Cellular discriminants for a biological classification of human colon carcinoma

We categorized established human colon carcinoma cell lines into three biological groups. Our studies were performed on six colorectal cancer lines representing the proposed three groups. Group I consisted of two lines designated LoVo and SW 48; Group II comprised two lines called SW 480 and SW 620; and Group III was represented by lines SW 403 and SW 1116. Group I consisted of the most differentiated cells. This differentiation encompassed morphological markers, gland and signet ring formation, and ciliary development. The outstanding morphological characteristic of Group III was the development of numerous multinucleated giant cells. The range and modal chromosome number increased from Group I to Group III, a change reflected by the higher DNA content of these cells as measured by flow cytometry. Carcinoembryonic antigen synthesis was maximal for Group III and virtually absent for Group II. The number of clonogenic cells decreased from Group I to Group III, while the proportion of nonproliferating cells calculated both by experiments using continuous labeling with tritiated thymidine, and by the primer-available alpha-DNA polymerase index, increased from Group I through Group III. Another important cytokinetic difference was that Group I had an exponential cell cycle stage distribution not seen for the other groups. Cells in Group I were easily propagated in athymic (nude) rats by s.c. injection; cells in Group II injected s.c. grew for about 30 days and then regressed spontaneously. Cells in Group III could only be grown when inoculated intracerebrally. Thus, our studies have now confirmed and extended the hypothesis that cultured human colorectal carcinomas can be separated into at least three groups on the basis of morphological differentiation, chromatin distribution, carcinoembryonic antigen production, cytokinetic properties, and xenograft propagation. Perhaps this classification is just the tip of the iceberg, and future studies will determine the existence of additional groups or subgroups on the basis of other markers. However, at present it appears established that malignant cells with a common histological origin in the gut express their phenotypic potential in a sufficiently discrete manner as to permit their classification into distinct biological groups. Thus, the stage is set for extrapolating this in vitro classification for an in vivo segregation of human colorectal tumors into categories with specific properties and diverse prognosis.

Convention on nomenclature for DNA cytometry. Committee on Nomenclature, Society for Analytical Cytology

Analysis of cellular DNA content by cytometry is important in clinical and biological research. Measurements are used widely to assess the relative DNA content of tumor stemlines and to assist in the detection and evaluation of malignant diseases. A review of the literature on DNA measurements in solid tumor and leukemias reveals a confusing variety of terms applied for the description of similar results. In order to facilitate the understanding of data and to standardize the terminology for DNA analyses, a questionnaire was distributed to more than 500 investigators. Subsequently, a workshop on terminology was held at the Combined Conference on Analytical Cytology and Cytometry IX and VIth International Symposium on Flow Cytometry, Schloss Elmau, West Germany, 18-23 October, 1982. The workshop nominated a nine-member committee to develop guidelines for nomenclature to be used in reporting results from analyses by DNA cytometry. The committee was charged by the Council of the Society for Analytical Cytology to complete this task and to publish its recommendations in Cytometry and in Cancer Genetics and Cytogenetics. The following guidelines are based on the questionnaires returned and the discussion at the workshop; they represent the unanimous recommendations of the committee. The five guidelines given herein apply to measurements of relative DNA content of cells that have been stained appropriately and analyzed by cytometry.

Cultured human tumour cells may be arrested in all stages of the cycle during stationary phase: demonstration of quiescent cells in G1, S and G2 phase

Six human colon carcinoma cell lines were induced to enter stationary phase of growth by nutrient deprivation and cell crowding. Growth kinetics parameters (cell number, flow cytometric analysis of DNA distribution, and labelling and mitotic indices) were measured sequentially for all lines during the various stages of in vitro growth. Our results demonstrated that a substantial fraction of cells (9-18%) were located in G2 phase when they changed from an exponential to a stationary mode of growth. Moreover, a large number of cells in stationary phase of growth had an S-phase DNA content, as determined by flow cytometry, but failed to incorporate radioactive DNA precursors (up to 15-fold difference). To substantiate these findings, cells in stationary phase of growth were induced to enter exponential growth by re-seeding in fresh medium at a lower density. Subsequently observed changes in DNA-compartment distribution, and in labelling and mitotic indices were those expected from cells that had been arrested at different stages of the cycle during their previous stationary phase. Thus, the non-proliferating quiescent state (Q), traditionally located 'somewhere' in G1 phase, appears to be composed also of cells that can be arrested at other stages of the cycle (Qs and QG2). Although the proportion of such cells is rather small, their contribution to the growth kinetics behaviour of human in vivo tumours will become apparent following 'recruiting' or 'synchronizing' clinical manoeuvres and will prevent the formation of a clear-cut wave of synchronized cells.

Estrogen receptor analysis by flow cytometry

A fluorescently labeled estradiol, N'-fluoresceino-N'-(17 beta-estradiol hemisuccinamide) thiourea (FE) was used for measuring estrogen receptor content per cell in tumor cells. The cellular content of FE was measured quantitatively by flow cytometry. Binding of FE occurs in the nanomolar concentration range, an indication of the high affinity of the labeled estradiol. Competition of FE for binding sites is observed with estrogens, but not with progestins, androgens, or glucocorticosteroids, indicating the specificity of FE binding. In contrast to other estrogen receptor assays, this new technique requires a small sample size (about 5000 cells) and permits the assessment of heterogeneity in estrogen receptor expression among tumor cells.

