Effect of adult T-cell leukemia cells on pokeweed mitogen-induced normal B-cell differentiation

Cancer/testis antigens are novel targets of immunotherapy for adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma (ATLL) is an intractable hematologic malignancy caused by human T-lymphotropic virus type 1 (HTLV-1), which infects approximately 20 million people worldwide. Here, we have explored the possible expression of cancer/testis (CT) antigens by ATLL cells, as CT antigens are widely recognized as ideal targets of cancer immunotherapy against solid tumors. A high percentage (87.7%) of ATLL cases (n = 57) expressed CT antigens at the mRNA level: NY-ESO-1 (61.4%), MAGE-A3 (31.6%), and MAGE-A4 (61.4%). CT antigen expression was confirmed by immunohistochemistry. This contrasts with other types of lymphoma or leukemia, which scarcely express these CT antigens. Humoral immune responses, particularly against NY-ESO-1, were detected in 11.6% (5 of 43) and NY-ESO-1-specific CD8(+) T-cell responses were observed in 55.6% (5 of 9) of ATLL patients. NY-ESO-1-specific CD8(+) T cells recognized autologous ATLL cells and produced effector cytokines. Thus, ATLL cells characteristically express CT antigens and therefore vaccination with CT antigens can be an effective immunotherapy of ATLL.

Newly developed multiple myeloma in a patient with primary T-cell lymphoma of bone

Primary non-Hodgkin's lymphoma of bone (PLB) is rare, and generally presents as a single extensive and destructive bone lesion. Histopathologically, most cases present as diffuse large B-cell lymphoma, and T-cell lymphoma is rare. By contrast, multiple myeloma is a disease defined as the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. We report a case of multiple myeloma that developed during treatment of PLB in a type of T-cell. A 48-yr-old man was diagnosed as T-cell PLB, stage IE, 18 months ago. The patient received the chemoradiotherapy and salvage chemotherapy for PLB. However, the lymphoma progressed with generalized bone pain, and laboratory findings showed bicytopenia and acute renal failure. On bone marrow biopsy, the patient was diagnosed as having multiple myeloma newly developed with primary T-cell lymphoma of bone. In spite of chemotherapy, the patient died of renal failure.

Delineation of Immunoregulatory Properties of Adult T-Cell Leukemia Cells

We characterized leukemic cells from 20 adult T-cell leukemia (ATL) cases and 7 ATL-derived cell lines in terms of Foxp3 messenger RNA (mRNA) expression, cytokine production, cell surface markers associated with regulatory T-cells (Treg), and in vitro immunoregulatory activity and compared the results with those of cells from 3 T-cell-type chronic lymphocytic leukemia (T-CLL) patients and normal CD4+ T-cells. Real-time polymerase chain reaction analysis showed that cells from 10 ATL cases, 1 T-CLL case, and 1 ATL cell line had higher Foxp3 mRNA levels than CD4+ T-cells. In 5 ATL cases, Foxp3 levels were comparable to those of CD4+CD25+ T-cells. Flow cytometric analysis revealed that CTLA-4 expression correlated with Foxp3 mRNA level in ATL cells. The cells of all ATL cases examined produced no interleukin 2 or interferon gamma after iono-mycin and phorbolmyristate acetate stimulation. Cases with low Foxp3 expression (Foxp3-low) tended to express higher levels of transforming growth factor beta mRNA, but this trend was not statistically significant. An in vitro inhibition assay showed that the proliferation of normal CD4+CD25- T-cells stimulated with anti-CD3 monoclonal antibody and autologous dendritic cells was significantly suppressed by coculture with Foxp3-high ATL cells. These results indicate that Foxp3 expression is variable in ATL cases and that Foxp3-high ATL cells, which resemble Treg phenotypically as well as functionally, may be involved in immune suppression in ATL.

Case report: adult T-cell leukemia/lymphoma associated with recurrent strongyloides hyperinfection

Adult T-cell leukemia/lymphoma (ATLL) was demonstrated postmortem in a 47-year-old woman initially manifesting severe hypercalcemia and a vertebral compression fracture. Hyperinfection with Strongyloides stercoralis preceded the appearance of ATLL by several months and ultimately dominated the terminal course. Although HTLV-I and S. stercoralis commonly infect the same host, only three other cases of concomitant ATLL and hyperinfection have been reported in English. The apparent rarity of this association suggests that immunologic sequelae of ATLL do not predispose to dissemination and multiplication of Strongyloides. Observations pertinent to this conclusion are reviewed.

Comparative study of cutaneous T-cell lymphoma and adult T-cell leukemia/lymphoma. Clinical, histopathologic, and immunohistochemical analyses

