Mouse red-cell rosettes in B-lymphoproliferative disorders

Establishment and characterization of a new leukaemic T-cell line (Peer) with an unusual phenotype

We report the isolation and establishment in continuous culture of a human lymphoid cell line (Peer) from a case of T-leukemia. The Peer cell line lacks some typical cell-surface properties of T cells, namely sheep erythrocyte rosette formation and reactivity with two anti-T-cell sera, but has focal acid phosphatase and does express two other T-cell antigens, one defined by a monoclonal antibody, the other related to a T-cell subset (TH2). The cells are negative for B-cell markers (SmIg or cytoplasmic mu Fcgamma and C3 receptors, mouse erythrocyte rosettes) and EBV (EBNA). In addition, the Peer cell does not possess the typical phenotypic markers of "non-B, non-T" leukemia: cALL and Ia-like antigens, and the cytoplasmic hexosaminidase isoenzyme I, but is positive for terminal deoxynucleotidyl transferase by enzymatic and immunofluorescent criteria. The cell line requires exogenous L-asparagine for adequate growth in culture, a property known to be characteristic of certain T cells but not of B cells. The Peer cell line appears to have a maturation arrest at a developmental stage intermediate between the cortical thymocyte and a mature T-cell subset and to have lost some T-cell differentiation features.

Prolegomenon for Chronic Lymphocytic Leukaemia

Chronic lymphocytic leukaemia (CLL) is a unique lymphoproliferative disorder that scarcely occurs under the age of 40; thereafter the incidence of CLL increases exponentially with age. CLL is characterized by progressive expansion of malignant CD5+ME+ B-cell clone accompanied by a myriad of cellular and humoral immune defects. Each of them might be linked to different clinically manifested complications such as increasing rate of infections, autoimmune disorders and disturbed immune surveillance against tumour cells. We assume that CLL occurs as a consequence of age-dependent, genetically related functional restrictions of the thymic microenvironment in supporting common lymphoid progenitor cells (CD5+ME+CD4-CD8-) to differentiate into mature T-cell and B-cell descendants. In conjunction with genetic abnormalities developing in B-cell progenitors, presumably expressing P glycoprotein (Pgp+), we postulate that developmentally altered T-cell descendants, along with quantitative imbalance among CD4+, their subsets and CD8+ lymphocytes in the peripheral blood, play an important additional role in facilitating the malignant B-cell clone emergence and in modulating the CLL clinical evolution. Namely, imbalance of any of T-cell-mediated cell interactive homeostatic mechanisms accompanied by imbalance in the production of various cytokines might in CLL influence leukaemic B-cell growth by deregulating inducer (c-myc and p53) and/or suppressor (bcl-2 and mutant p53) oncogenes responsible for the promotion or suppression of B-cell mitogenesis that may in turn further contribute to their impaired differentiation and/or differentiation arrest. In conclusion, CLL might be interpreted as a primary immunodeficiency syndrome developing in elderly population due to gradually evolving restriction of genetically controlled programs in the thymic microenvironment responsible for irregular maturation of common lymphoid progenitor cells that constitutively express CD5 antigen and ME receptor into T-cell and B-cell descendants.

New monoclonal antibody specific for a 6.5 kDa glycoprotein which presents mainly on a B cell of chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukaemia (CLL) is a most common form of adult leukemia. No specific marker for CLL has been defined until today. We attempt to produce a specific monoclonal antibody (mAb) to CLL B cells. For this purpose, Balb-C mice were immunised with peripheral blood lymphocytes of a patient with CLL. After the fusion, the immunised mouse spleen cells and SP2/0 myeloma cell line, antibody secreting clones were selected by ELISA and specific antibody was determined by flow cytometry. Leukemic cells from different patients, different cell line and lymphoid tissue were tested with this mAb using flow cytometry and immunoperoxidase methods. Ligand of the mAb on cell surface was identified using epitope analysing method. We have shown that this mAb is specific to a molecule with 6.5 kDa molecular weight, which is present mainly on B CLL cells (63.7+/-16.4%). It has also been shown that this molecule was a glycoprotein. Amongst the different cell lines that were tested, Raji cell, Molt-3 and P3HR-1 cells were expressing this molecule. We, therefore, suggest that it is a novel molecule with unknown function and is mainly present on the B cells of CLL.