Effective treatment of advanced multiple myeloma refractory to alkylating agents

Twenty-nine patients with advanced refractory multiple myeloma were treated with intermittent high-dose dexamethasone in combination with four-day infusions of vincristine and doxorubicin. Rapid and marked tumor-mass reduction (greater than 75 per cent) was noted in 14 of 20 patients whose disease was resistant to alkylating agents and in 3 of 9 patients with additional resistance to doxorubicin--a result far superior to those in previous trials with similar patients. In responsive patients, remissions were of excellent quality, and survival was significantly longer than in unresponsive patients.

Evolution of oligoleukemia

Chronic lithium administration to 22 patients with oligoleukemia did not alleviate cytopenia or stimulate bone marrow proliferative activity. The authors identified, however, pretreatment characteristics discriminating two evolutionary endpoints of oligoleukemia (marrow failure, 10 patients; overt acute leukemia, 12 patients): higher marrow leukemic infiltrate, normal myeloid precursor proportion, platelet count, and female sex all favored eventual transition to overt leukemia which, in comparison with marrow failure, was associated with a significantly longer survival duration from symptoms. For patients developing overt leukemia, survival from diagnosis was inversely correlated with the degree of marrow leukemic infiltrate. The lack of lithium responsiveness in oligoleukemia is consistent with the concept of differentiated leukemia with abnormalities either at the level of a lithium-responsive adherent cell elaborating colony stimulating activity (CSA) or at the level of CSA-responsive CFUs.

Flow-cytometric analysis of DNA content in postmortem tissue

In order to determine the heterogeneity of ploidy in disseminated cancer, we assessed the suitability of postmortem tissue for flow-cytometric analysis of cellular DNA content. Forty tissue samples from various tumor-bearing sites in 12 patients with widely metastatic cancer were analyzed. In eight cases studied there was a single unimodal ploidy level in all disease sites studied. The remaining four cases revealed bimodal tumor populations present in different proportions in the various sites studied. No difference in ploidy could be detected between irradiated and nonirradiated sites in patients who had received radiation therapy. Samples taken from normal tissues all revealed diploid DNA content, suggesting that DNA fluorescence is not altered in the immediate postmortem period. Systematic analysis of cellular DNA content in autopsy material is feasible and may contribute to our understanding of patterns of metastatic spread in patients with cancer.

In vitro suppression of DNA synthesis by a remission induction agent and its correlation with response in adult acute leukemia

Fifty-three adult patients who presented with previously untreated acute leukemia had leukemic cells incubated in vitro with five doses of cytosine arabinoside (0.001-0.1 microgram/ml) and adriamycin (0.1-10 microgram/ml). Thymidine incorporation was measured in treated and untreated cells. Greater than 80% suppression of pretreatment thymidine incorporation after treatment with 0.004 micrograms/ml of cytosine arabinoside correlated with complete remission (CR) of the patient. A Mahalanobis' D2 score, which provides an index of the deviation of patient's in vitro drug response from the mean profile of responders, was calculated for each drug. Patients who had D2 values greater than 10 for Ara-C were less likely to respond to therapy. Patients with low D2s had rates of CR higher than predicted by the prognostic model employed at U.T.M. D. Anderson Hospital. However, unlike in our previous report, responders and non-responders were not clearly separable on the basis of the D2 value.

High-dose cytosine arabinoside in multiple myeloma

In 14 patients with advanced refractory multiple myeloma, the effect of high-dose cytosine arabinoside (ara-C) administration was evaluated. There was one partial remission among 13 evaluable patients who received 2 g/m2 intravenously over 2 hr every 12 hr, for a total of 2-8 g/m2 per course, repeated every 3-4 weeks. Myelosuppression constituted the dose-limiting toxicity, causing two treatment-related deaths from infection and bleeding. Prior extensive therapy, a low percentage of cells in S phase and low levels of intracellular ara-CTP accumulation in the bone marrow could explain the resistance of myeloma to this treatment.

High-dose cytosine arabinoside in non-Hodgkin's lymphoma

Thirty-two patients with refractory non-Hodgkin's lymphoma were treated with high-dose cytosine arabinoside (ara-C) given at 2 g/m2 IV over three hours every 12 hours for 4-8 g/m2/course repeated at three to four week intervals. There were eight partial responses (29%) and two minor responses among 28 evaluable patients. The median response duration was 10 weeks (range, 6-33 weeks). The median survival was significantly prolonged in responders compared to nonresponders (28 versus 15 weeks; p = 0.03). Two additional patients treated with 12 g/m2/course died of sepsis and myelosuppression. The dose-limiting toxicity was myelosuppression, which was more pronounced in patients with prior extensive radiation therapy and bone marrow involvement. In vivo measurements of intracellular concentrations of ara-CTP, the active metabolite of ara-C, showed significantly higher values in bone marrows with lymphomatous involvement compared to normal bone marrows (210 versus 95 microM; p = 0.05), probably indicating a preferential formation and retention of ara-CTP in malignant cells compared to normal hemopoietic cells. In addition, higher ara-CTP levels were found in bone marrows that had higher percentages of cells in S phase.