An important disease entity distinct from cutaneous T-cell lymphoma (CTCL) in Japan is adult T-cell leukemia/lymphoma (ATL), which usually shows the same phenotype as CTCL, i.e., a helper/inducer T-cell phenotype (CD4+CD8-), and usually involves the skin. Clinically, both CTCL and ATL are heterogeneous in nature. In this study, we demonstrated differences between CTCL and ATL in terms of clinical and immunopathologic cell surface features. In patients with ATL, the predominant clinical findings were peripheral lymph node involvement, skin lesions, hepatosplenomegaly, leukemic manifestations, and an aggressive course. In patients with CTCL, by contrast, only skin lesions predominated at the onset of the disease and a relatively good prognosis was demonstrated. Phenotypic heterogeneity of ATL in the skin, i.e., CD4-CD8-, CD4+CD8-, and CD4-CD8+, was demonstrated. Expression of Leu8, CD7 (Leu9), and CD45RA (2H4) was high in both the skin-infiltrating ATL cells and peripheral blood and lymph node ATL cells compared with that in the skin-infiltrating CTCL cells. Expression of CD25 (IL-2R), CD71 (OKT9), HLA-DR, and HLA-DQ was higher in the skin-infiltrating ATL cells than in CTCL cells. Expression of CD29 (4B4) was high, and that of CD45RA (2H4) was low in both the skin-infiltrating ATL and CTCL cells compared with the peripheral blood and lymph node ATL cells. Expression of CD45RO (UCHL-1) was not significantly high in the skin-infiltrating CTCL cells compared with that in ATL cells. The most significant phenotypic difference between ATL cells and CTCL cells was the expression of Leu8 (lymph node homing receptor), CD7 and CD25 antigens on the cell surface, and the main phenotypic difference between skin-infiltrating ATL and CTCL cells and peripheral blood and lymph node ATL cells was the expression of CD29 and CD45RA. These findings confirm that the difference in antigen expression on the cell surface might reflect the clinical features of ATL and CTCL, and suggest that the predominant phenotype of peripheral blood and lymph node ATL cells is that of naive, relatively immature or activated T-cells, and that CTCL cells are previously activated (memory) T-cells. In other words, CTCL cells do not share the same origin as ATL cells. These observations support the concept that ATL is a disease distinct from CTCL.

Human T cell leukemia virus type I induces DNA synthesis and immunoglobulin secretion in human lymphocyte cultures

Viral particles obtained from HTLV-I (human T cell leukemia virus, type I)-transformed T cell lines induced immunoglobulin production by normal peripheral blood lymphocytes. Conversely, no immunoglobulin could be detected in the supernatant medium in purified B cells cultivated with HTLV-I, suggesting that the presence of T cells is mandatory for HTLV-I to induce B cell polyclonal activation. The T cell help was mediated by soluble factors, as indicated in experiments showing that cell-free conditioned medium from T lymphocytes activated by HTLV-I was able to induce B cell proliferation and differentiation. Furthermore, a direct effect of HTLV-I on B cell proliferation was demonstrated when viral particles were added to purified B cells together with suboptimal doses of Staphylococcus aureus Cowan strain I (SAC). These observations show that an immediate early effect of HTLV-I infection was exerted on B cells, mainly in a T cell-dependent manner. Such an effect may account for the hypergammaglobulinemia observed in HTLV-I seropositive individuals, and in patients with HTLV-I-associated neurological disorders.

Discordance between phenotype and function of Japanese adult T cell leukemia cells

Phenotypes of cells from 12 patients with ATL were analysed by means of a fluorescence-activated cell sorter by utilizing a panel of monoclonal antibodies. A majority of the cells from peripheral blood coexpressed the antigens against MAbs CD2, CD3, CD4, CD5, Ti (WT31), CD25, CD38, CD45, and CD29, but did not express the antigens against CD1, CD13, CD14, CD33, CD36, CD10, CD19, CD20, CD21, CD24, CD41, CD42, CD45RA, CD56, and CD57. The expression of antigen for TQ-1 or Leu8 was variable. Surface immunoglobulins were not detected. Phenotypes of cultured cells established by utilizing recombinant interleukin II were similar to those of the uncultured peripheral blood lymphoid cells except for the lack of expression of CD8. By means of two-color fluorescence, the ATL cells possessing CD4 in peripheral blood and culture coexpressed CD29, but did not express CD45RA. The suppression of PWM-induced B-cell immunoglobulin synthesis by normal T and B cells was found in five cases in the presence of ATL cells. The ATL cells demonstrated helper T-cell phenotypes (CD4+, CD29+) with suppressor function, paradoxically. We conclude that the phenotype of the ATL cells was CD4+, CD29+, and CD45RA- but that the function of these cells was of suppressor T-cells. Our results inevitably suggest the possible existence of suppressor T-cells with CD4+, CD29+ phenotype in persons without evidence of any underlying hematologic disorder.

Low-titer antibodies reactive with HTLV-I gag p19 in patients with chronic myeloneuropathy

To elucidate the possible association of human T-lymphotropic virus type I (HTLV-I) and chronic neurological diseases, 156 serum samples from patients with various neurological diseases, including multiple sclerosis, chronic progressive myelopathy, chronic inflammatory polyradiculoneuropathy, myasthenia gravis, polymyositis, motor neuron disease, and tension headache, and healthy control subjects were examined for IgG antibodies to HTLV-I by three independent techniques--gelatin particle agglutination test, enzyme-linked immunosorbent assay, and Western blot assay. Specificity of antibodies was assessed by homologous competitive inhibition on Western blot assay. Six patients (3 with chronic progressive myelopathy, 1 with chronic inflammatory polyradiculoneuropathy, 1 with motor neuron disease, and 1 with tension headache) had high-titer HTLV-I antibodies. Twelve patients (5 with multiple sclerosis, 1 with chronic progressive myelopathy, 2 with chronic inflammatory polyradiculoneuropathy, 2 with myasthenia gravis, and 2 with motor neuron disease) had low-titer HTLV-I antibodies that reacted with a single gag protein, p19 or p24, on Western blot assay. In 4 (2 with multiple sclerosis, 1 with chronic progressive myelopathy, and 1 with chronic inflammatory polyradiculoneuropathy) of these 12, the antibodies that were all directed to p19 were determined to be specific by homologous competitive inhibition. In the remaining 8 patients (3 with multiple sclerosis, 1 with chronic inflammatory polyradiculoneuropathy, 2 with myasthenia gravis, and 2 with motor neuron disease), restricted reactions against p19 or p24 were considered to be nonspecific because they were not inhibited by homologous competitive inhibition. The results suggest that in some patients chronic myeloneuropathy diagnosed as chronic progressive multiple sclerosis, chronic progressive myelopathy, and chronic inflammatory polyradiculoneuropathy may be associated with HTLV-I or related retroviruses.

