Blood lymphocytes surface markers and clinical findings in chronic lympoproliferative disorders

Hypercalcaemia associated with chronic lymphocytic leukaemia in a Giant Schnauzer

A 7-year-old male Giant Schnauzer was referred with a history of severe vomiting, lethargy, weight loss, polydipsia and polyuria. Detailed investigations revealed leucocytosis with a marked lymphocytosis, mild non-regenerative anaemia, thrombocytopenia, hypercalcaemia and azotaemia. Circulating lymphocytes were small and well-differentiated, and the same lymphoid population was present in bone marrow. Chronic lymphocyctic leukaemia with associated paraneoplastic hypercalcaemia was diagnosed. Immunohistochemical staining of a bone marrow biopsy revealed a neoplastic B-cell line expressing CD79. The dog responded to therapy with prednisolone and chlorambucil for a period of 8 months.

B-cell chronic lymphocytic leukaemia: prognostic value of the immunophenotype and the clinico-haematological features

Sixty-two previously untreated patients with B-cell chronic lymphocytic leukaemia were analysed to study the prognostic value of both the immunologic phenotype and the clinicobiologic characteristics. Univariate studies showed that none of the immunological markers analysed, sheep-rosette, mouse-rosette, slg, and HLA/DR, CD20, FMC7, CD5, and CD9 antigens, had a significant influence on survival. On the other hand, several clinical and haematological characteristics were identified as being associated with survival: 1) clinical features--presence of lymphadenopathies (P less than .05) and hepatomegaly and/or splenomegaly (P less than .04); 2) haematologic parameters--presence of anaemia and/or thrombopenia (P less than .05), the absolute peripheral blood lymphocyte count (P less than .03), and the presence of hypogammaglobulinemia (P less than .08); 3) biochemical parameters--serum uric acid (P less than .03); and 4) bone marrow histopathological features--biopsy pattern (P less than .04) and the percentage of lymphocytes in bone marrow aspirate (P less than .03). Both the Rai staging and the International Workshop on CLL staging systems were effective in identifying groups of patients with significantly different prognoses (P less than .05). Multivariate regression analysis demonstrated that the combination of three clinicopathologic characteristics (bone marrow histopathologic pattern, absolute peripheral blood lymphocyte count, and the presence or not of hypogammaglobulinaemia) had the strongest predictive relationship with survival time. In summary, our findings show that the clinicobiological and anatomopathologic parameters have much more prognostic relevance than the immunological markers analysed in the present study.

Long survival in B-CLL correlates with surface IgM kappa phenotype

200 patients with B-cell chronic lymphocytic leukaemia (B-CLL) presenting to a single centre over 13 years have been studied. In 72.2% the diagnosis was made on an incidental blood count, and 70.1% were stage A at presentation. Those patients whose cells expressed surface IgM kappa were significantly more likely to be stage A at presentation and significantly less likely to have a lymphocyte count greater than 50 X 10(9)/l, to have progressive disease or to require treatment than those with other classes of surface Ig. Patients whose cells express surface IgM kappa have a significantly longer actuarial survival than others and this is also so when only patients in Binet stage A or when only patients presenting below the age of 75 are studied. By studying all of the cases presenting in a single catchment area we have attempted to avoid the bias against trivial disease likely to be seen in specialist referral centres.

Surface immunoglobulin pattern of the leukaemic cell population in chronic lymphocytic leukaemia (CLL) in relation to disease activity

The surface membrane immunoglobulin (smIg) isotype pattern of the leukemic lymphocytes was studied in 66 unselected patients with CLL. Five distinct patient groups were identified according to the dominant heavy chain isotype(s); I: smmu + (n = 22), II: smmu +/smdelta + (n = 25), III: smdelta + (n = 4), IV: smgamma + (n = 5), V: no detectable heavy chains (n = 10). The majority of group I patients had a progressive disease at test while all patients in group II were in a non-progressive state. Moreover, the smIg pattern changed with the clinical activity of the disease: when the disease progressed, the relative number of smmu + cells increased and when patients entered an indolent stage after treatment the smmu + cell population decreased. In patients with stationary disease the smIg pattern remained essentially unchanged or the relative number of smdelta + cells increased. These observations might suggest that the smIg isotype pattern of the leukemic cell population reflects the biological behaviour and the clinical activity of the disease.