Chronic lymphocytic leukaemia: the nature of the leukaemic cell

Far from being the boring, inactive, inert lymphocyte that haematologists of old perceived it to be, the chronic lymphocytic leukaemia (CLL) cell has set us many complex problems. The cell is apparently stuck in G0 in cell cycle, yet expresses many activation markers. The cells apparently manufacture many cytokines and respond in vitro to even more, yet cells entering even G1 are few. The cell surface marker profile is unique. There is apparently no normal equivalent of the CLL cell. In part, this may be because the cell is malignant; malignant cells often express aberrant markers. Consistent chromosomal abnormalities are emerging but we have no idea how these abnormalities translate into molecular mistakes that dictate the peculiar nature of the cell. CLL cells carry a characteristics set of adhesion molecules, but we cannot read their homing and recycling instructions. The outstanding irregularities of the CLL cell are its CD5 positivity and its sparse surface immunoglobulin. This ought to translate as an anergic B1 cell, perhaps programmed for autoimmunity. If the tumour cell were responsible for the patient's production of immunoglobulin or secretion of autoantibodies, then a pattern might have emerged. Alas, these are the product of the normal B cells. How the CLL cell induces these complications is unknown. Thus, despite the information contained in this review, the CLL cell remains a puzzle.

The pathogenesis of chronic lymphocytic leukemia: analysis of the antibody repertoire

CD5+ B cells predominate early in ontogeny and have been associated with autoantibody production. In chronic lymphocytic leukemia (CLL), B lymphocytes express CD5 and frequently produce autoantibodies using developmentally regulated variable (V)-gene segments. Does the self-reactivity observed in CLL reflect transformation of a 'fetal' lineage of cells, or could overexpansion of these B cells occur as a consequence of antigen stimulation? Harry Schroeder and Guillermo Dighiero have reviewed the literature describing antibody sequences in CLL and have compared them with the 'fetal' repertoire. This analysis indicates that CLL cells use a repertoire characteristic of mature cells, and suggests that antigen may play a role in the pathogenesis of this disease.

Biology of the neoplastic lymphocyte in B-CLL

Immunological markers have identified the proliferating lymphocyte in CLL as a mature B lymphocyte which, unlike lymphocytes in other B cell malignancies, expresses low amounts of surface membrane immunoglobulin (smIg), forms rosettes with mouse erythrocytes and expresses the CD5 marker. It has been postulated that Ly1 B cells (the murine counterpart of human CD5+B cells) constitute a separate B cell lineage. Whether the CD5 marker defines a discrete lineage or is a maturation marker is one of the main issues that might be solved in the near future. Another recent advance has been the discovery that the B lymphocyte in CLL is in an activated state and can be induced to differentiate. Using B cell mitogens and somatic hybridization, it has been demonstrated that the B-CLL lymphocyte is frequently involved in the production of natural autoantibodies and expresses a restricted set of genes. These results may provide a basis for passive immunotherapy using anti-idiotypic antibodies. Hypogammaglobulinaemia is a distinct feature of B-CLL, observed in 60% of patients. It may result from impaired function of residual normal B cells. This could occur as a consequence of progressive dilution of normal non-clonal B cells, or because normal B cells are downregulated by an unknown mechanism. This decrease in or inhibition of normal CD5-B cells could also explain the classical inability of patients with B-CLL to respond to new antigenic challenges, since Ly1 B cells have been claimed to be unable to respond to exogenous antigens. Although regulatory abnormalities in T cells may play a role in the induction of hypogammaglobulinaemia, data concerning helper, suppressive, NK and ADCC cells are contradictory and fail to establish firmly the contribution of these cells in the development of hypogammaglobulinaemia. Associated autoimmune phenomena are a prominent complication in CLL. They are related to the presence of autoantibodies directed mainly against blood components, which in most cases are not the product of the malignant clone. The relationship between autoimmune phenomena and hypogammaglobulinaemia is not definitively substantiated. That hypogammaglobulinaemia may determine the loss of some anti-idiotypic antibodies designed to antagonize autoimmune clones is an attractive hypothesis, which needs to be substantiated. Several recurrent chromosomal abnormalities, such as trisomy 12, structural aberrations of the 13q14 and 14q32 bands, are frequently observed in B-CLL. Less frequently, alterations of chromosomes 11, 6, 18, 3, 17, 7 and 8 have been reported.(ABSTRACT TRUNCATED AT 400 WORDS)

Human CD5-positive B cells in lymphoid malignancy and connective tissue diseases

The current literature on human CD5-positive B cells (CD5 + B cells) has been analysed, with a special emphasis on non organ-specific auto-immune diseases. Malignant cells of most of the chronic lymphoid leukaemias of the B cell lineage express the CD5 molecule. Antibodies of the IgM class produced by leukaemic B cells are multispecific auto-antibodies. The CD5 + B cell subset may be expanded in non organ-specific autoimmune diseases, such as rheumatoid arthritis, primary Sjögren's syndrome, systemic lupus erythematosus. This holds true for various conditions, including organ-specific auto-immune diseases. Since auto-immune features are common in lymphoproliferative disorders, and the latter be a complication in non organ-specific auto-immune diseases, CD5 + B cells may represent an intermediary between these auto-immune diseases and B cell lymphoproliferations. Studies on the regulation of CD5 + B cell production and function are likely to shed light on the aetiology of, and pathogenetic mechanisms operating in the different disease states.

