Peripheral blood T- and B-lymphocytes in patients with lymphoma and acute leukemia

Coexpression of multiple immunoglobulin isotypes on human B-lymphocytes

Endogenous immunoglobulin (Ig) determinants on blood B-lymphocytes (B-cells) were investigated in 13 healthy individuals, 9 patients with thyrotoxic Graves disease, 5 patients with chronic sarcoidosis, and 4 patients with IgA deposition in renal glomeruli. Specificities of goat antisera to Ig determinants were confirmed by studying Ig isotypes on leukemic B-cells. Absence of nonspecific attachment of the goat antisera was ascertained by reacting cells with goat IgG. Lymphocytes were distinguished from monocytes by morphology and by reacting monocytes with rhodamine-conjugated immune complexes. The endogenous nature of the cell surface Ig was established by an antibody-prelabeling technique as follows: after the surface Ig had been labelled with fluorescent antibody, the cells were cultured for 3 days. Antibody-prelabelled surface Ig diminished by the third day of incubation because of shedding. Thus restaining of the cells at the end of the culture identified the membrane Ig determinants expressed during the incubation. Our results indicated that endogenous gamma and alpha chains were present on B-cells of all donors. In Graves disease, epsilon chain was also found. In all cases of Graves disease, 2 cases of sarcoidosis and 2 normal individuals, gamma, alpha, mu and delta chains were present on the majority of B-cells suggesting coexpression of these heavy chains on a single cell. I conclude that all 5 Ig isotypes may be coexpressed on B-cells under certain clinical conditions.

Lymphoid subpopulations of peripheral blood and spleen in untreated Hodgkin's disease

A panel of monoclonal antibodies with well-defined specificities were used as probes to investigate the phenotypes and lineage of circulating lymphoid cells and splenocytes in untreated patients with Hodgkin's disease. A significant relative and absolute reduction in T cells (anti-T3+) was found only in patients with B-symptoms. There was no alteration in the fraction of helper (anti-T4+) or cytotoxic/suppressor (anti-T5+) T cells circulating in peripheral blood when compared to normals, nor was there activation of these cells as measured by the development of surface Ia (anti-I1+). Circulating T cell subsets were not altered 5 to 14 days after splenectomy. Splenic T cells were increased equally in involved and uninvolved spleen when compared with control spleens obtained from accident victims. These findings indicate that abnormal T cell function in Hodgkin's disease may be the result of subtle alterations in T cells or non-T immunoregulatory mechanisms.

Morphology of lymphatic cells and of their derived tumours

Images

Lymphoid cell surface markers in acute lymphocytic leukaemia

Peripheral blood lymphoid cells of 29 patients with acute lymphocytic leukaemia (ALL) at onset were studied for characterization of B and T membrane markers and phytohaemagglutinin responsiveness. 24 cases (83%) were classified as "null" cell ALL and 5 (17%) as T-cell ALL. No relationship could be found between cytological presentation and immunological classification. Moreover, no correlation has been demonstrated between clinical-immunological parameters and prognosis, indicating that in our series of patients, assessment of cell size and surface markers were not a reliable predictor of prognosis.

Clinical significance and prognostic value of the T-B immunological classification of human primary acute lymphoid leukaemias

50 cases of primary acute lymphoid leukaemia (A.L.L.) were analysed for the presence of T and B membrane markers on bone-marrow and/or peripheral-blood cells. 26% of cases were predominantly T-cell in type, 4% were B, the remaining 70%, without detectable membrane markers, were classified as "null" cell A.L.L. Of particular interest is the correlation between this immunological classification and the prognosis, since T-cell and B-cell A.L.L. were associated with a poorer prognosis than null-cell A.L.L. in terms of both median length of first complete remission and median survival. With one exception the T-cell cases were, according to the W.H.O. classification, of either the prolymphocytic or macrolymphoblastic type of A.L.L. and were more extensive than the comparable null-cell A.L.L. In contrast, cases of the W.H.O. prolymphoblastic and microlymphoblastic types were all found to be null-cell A.L.L. and were associated with the worst and best prognosis respectively. The correlation found between the immunological classification of A.L.L. and the prognosis means that patients with a poor prognosis can be selected for more intensive therapy.