Adenosplenomegaly and prognosis in uncomplicated and complicated chronic lymphocytic leukemia. A study of 362 cases

Presence and size of lymph nodes and spleen, graded from 0 to , in 362 patients with CLL observed from diagnosis were evaluated. Statistical analysis showed a relationship with age, sex, anemia and thrombopenia, leukocytosis, and outlined two different groups: the one without organomegalies , with higher mean age (67 years), female prevalence, and better prognosis; the other with adenosplenomegaly graded ++/ , with lower mean age (57 years), clear male prevalence, and worse prognosis. Survival results were statistically different only between groups 0/+ versus group ++/ . Important chronic diseases were present at diagnosis in approximately 25% of the cases, with a severely reduced survival (median, 27 months), close to that of the cases with anemia and/or thrombopenia (22 months). Therefore it seems that in every prognostic grouping system, complicated cases should be taken into account and grouped with the anemic and/or the thrombopenic ones. The following prognostic groups are proposed: I: low risk: cases without or with adenomegaly and/or splenomegaly + (65% surviving at 100 months); II: intermediate risk: cases with adenomegaly and/or splenomegaly ++/ (median survival, 70 months); III: high risk: cases complicated by chronic diseases, or with anemia and/or thrombopenia (median survival, 25 months).

Routine flow cytometric diagnosis of lymphoproliferative disorders

The results of the analysis of suspected lymphoproliferative disorders using flow cytometry (FACS II) over the past 12 months have been evaluated and assessed with respect to "conventional" microscopical examination. The major advantages in using these methods is the speed, the number of parameters which are capable of measurement, the sensitivity, and the ability to quantitate large numbers of cells for a particular criterion. These qualities have proved extremely helpful in the diagnosis of chronic lymphocytic leukemia, acute lymphoblastic leukemia, lymphoma, and other abnormalities. The combination of flow cytometry and a panel of monoclonal antisera (many of which are available commercially) allows the investigator a system of fine resolution which can confidently identify or characterize an abnormal clone or population of cells. With the increase in advanced flow cytometers, it is suggested that time should be allocated for the routine analysis of possible lymphomas and leukemias to allow quick and accurate evaluations of the disease status.

Impairment of neutrophil chemotaxis by serum from patients with chronic lymphoproliferative disease

The sera of 74 individuals with chronic lymphoproliferative disease were screened for the presence of inhibitory activity against neutrophil chemotaxis. This was present in more than half the patients with IgA myeloma and Hodgkin's disease but was less common in chronic lymphocytic leukaemia, lymphocytic lymphoma and non-IgA paraproteinaemia. Heating the sera prior to testing frequently enhanced inhibitory activity particularly in myeloma and lymphoma.

Chronic lymphocytic leukemia. Immunologic markers and functional properties of the leukemic cells

In 230 cases of chronic lymphocytic leukemia (CLL), marker analysis was performed with rosette techniques and a panel of xeno-antisera. A monoclonal B-cell proliferation was found in the majority of cases (94%). In most cases, the B-cells carried IgM, with or without IgD. Cytoplasmic immunoglobulin-inclusion bodies were seen in 7% of the cases of B-CLL. The number of patients with non-B/non-T-CLL was small (2%) in this series. In eight patients (4%), a proliferation of T-cells was established. These patients had a different clinical presentation and marker analysis of the lymphocytes, together with functional studies, showed that this group represented a mixture of different disease processes. Functional analysis of the B-CLL cells in 19 cases showed a poor or absent mitogen response and in nine cases the absence of the capacity to differentiate in vitro into plasma cells and/or to produce immunoglobulins.

Aggressive behavior of squamous cell carcinoma in a patient with preceding lymphocytic lymphoma

Actinically induced squamous cell carcinomas of the skin (SCC) are generally considered nonaggressive and usually curable tumors. However, in patients with lymphoma or leukemia, these tumors may behave in an extremely aggressive manner. We report a case in which an actinically induced SCC occurred in a patient with preceding lymphocytic lymphoma. The tumor progressed from a localized lesion to an invasive destructive lesion which resulted in death. The occurrence of SCC in patients with lymphoma or leukemia possibly should be more aggressively treated, early in its course.