Immunophenotyping of subtypes of B-chronic (mature) lymphoid leukemia. A study of 242 cases

BACKGROUND

The French-American-British group's proposal for the classification of chronic lymphoid leukemias is unique at this time. Testing, expanding, and adding to the theory by immunophenotyping will help to additionally characterize this group of diseases.

METHODS

Peripheral blood samples from 242 patients with chronic lymphoid leukemias were analyzed for immunologic evaluation of the following subtypes: typical chronic lymphocytic leukemia (CLL), 189; CLL with pleomorphic lymphocytes (CLL-pleo), 19; CLL of mixed cell type (CLL/PL), 20; prolymphocytic leukemia (PLL), 22; hairy cell leukemia (HCL), 10; HCL-variant, 1; and splenic lymphoma with villous lymphocytes, 1.

RESULTS

The phenotype of CLL and CLL-pleo was weak surface immunoglobulin (SIg) with positive results of mouse rosettes (MR+), CD5+, and CD22-. Of PLL and HCL, it was strong SIg, MR-, CD5-, and CD22+. By analyzing the four markers and accepting the relevant results of two or more as sufficient for diagnosis, all cases (100%) of CLL, CLL-pleo, PLL, and HCL were diagnosed. CLL/PL showed the phenotype of CLL in 66.67% and of PLL in 33.33% of patients. The frequency of cases with weak fluorescence in decreasing order was CLL, CLL-pleo, CLL/PL, and PLL and HCL. The same sequence applied to the mean percentage of mouse rosette-forming cells and CD5 cells, but the sequence was reversed for CD22 cells.

CONCLUSIONS

SIg intensity, MR, CD5, and CD22 constitute the minimum number of immune markers for the differential diagnosis of the subtypes of chronic lymphoid leukemia. The frequency of the four markers among the subtypes suggested that CLL and CLL-pleo have identical phenotypes and that the five subtypes follow a continuous range of B-cell differentiation from early mature (CLL and CLL-pleo) to late mature pre-plasma cell stages (PLL followed by HCL), with CLL/PL of intermediate maturity.

Mouse erythrocyte rosette formation with malignant human B-lymphocytes re-evaluated: still a useful marker for differentiating mature B-cell malignancies

We have re-evaluated mouse rosette formation (MRF) as a marker for B-CLL by estimating the fraction of mouse rosette forming B-lymphocytes (identified by CD20 monoclonal antibodies) in normal donors and malignant CD20+ cell proliferations (ALL, AML, B-NHL, B-HCL and B-CLL). Whereas this ratio was increased in B-CLL, all other CD20 positive malignancies showed mean ratios of less than 0.1. As part of a Danish multi-centre study, we furthermore prospectively analysed 86 patients and found that the mouse/CD20 ratio divided the 78 patients with monoclonal B-cell populations suspected of B-CLL in two distinct groups. In the low ratio group, three patients were categorized as leukaemized B-NHL and one as PLL. The remaining three patients with low ratio were clinically and immunologically (by SmIg density and CD5 expression) B-CLL patients suggesting a frequency of MR-negative B-CLLs of approximately 5%. In the high ratio group two of 70 patients were diagnosed as B-NHLs. Thirdly, MRF was a valuable parameter in patients, where transformation of disease is suspected, since it preceded clinical changes by several months. Thus, MRF is still a useful marker in the age of monoclonal antibodies.

Mouse rosettes and surface immunoglobulin in small lymphocytic lymphoma. Importance in immunophenotyping and differential diagnosis

Cell suspensions from lymphoid tissue of 82 small lymphocytic lymphoma (SLL), 8 intermediate lymphocytic lymphoma (ILL), 286 other B-non-Hodgkin's lymphoma (B-NHL), and 248 reactive lymphadenopathy (RLA) cases were analyzed to evaluate the diagnostic significance of mouse-rosette (M-rosette) assay, and surface immunoglobulin clonality (SIg) and level of expression. In SLL, 55 were M-rosette positive (67.07%) and 72 SIg positive (87.8%), with weak fluorescence in 63 and strong fluorescence in 9 cases. Of 10 SIg-negative cases, 9 were M-rosette positive; of 27 M-rosette-negative cases, 26 were SIg positive. Seven of the nine cases with strong fluorescence were M-rosette positive. In other B-NHL, 252 were M-rosette negative (88.11%) and 245 SIg positive (85.66%), with strong fluorescence in 211 and weak fluorescence in 34 cases. Thirty-two of the 34 cases with weak fluorescence were M-rosette negative. Of the RLA cases, 213 were M-rosette negative (85.89%) and 1 SIg positive (0.4%). The study demonstrated the independent expression of M-rosettes and SIg in SLL and their complementary role in diagnosis. It showed that positive results for M-rosettes and weak fluorescence are characteristic of SLL, that M-rosette negativity and strong fluorescence are characteristic of other B-NHL, and that M-rosette negativity and polyclonal SIg are characteristic of RLA. In 26 cases with paired data for CD5, M-rosettes, and SIg, a positive result for M-rosettes was superior to CD5 in differentiating SLL from other B-NHL. Intermediate lymphocytic lymphoma frequently showed weak SIg fluorescence and M-rosette negativity.