Immunological evaluation of 15 children with non-Hodgkin lymphoma

In the present study, 15 children with non-Hodgkin lymphoma have been immunologically evaluated by the following parameters on peripheral blood (PB) lymphocytes: phytohemagglutinin responsiveness (PHA-r); non-immune rosette formation with sheep red blood cells (RF-L) as T-cell marker; presence of surface immunoglobulins (sIg-L) as B-cell marker; serum immunoglobulins levels (IgA, IgM, IgG). Our patients (pts) have been divided in two groups: the first one includes 10 children without PB involvement; the second one includes 5 pts with bone-marrow and PB invasion. From our data it appears that: 1) the majority of pts of the first group presented normal values of membrane markers; PHA-r was impaired in 4/8 pts; 2) in pts with PB invasion absolute number of B and "null" cells was always abnormal and PHA-r altered; 3) in the second group of pts, a "null" cell origin can be suggested by the high percentage and absolute number of cells without surface markers. In our opinion, the high incidence of "null" cells represents the most relevant question: whether they are cells deprived of specific markers, or endowed with markers not identifiable by our current techniques, remains to be established.

Etiological, clinical and prognostic significance of the T-B immunological classification of primary acute lymphoid leukemias and non Hodgkin's lymphomas

The discovery of B or T markers on neoplastic cells in acute lymphoid leukemia (ALL) is correlated with a poor prognosis, while a cure expectancy of 50% can be expected for null cell ALL patients of all ages. In the case of Non Hodgkin's malignant lymphoma the patients with the T cell types carry a poor prognosis, while the patients with a B cell type present an 85% cure expectancy, and those with the null cell type a 65% cure expectancy. The correlation between immune markers on the one hand, and WHO cyto-histological typing and clinical presentation on the other, is reported.

Human thymus/leukemia-associated antigen in normal and leukemic cells

A saline extractable human thymus/leukemia-associated antigen (HThy-L) has been detected in immunodiffusion using rabbit antisera raised to human thymus extracts. HThy-L was demonstrated in extracts of normal thymocytes, lymphocytes from E-rosetting T-cell lines and from the blast cells of patients with E-rosetting acute lymphoblastic leukemia. Extracts of leukemic cells from patients with acute myeloblastic leukemia and E-rosette-negative acute lymphoblastic leukemia contained significantly lower quantities of HThy-L. Only trace amounts of the antigen were detected in normal spleen tonsil, peripheral blood, bone marrow and PHA-induced lymphoblasts. HThy-L appears to be an antigen associated with the intrathymic differentiation of human T cells and a marker of leukemic cells in certain forms of acute leukemia.

Malignant lymphoma, lymphoblastic

Among the malignant lymphomas of the diffuse, poorly differentiated lymphocytic type, a cytologically distinctive form can be recognized. It is composed of immature lymphoid cells that are indistinguishable from the cells of acute lymphoblastic leukemia (ALL). Although these neoplasms usually have been classified as malignant lymphoma, lymphoblastic type, they contain, in addition to lymphoblasts, prolymphocytes in varying proportions. On the basis of the nuclear morphology, malignant lymphoma of the lymphoblastic type, (MLLB) can be further divided into those with and those without convoluted nuclei. In our series both groups had the following clinical features in common: 1) frequent occurrence in children and adolescents; 2) clinical presentation with mediastinal masses in 50% of cases; 3) a high incidence of bone marrow and perpheral blood involvement during the course of the disease; and 4) rapid progression of the disease with a median survival of 8 months. Our observations indicate that nuclear convolutions are helpful but not essential for the recognition of a clinicopathologic entity which is histologically and cytologically characterized by 1) the immaturity of the lymphoid cells indistinguishable from the lymphoblasts and prolymphocytes of ALL and 2) a high mitotic index. Because of the frequency with which MLLB progresses into ALL, systemic therapy may be indicated even before this progression is hematologically evident. This indicates the need for morphologic recognition of this malignant lymphoma regardless of the presence of nuclear convolution, age of the patient, and site of presentation.