Marrow cytometry and prognosis in myeloma

We have previously shown that flow cytometric analysis of acridine orange-stained bone marrow cells is useful for the objective enumeration and characterization of plasma cells from patients with myeloma, frequently exhibiting an abnormal DNA and an elevated RNA content. In this report on 77 previously untreated patients, we have investigated the biologic and prognostic implications of these quantitative tumor cell parameters. The degree of marrow involvement by tumor, both by microscopic and cytometric analysis, correlated with the clinically derived tumor mass stage. Examination of the product of relative tumor cell RNA content and marrow tumor infiltrate (as a measure of metabolic capacity for immunoglobulin production) in relationship to the myeloma protein concentration in the serum revealed differences in the efficiency of immunoglobulin production and/or catabolism. There was an inverse relationship between the degree of marrow tumor involvement and RNA index, suggesting a more aggressive behavior of myeloma in patients with a low tumor cell RNA content. Prognostically, high tumor cell RNA content identified patients with a high likelihood of response to both initial treatment (32 patients, P = 0.004) and salvage therapy (29 patients, P = 0.01). Favorable factors for survival were low clinical tumor mass stage (P = 0.07) and low marrow tumor infiltrate as determined morphologically (P = 0.04) and cytometrically (P = 0.004). Thus, the direct examination of marrow cellular DNA and RNA content permitted assessment of tumor burden and was useful in the prediction of response and survival.

Analysis of pleural effusions using automated flow cytometry

Flow cytometry allows rapid and accurate analysis of the deoxyribonucleic acid (DNA) content of a large number of cells. In solid tumors, the presence of aneuploidy has been shown to correlate wall with the presence of neoplastic cells. Both cytologic examination and DNA analysis by flow cytometry were performed on pleural effusions from 33 patients. Results of the two examinations were in agreement in 10 of 12 malignant pleural effusion (two false-negatives) and in 20 of 21 benign effusions. One patient with cirrhosis, ascites and Nocardia pneumonia had hypodiploid cells (false-positive) in the pleural fluid. All patients who had a malignancy, but whose pleural effusion proved to be due to a benign cause, had cells with normal DNA content in their pleural effusion. DNA analysis using flow cytometry can be rapidly performed and is highly specific and sensitive. The finding of hyperdiploid cells is highly suggestive of malignancy.

Potentiation of DNA-reactive antineoplastic agents and protection against S-phase-specific agents by anguidine in Chinese hamster ovary cells

Anguidine, a protein synthesis inhibitor, has been shown to induce a reversible cell cycle arrest in exponentially growing Chinese hamster ovary cells. The effect of pretreatment with anguidine on the cytotoxicity of subsequently administered various chemotherapeutic agents, hyperthermia, and radiation was investigated. We found that anguidine greatly potentiated the cytotoxic activity of cis-dichlorodiammineplatinum(II) and melphalan by abolishing the initial shoulder and steepening the subsequent exponential portion of the survival curves. Bleomycin-induced cell kill was also potentiated by anguidine pretreatment but to a lesser extent. However, anguidine pretreatment did not substantially alter radiation cytotoxicity. In contrast, anguidine markedly reduced the lethal effect of hydroxyurea, 5-fluorouracil, and hyperthermia, three modalities with S-phase activity. To investigate whether both anguidine-induced potentiation and protection of cells by different antitumor agents were due to its induction of complete suspension of cycle traverse, experiments were also conducted with plateau-phase cultures. Whereas anguidine potentiated cis-dichlorodiammineplatinum(II) cytotoxicity in an identical fashion as noted in exponentially growing cells, its protective effect against lethal damage from Adriamycin was absent. Thus, it appears that the two opposite effects of anguidine modification of cell kill by cytotoxic agents (protection and potentiation) come about by two different mechanisms, with cell cycle arrest underlying cytoprotection and the mechanism of synergistic toxicity remaining obscure.

Comparative cytotoxicity of bisantrene, mitoxantrone, ametantrone, dihydroxyanthracenedione, dihydroxyanthracenedione diacetate, and doxorubicin on human cells in vitro

The cytotoxic efficacies of several substituted anthraquinones, ametantrone, dihydroxyanthracenedione, dihydroxyanthracenedione diacetate, mitoxantrone, bisantrene, and doxorubicin, were evaluated on an established human colon adenocarcinoma cell line by the method of inhibition of colony formation. The concentration-dependent survival curve following treatment for 1 hr was biphasic exponential for all agents. At concentrations below 1 microgram/ml, mitoxantrone was about twice as active as both hydroxyl-substituted anthracenediones and doxorubicin, about 14 times more efficacious than ametantrone, and about 22 times more powerful than bisantrene. At higher concentrations, these differences in efficacy became even more pronounced. Treatment in stationary phase decreased the lethal efficacy of doxorubicin but not that of the other agents. No recovery of potentially lethal or sublethal damage was noted for any agent, but for anthracenedione derivatives, there was a small but statistically significant increase in cell kill during fractionated exposure. Continuous treatment with mitoxantrone or bisantrene resulted in marked degrees of cell killing, reaching 99.95 and 99.5%, respectively, after 24 hr. For doxorubicin, cell kill efficacy declined after 4 hr. Mitoxantrone was 10-fold more active on cells in G2 phase than on those in mid- to late-S phase. Sensitivity in G1 phase was intermediate. Thus, mitoxantrone appears as the most active compound while bisantrene and ametantrone are the least active agents. The cytotoxic efficacy of bisantrene increases during prolonged continuous exposure, while that of mitoxantrone increases in fractionated administration. These characteristics could be exploited in clinical strategies designed to improve the performance of these agents.