Adult T cell leukaemia cells are of CD4+ CDw29+ T cell origin and secrete a B cell differentiation factor

Cells from six cases of adult T cell leukaemia were studied with respect to phenotypical and functional features. All cells were reactive with anti-CD4 and anti-CDw29 monoclonal antibodies (antibody against helper inducer T cells) but were unreactive with anti-CD45R monoclonal antibody (antibody against suppressor inducer T cells). Functionally, these cells secreted a B cell differentiation factor detected by SKW6-CL4 cell differentiation to IgM-producing cells, this secretion being enhanced by culture with recombinant IL-2. Though these results indicate that adult T cell leukaemia cells are of mature helper inducer T cell origin, these cells strongly suppressed PWM-induced B cell differentiation in the absence of CD8+ suppressor effector T cells.

Laboratory and clinical applications of monoclonal antibodies for leukemias and non-Hodgkin's lymphomas

Important insights into leukocyte differentiation and the cellular origins of leukemia and lymphoma have been gained through the use of monoclonal antibodies that define cell surface antigens and molecular probes that identify immunoglobulin and T-cell receptor genes. Results of these studies have been combined with markers such as surface membrane and cytoplasmic immunoglobulin on B lymphocytes, sheep erythrocyte receptors on T lymphocytes, and cytochemical stains. After using all of the aforementioned markers, it is now clear that acute lymphoblastic leukemia (ALL) is heterogeneous. Furthermore, monoclonal antibodies that identify B cells, such as the anti-CD20 and anti-CD19 antibodies in combination with studies of immunoglobulin gene rearrangement, have demonstrated that virtually all cases of non-T-ALL are malignancies of B-cell origin. At least six distinct subgroups of non-T-ALL can now be identified. T-ALL is subdivided by the anti-CD7, anti-CD5, and antibodies that separate T lymphocytes subsets into three primary subgroups. Monoclonal antibodies are also useful in the subclassification of non-Hodgkin's lymphoma, and certain distinct markers can be correlated with morphological classification. Although monoclonal antibodies are useful in distinguishing acute myeloid from acute lymphoid leukemias, they have less certain utility in the subclassification of acute myelogenous leukemia (AML). Attempts to subclassify AML by differentiation-associated antigens rather than by the French-American-British (FAB) classification are underway in order to document the potential prognostic utility of surface markers. Therapeutic trials using monoclonal antibodies in leukemia and lymphoma have been reported. Intravenous infusion of unlabeled antibodies is the most widely used method; transient responses have been demonstrated. Antibodies conjugated to radionuclides have been quite successful in localizing tumors of less than 1 cm in some studies. Therapy trials with antibodies conjugated to isotopes, toxins, and drugs have shown promise. Purging of autologous bone marrow with monoclonal antibodies and complement in vitro has been used in ALL and non-Hodgkin's lymphoma; preliminary data suggest that this approach may be an effective therapy and may circumvent many of the obstacles and toxicities associated with in vivo monoclonal antibody infusion.

Generalized lymph node metastasis of early uterine cancer in an HTLV-I carrier

Generalized lymphadenopathy due to metastases of keratinizing squamous cell carcinoma developed in a 68-year-old woman who was a carrier of human T-cell leukemia Type I (HTLV-I). On her 74th hospital day, she died of massive metastases of the superficial and deep-seated lymph nodes, thyroid, lungs, pleura, liver, spleen, pancreas, kidneys, and retroperitoneum. At autopsy, the primary tumor was found in the uterine cervix. The depth of stromal invasion was approximately 4.0 mm. Such an extensive dissemination usually does not occur in cervical cancer with this type of early stromal invasion. It is conceivable that the chronic HTLV-I infection compromised the immunosurveillance against cancer and accelerated progression of the disease in this patient.

Distribution of the CD45R antigen in the maturation of lymphoid and myeloid series: the CD45R negative phenotype is a constant finding in T CD4 positive lymphoproliferative disorders

We have compared the expression of the common leucocyte antigen (CD45) and the restricted leucocyte antigen (CD45R) on normal haematopoietic cells, cell lines, and a total number of 136 cases of myeloid and lymphoid proliferative syndromes. CD45, the conventional leucocyte antigen, presents a generalized distribution along the lymphoid and myeloid maturation pathway with the exception of some myelomas and pre-B leukaemias. In contrast, the expression of the CD45R determinant is more limited. Although it is found in the majority of the differentiation stages of B cells and monocytes, it is present only in the early stages of myeloid differentiation. On T cells it is expressed on mature thymocytes and in the majority of CD8+ lymphocytes and a subset of CD4+ cells on peripheral blood. Finally, our results also indicated that CD4+ T lymphoproliferative syndromes are derived from the CD4+ CD45R- subset (20/20 cases).

T4+ (helper phenotype) chronic lymphocytic leukemia: case report with liver failure and literature review

T-cell lymphomas and leukemias are a heterogeneous group of neoplasms found in each anatomic compartment of the T system (marrow, thymus, and various peripheral tissues) and that have varying phenotypic expressions. Histopathologic features of the thymic and peripheral T neoplasms do not fit into a clearly defined pattern, and clinical expressions of T neoplasms are likewise variable. This report describes a 60-year-old man with "chronic" lymphocytic leukemia of T4+ (helper) phenotype. Rapid deterioration in liver function, presumably due to tumor infiltration, was unexpected and has not previously been reported. The unusual clinical and pathologic features are reviewed in the context of T-cell neoplasms, particularly T4+ processes.