Immunological classification of acute lymphoblastic leukaemias: evaluation of its clinical significance in a hundred patients

The use of T and B lymphocyte markers and of different antisera raised against malignant B cells and fetal thymocytes allowed the classification of 100 patients with acute lymphoblastic leukemia (ALL) into three groups. (I) Patients with non-T non-B ALL whose cells were devoid of conventional B and T markers but characterized by a leukaemia associated antigen (69 cases). (2) Patients with T-derived ALL (28 cases). (3) Patients with ALL of B cell origin (three cases). The search for haematological and clinical correlations showed that those patients with T-derived ALL tended to have a higher leucocyte count (P=0.05) and acid phosphatase positivity of blast cells (P= 0.01), a higher incidence of tumour presentation (P=0.05) and a thymic mass. Survival curves for the two main groups of patients are similar at 36 months but meningeal relapses were more frequent in patients with T-derived ALL (P=0.02).

T and B lymphocytes in breast cancer stage relationship and abrogation of T-lymphocyte depression by enzyme treatment in vitro

B and T lymphocytes have been measured in 100 women--71 patients with breast cancer and 29 controls--using sheep-erythrocyte rosetting techniques. Compared with controls (healthy women or patients with benign breast disease), there is a highly significant depression of T-cell percentage in all stages of breast cancer except locally advanced (stage 3) disease. These stage-3 cases seem to constitute a biologically distinct group. T-cell percentages in early (stage 1) patients overlap with those seen in stages 3 and 4, raising the possibility that there are in stage 1 two subpopulations of T-cell values that are associated with differences in subsequent tumour progression. B-lymphocyte levels are similar in all groups. Low T-cell levels return to normal after incubation with papain in virto but fall again after resuspending the treated lymphocytes in autologous (cancer) serum. The results suggest that T-cell depression is due to a masking factor on the surface of some T lymphocytes which is also present in the serum of cancer patients, and removable by enzyme digestion.

Leukaemia-associated antigen in serum of patients with acute lymphoblastic leukaemia

A antigen (HThy-L) previously found in extracts of human thymocytes and leukalphaemic cells was detected in sera from four patients with E-rosette-positive untreated acute lymphoblastic leukalphaemia (A.L.L.) and one patient with previously treated acute myelogenous leukaemia (A.M.L.) The disappearance HYth-L angignaplhaemia with treatment was coindent with a decrease in the number of leukaemic blast cells in the peripheral blood. HThy-L antigen was not detected in the sera of the remaining twenty-one patients with E-rosette-negative A.L.L. and seven patients with A.M.L..

Prognostic significance of surface marker analysis in childhood non-Hodgkin's lymphoproliferative malifnancies

Blast cell surface markers for T- and B-lymphocyte characteristics were studied at diagnosis in 73 children with non-Hodgkin's lymphoproliferative malignancies. Three distinctive groups of patients were identified on the basis of the analysis of blast cells for surface immunoglobulin (SIg), sheep erythrocyte (sE) rosette formation, and complement receptors, The seven group I patients had monoclonal IgM on their blast cells, morphologic features of Burkitt's lymphoma, abdominal masses, and very short survival. The 13 group II patients had receptors for sE, complement, or both on their blast cells, mediastinal or nodal masses, and short survival. The distinction between leukemia and lymphoma based on the presence of bone marrow involvement at diagnosis is not prognostically useful in this group of patients. The blast cells of group II patients could not be morphologically distinguished from those of the group III patients. The 53 groups III patients had SIG, sE, and complement negative blast cells and could be further subdivided on the basis of while blood cell count. The nine group IIIA patients (greater than 100.0 X 10(9)/liter) had in general short survival, while most of the 44 group IIIB patients (less than than 100.0 X 10(9)/liter) have remained in complete remission. Positive surface markers, mass lesions, male sex, and age of diagnosis less than 2 years of greater than or equal to 10 years appear to be interrelated factors indicating poor prognosis. Elevated while blood cell count is a prognostic indicator independent of surface marker analysis or presence of mass lesions.