The importance of surface immunoglobulin, mouse rosettes, and CD5 in the immunophenotyping of chronic lymphocytic leukemia and reactive lymphocytosis

Peripheral blood from 167 B-chronic lymphocytic leukemia (B-CLL) and 119 reactive lymphocytosis (RLC) patients were analyzed to evaluate the immunophenotypic diagnostic value of mouse rosettes (M-rosette), and weak expression of monoclonal surface immunoglobulin (SIg). In B-CLL, 145 cases were M-rosette+ (86.83%), 135 surface immunoglobulin (SIg)+ (80.84%), and 117 M-rosette+ SIg+ (70.06%). Of 32 SIg- cases, 28 were M-rosette+; and of 22 M-rosette-cases, 18 were SIg+. By combining results of the two assays and accepting positivity of either one or both as sufficient for diagnosis, B-CLL was diagnosed in 163 cases (97.60%). CD5 was performed in 49 cases of the 167 with paired data for SIg and M-rosettes. By combining the results of the three assays and accepting positivity of any two or all three as sufficient for diagnosis, all 49 cases (100%) were diagnosed. Correlation analysis showed no significant association between M-rosette, SIg, and CD5 expression. The results demonstrate the independent expression of the three markers, and their complementary role in immunophenotyping B-CLL. In RLC, all 119 cases were T-lineage and SIg-, and 115 were M-rosette-, indicating the role of the two markers in differentiating B-CLL from RLC. Three of the four M-rosette+ T-RLC were subsequently diagnosed as B-CLL, suggesting the necessity of follow-up of such cases.

B-cell monoclonal antibodies and their use in clinical oncology

The use of MAbs directed against B-cell markers has identified considerably more heterogeneity within B-cell neoplasms than was evident by standard morphologic and histochemical techniques. Using markers specific for lineage and state of differentiation, it is possible to correlate malignant B cells to their normal cellular counterparts. Considering the complexity of normal B-cell ontogeny, differentiation, and function, it is not surprising that these malignancies reflect this diversity. Hopefully, with increasing characterization of the normal function of cell surface molecules, as well as the subpopulations of normal cells to which these malignancies correspond, we will have a better understanding of the biologic and clinical behavior of these malignancies.

Production of mouse monoclonal antibodies for the analysis of idiotypes in serum of patients with chronic lymphatic leukaemia

In this report a simple procedure for the production of murine monoclonal antibodies (MoAb) against the idiotype of malignant B cells is described. Mice were immunized with lymphoid cells from patients with B-cell chronic lymphocytic leukaemia (B-CLL). After fusion of the spleen cells, hybridoma supernatants were screened for anti-idiotypic MoAb in ELISA with immunoglobulins obtained from tumour-cell lysates, xenohybridomas and patients' sera. The anti-idiotypic MoAb were used to study tumour cells and serum immunoglobulins (Ig) from four different patients with B-CLL. It was found that the serum IgM and IgD in one patient shared the same idiotype. Evidence is presented that IgG-secreting cell populations are not restricted to lambda-Ig-light chain-expressing B-CLL cells. With the help of anti-idiotype MoAb accurate measurements of total and idiotype-positive serum immunoglobulin levels during chemotherapy were possible.

Transferrin receptor expression in the leukaemias and lymphoproliferative disorders

The expression of the transferrin receptor (TfR) was studied in the acute leukaemias and lymphoproliferative disorders by means of indirect immunofluorescence and/or the enhanced alkaline phosphatase anti-alkaline phosphatase (APAAP) techniques using monoclonal antibodies to the receptor. A total of 174 cases of acute leukaemia and lymphoproliferative disorder were studied. The results indicate that the receptor is expressed with increased density in the majority of positive cases of acute leukaemia. The lymphoproliferative disorders, however, only expressed the receptor in a minority of cases and did so with weak density. It is proposed that this weak expression in the lymphoproliferative disorders may be of use as an indicator of an increase in cell activity.

Hairy cell leukemia

Hairy cell leukemia is a chronic lymphoproliferative disorder that has been recognized as a separate clinical pathologic entity for the last 25 years. After a decade of discussions about the origin of the neoplastic cell, it has now been well established that hairy cells represent a certain, rather mature stage of B-cell differentiation. Evidence for this has been derived from studies using immunophenotyping with monoclonal and polyclonal antibodies, cytochemistry, and immunoglobulin gene rearrangement. For many years, splenectomy was the only therapy of proven value in hairy cell leukemia. For patients who showed insufficient response to the operation, chemotherapy with low-dose alkylating agents was moderately successful, whereas polychemotherapy often resulted in excessive toxicity. More recently, therapy with alpha-interferon has been shown to be very promising, whereas deoxycoformicin may be an attractive alternative. These new advances in immunology and therapy are reviewed.