Clinical evolution of cutaneous T cell lymphoma in a patient with antibodies to human T-lymphotropic virus type I

A woman who emigrated to the United States from the Dominican Republic developed the first signs of cutaneous T cell lymphoma during the last trimester of her pregnancy. This patient, found to have a positive reaction against human T-lymphotropic (leukemia-lymphoma) virus type I (HTLV-I), was followed up prospectively from the appearance of the initial skin lesion to the development of high-count helper T cell leukemia. Antibodies reactive with the core protein of HTLV-I were also identified in her husband and mother but not in her 2-year-old daughter. Examination of the patient's course provides clues about the latency period and transmission of HTLV-I and highlights similarities between HTLV-I-positive and HTLV-I-negative cutaneous T cell lymphoma.

Immunologic classification of lymphoma and lymphoid leukemia

Important insights into lymphocyte differentiation and the cellular origins of lymphoma and lymphoid leukemia have been gained through the use of monoclonal antibodies that define cell surface antigens and molecular probes that identify immunoglobulin and T cell receptor genes. Results of these studies have been combined with markers such as surface membrane and cytoplasmic immunoglobulin on B lymphocytes, sheep erythrocyte receptors on T lymphocytes, and cytochemical stains. Utilising all of the above markers, it is now clear that acute lymphoblastic leukemia (ALL) is heterogeneous. Furthermore, monoclonal antibodies that identify B cells such as the anti-B1 and anti-B4 antibodies in combination with studies of immunoglobulin gene rearrangement have demonstrated that virtually all cases of non-T-ALL involve B lymphocytes. At least six distinct subgroups of non-T-ALL can now be identified. T-ALL is subdivided by the anti-Leu-9, anti-Leu-1, and additional antibodies that separate T lymphocyte subsets into three primary subgroups. Monoclonal antibodies are also useful in the subclassification of non-Hodgkin's lymphoma, and certain distinct markers can be correlated with morphologic classification.

IgA multiple myeloma coexistent with atypical adult T-cell leukemia

We report a 65-yr-old male with adult T-cell leukemia (ATL) who developed multiple myeloma (MM) concomitantly. Skin lesions and peripheral leukocytosis were noted during the 5-yr observation period. There was abnormal lymphocytosis with indented or lobulated nuclei in the peripheral blood and in the bone marrow. The neoplastic cells reacted with monoclonal antibodies, OKT3, OKT4, OKIa1 and anti-Tac. His serum was positive for the antibodies to ATL-associated antigens. Human T-cell leukemia virus (HTLV) proviral DNA was detected in the leukemic cells. Thus, a diagnosis of ATL was made. There was IgA (k) paraprotein in his serum, and Bence-Jones protein (k) in urine samples. Fine needle aspiration revealed pathologic flaming plasma cells. Multiple osteolytic lesions appeared on his skull 5 yr after the initial examination. Thus, a diagnosis of MM concomitant with ATL was made.

The arrangement of immunoglobulin and T cell receptor genes in human lymphoproliferative disorders

Immunoglobulin and T cell antigen receptor genes in their germ-line form are organized as discontinuous DNA elements that are joined by recombinations during lymphocyte development. The analysis of immunoglobulin gene structure and arrangement has been of great value in the study of human lymphoid neoplasms. The analysis of rearranged immunoglobulin and T cell receptor genes has been of value in defining the lineage (T or B cell) of neoplasms that were of controversial origin previously, determining the clonality of abnormal lymphocyte proliferations, diagnosing and monitoring the therapy of lymphoid malignancies, determining the state of maturation and the causes for failure of maturation of cells of the B cell series, and providing major insights into the cause of malignant transformation of B and T lymphoid cells. Thus, the application of this molecular genetic approach has great potential for complementing conventional marker analysis, cytogenetics, and histopathology, thus broadening the scientific basis for the classification, diagnosis, and monitoring of the therapy of lymphoid neoplasia.

Quantitative analysis of cytotoxicity induced by HTLV-I carrying cells against a human lymphoblastoid cell line, Molt-4

Co-cultivation of HTLV-I carrying cells and virus-free lymphoid cells resulted in the cytopathic effect and cytotoxicity of the latter cells. Microscopically, these phenomena were observed as early as 2 h as the appearance of multinuclear giant cells and ballooning cells with striking resemblance with cytopathic changes induced by HTLV-III. When the cytopathic effect and cytotoxicity of the target cells by HTLV-I carrying cells were assayed by 51Cr-release assay system, these phenomena were quantitatively analysed and the cytotoxic activity was observed generally in HTLV-I positive cells. Virally induced cytotoxicity was inhibited by plasma of adult T-cell leukemia (ATL) patients specifically. Cytotoxic activity of HTLV-I positive cell lines was correlated with HTLV-I antigen expression of them. HTLV-I negative cell lines did not express cytotoxicity significantly.

Infection of human T lymphotropic virus-I-specific immune T cell clones by human T lymphotropic virus-I

Human T lymphotropic virus-I (HTLV-I)-specific T cell lines were established and cloned. K5, an OKT8+ clone bearing multiple proviral integration sites, retained its HTLV-I-specific cytotoxicity and a normal dependence on interleukin 2 (IL-2), indicating that there is a finite number of transforming integration sites. R2, an OKT4+ HTLV-I-infected clone, initially mounted a proliferative response to HTLV-I; but then its IL-2-independent proliferation increased and the antigen specificity was lost. All HTLV-I-infected clones tested including K7, another OKT8+ transformed cytotoxic clone that had lost its reactivity, expressed comparable levels of T cell receptor beta-chain (TCR-beta) messenger (m)RNA. Although clones K5 and K7 had different functional properties, they had the same rearrangement of the TCR-beta gene, suggesting that they had the same clonal origin. These data indicate that HTLV-I-specific T cells retain their immune reactivity for variable periods of time following infection, but then usually lose it; in some cases, however, no alteration in function can be detected. The data also suggest that different consequences can take place in the same clone depending on the pattern of retroviral infection.