Selective protection by anguidine of normal versus transformed cells against 1-beta-D-arabinofuranosylcytosine and Adriamycin

Anguidine, a protein synthesis inhibitor, has been shown previously to induce a reversible arrest of cell progression through all phases of the mitotic cycle without inducing appreciable cell kill. This "frozen" cell cycle state provided protection of Chinese hamster ovary cells against the lethal effects of 1-beta-D-arabinofuranosylcytosine, Adriamycin, hydroxyurea, 5-fluorouracil, and hyperthermia. We now report on the preferential induction of cytostasis by anguidine in normal WI-38 fibroblasts, occurring at one-tenth of the dosage required to inhibit the cycle progression of WI-38 VA13 cells, the SV40 transformant. Pretreatment with anguidine at a concentration producing effective inhibition of normal cell cycle traverse while permitting sustained proliferation of transformed cells resulted in almost complete protection of WI-38 normal cells against the growth-inhibitory effects of 1-beta-D-arabinofuranosylcytosine and Adriamycin, without reducing the antiproliferative effects of these two agents against WI-38 VA13 transformed cells. Thus, this cytokinetic concept of preferential normal tissue protection should be explored in vivo to increase the therapeutic index of cancer chemotherapy.

Anaplastic myeloma with massive extramedullary involvement. Report of two cases

Two patients developed anaplastic myeloma associated with prominent extramedullary disease one and four years after the initial diagnosis of multiple myeloma. Most tumor cells in the extramedullary sites were primitive-appearing and anaplastic, although plasmacytoid differentiation was evident. One patient had concurrent bone marrow involvement by cytologically similar cells, while the other patient was in bone marrow remission when he developed clinically evident soft tissue infiltration. Immunoperoxidase staining showed similar cytoplasmic immunoglobulin in both the mature-appearing and anaplastic cells in both patients. Electron microscopy in both cases showed a morphologic spectrum between the mature-appearing and anaplastic cells. DNA flow cytometric studies following the onset of extramedullary disease revealed a tumor cell population with a high degree hyperdiploid abnormality and unusually high proliferative activity in both cases, consistent with the morphologic anaplasia. Anaplastic myeloma appears to represent a distinct, aggressive variant of multiple myeloma which may result from a transformation of well differentiated myeloma cells to poorly differentiated immunoblast-like cells.

Combined ultrasound and radiation therapy treatment of human superficial tumors

Ultrasound, used to generate local tumor hyperthermia, was combined with radiation therapy in a pilot study to determine efficacy and toxicity of this combined-modality therapy. Twenty-one lesions in eighteen patients were treated at graded doses from 2400-4000 rads (24-40 Gy) with ultrasonic hyperthermia administered immediately prior to irradiation at 43.5 degrees C +/- 0.5 degrees C for one hour. The overall response rate was 100%, with a 62% complete response rate. Of those lesions that responded completely and were followed for periods of three to twenty-two months, there have been no recurrences of the lesions treated with the combined modalities. The response rate for control unheated lesions in the same patient in the same radiation field was markedly lower (30% overall and no complete responses). Heat treatment alone in the same patients also showed lower response rates (50% overall and 10% complete) with a short response duration. Toxicities were minimal, consisting of one case with long-term treatment-associated sequelae. It is concluded that this combined modality of therapy is safe and effective where applied in human superficial tumors and that further development is warranted.

Growth characteristics of human colonic adenocarcinomas propagated in the Rowett athymic rat

Two human colonic adenocarcinoma cell lines were propagated in the Rowett athymic rat. Line LoVo displayed a well-differentiated morphology and exhibited progressive growth over a 70-day observation period with a doubling time of 8.5 days throughout. No metastatic involvement was noted. Xenografts of SW 620 cells were undifferentiated and highly necrotic. These tumors grew progressively for approximately 30 days with a doubling time of 5.5 days, but over 90% of the animals exhibited a spontaneous regression with a mean time to total regression of 51 +/- 3 (S.E.) days. Animals which had rejected the SW 620 xenografts would not support the growth of either the SW 620 or LoVo xenografts when challenged a second time with inocula producing a 100% tumor incidence in control rats. No metastatic involvement was noted for the SW 620 xenografts, but the tumors frequently invaded the underlying musculature and protruded into the peritoneal cavity without producing ascites or tumor nodules at sites distant from the primary.

Ultrasound-induced hyperthermia for the treatment of human superficial tumors

Ultrasonic systems were developed for the treatment of superficial human tumors, generating local tumor hyperthermia at tumor center temperatures ranging from 43 degrees to 50 degrees. Twenty-eight patients with disease of varying histology were evaluable for response, and demonstrated an overall response rate of 57% with a complete response rate of 18%. In 11 patients who had received definitive radiation therapy to the heat treated area, the response rate was 81%; there were no toxicities other than those noted for the overall study. As temperature was escalated a marked increase was observed both in response rates (from 53% (43-44 degrees C) to 83% (48-50 degrees C) and in duration of response (from 29 to 250 days for the same temperatures). Toxicities were minimal, consisting of superficial blistering in four patients and pain in six patients. Pain was usually associated with tumor involvement in the periostium.

Ploidy, proliferative activity and estrogen receptor content in human breast cancer

Tumor samples from 80 patients with breast cancer (43 primary, 37 metastatic) were analyzed for ploidy and proliferative activity using DNA flow cytometry. Sixty-one tumors (40 primary, 21 metastatic) were also analyzed for estrogen receptor content. Eighty-five percent of all tumors had an abnormal DNA content. The majority of tumors were hyperdiploid (65%). Seventy-three tumors had a unimodal ploidy distribution, while in seven cases two distinct aneuploid subpopulations were identified. The degree of ploidy abnormality was not related to extent of disease or menopausal status, but was higher (DNA index greater than 1.5) in poorly differentiated tumors (p = 0.05). ER-positive tumors were more often diploid (7 of 31) than ER-negative tumors (3 of 30, p = 0.16). DNA content was constant in biopsies from multiple sites in 5 patients with metastatic disease and in serial biopsies over the course of the disease. High proliferative activity (percent cells in S-phase) was more often associated with ER-negative tumors than ER-positive tumors (p = 0.03). However, in all subgroups analyzed a wide range of values was noted. We conclude that flow cytometric analysis of cellular DNA content provides a rapid means of quantitating ploidy and proliferative activity in human breast cancer. Ploidy abnormalities were common, stable, and usually unimodal. Proliferative activity was inversely related to estrogen receptor content.

