stem ic the rapy w ith

a -in te rfe ron o r dC F bu t lo ca l ra d ia tio n the ra py is a lso o fte n

requ i red .9 27 28 The firs t patient reported here responded to

com b in a t ion therap y w ith bo th dC F and a-IN F w ith an

imp ro v emen t i n p eri ph e ra l b lood coun ts and norm aliza tio n

of so luble IL-2 receptor lev e ls and her bone disease radio -

graph ic a lly h as rem a ine d sta b le . If the bon e com p lica tio ns

are inde ed du e to abnorm al platele t re lease ofg row th factors ,

i t w ou ld

b e a n ti ci pa te d

that the bone dise ase mig ht

imp rove

or stabilize w ith correction of the functional plate le t abnor-

m ality . Further studies o f grow th factor r e lease and bone ce ll

activation by plate le ts in hairy ce ll leukem ia and other B -ce ll

neop la sms

are ne ede d.

A C K N O W L E D G M E N T

W e w ish to thank Sharo n Lew is for her secretarial assistance in

preparation of the m anusc ript and D r Jo hn W . S m ith II for

ass istance in the care of these patients.

3 . B ouronc le B A : Leukem ic reticuloendothel ios is (hairy ce ll le u-

kem ia). B loo d 53 :41 2 , 19 79

4 . Go lom b H M , Catov sky D , G olde D W : Hairy c ell le uke mia-a

clinical

re v ie w based on 71 c ase s. A nn Intern M e d 89 :67 7 , 1 978

5. D em anes D i, Lane N , B eckstead JH: B one invo lvem ent in

hairy-cell le ukemia. C anc er 49 :16 97 , 19 82



5/5

O S TEO SC L ER O S IS IN H A IR Y C E LL L EU K E M IA

2 6 9

6 . Pete rso n C, Kaplan PA , Lo renzen K M : Case repo rt 41 0 .

S kele tal R adio l 16 :82 , 19 87

7 . Lem bersky B C , R atain M J, G olom b HM : S keletal co m plica-

tions in hairy ce ll leuke mia: D iagnos is and therapy . J C lin O nco l

6 : 1 2 8 1 9 8 8

8. K hyner K , S treuli R , K istler OS : H aarzell-leukam ie (H airy-

ce ll leukem ia) M it o ste o ly tisc he n knoc henveranderung en. S chw eiz

M ed W o chenschr 1 07:863 , 1977

9 . N erens tone 5 , M artin A , U rba W , Law rence J, C lark J, S m ith

J, C rum E, M iller R , S choenberg er C , H aw kins M , Lo ngo D , Ste is

R : Treatm ent of hairy ce ll leukem ia (HC L) w ith alternating cyc les

of 2deox yc ofo rmy cin (D C F) and re co mbinant alpha interfe ron

( IFN ). Pro c A m S oc C lin Onco l 7 :679 , 1 988 (abstr)

10 . Chilos i M , S em enz ato 0 , C etto G , A mbrosetti A , Fio re-

D onati L , Pero na 0 , B erto n 0 , Lestani M , S carpa A , A gos tini C ,

Tre ntin L, Zam bello R , M asciare lli M , D azz i F, V inante F, C aligar-

is -Cappio F, Pizzo lo 0: S oluble inte rle ukin-2 re ceptors in the se ra of

patients w ith hairy cel l le uke mia: Re lationship w ith the ef fec t of

re com binant a-interfero n therapy on c linical parame ters and natural

k i l l e r

in v itro activ ity . B loo d 7 0:5:1530 ,

1987 .