Healthy HTLV-I carriers in Japan: the haematological and immunological characteristics

The haematological and immunological characteristics of 34 healthy anti-HTLV-I antibody-positive individuals (HTLV-I carriers) in southwestern Japan were examined. No significant difference was noted between carriers and the controls in counts of RBC, WBC and the absolute number of lymphocytes. The serum IgG in the carriers was higher than that of the controls. The percentages of OKT4, OKT8, OKIa1 and B1-positive cells were found to be normal in the peripheral blood of the carriers, whereas the percentages of OKT11 and anti-Tac-positive cells were significantly higher in the carriers than in the controls. A correlation was observed between the percentages of anti-Tac-positive cells and the titres of anti-HTLV-I antibody in the carriers. After a 72 h incubation of peripheral blood lymphocytes with medium alone, the percentage of anti-Tac-positive cells tended to decrease in the controls, but to increase in carriers, with the appearance of large blastoid cells resembling blastic transformed lymphocytes cultured with mitogen. Tac and Ia antigens were markedly expressed on these large blastoid cells.

Alterations in cytotoxic and helper T cell function after infection of T cell clones with human T cell leukemia virus, type I

HTLV-I is a transforming human retrovirus that is an etiologic agent of adult T cell leukemia/lymphoma. To investigate the effects of this virus on T cell functions, two OKT3+, OKT4+, OKT8- cytotoxic clones (8.7 and 8.8) specific for allogeneic cells bearing DPw2, a class II histocompatibility antigen, were studied before and after infection with HTLV-I. The clones retained cytotoxic function for up to 70 d after exposure to HTLV-I, even without subsequent antigenic stimulation, but then lost their cytotoxic activity. Prior to infection with HTLV-I, clone 8.8 also lysed OKT3 hybridoma cells; after infection, cytotoxic activity against these OKT3-antibody bearing cells was lost in parallel with the loss of activity against DPw2-bearing target cells. In addition, expression of T3 surface antigen by HTLV-I-infected 8.8 cells was decreased at a time when they lost their cytotoxic activity, possibly contributing to the loss of cytotoxic function. Finally, clone 8.8 could provide help for nonspecific IgG production by autologous B cells when stimulated with irradiated DPw2-bearing non-T cells. After infection with HTLV-I, this helper function became independent of DPw2-stimulation and persisted even when the cytotoxic activity was lost. An OKT4+ T cell clone thus could simultaneously manifest both cytotoxic and helper T cell activities, and these activities were differentially affected after HTLV-I infection.

Clinical analysis of 33 patients with adult T-cell leukemia (ATL)-diagnostic criteria and significance of high- and low-risk ATL

The clinical characteristics of 33 patients with adult T-cell leukemia (ATL) are described. All patients were born and have lived in Miyazaki Prefecture (southwest of Japan). Because of a wide range of clinical presentations and courses, they were subdivided into 2 groups. In the high-risk group, patients presented with high white-cell counts (WBC greater than or equal to 20,000/microliter) and over 30% of abnormal lymphoid cells (18 patients) and hypercalcemia with a low percentage of leukemic cells (5 patients). In this group the median survival time was only 3 months despite various modes of treatment. In contrast, patients of the second group exhibited a low percentage of abnormal lymphoid cells (WBC less than 20,000/microliter and/or leukemic cells less than 30%) and had no hypercalcemia (8 patients). Their clinical course was chronic with a median survival of 8 months, regardless of modalities of treatment. Two patients went through a period when the number of circulating leukemic cells was low (less than or equal to 5%) before overt leukemia appeared. Other clinical features, signs, symptoms, routine laboratory data, serum anti-ATL-associated antibody, cell membrane markers and cytogenetic studies were similar to those observed in other districts of Kyushu island.

Immunoregulatory function and expression of OKT17 antigen of adult T-cell leukemia cells

Research was carried out on neoplastic T-cells taken from 10 cases of Japanese adult T-cell leukemia (ATL) in regard to their immunoregulatory activity on pokeweed mitogen (PWM)-driven immunoglobulin (Ig) production and their differentiation antigens. ATL cells were reactive with OKT3, OKT4 and OKT11 in most cases; however, the ATL cells from one case did not react with OKT11 nor formed E-rosettes. ATL cells of three cases were reactive with OKT8 as well as OKT4. In six cases, the ATL cells were reactive with OKT17 and coincidentally displayed suppressor activity on Ig production. The cells of the remaining four cases did not have such reactivity with OKT17 or suppressor activity. Moreover, the OKT17(+) ATL cells from one case sorted by FACS 440 demonstrated suppressor activity, while the OKT17(-) ATL cells did not. These results indicated that ATL cells with suppressor activity had OKT3(+), OKT4(+), OKT17(+) phenotype.

An OKT4+ T-cell population in Sézary syndrome: attempts to elucidate its lack of proliferative capacity and its suppressive effect