Prognostic implications of ploidy and proliferative activity in human solid tumors

Ploidy and cell cycle compartment distribution were measured by DNA flow cytometry in 261 patients with a variety of different tumors. Eighty-one percent of all tumors were aneuploid, and 72% were hyperdiploid. Ploidy levels spanned a wide range from hypodiploid (maximum 30% less than diploid controls) to hyperoctaploid (440% in excess of diploid controls) with a mean and median values coinciding at a near-triploid DNA content. The proportion of cells with G1 DNA content decreased with increasing hyperdiploid abnormality. While unrelated to biopsy site and to a number of host factors such as age, sex and race, both ploidy and cytokinetic parameters were markedly affected by histopathologic diagnosis. Patients with metastatic lung, breast and GI cancer had higher ploidy levels than individuals with the corresponding primary tumors. Ploidy (except for one patient) remained constant, and G1/100 proportions showed only minor variation by disease site and over a median observation time of 6 months. Prognostic factor analysis was performed in the subgroup of patients studied within 6 months from diagnosis. The adverse impact of low tumor G1/100 proportion on survival was lost as the proportional hazard analysis was extended to include diagnostic subgroups. Accounting for histopathologic diagnosis, stage of disease, ploidy, and the proportion of tumor G1/100 cells, the following sequence of adverse prognostic factors in order of their relative ranks was established: (1) absence of breast cancer (p=0.0001), (2) hypertriploid DNA index (p=0.049), and (3) presence of metastatic disease (p=0.079). Our study demonstrates that DNA content-derived information on instrinsic tumor cell features pertaining to cytogenetics and cytokinetics may provide an objective means of biologically relevant cancer classification.

Tubular complexes of endoplasmic reticulum in lymphoblastic lymphoma: case report

Distinctive intracytoplasmic tubular complexes have been identified occasionally by electron microscopy in a wide variety of hematologic and nonhematologic disorders. The mechanism of induction and significance of these tubular complexes are unknown. Tubular complexes were identified in the majority of bone marrow lymphoma-leukemia cells in a patient with documented lymphoblastic lymphoma in lymph node. These complexes varied in size but in general ranged from 800--1500 nm, and consisted of masses of nonparallel, twisted, smooth, 40-nm tubules. Continuity with adjacent endoplasmic reticulum was evident in some of the complexes. Cytochemical characteristics of the malignant cells included strong, focal, paranuclear acid phosphatase reactivity and strong, stippled nuclear terminal deoxynucleotidyl transferase positivity. Flow cytometric analysis showed a DNA-RNA content pattern consistent with acute lymphoblastic leukemia and typical of T-cell lymphoma. This represents the first report of such tubular complexes in a presumed T-cell malignancy.

Tubular complexes of endoplasmic reticulum in lymphoblastic lymphoma: case report

Distinctive intracytoplasmic tubular complexes have been identified occasionally by electron microscopy in a wide variety of hematologic and nonhematologic disorders. The mechanism of induction and significance of these tubular complexes are unknown. Tubular complexes were identified in the majority of bone marrow lymphoma-leukemia cells in a patient with documented lymphoblastic lymphoma in lymph node. These complexes varied in size but in general ranged from 800--1500 nm, and consisted of masses of nonparallel, twisted, smooth, 40-nm tubules. Continuity with adjacent endoplasmic reticulum was evident in some of the complexes. Cytochemical characteristics of the malignant cells included strong, focal, paranuclear acid phosphatase reactivity and strong, stippled nuclear terminal deoxynucleotidyl transferase positivity. Flow cytometric analysis showed a DNA-RNA content pattern consistent with acute lymphoblastic leukemia and typical of T-cell lymphoma. This represents the first report of such tubular complexes in a presumed T-cell malignancy.

Tubular complexes of endoplasmic reticulum in lymphoblastic lymphoma: case report

Distinctive intracytoplasmic tubular complexes have been identified occasionally by electron microscopy in a wide variety of hematologic and nonhematologic disorders. The mechanism of induction and significance of these tubular complexes are unknown. Tubular complexes were identified in the majority of bone marrow lymphoma-leukemia cells in a patient with documented lymphoblastic lymphoma in lymph node. These complexes varied in size but in general ranged from 800--1500 nm, and consisted of masses of nonparallel, twisted, smooth, 40-nm tubules. Continuity with adjacent endoplasmic reticulum was evident in some of the complexes. Cytochemical characteristics of the malignant cells included strong, focal, paranuclear acid phosphatase reactivity and strong, stippled nuclear terminal deoxynucleotidyl transferase positivity. Flow cytometric analysis showed a DNA-RNA content pattern consistent with acute lymphoblastic leukemia and typical of T-cell lymphoma. This represents the first report of such tubular complexes in a presumed T-cell malignancy.