Evidence for origin of certain childhood acute lymphoblastic leukemias and lymphomas in thymus-derived lymphocytes

Lymphoblasts from children with acute lymphoblastic leukemia (ALL) or malignant lymphoblastic lymphoma were studied using surface markers characteristic of T and B lymphocytes. A B-cell marker, i.e. surface immunoglobulin, was absent in all cases studied. Fouteen of 22 children (64%) had lymphoblasts with one or both markers of T lymphocytes, i.e. receptors for sheep erythrocytes (E) and/or human T-lymphocyte antigen (HTLA) detectable using heterologous antithymocyte sera absorbed with B lymphocytes. In all instances, lymphoblasts which carried E receptors also carried HTLA. However, lymphoblasts in 6 cases carried HTLA but not E receptors. It is possible that ALL may often involve T lymphocytes which are early in differentiation (i.e. prior to development of E receptors) or, alternatively, that E receptors may be lost from T cells following malignant transformation. Thymus enlargement was found only in cases of ALL or lymphoma where T markers were present. Lymphoblasts carried the same markers when examined in various sites and at various times from the same patient.

[The distribution of B-lymphocytes in lymphoepithelial tissues as well as in tumors of the neck-, nose-, and throat region derived from lymphoreticular and lymphoepithelial tissues (author's transl)]

B-Lymphocytes carrying IgG-, IgM,- and IgA-surface receptors were estimated by fluorescence microscopy in the palatine tonsil of 50 patients aged 3 to 18 years as well as in 44 patients with various types of malignant lymphoms and lymphoepithelial carcinomas. Hyperplastic tonsillartissue contains large numbers of B-cells with a marked variability in concentration (4-30% IgG-cells, medium 12,9%;6-36 IgM-cells, medium 23.4%;3-38% IgA cells, medium 20.8%). There appears to exist an age-dependent increase in IgM-cells and an increase in IgG-and IgA-cells in patients with numerous recurrent infections of the upper respiratory tract. Malignant lymphomas can be grouped into three main categories: Such with a predominance of one B-cell line (above 75-80% of one immunological cell type); these include primarily malignant lymphomas of the well differentiated lymphocytic type (IgM and IgA receptors). Secondly, such with a significant decrease in B-cells (below 10%) which include primarily malignant lymphomas of the poorly differentiated lymphocytic type. Thirdly, such with an increased B-cell content but with more than one cell line participating in cell proliferation. The latter ones comprise certain cases of Hodkin's lymphomas. Lymphoepithial carcinomas are charactersized by a significant decrease in total B-cell content, except for IgE- and IgD-cells which were not investigated. The results show that the immunologic classification of malignant lymphomas correlates only to a certain degree with the morphologic classification; i.e. the same morphologic type of tumor may possess different immunologic characteristics. Since the immunologic characteristics may reflect a certain functional potential of these tumors as well as probably a certain kind of immunologic incompetence prior to tumor development, it is suggested, that future morphologic investigations of malignant lymphomas and lymphoepithelial carcinomas are combined with immunologic classifications.