Prolymphocytoid variants of chronic lymphocytic leukaemia: an immunological and morphological survey

Of 417 cases of chronic lymphocytic leukaemia (CLL) examined morphologically, 346 (83%) showed low (less than 10%) numbers of cells with prolymphocytoid (PLC) morphology. Immunological studies in 267 of these cases, with particular reference to membrane surface immunoglobulin (SIg) densities and FMC7 expression, revealed that of 223 cases with insignificant prolymphocytoid components, 185 were phenotypically consistent with typical CLL whilst the other 38 cases showed significant (greater than 20% positive cells) FMC7 expression and/or increased SIg density. In contrast, 40 of the 44 cases with greater than 10% PLC showed atypical immunophenotypic features even though the expression of individual membrane components associated with B-cell differentiation appeared to be unrelated. MRBC receptor expression showed little correlation with the degree of prolymphocytoid change although all TU1- cases showed greater than 10% PLC. The results suggest that abnormal phenotypic features, similar to those observed in "prolymphocytoid" transformation, may be found in cases of CLL in the absence of morphological change.

Acid hydrolases in B-chronic lymphocytic leukemia (B-CLL): a comparison with normal peripheral B lymphocytes and normal B-cell subset with the phenotype of B-leukaemic cells

The acid phosphatase (AP), beta-glucuronidase (BG), and alpha-naphthyl-acetate esterase (ANAE) distribution and the morphology of stage 0 B-CLL lymphocytes were studied. The results were compared with the same hydrolase equipment and morphology of normal B-cell populations showing the B-CLL-like phenotype, and thus regardable as the possible counterpart of leukaemic cells. The functional and structural characters of the former were strikingly different from those of the latter. In fact the normal B-cell population with B-CLL-like phenotype showed an homogeneous enzyme pattern with predominant ANAE and a strictly lymphocytic cell morphology. In contrast, the leukaemic cells showed various and unrelated morphological and cytochemical features, thus forming apparent subgroups of B-CLL. The development of an irregular "switch on" mechanism in the blocked malignant cell clone, may account for these functional and structural maturation discrepancies. Moreover, the fact that in the leukaemic cells ANAE activity could be demonstrated only after the appearance of the other hydrolases, makes it a marker of functionally differentiated B lymphocytes.

The correlation between surface immunoglobulin expression and the leucocyte-common antigen in B-cell chronic lymphocytic leukaemia

The expression of the 230 kD glycoprotein of the leucocyte-common antigen by the leukaemic lymphocytes of patients with B-cell CLL, PLL and HCL and of normal B lymphocytes has been measured in a flow cytometer by the binding of the McAb F8-11-13 and surface tritiation. Its expression has been correlated with the expression of surface immunoglobulin heavy chain and light chain. The levels of binding of F8-11-13 and sIg cover a wide range within the CLL panel, ranging from very low (10% normal) to levels found in the other two leukaemias and normal cells. The progressive deviation from normal in the CLL panel is accompanied in all but a minority of patients by the expression of the leucocyte sialoglycoprotein.

The incidence, clonal origin and secretory nature of serum paraproteins in chronic lymphocytic leukaemia

Immuno-isoelectric focusing (IIEF) showed a 61% incidence of serum paraproteinaemia in 56 patients with chronic lymphocytic leukaemia (CLL). A strong correlation between the serum paraprotein heavy chain isotypes and those of the cytoplasmic heavy chain immunoglobulins was observed with no discrepancy noted in light chain expression. Density gradient ultracentrifugation analysis of selected sera containing monoclonal IgM showed that the IgM paraproteins were mostly 19S, secretory IgM but one patient was found to have both 19S and 8S monoclonal IgM. When the cellular origin of the IgM and IgD paraproteins found in one patient was investigated, both paraproteins were found to share the same idiotype and originate from the neoplastic clone. These findings confirm the view that there is an incomplete maturation block in chronic lymphocytic leukaemia and that in vivo secretion of paraproteins by the neoplastic cells is a relatively common occurrence.

A cytological analysis of FMC-7 positive leukaemias

The subdivision of the B lymphoid leukaemias by conventional techniques is subjective and poorly reproducible, with a range of cytological diagnoses available for cases which are not typical examples of chronic lymphatic leukaemia or acute lymphoblastic leukaemia. The monoclonal antibody FMC-7 recognizes a determinant on a subpopulation of B lymphoid cell and stains follicular B cells. Routiune FACS analysis of chronic lymphoid leukaemias with a panel of monoclonal antibodies identified a subset of lymphoproliferative disorders (20 of 88) which were FMC-7 positive. a careful 'blind' cytological assessment of this subset gave some support for the suggestion that they were examples of lymphoproliferative disease of follicular origin. Eight cases, however, were considered cytologically typical of CLL. The wider application of this antibody, particularly in sequential studies over a longer time scale may improve objectivity in the classification of this group of diseases.