Ploidy and proliferative characteristics in monoclonal gammopathies

Measurements were performed in 143 patients with monoclonal gammopathy of the cellular substrate in the bone marrow, including analysis of DNA and RNA content and tritiated thymidine labeling index. Aneuploidy by DNA content was present in 80% of 115 patients with active multiple myeloma and in 4 of 9 patients with benign monoclonal gammopathy, but was absent in all 12 patients with myeloma in remission and in 7 individuals with Waldenström's macroglobulinemia. With regard to prognosis in multiple myeloma, a low pretreatment plasma cell labeling index of less than or equal to 1% heralded longer survival than that observed in patients with a labeling index less than 1%, independent of myeloma tumor burden and ploidy pattern, except for a subset of 17 patients with a low-degree hyperdiploid abnormality whose survival was not affected by the magnitude of the pretreatment labeling index. Thus, besides tumor burden, tumor proliferative activity and ploidy both appear to have additional prognostic importance for patients with multiple myeloma.

Lethal activity and kinetic response of cultured human cells to 4'-(9-acridinylamino)methanesulfon-m-anisidine

Cytotoxic and cytokinetic effects of 4'-(9-acridinylamino)methanesulfon-m-anisidine (m-AMSA) were studied on a cultured human colon carcinoma and on a human lymphoma (T1) cell line. Proliferating cells were more susceptible (10-fold) to the cytotoxic effect of m-AMSA than were nonproliferating cells. The agent had minimal effects on DNA synthesis. At comparable exposure doses on m-AMSA, the degree of lethal cell damage exceeded inhibition of DNA synthesis by 4-fold. Cells synchronized in different stages of the cell cycle were equally sensitive to the cytotoxic effects of the drug, although the major cytokinetic effect was a block in G2. A greater killing effect was obtained by fractionated delivery than by a comparable dose delivered at one. These results suggest that superior antitumor results may be achieved by adequately spaced low doses of m-AMSA in the treatment of sensitive human tumors.

Biological properties of the human colonic adenocarcinoma cell line SW 620 grown as a xenograft in the athymic mouse

The biological and cell kinetic properties of the poorly differentiated human colonic adenocarcinoma cell line SW 620 grown as xenografts in BALB/c athymic mice are described. The SW 620 cells consistently produced tumors when inoculated i.v., i.p., and s.c. The lowest cell inoculum requirements were seen i.p. where 10(7) cells produced a 100% incidence. Intravenous inocula (10(5) to 10(8) cells) produced microscopic lung colonies within 30 days, becoming macroscopic nodules after 60 days. Subcutaneous tumors exhibited a marked Révész effect, using a thromboplastic brain extract which increased both tumor incidence and growth rate. All SW 620 xenografts presented a poorly differentiated morphology with extensive necrotic foci. No metastatic involvement was noted in any murine tissues. No demonstrable levels of carcinoembryonic antigen were present in the sera of animals bearing s.c. xenografts greater than 5.0 cu cm. Early SW 620 xenografts (0.3 to 0.6 cu cm) exhibited a characteristically human cell kinetic profile (Tc congruent to 34 to 43 hr; Ts congruent to 22 hr), with a growth fraction of 30.5% as measured by the primer-available DNA polymerase-index and a high cell loss factor (45%). Among late xenografts (1.1 to 1.6 cu cm), the kinetic events noted were an increase in the Tc, cell loss and, unexpectedly, an increase in the primer-available DNA polymerase index. A colony formation assay was established with the use of mechanical mincing plus collagenase (150 IU/ml; 37 degrees; 30 min), which produced a mean plating efficiency of 33.6 +/- 7.2% (S.E.) for s.c. xenografts (range, 14.6 to 51.0%). The SW 620 xenograft model possesses the biological and cell kinetic profile of many human colonic adenocarcinomas in situ. These properties, coupled with the capacity for large-scale xenograft production, should provide a clinically relevant model for the screening of potential antitumor agents and procedures.

Metastasizing malignant juxtaovarian tumor with terminal hypercalcemia: a case report

A juxtaovarian tumor of probable mesonephric origin in an 18-year-old white woman recurred six years later with a pelvic mass and widespread peritoneal metastases. Chemotherapy with cyclophosphamide, Doxorubicin, and cis-platinum induced a partial response of approximately one year duration. The terminal disease course was associated with hypercalcemia and disseminated intravascular coagulation. At autopsy, there were extensive abdominopelvic tumor masses with pleural deposits.

Differential killing efficacy of twenty antitumor drugs on proliferating and nonproliferating human tumor cells

The lethal effects of a 1-hr treatment with 20 antitumor drugs on proliferating and nonproliferating cultured human colon carcinoma cells (line LoVo) were analyzed quantitatively by the colony-forming technique. Proliferating cells were obtained from exponentially growing cultures, while nonproliferating cells were from cultures in a stationary phase of growth. The 1-hr treatment was intended to approximate serum peak levels after bolus administration. Two agents, cis-platinum and vindesine, were more effective on nonproliferating than on proliferating cells. Mitomycin C, nitrosourea, and dihydroxybisalkylanthracenedione were equally effective on proliferating and nonproliferating cells. The low lethal activity (less than 1 log) of methylglyoxal bis(guanylhydrazone), hycanthone, and vinblastine was similar in proliferating and nonproliferating cells. For most drugs (Adriamycin, rubidazone, bleomycin, maytansine, vincristine, epipodophyllotoxin, fluorouracil, hydroxyurea, methotrexate, and transplantinum) cytotoxicity was significantly less pronounced (or even totally absent) in nonproliferating than in proliferating cells. These results demonstrate the significance of cellular proliferation kinetics in determining sensitivity to antitumor therapy. Nonproliferating human cells have decreased sensitivity to most antitumor agents. An occasional agent may present increased activity to nonproliferating cells; but at best, few agents can be expected to be as effective on nonproliferating as on proliferating cells.