We have previously reported a case of Sézary Syndrome (SS), in which an OKT4+ T-cell population exhibited a defective response to non-specific mitogens, and an ability to suppress lectin-induced T-cell proliferation and pokeweed mitogen (PWM)-induced B-cell differentiation of normal donor peripheral blood mononuclear cells (PBMC). We report now that resting Sézary cells (SC) were essentially negative for activation antigens (Ag) detected by monoclonal antibodies (MoAb) B1.49.9, anti-Tac, OKT9, OKT10, and OKIa1. After phytohaemagglutin (PHA) stimulation, all these Ag were expressed with the notable exception of OKT10. Further investigations of SC functions indicated that no interleukin 2 (IL-2) biological activity was detected in culture supernatants of SC constimulated with PHA and phorbol myristate acetate (PMA). Interestingly, such stimulated SC exhibited a marked capacity to absorb exogenous IL-2 while remaining unable to proliferate. These data suggest that patient's unresponsiveness to PHA may be unrelated to IL-2 as an extracellular growth signal, but may instead be due to a failure in a later cellular activation event, subsequent to the binding of IL-2 to its receptors. Lack of T10 Ag expression may be involved as a cause or a consequence. Kinetic study of suppression of PHA-induced T-cell proliferation of normal PBMC revealed that inhibition occurred during the first 24 h; moreover we showed that it was not due to limitation of available IL-2 since it persisted in excess of IL-2; remarkably the growth of an IL-2-dependent murine cell line was unaffected by the presence of SC. Further, inhibition was also observed on IL-2-independent calcium ionophore A 23187-induced T-cell proliferation of normal PBMC. Taken together, the data suggest that the target of suppressor activity is probably an important obligatory intracellular event controlling DNA replication, which is common to both IL-2-dependent and IL-2-independent T-cell activation processes. Human T-cell leukaemia/lymphoma virus I (HTLV-I) related p.19 and p.24 Ag were absent on fresh and 30-day cultured SC, suggesting the absence of HTLV-I infection, although not ruling out a proviral integration in the SC DNA.

Immunoregulatory functions of neoplastic lymphoid cells and their humoral products

The immunologic functions of neoplastic lymphoid cells from 57 cases of lymphocytic leukemia or malignant lymphoma were examined in vitro where cells from 16 cases demonstrated regulatory functions in immunoglobulin production: 4 with helper activity, 8 with suppressor activity, 1 with presuppressor activity, and 3 with helper-inducer activity. The neoplastic lymphoid cells with such functions did not necessarily form E-rosettes, but because of the presence of human T-cell antigens, most of them appeared to be of the T-cell lineage. These regulatory functions were proven to be mediated by the humoral factor, at least in some of the cases tested. Neoplastic lymphoid cells from all 6 cases with Fc receptors showed antibody-dependent cell-mediated cytotoxicity, but lacked natural killer activity. These studies should provide further insight into the origin of the neoplastic cells.

Functional and phenotypic studies of Japanese adult T cell leukemia cells

The cell surface marker profile and functional analysis of peripheral blood lymphocytes from 11 Japanese adult T cell leukemia patients were studied. The phenotypic analysis of Japanese adult T cell leukemia (ATL) cells by a series of 13 monoclonal antibodies showed that all ATL cells are anti-T4 reactive but some differ in their expression of T3, T11, and T12 antigens. Thus, considerable phenotypic heterogeneity exists in these populations of leukemia cells. When analyzed in functional assays, ATL cells were suppressive when added to a pokeweed mitogen- (PWM) driven Ig synthesis system. However, the suppression mechanism seemed to be more complex than originally conceived. ATL cells examined in this study seem to function mainly as an inducer of suppressor cells, and as such, activate normal T8 precursors of suppressor cells rather than function as suppressor effector cells. In addition, no evidence was obtained to suggest that suppression of PWM-stimulated IgG synthesis was mediated by natural killer (NK) activity of ATL cells. Rather, ATL cells seem to be markedly deficient in NK activity. These studies suggest that the majority of ATL cells tested are representative of and seem to be the leukemic counterparts of the T4+ suppressor inducer subset.

Large granular lymphocyte (LGL) lymphoproliferative diseases: naturally cytotoxic tumors in man and experimental animals

It has recently become clear that in the spleen and blood of both rodents and man that a unique subpopulation of lymphocyte is the mediator of virtually all of the inherent natural killer (NK) and antibody-dependent cell-mediated cytotoxic (ADCC) activity. Because of their large size, eccentric kidney-shaped nucleus and prominent cytoplasmic granules, these cytotoxic cells, termed large granular lymphocytes (LGL), can be readily identified in Geimsa stained cytocentrafuge preparations. Unfortunately, the relatively low numbers of these cells in normal lymphoid tissues has made the detailed analysis of LGL quite difficult. Recently however, a number of investigators have reported both rodent and human leukemias or leukocytosis in which there was an abnormally high number of circulating lymphocytes with either the appearance and/or function of LGL. The present manuscript reviews this literature with an emphasis on the biological and clinical characteristics of this lymphoproliferative disease. Emphasis is also placed on the usefulness of these cells for the detailed analysis of LGL morphology and function.

Clinical features of OKT4+/OKT8+ adult T-cell leukemia

Adult T-cell leukemia (ATL) has a range of clinical characteristics. Phenotypically the leukemic cells usually express the helper/inducer associated antigen OKT4 with lack of OKT8. We have observed three patients with acute ATL cytologically indistinguishable from OKT4+/OKT8- ATL but whose neoplastic cells had the unusual phenotype, OKT3+, OKT4+, OKT6-, OKT8+ OKT9+/-, OKT11+, Tac+/-, TdT-. All patients had abnormal karyotypes and antibodies against anti-ATL associated antigens as well as proviral DNA of human T-cell leukemia virus in the leukemic cells. The clinical course was complicated by skin eruptions, hypercalcemia, pulmonary infection and disseminated intravascular coagulopathy. All died of complications shortly after diagnosis. The clinical features of these patients were similar to those of OKT4+/OKT8- ATL. However, their acute course suggests that co-expression surface antigens OKT4 and OKT8 may be a sign of aggressive nature of the disease with poor prognosis.

A case report of T-cell lymphoma with suppressor phenotype and helper function for immunoglobulin synthesis

A patient with T-cell lymphoma is presented. The morphologic features of a biopsied lymph node were consistent with adult T-cell lymphoma with hypergammaglobulinemia, and most of the lymph node cells were reactive with monoclonal antibody OKT8, which detects suppressor/cytotoxic T lymphocytes. However, in a pokeweed mitogen-driven test system in which the capability of T lymphocytes to help or suppress the differentiation of B lymphocytes is measured, the lymphoma cells induced immunoglobulin synthesis of B lymphocytes, thus providing helper function. As far as we know, this is the first report on T-cell lymphoma having suppressor phenotype and helper function for immunoglobulin synthesis.