Quantitation of T and B lymphocytes and cellular immune function in Hodgkin's disease

Peripheral blood T and B lymphocytes were quantitated in 42 patients with untreated Hodgkin's disease and the results compared with the response to phytohemagglutinin (PHA) stimulation and delayed hypersensitivity skin testing. T lymphocytes were identified by an in vitro cytotoxicity assay employing a specific anti-T-cell serum and by spontaneous rosette formation with sheep erythrocytes (E rosettes). The percentage of T cells in the patients was similar to that of normal subjects as judged by the cytotoxicity assay (65 to 90%). In addition, absolute T-lymphocyte counts were normal in 63% of the patients and were generally reduced only in those with lymphopenia. The percentage of T lymphocytes determined by the E-rosette assay was similar to that determined by the cytotoxicity assay in normal controls, but was significantly lower than that determined by the cytotoxicity assay in the patients. Moreover, the decreased response to PHA stimulation in the patients was directly correlated with the decrease in E-rosette formation. These findings suggest that T lymphocytes in the peripheral blood are not generally diminished in untreated Hodgkin's disease. However, a proportion of these cells exhibits altered surface interactions that may account for some aspects of their impaired immunologic function.

Studies of human lymphocytes in the newborn and the aged

Proportions and absolute numbers of T and B lymphocytes were determined among 30 newborn infants and group of 77 elderly patients 60 to 95 years of age. Total lymphocytes in the cord blood of the newborn showed a distinct elevation in total numbers of T and B lymphocytes (p less than 0.005) as compared to that in blood from normal adult controls, reflecting the relative lymphocytosis of infancy. Proportions of cord blood T lymphocytes as reflected by the sheep cell rosette technic were considerable lower than those in lymphocytes from normal adult controls, however, proportions of cord blood T lymphocytes as determined by indirect immunofluorescence were not significantly different from those in controls. Old people showed a significant reduction in total numbers of lymphocytes (p less than 0.005) when compared with those in normal adult controls 18 to 51 years of age. Moreover, there was a significant increase in the relative proportions of peripheral blood B lymphocytes in the elderly although the absolute numbers of B lymphocytes in the elderly although the absolute numbers of B cells did not differ from those in younger controls. A significant decrease in total numbers of T cells as measured both by sheep cell rosettes and indirect immunofluorescence was recorded among older patients (p less than 0.001). In addition, there was a broad increment in the incidence of various autoantibodies (anti-nuclear, andi-IgG, antismooth muscle, antimitochondrial and antiparietal cell) among the old people studies. No direct correlation could be determined between relative B-cell percentage increase or T-cell decrease and the presence of various autoantibodies in individual patients. Diminution in total lymphocyte counts as well as absolute numbers of T cells in the elderly may provide the cellular basis for an increased susceptibility to neoplasia and infection.

Clinical importance of lymphoblasts with T markers in childhood acute leukemia

Of 48 children with acute lymphocytic leukemia 11 had blast cells with receptors for sheep erythrocytes in their initial bone-marrow aspirates and 37 did not. A comparison of selected clinical features indicated striking differences between the two groups. Leukemia with the receptors was associated with a high proportion of older children, predominantly boys, a thymic mass, and a high white-cell count at diagnosis. In contrast, the 37 children with leukemia without the receptors were generally less than five years of age, with a nearly equal distribution of boys and girls; all but one had normal chest roentgenograms, and only one had a white-cell count greater than 100,000. Thus, the presence or absence of lymphoblasts with sheep erythrocyte receptors--a T-cell marker--distinguishes two forms of childhood acute lymphocytic leukemia, each with a distinct distribution of age and sex as well as other characteristic clinical features.

Terminal deoxynucleotidyl transferase activity in human leukemic cells and in normal human thymocytes

Peripheral leukocytes from patients with and without leukemia were assayed for presence of terminal deoxynucleotidyl transferase. Activity of this enzyme was detected in circulating leukemic cells from 11 to 13 patients with acute lymphoblastic leukemia, and in one of four with chronic myelogenous leukemia in blast crisis, but not in leukocytes from patients with other kinds of leukemia or in normal leukocytes. Its presence in a patient with chronic myelogenous leukemia in blast crisis lends biochemical support to the suggestion that some patients with chronic myelogenous leukemia undergo a lymphoblastic rather than a myeloblastic crisis. The thymocyte and leukemic-cell enzyme have the same substrate and primer preference. Normal thymocytes and leukemic cells contain two forms of terminal deoxynucleotidyl transferase that can be separated by phosphocellulose chromatography. The enzyme may provide a means for classifying leukemic cells on a biochemical basis independently of classic morphologic and clinical criteria.