Membrane phenotypic studies in B cell lymphoproliferative disorders

A total of 398 cases of B cell lymphoproliferative disease were phenotypically characterised by membrane mouse red blood cell (MRBC) receptor, surface immunoglobulin, common acute lymphoblastic leukaemia (CALLA), and FMC7 and T1 monoclonal antibody studies. Relations between chronic lymphocytic leukaemia (CLL), prolymphocytic leukaemia (PLL), and "prolymphocytoid" CLL variants were examined with particular reference to the expression of FMC7. In addition, the reactivity of TU1 monoclonal antibody with B cell disorders was established. The results suggest that despite some heterogeneity most cases may be characterised by their phenotypic patterns and that these investigations provide a reproducible basis for classification.

Hairy cell leukaemia occurring during phenytoin (diphenylhydantoin) treatment

We describe the case of a patient who developed hairy cell leukaemia (leukaemic reticuloendotheliosis) during phenytoin treatment. Hairy cells were identified by fluorescence, phase contrast and electron microscopy; they contained tartrate-resistant acid phosphatase activity, formed rosettes with mouse but not sheep erythrocytes and bore monoclonal surface immunoglobulin. Because of the association of pseudo- and true lymphomas with phenytoin it is possible that this lymphoproliferative disorder arose as a result of the treatment with phenytoin, possibly in conjunction with sulthiame.

Histocompatibility antigen frequencies in patients with chronic lymphocytic leukaemia: possible identification of a subgroup with relatively benign disease

A series of 57 patients with chronic lymphocytic leukaemia was typed for HLA-A, B and DR antigens and compared with a control population of equal size. There was an increased frequency of HLA-A1 and B8 in the patient group, although it was not statistically significant after allowance for the number of specificities tested. A subgroup of patients lacking both A1 and B8 differed from the others in sex ratio, degree of lymphocytosis and incidence of hypogammaglobulinaemia at presentation. This subgroup also had less need for treatment within 6 months of presentation. While these findings must be considered preliminary, it is possible that tissue typing may help to identify patients with a relatively benign form of the disease.

Immunoglobulin abnormalities in malignant non-Hodgkin's lymphoma

The association of monoclonal gammopathy and lymphoma was investigated in 100 consecutive, untreated cases of chronic lymphocytic leukaemia (CLL) and non-Hodgkin's lymphoma (NHL) of B-cell type, classified according to the criteria of Lukes & Collins (9). The overall incidence of monoclonal immunoglobulins (Ig) was 24%. The highest incidence (57%) was seen in plasmacytoid lymphocytic lymphoma and the lowest (7.9%) in cases of CLL. IgM was the predominant class of monoclonal Ig. It is concluded that the presence of monoclonal gammopathy in NHL reflects the stage of differentiation and maturation of the malignant B-cell clone.

Prolymphocytic leukaemia: surface morphology in 21 cases as seen by scanning electron microscopy and comparison with B-type CLL and CLL in 'prolymphocytoid' transformation

The surface architecture of leukaemic cells obtained from 21 cases of proven prolymphocytic leukaemia (PLL) and eight cases of chronic lymphocytic leukaemia (CLL) with 'prolymphocytoid' transformation (PL-CLL) was compared with the cell surface morphology of leukaemic cells obtained from 46 cases of B-type CLL, using the scanning electron microscope (SEM). All cases were defined by cytochemistry, immunological markers and transmission electron microscopy prior to SEM examination. B-CLL cells showed the well-recognized spectrum of surface architecture described in earlier studies. The majority of cells had moderate numbers of short microvilli, although in a minority, cells with relatively smooth surfaces predominated. In seven of the eight cases of PL-CLL, cells were villous in nature and in this respect similar to CLL cells; however, more cells with dense microvilli were seen. The prolymphocytic cells were recognized by their larger size and in 18 of the 19 cases of B-derived PLL, villous cells predominated. Two cases of T-derived PLL showed variable cell surface morphology ranging from smooth to moderately villous. It appears that B-PLL cells are most frequently villous and display more surface microvilli than B-CLL cells. B-prolymphocytes display the surface features regarded as characteristic for neoplastic B-cells as seen in patients with B-type lymphoma and leukaemia.