I . S te is RO , M arc on L, Clark J, U rba W , Lo ngo D L, N e lso n

D L, M aluish A E: Serum soluble IL-2 receptor as a tum or m arker in

patie nts w ith hairy-ce ll leukem ia. B lood 7 1:1 304 , 198 8

12 K yle R A . M ultiple m yelom a. R ev iew of 869 cases . M ayo C lin

Proc 50 :2 9 , 1 975

I

3 . D riedger H , Pruzanaski W : Plasm a cell neoplas ia w ith o ste o-

scle rotic lesio ns . A rch Intern M ed 1 39:892 , 1 97 9

1 4 . Janse n J, S chuit HR E, M eijer JLM , v anN ie uw koo p JA ,

Hijmans W : C ell m arkers in hairy ce ll leukem ia in ce lls fro m 51

patie nts. B loo d 5 9:52 , 1 982

I 5 . A nderson K C, B oyd A W , Fishe r D C, Leslie D , S chlossm an

S F, N adler LM : H airy ce ll leukem ia: A tum o r o f pre-plasm a ce lls.

B l o o d

6 5:6 20 , 1 985

16 . M ellste dt H , Petterso n D , H oIm G : Lym pho cyte sub-popula-

tio ns in chronic lym pho cytic leuke mia (C LL). A c ta M ed S c and

204 :48 5 , 19 78

17 Rosove M H, N aeim F, Harw ig 5 , Zighelbo im J: Severe

plate let dy sfunction in hairy c ell leukem ia w ith improv em ent afte r

sple ne ctom y. B loo d 55 :90 3 , 1 98 0

8. N e n c i

G O , G rese le P. A gnelli P, Parise P: Intrins ically

defe ctive or exhaus ted plate lets in hairy c ell le ukem ia? Thro mb

Haem ost 4 6:5 72 , 1 98 1

1 9 . D upuy E, S igaux F, B ryckaert M C , Tobelem 0 , Cas taigne 5 ,

Flandrin 0 , D agos L, C aen JP: Platelet ac quired defe ct in PD G F in

3 throm bog lobulin c ontent in hairy ce ll leukem ia: Improv em ent

after inte rferon the rapy . B r J H aem ato l 6 5:1 07 , 198 7

20 . Zuze l M , C aw ley JC , Paton R C , B urns G F, M cN ico l G P:

Pla te le t func tion in hairy ce ll leukem ia. J Clin Patho l 3 2:8 14 , 197 9

21 . S eye din S M , Thom pson A Y , B entz H, R ose n D M , M cPhe r-

son JM , C onti A , S ie gel N R, Galluppi GR , Piez K A : C artilag e

induc ing facto r. A ppare nt identity to the transform ing grow th

fac tor- fl. J B io l C he m 26 1:5 693 , 1 98 6

22 . D eue l TF, Huang JS : Plate le t-derived gro w th factor struc-

ture, function and role s in no rm al and transform ed c ells . J C lin

Inv est 74 :66 9 , 198 4

23 . Canalis E, M c Carthy 1 , Ce ntrella M : Gro w th fac tors and the

reg ulation o f bo ne rem odeling . J Clin Inv est 8 1 :2 77 , 19 88

24 . Ce ntrella M , M assag ue J, C analis E: Human platelet-derived

transfo rm ing g row th facto r s tim ulates perime ters of bo ne grow th

i n f eta l

rat calvariae . Endocrino log y 1 1 9 :23 06 , 1 986

25 . C entrella M , M cC arthy 1 , Cannalis E: Trans form ing g row th

fac tor is a bifunctional regulato r of re plication in c o llagen synthes is

in osteoc las t-enric hed c ell c ultures fro m fe tal rat bone . J B io l Chem

262 :2 869 , 19 87

2 6 . Pfei lschifte r J, M undy O R : M odulation of ty pe -B transform -

ing grow th facto r in bone cultures by os teo trophic hormo nes . Pro c

N atI A cad S ci U S A 8 4:202 4 , 1 987

27 . Quesada JR . He rsh EM , M anning J, Re ube n J, Keating M ,

S chnipper E, Itri L , Outte rm an JU : Tre atm ent of hairy c ell leuke-

m ia w ith recom binant interfero n. B loo d 68:49 3 , 19 86

2 8 . Johnston JB , Glazer RI, Pugh L, Israels LO: The tre atm ent

o f hairy cel l leukem ia w ith 2 deo xy coform ycin. B r J Haem ato l

6 3:5 25 , 198 6


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