New looks in leukemia

Immunologic markers are now available for acute leukemia. These show that most patients now diagnosed as having acute lymphatic leukemia have blast cells which react with antihuman T antisera. In addition, about 20% of patients have blast cells which form E rosettes. These patients tend to be those with high white counts and aggressive disease. Tumor-associated antigens have been identified in acute leukemia. Antisera raised in other species by immunization appear to detect some antigens common to all acute leukemias and other antigens which can distinguish the myeloid from the lymphoid leukemias. The reactivity to leukemia antigens can be related to prognosis. The immune manipulations required to produce cure, however, are not understood. These antigenic markers, by allowing us to detect smaller amounts of tumor than can be detected by morphology alone, may help us to predict relapse and define cure.

Immunologic and morphologic studies of T cell lymphoma

Thymic-independent (B) lymphocytes, thymic-independent (T) lymphocytes and histiocytes may be distinguished by the presence of certain surface markers. In addition B and T lymphocytes have been reported to show distinctive surface architecture by scanning electron microscopy. Neoplastic cells from a lymph node and cerebrospinal fluid of a patient with a diffuse malignant lymphoma of the poorly differentiated lymphocytic type were examined in frozen sections and cell suspensions for the presence of surface immunoglobulin and the antigen-antibody-complement (IgMEAC) receptor of B lymphocytes, the presence of the cytophilic antibody (IgGEA) receptor of histiocytes and the ability to form nonimmune rosettes with sheep red blood cells (E) characteristic of T lymphocytes. Cells from the lymph node were also studied by scanning electron microscopy. The majority of neoplastic cells from the lymph node and cerebrospinal fluid formed rosettes with E, but lacked surface immunoglobulin and failed to bind IgMEAC or IgGEA. By scanning electron microscopy the neoplastic cells, although larger in diameter, showed surface architecture similar to normal lymphocytes with a varying number of surface microvilli. These studies suggest that the malignant cells of this lymphoma are of thymic type.

Lymphocyte membrane receptors in human lymphoid leukemias

Membrane-bound immunoglobulins, receptors for the Fc fragment of IgG and receptors for the third component of human or murine complement were used as B cell membrane markers to study peripheral blood lymphocytes from twenty-two patients with chronic lymphatic leukemia (CLL), five patients with acute lymphoblastic leukemia (ALL) and one patient with Sézary syndrome. The capacity of human T cells of forming "spontaneous rosettes" with sheep erythrocytes was employed as T cell membrane marker. In nineteen out of twenty-seven CLL or ALL cases tested a larger percentage of cells than that found in normal individuals expressed at least one of the three B cell membrane markers studied. In the patient with Sézary syndrome the percentage of cells forming "spontaneous rosettes" with sheep erythrocytes was larger than the normal, while cells bearing B cells markers were below the normal values.

Combined T and B cell acute lymphoblastic leukaemia

A case of acute lymphoblastic leukaemia in a 17-year-old male is described. The patient had many distinctive features including a very high blast cell count, prominent lymphadenopathy and hepatosplenomegaly, thymic mass, and a fulminant clinical course. Immunological studies on the blast cells using a variety of techniques showed the presence of two distinct subpopulations, one having the surface characteristics of thymus-dependent (T) lymphoid cells and the other those of bursa-equivalent (B) lymphoid cells. The case therefore represents the first example of a combined T and B cell acute leukaemia.

Acute lymphoblastic leukemic cells with T (thymus-derived) lymphocyte markers

Five of nine children with acute lymphoblastic leukemia had lymphoblasts that bound sheep erythrocytes or reacted with antiserum to thymocytes, suggesting involvement of T (thymus-derived) cells. When lymphoblasts from all patients were examined by immunofluorescence they were found to lack a marker for B (bone marrow or bursa-equivalent) cells, that is, the presence of surface immunoglobulins.