Lineage relationship of chronic lymphocytic leukemia and hairy cell leukemia: studies with TPA

The tumor promoting agent TPA (phorbol ester; 1.6 X 10(-8)M) was used to induce the differentiation in vitro of B-chronic lymphocytic leukemia (B-CLL) cells from 14 untreated patients. The uninduced phenotype was SIg+, Mrbc+, RFT-1+, RFA-4-, FMC7-. After 72 h incubation with TPA, B-CLL cells became RFA-4+, FMC7+ and lost the capability of Mrbc rosetting. Large proportions of the "induced" cells also showed morphological and ultrastructural changes, such as undulating membranes and bleblike protusions and became strongly positive for tartrate resistant acid phosphatase (TRAP+) and also contained cytoplasmic immunoglobulins. These features are very similar to the features of hairy cell leukemia (HCL). These observations confirm previous clinical findings that B-CLL and HCL are related disorders of the B lineage. The development of "hairy" features in induced B-CLL and in HCL seems to be a malignancy-associated feature because the Mrbc+ normal B cells (B-CLL-equivalent cells) isolated from tonsil also develop TRAP positivity but no membrane aberrations.

Lymphocyte markers in health and disease

In the 7 years since the last review of lymphocyte markers, written by Tomasi and Stobo, appeared in this journal, there has been a revolution in the diversity and sophistication of immunologic tests directly applicable to investigations of clinical disorders. The promise of such procedures and their allied genetic and monoclonal antibody probes in aiding the classification, early recognition, and therapy of hematologic malignancies, autoimmune disorders, and infectious diseases now is approaching fruition. A synopsis of those assays in vitro and in vivo, together with the primary immune cell subsets they define, is given in Table 12. A grasp of the basic mechanisms underlying them should permit their judicious use, as they are requested either through the clinical laboratory (the initial screen) or as they are complemented by more complex studies obtained through university-affiliated immunology centers (further workup). In this manner, clinically relevant information for the diagnosis and treatment of disorders of immune function will be realized.

Stereologic analysis of the ultrastructure of isolated human T and non-T lymphoid cells. III. Studies in chronic lymphoid leukemias, hairy cell leukemia and some malignant lymphomas

Malignant cells from 9 cases of chronic lymphocytic leukemia (CLL), 4 cases of prolymphocytic leukemia (PLL), 4 cases of hairy cell leukemia (HCL), 4 cases of malignant lymphoma of centrocytic type and 3 cases of malignant lymphoma of lymphoblastic type (Kiel classification), all examined for T and B markers, were analysed by electron microscopy. Stereological methods were applied to assess relative and absolute values concerning the whole cell and nuclear and cytoplasmic components of the average cell in each population, and comparisons were made between the morphologically and immunologically defined subsets. The CLL-lymphocyte possessed the smallest cell volume, a high nucleo-cytoplasmic volume ratio, densely packed heterochromatin, a small nucleolar volume and a sparse Golgi complex. The 7 B-derived cases were characterized by a larger volume of rough ER and a more irregular plasma membrane than the two T-derived cases, which typically displayed dense granules in paranuclear aggregations. The prolymphocyte could be distinguished from the CLL-cell by its larger cell volume, lower nucleo-cytoplasmic volume ratio, proportionally lesser heterochromatin, typically condensed at the periphery and around a prominent nucleolus. All 4 cases of PLL were of B-nature and shared the features of B-CLL regarding increased rough ER and low content of granules. The hairy cell exhibited the largest cell volume, the lowest nucleo-cytoplasmic volume ratio, an indented nucleus and a remarkable irregular cellular surface with long "hairy" processes. The cytoplasmic inclusions of ribosome-lamella complexes were recorded exclusively in hairy cells, in half of the patients. The centrocyte was characterized by a cell volume of intermediate size, a high nucleo-cytoplasmic volume ratio and the highest degree of nuclear irregularity recorded. The amount of rough ER was considerably less than in B-CLL and B-PLL. Finally, the blast from the cases of lymphoblastic lymphoma, all of T-nature, displayed a smooth plasma membrane, a high euchromatin-heterochromatin volume ratio and dense granules, characteristically clustered in the vicinity of the Golgi complex. Stereology on the ultrastructure of malignant lymphoid cells provides a more accurate characterization and may be helpful in classification.

The incidence of B cell leukaemia and lymphopenia in B cell neoplasia in adults: a study using the Kiel classification of non-Hodgkin's lymphoma