Flow cytometry and cytomorphology in primary resectable breast cancer

Using flow cytometry for DNA analysis, ploidy and proliferative activity were measured in 43 cases of primary resectable breast cancer, 24 of which were also assayed for estrogen receptors. Tumors were studied histopathologically by multiple samples and cytopathologically by means of imprint smears and pepsinized cell suspensions. Cytologic preservation was far superior in imprint smears than in cell suspensions or histologic sections. As determined by the DNA index (tumor G1/G0:normal G1/G0), 72% of the tumors were aneuploid, with the majority falling between diploid and tetraploid. There was no correlation of ploidy with tumor cell proliferation expressed as percentages in the S-phase. A high percentage of S-phase cells was associated with estrogen receptor negativity and tended to correlate with cytologic atypia but showed no correlation with UICC stage, menopausal status, tumor size, lymph node involvement or histologic degree of malignancy. In contrast, ploidy showed no correlation with any of the above parameters but served as a reliable marker for individual tumors since it did not change with time in multiple biopsies of the primary site.

Reduction of 1-beta-D-arabinofuranosylcytosine and adriamycin cytotoxicity following cell cycle arrest by anguidine

The protein synthesis inhibitor anguidine induced a frozen cell cycle state in exponentially growing Chinese hamster ovary cells, as demonstrated by serial DNA flow cytometric measurements in the absence and presence of Colcemid as a stathmokinetic agent. The minimally effective concentration of anguidine for induction of cell cycle arrest was 0.1 microgram/ml. As demonstrated by tritiated thymidine labeling index and DNA flow cytometric investigations in the presence of Colcemid, a 4-hr exposure of Chinese hamster ovary cells to greater than or equal to 4 micrograms of anguidine per ml effected a greater than or equal to 12-hr cycle perturbation at no cytotoxic expense. Preincubation of exponentially growing Chinese hamster ovary cells for 4 hr with 5 micrograms of anguidine per ml reduced the cytotoxicity from Adriamycin (1 hr; 0.1 to 10 micrograms/ml) and from 1-beta-D-arabinofuranosylcytosine treatment (18 hr; 5 to 50 micrograms/ml) by 10- to 100-fold. Further investigation of the concentration dependence and time course of this protective effect of anguidine revealed a plateau at 1 microgram of anguidine per ml and lack of protection in case of anguidine exposure subsequent to Adriamycin and 1-beta-D-arabinofuranosylcytosine treatment. Prolongation of the treatment-free interval between initial anguidine exposure and 1-hr Adriamycin treatment demonstrated partial recovery of DNA synthesis associated with some loss in cytoprotection. Our results indicate that the largely indiscriminate interference with cycle progression by anguidine under noncytotoxic conditions affords significant protection against 1-beta-D-arabinofuranosylcytosine and Adriamycin-related cytotoxicity, the degree of which appears to be related to the extent of reduction in cycle traverse rate. Thus, anguidine may serve as a useful probe to study in detail drug-induced lethal injury as a function of cycle traverse rate.

A rapid automated stathmokinetic method for determination of in vitro cell cycle transit times

To provide a rapid method for examining cell cycle dynamics, we utilized continuous exposure of Chinese hamster ovary cells and human colon cancer cells to colcemid to block cycling cells in metaphase, suppressing re-entry into G1. Changes in cell cycle compartment distribution were monitored by DNA flow cytometry. Analysis of the rate of G2 + M compartment accumulation after addition of colcemid permitted calculation of all cycle transit parameters. These compared favorably with data in the same cell lines determined by the fraction of labeled mitoses technique. Serial assessment of DNA flow cytometry after addition of colcemid permits rapid quantitation of cycle traverse rates.

The growth fraction of human myeloma cells

Greater reductions of tumor load in patients with multiple myeloma may result from therapeutic strategies that are based on a better knowledge of growth kinetics. We have previously shown that the labeling index of myeloma cells remains unchanged when tumor mass is reduced and that the cells of relapsing patients have differnt biologic properties than the cells present before melphalan-prednisone therapy. This study investigated the growth fraction (GF) of myeloma cells at various disease stages using continuous i.v. infusions of tritiated thymidine. We studied 17 patients on 22 occasions (4 untreated, 2 unresponsive, 6 in remission, and 10 in relapse). All untreated an unresponsive patients and 5 of 6 patients in remission had a GF of less than 4%. GF was defined in these studies as the maximum percentage of labeled plasma cells exposed continuously to tritiated thymidine. Relapsing patients, with the most rapid tumor doubling times, had GF ranging from 14% to 83%. The plasma cell transit time through the proliferative compartment for all of the relapsing patients ranged from 6.6 to 11.9 days and the calculated intrinsic cell loss ranged from 50% to 86%. These findings support our model for the growth kinetics of multiple myeloma that assumes that the entire tumor mass issues from a small proportion of proliferating cells and that the growth kinetics of myeloma cells in relapsing patterns differ from those in untreated and unresponsive patients. Therapeutic trials with cycle-active agents need further investigation in selected relapsing patients who are likely to have a high growth fraction.