The intracutaneous growth of murine lymphomas: epidermal invasion is characteristic of multiple tumor phenotypes

Affinity of lymphoid cells for the epidermis (epidermotropism) is characteristic of the cutaneous T-cell lymphomas, mycosis fungoides and the Sézary syndrome. Consistent with numerous studies indicating that mycosis fungoides is a neoplasm of OKT4+T8- ("helper/inducer") T lymphocytes is the possibility that epidermotropism is a phenotypic hallmark of this subset of malignant T cells. This proposal was investigated in mice using 8 phenotypically characterized lymphomas of BALB/c origin: 3 histiocytic (phagocytic, lysozyme-positive, FcR+, Ig-, Thy 1-), 1 B-cell (IgM+, FcR+, Thy 1-), and 4 T-cell (Ig-, Thy 1+) lines, including 1 with markers of mouse helper/inducer T cells (Lyt1+23-), 2 with suppressor/cytotoxic markers (Lyt1-23+), and 1 with markers of immature thymocytes (Lyt1+23+). The intracutaneous growth pattern of these lines was studied on hematoxylin and eosin-stained sections through the centers of tumors obtained at times after intradermal injection into parallel groups of syngeneic mice. All of these lymphomas manifested variable epidermotropism that followed a typical sequence. Following dermal growth and spread to the dermal-epidermal junction, tumor cells appeared within the stratum spinosum. Subsequently, collections of cells appeared in spaces within the epidermis (Pautrier-like microabscesses) in tumors greater than 2 cm in diameter, coincident with early epidermal necrosis. Thus, in this animal model it is clear that the intraepidermal invasion/growth does not correlate with the helper/inducer T-cell surface phenotype. These observations are nonetheless consistent with recent studies using monoclonal antibodies to cell surface antigens which have demonstrated a heterogeneity of lymphoid cell subsets within the epidermis in lesions of mycosis fungoides and of other malignant and benign dermatoses.

Sézary syndrome with hyposplenism

Phenotypic, functional and clinical analysis of two patients with Sezary Syndrome are presented. Both patients had an elevated lymphocyte count with the helper/inducer cell phenotype by analysis with monoclonal antibodies (OKT3+, T4+, T6-, T8-, M1-), had the characteristic cerebriform nucleus of Sezary cells, and were Fc-IgG receptor negative. The functional tests revealed no proliferative, cytotoxic or immunoregulatory activity of patient E.P.'s leukemic cells, while the lymphocytes of patient A.N. responded to mitogen stimulation and had helper cell capacity in pokeweed mitogen driven B cell differentiation and maturation. Both patients presented skin involvement, pruritus, hepatomegaly and patient E.P. showed generalized lymphadenopathy. The spleen size of patient A.N. was below the normal range with an estimated spleen weight of approximately 160 g (normal 180-229 g). Patient E.P. had an extremely small spleen size with an estimated weight of approximately 20 g as shown by abdominal sonography and spleen scintigraphy and had Howell-Jolly bodies within the erythrocytes. The size of the spleen in various other diseases with T cell proliferations is discussed with respect to the possible proliferative centers of the various T-cell subpopulations.

Human T-cell leukemia virus (HTLV) in the United Kingdom

Ten out of 26 leukaemic patients who had emigrated from the Caribbean region to the United Kingdom had adult T-cell leukaemia with associated serum antibodies to HTLV I. Antibodies to HTLV were also detected in sera from a small proportion of non-leukaemic Caribbean immigrants but not in any sera from other (non-ATL) T-cell leukaemias or a variety of control groups. The long period between immigration to the UK and diagnosis of leukaemia (up to 30 years) suggests that an extensive latent period in disease development may exist. Cell lines were isolated from two patients with HTLV antibody-positive ATL and were shown to be virus-positive by electron microscopy and immunofluorescence using antibodies to the p19 and p24 viral proteins. HTLV1 provirus integration and active transcription were demonstrated by Southern blotting of DNA and in situ hybridization respectively using molecularly cloned HTLV1 probes. Virus from one of these cell lines could be transmitted to normal T cells by co-cultivation.

Functional and phenotypic comparison of human T cell leukemia/lymphoma virus positive adult T cell leukemia with human T cell leukemia/lymphoma virus negative Sézary leukemia, and their distinction using anti-Tac. Monoclonal antibody identifying the human receptor for T cell growth factor

Adult T cell leukemia (ATL) and Sézary leukemia are malignant proliferations of T lymphocytes that share similar cell morphology and clinical features. ATL is associated with HTLV (human T cell leukemia/lymphoma virus), a unique human type C retrovirus, whereas most patients with the Sézary syndrome do not have antibodies to this virus. Leukemic cells of both groups were of the T3, T4-positive, T8-negative phenotype. Despite the similar phenotype, HTLV-negative Sézary leukemic cells frequently functioned as helper cells, whereas some HTLV-positive ATL and HTLV-positive Sézary cells appeared to function as suppressors of immunoglobulin synthesis. One can distinguish the HTLV-positive from the HTLV-negative leukemias using a monoclonal antibody (anti-Tac) that appears to identify the human receptor for T cell growth factor (TCGF). Resting normal T cells and most HTLV-negative Sézary cells were Tac-negative, whereas all ATL cell populations were Tac-positive. The observation that ATL cells manifest TCGF receptors suggests the possibility that an abnormality of the TCGF-TCGF receptor system may partially explain the uncontrolled growth of these cells.