The incidence of B cell leukaemia in 186 consecutive untreated patients with histologically defined B cell neoplasms is described. The lymphomas were classified by the Kiel convention. B cell leukaemia in the context of this paper refers to the situation where a neoplastic clone of B cells in the blood greatly outnumbers normal blood B cells. It is defined as an absolute blood B cell count greater than 0.75 X 10(9)1(-1) where either greater than 90% B cells express kappa immunoglobulin light chains or greater than 80% express lambda light chains. This was found in several patients where the total blood lymphocyte count was within normal limits. All patients with diffuse lymphocytic lymphoma with the histological appearances of B cell chronic lymphocytic leukaemia (ML-BCLL) were found to have B cell leukaemia. However, more than half these patients had blood B cell counts less than 10 X 10(9)1(-1). B cell leukaemia was also a feature in approximately 33% of patients with follicle centre cell tumours and 33% of those with lymphoplasmacytoid tumours. B cell leukaemia was not detected in 34/35 patients with myelomatosis. The 35th patient had plasma cell leukaemia. Only 3/22 patients with high grade lymphoma had B cell leukaemia. In the three principal tumour types associated with B cell leukaemia mu + delta was the most common immunoglobulin heavy chain phenotype. Spontaneous mouse red cell rosette formation also characterised leukaemic B cells in these three groups but high proportions of mouse rosetting cells were seen only in association with ML-BCLL. None of 4 cases of prolymphocytic leukaemia showed mouse red cell rosetting. HLA-DR alpha chain was found on the leukaemic cells of all patients except one with ML-BCLL. B cell lymphopenia was a frequent finding in all histological groups in those patients who did not have B cell leukaemia.

Agglutination of mouse erythrocytes by binding of non-choline phospholipids to a 70 000-Dalton protein

The structure of some phospholipids that cause agglutination of mouse erythrocytes has been studied. Haemagglutination is a property of non-choline-containing phospholipids; the phosphate group is essential and unsaturated fatty acids optimal. A protein of Mr 70 000 was isolated from mouse erythrocyte membranes which completely inhibited phospholipid-mediated erythrocyte agglutination. It is proposed that this protein is the phospholipid binding site on mouse erythrocytes and the ligand for the human B-lymphocyte receptor for mouse erythrocytes. Preliminary investigations suggest that a similar inhibitor of phospholipid-mediated agglutination is found in serum. Agglutination of mouse erythrocytes by phospholipid and specific inhibition by the 70 kDa membrane protein constitute a simple system for studying the interaction of phospholipid with protein.

Lymphosarcoma cell leukemia and other non-Hodgkin's lymphomas in leukemic phase

Lymphosarcoma cell leukemia has been used to refer to three related clinical syndromes. As originally described, it refers to the invasion of peripheral blood by poorly-differentiated lymphocytic lymphoma. Blood involvement occurs in 10 to 70 percent of patients with poorly-differentiated lymphocytic lymphoma, depending on the methods and criteria used to define leukemic phase, but it may have little impact on the clinical course of such patients. Second, lymphosarcoma cell leukemia can describe a variant of chronic lymphocytic leukemia, presenting clinically without lymphoma. Although not all hematologists recognize this as a distinct entity, others believe that such patients have a poorer prognosis than those with typical chronic lymphocytic leukemia. In the absence of a lymph node biopsy diagnostic of poorly-differentiated lymphocytic lymphoma, the diagnosis of lymphosarcoma cell leukemia should be reserved for cases demonstrating immunologic features of poorly-differentiated lymphocytic lymphoma, namely bright surface immunoglobulin immunofluorescence, normal capping, and low mouse red cell rosette formation. Finally, lymphosarcoma cell leukemia has been used to describe the invasion of blood by other types of lymphoma, including large cell, lymphoblastic, and Burkitt's lymphoma, although these are better designated as the particular lymphoma in leukemic phase. When abnormal cells appear in the blood samples of patients with lymphoma, acute myelogenous leukemia must also always be considered, particularly in patients who have received substantial prior chemotherapy or irradiation.

Density separation of chronic lymphocytic leukemia cells: low-density non-T cells are efficient stimulator cells in allogeneic and autologous mixed leukocyte reaction

Unseparated mononuclear cells and E rosette-depleted non-T cells from a majority of patients with chronic lymphocytic leukemia (CLL) were found to be weak stimulators in the allogeneic mixed-leukocyte reaction (MLR). However, a minor population (1-5%) of highly active stimulator cells could be isolated from all patients studied by buoyant density centrifugation using discontinuous gradients of Percoll. The same low-density non-T-cell fraction also stimulated autologous T-cell proliferation in the autologous mixed-leukocyte reaction (AMLR). In contrast, Percoll-separated high-density non-T cells, including the leukemic B-cell pool, were completely inactive as stimulators in AMLR. These results suggest that the presence of efficient stimulator cells among CLL mononuclear cells may be masked by the large number of nonstimulating leukemic B cells.

Cell marker studies in patients with newly diagnosed chronic lymphatic leukaemia

Cell marker analysis including mouse red cell rosetting ability was carried out on 24 newly diagnosed patients with chronic lymphatic leukaemia. Using a technique not employing neuraminidase a significant difference in mouse red cell rosetting ability was noted between male and female patients. It is well accepted that females often have a milder form of disease and better longterm survival than it is suggested this might be a reflection of the difference found in mouse red cell rosetting ability between the sexes in this condition.