Marrow cell kinetics in patients treated with methotrexate and citrovorum factor

Methotrexate (MTX) was administered by continual intravenous infusion for 24 hours in doses ranging from 200-800 mg/m2 to 16 patients who had metastatic cancers and normal bone marrows and 11 patients with acute leukemia. Citrovorum factor (CF) was administered every 6 hours for 12-15 doses beginning 36 hours after the start of the MTX infusion. Plasma and urine were collected to measure MTX concentration. Daily bone marrow aspirates were obtained for measuring intracellular MTX concentration, labelling index (LI), mitotic index (MI), grain count distribution, cellular DNA distribution by flow cytometry (FCM), and marrow morphology. The plasma MTX concentration proved to be a function of dose and creatinine clearance. There was a positive correlation between the creatinine clearance and MTX clearance. The intracellular MTX concentration correlated highly with the plasma concentration. The LI, grain count, and proportion of cells in S phase increased on days 2 and 3. The magnitude of the changes on days 2 and 3 was dose related. The MI fell on day 2 and recovered by day 4. Transient megaloblastic changes occurred. The cell cycle perturbations in leukemic marrow were less pronounced than those in normal marrows. These observations are consistent with a transient, dose related, S phase delay.

Synergistic lethal effect of cis-dichlorodiammineplatinum and 1-beta-D-arabinofuranosylcytosine

cis-Dichlorodiammineplatinum(II) and 1-beta-D-arabinofuranosylcytosine display a dramatic synergistic effect when tested in simultaneous combination on LoVo cells, a human colon carcinoma cell line. 1-beta-D-Arabinofuranosylcytosine alone does not induce any cytotoxicity on LoVo cells even at high concentrations but is able to increase up to 1000 times the lethal effects of cis-dichlorodiammineplatinum(II). DNA elution experiments show that 1-beta-D-arabinofuranosylcytosine increases the amount of cis-dichlorodiammineplatinum(II)-induced DNA cross-links. The possible mechanisms of this effect are discussed, and some explanations are proposed.

Tumor cell phagocytosis. Its occurrence in a patient with medulloblastoma

Phagocytosis was observed in tumor cells from a metastatic medulloblastoma to the bone marrow. Erythrocytes and leukocytes were seen in the cytoplasm of the tumor cells. Another abnormal finding was self-phagocytosis, in which tumor cells engulfed one another. The mechanism of tumor phagocytosis is not yet clearly understood. Only a few cases of erythrophagocytosis by epithelial tumor cells have been reported in the literature. To our knowledge, this is the first reported case of a medulloblastoma with hematophagocytosis.

Lethal and cytokinetic effects of mitomycin C on cultured human colon cancer cells

The lethal and cytokinetic effects of mitomycin C (MC) as a function of drug concentration and exposure time were assessed in cultured human colon adenocarcinoma (LoVo) cells using colony formation to determine cell survival and DNA flow cytometry to examine cell cycle perturbation. MC evoked threshold-exponential type 1-hr dose-dependent survival curves in both exponential and stationary growth phases (Dq = 0.4 microgram/ml; Do = 1.0 microgram/ml). In exponentially growing cultures, a given exposure dose of MC induced equitoxic effects regardless of the specific drug concentration and exposure time used with uninterrupted treatment. However, dose fractionation experiments revealed the ability of LoVo cells to partially repair sublethal damage from MC exposure. Cell cycle progression was reversibly delayed or blocked in G2, S, and G1 phases in this order of sensitivity, with a frozen cycle distribution after greater than or equal to 24 hr treatment with 5 microgram of MC per ml. The reversible delay in S-phase traverse without a significant subsequent G2 block may be exploitable for administration of S-phase-specific drugs to maximize cell kill.

Flow cytometry of DNA content in human bone marrow: a critical reappraisal

Because cytokinetic studies of the human bone marrow aspirate as a prognostic factor and as a monitor of drug perturbation are frequently inconsistent, we investigated reproducibility of DNA distribution measured by flow cytometry of DNA content in patients with morphologically normal bone marrow. In 15 patients, correlation was noted between DNA distributions simultaneously obtained on right and left iliac crest bone marrow aspirates (r = .588), although considerable variation in individuals was encountered. Much better reproducibility (r = .879) was achieved using bilateral core biopsy of bone marrow in these same patients. In 60 samples, comparison of DNA distribution between bone marrow aspirate and simultaneously obtained biopsy revealed higher relative proportions of S and G2 + M phase cells in biopsies (p less than 0.001), suggesting peripheral blood contamination of aspirate material. Brisk shaking of biopsy specimens in saline expelled a representative sample in the supernatant that could be subjected to simultaneous cytomorphological and cytokinetic analysis. To improve reproducibility of DNA content determinations in normal human bone marrow, bone marrow biopsy should be utilized.

In vitro thermochemotherapy of human colon cancer cells with cis-dichlorodiammineplatinum(II) and mitomycin C

The thermosensitivity of human colon adenocarcinoma (LoVo) cells was investigated as a function of temperature and duration of heating in exponentially growing cultures. At 39-43 degrees, time-dependent survival followed a simple exponential function. Do values decreased progressively with a rise in temperature, from Do at 40 degrees = 38 hr to Do at 42 degrees = 17 hr to Do at 43 degrees = 1.5 hr. thus indicating relative thermoresistance of LoVo cells compared to Chinese hamster ovary cells. Dose-dependent 1-hr survival of LoVo cells treated with cis-dichlorodiammineplatinum(II) and mitomycin C was effectively modified when treatment was conducted under hyperthermic conditions. For both agents and cultures in exponential and stationary growth phases, hyperthermia abolished the initial shoulder portion and steepened the subsequent exponential part of the survival curves for dose-modifying factors at the 10% survival level of 1.5 to 2.0 at 41 degrees and 2.6 to 2.8 at 42 degrees. This significant enhancement of drug-induced cell kill by moderate hyperthermia suggests that thermochemotherapy with mitomycin C and cis-dichlorodiammineplatinum(II) should be tested clinically with both regional and total-body hyperthermia.