Well-differentiated lymphocytic leukemia in a dog: long-term survival without therapy

Well-differentiated lymphocytic leukemia was found during routine hematologic examination of a 12-year-old female poodle with signs of anxiousness, panting and pica. The total white blood cell count was 106,900/microliters and at least 90% of the leukocytes were small, normal-appearing lymphocytes. The dog was examined several times during a 23-month period before it was killed at the owner's request for conditions unrelated to the leukemia. The hematologic picture of the leukemia was essentially unchanged during this time. A deep nuclear cleft was seen in most lymphocytes examined by electron microscopy. Cell surface markers showed most blood lymphocytes to be B-cells. These cells responded poorly to mitogen stimulation.

Aggressive biologic behavior of basal- and squamous-cell cancers in patients with chronic lymphocytic leukemia or chronic lymphocytic lymphoma

Three basal- and four squamous-cell carcinomas in seven patients with chronic lymphocytic leukemia or chronic lymphocytic lymphoma recurred repeatedly after conventional treatment, and grew to large sizes. The squamous-cell carcinomas metastasized in all four of the patients so afflicted. Absolute numbers of circulating T lymphocytes were normal in the seven patients, but they had cutaneous anergy to intradermal tests with common antigens and to dinitrochlorobenzene. The following recommendations for management of cutaneous carcinomas in patients with malignant lymphomatoses are made: 1) closer surveillance than for patients with cutaneous cancers but without malignant lymphomatoses, 2) early treatment of actinic keratoses to prevent possible transformation to malignancy, and 3) microscopically controlled excision of basal- or squamous-cell carcinomas larger than 1 cm in diameter.

Hairy-cell leukaemia: a B-lymphocytic disorder

Fifteen cases of histologically proven hairy-cell leukaemia (HCL) were studied with immunofluorescence, rosette, and phagocytosis techniques. Unfixed hairy cells (HC) bound all kinds of labelled antiserum; but after fixation with formaldehyde a much more selective binding was observed. In two cases no surface-bound Ig was detected; four cases showed gamma and in nine cases two or three heavy chains were found, alpha and delta being the most frequent. Few cases were clearly positive for mu. The picture was invariably monoclonal with respect to light chains. Cytoplasmic Ig was present in only 3/15 cases; it was always IgM. HC did not form E-rosettes or react with a fluorescent anti-T cell antiserum. No EAIgMC-rosettes were formed. All cases showed Fc receptors, which were detected with EAIgG-rosettes (13/13) or with antigen-antibody complexes (6/6). The density of Fc receptors varied widely. Incubation with latex particles resulted in cell-associated particles in 16-63% of the HC; with Staphylococcus epidermidis, the percentage was 2-36. After enzyme treatment (lysostaphin), however, no ingested bacteria were found, which suggests that HC are essentially non-phagocytic. At least 13 cases were therefore classified as B-cell malignancies.

Identification of a pure splenic form of chronic lymphocytic leukaemia

We have recently proposed a new staging system for chronic lymphocytic leukaemia (CLL) in which patients with isolated splenomegaly are classified into a distinct stage (stage II). Twenty-three such patients (from two institutions) have been studied without recorded death in a follow-up of 18 months to 30 years. This favourable prognosis justifies separation of these 'pure splenic forms' (SCLL) which must be distinguished from what Galton has termed prolymphocytic leukaemia (PL). This distinction can be made on the basis of three criteria: (i) Clinically, SCLL has a slow uneventful course and neither anaemia and/or thrombocytopenia: (ii) cytologically PL can be distinguished from other forms of CLL though atypical forms of CLL may be confused with the former; and (iii) the study of surface membrane immunoglobulins (SmIg) showed that while lymphocytes from most patients with both PL and SCLL bore uniform SmIg, suggesting a monoclonal B-cell proliferation, there was a major quantitative difference in that whereas PL lymphocytes had a number of antigenic sites close to that of normal lymphocytes (mean: 82 000 sites per cell), SCLL lymphocytes had a drastically reduced number of sites. It is our opinion that this is an important criterion for the differential diagnosis between PL and SCLL.