The cutaneous lymphomas with convoluted nucleus. Analysis of thirty-nine cases

The clinical and histopathologic findings in thirty-nine cases of cutaneous lymphoma characterized by a proliferation of convoluted cells were reviewed. Thirty patients (77%) presented with erythematous or papular lesions (group I). The remaining nine patients (23%) presented with cutaneous nodules or tumors without erythematous lesions (group III). Histologically, the polymorphous infiltration was the common feature in both groups, but the presence of epidermotropism in group I was contrasted to the absence of epidermotropism in group II disease. The patients in group I had a higher median age (54 years) than those in group II (35 years), and a more favorable 3-year survival rate (44%) than that of the latter (19%). An evolution occasionally occurred from the epidermotropic to the nonepidermotropic form, followed by a poor clinical course. When the skin lesions were nonepidermotropic , irrespective of preceding clinical course, the prognosis was poor.

Helper T-cell lymphoma with marked plasmacytosis and polyclonal hypergammaglobulinemia. A case report

A case of malignant lymphoma with a helper activity of neoplastic cells is reported. On admission, a significant number of plasma cells of polyclonal nature were seen in the peripheral blood, and polyclonal hypergammaglobulinemia was seen. The biopsied lymph node showed poorly differentiated lymphocytic lymphoma with marked proliferation of plasma cells. At the terminal stage, the patient became leukemic in contrast with the disappearance of plasma cells from the peripheral blood. Although the leukemic cells failed to form sheep erythrocyte rosettes, they were considered to be of T-cell origin morphologically. Cytochemically, they had a "dot"-like pattern of alpha-naphthyl acetate esterase and acid phosphatase activity. Ultrastructurally, they had highly convoluted nuclei, and cytoplasmic clustered dense bodies. They showed marked helper activity on pokeweed mitogen-induced B-cell differentiation in vitro. This case may provide a novel view concerning the cause of hypergammaglobulinemia induced by lymphoproliferative disorders.

Immune T cells reactive against human T-cell leukaemia/lymphoma virus

Six patients with malignant disorders associated with human T-cell leukaemia/lymphoma virus (HTLV) were studied to see whether long-term cultures of immune T cells reactive against HTLV-infected tumour cells could be achieved. Immune T-cell lines could not be developed from the cells of five patients who died or eventually had a relapse of disease, but in one patient who had an unusually long remission of his disease after therapy, immune T-cell lines were propagated that could produce their own T-cell growth factor and proliferate upon stimulation with autologous tumour cells and also specifically lyse HTLV-infected target cells. These immune T cells recognised the presence of circulating HTLV-bearing neoplastic cells in another patient with HTLV-associated T-cell leukaemia, who had been in clinical remission after chemotherapy when this study started, thereby providing early evidence of relapse.

Transformation and cytopathogenic effect in an immune human T-cell clone infected by HTLV-I

Human T-cell leukemia-lymphoma virus (HTLV) is a human C-type retrovirus that can transform T lymphocytes in vitro and is associated with certain T-cell neoplasms. Recent data suggest that, in the United States, patients with acquired immunodeficiency syndrome (AIDS), homosexual men with lymphadenopathy, and hemophiliacs have had significant exposure rates to HTLV, whereas matched and unmatched control American subjects have rarely been exposed to this agent. In the present experiments, T cells specifically reactive against HTLV were propagated from a patient whose HTLV-bearing lymphoma was in remission. The T cells were cloned in the presence of the virus and an HTLV-specific cytotoxic T-cell clone was isolated. This clone was infected and transformed by the virus, with one copy of an HTLV-I provirus being integrated into the genome. This T-cell clone did not exhibit the normal dependence on T-cell growth factor (interleukin-2) and proliferated spontaneously in vitro. Exposure of the clone to HTLV-bearing, autologous tumor cells specifically inhibited its proliferation and resulted in its death. These results may have implications for HTLV-associated inhibition of T-cell responses.

Membrane markers, karyotypic abnormalities, ultrastructure and functional properties of lymphocytes in a case of 'D-cell' chronic lymphatic leukemia

D cells are lymphocytes bearing both receptors for the third complement component and the ability to form spontaneous rosettes with SRBC. We report the case of a patient with a D-cell chronic lymphatic leukemia who presented a long evolution without treatment and whose leukemic cell characteristics have been extensively studied. Cytogenetic analysis showed numerous karyotypic abnormalities among leukemic cells; all metaphases were hypodiploid and arranged in four different clones; seven marker chromosomes were present. The cells were found to bear human T-cell specific antigen, the T helper/inducer phenotype, HLA-A and HLA-B determinants, but no HLA-DR antigens. They displayed a high proliferative response to PHA and Con A, no response to PWM stimulation, and possibly the capacity of allogeneic stimulation in the mixed lymphocyte culture system. Assays for cell-mediated cytotoxicity in the CML system, and for K and NK activities were negative.

Regulatory activity of neoplastic T cells in Sezary syndrome on in vitro immunoglobulin production

Functional activities and surface markers of the neoplastic T cells of three patients with Sézary syndrome were studied and compared with the functional activities of OKT4+ and OKT8+ T-cell subsets from healthy donors. The neoplastic T cells of the patients had the following marker phenotype: OKT1+3+4+6-8-11+17+I1-M1-3A1-. In contrast to healthy donor OKT4+ T cells, none of the neoplastic T cells had significant helper activity on pokeweed-mitogen-driven Ig synthesis. In one patient the neoplastic T cells suppressed pokeweed-mitogen-driven Ig synthesis. The suppression by the patient cells did not require the presence of radiosensitive OKT4+ suppressor-inducer cells in the culture. It is concluded that OKT4+8-3A1- neoplastic T cells from Sézary-syndrome patients lacking helper activity are more common than previously thought and that in some cases the OKT4+8-3A1- Sézary cells can mediate suppressor activity.