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Cutaneous, Purpuric Painful Nodules Upon Addition of Ibrutinib to RCVP Therapy in a CLL Patient: A Distinctive Reaction Pattern Reflecting Iatrogenic Th2 to Th1 Milieu Reversal. Am J Dermatopathol 2016; 38:492-8. [DOI: 10.1097/dad.0000000000000441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Monoclonal B-cell lymphocytosis (MBL) is a preclinical hematologic condition wherein small numbers of clonal B cells can be detected in the blood of otherwise healthy individuals. Most MBL have a surface immunophenotype nearly identical to that of chronic lymphocytic leukemia (CLL), though other phenotypes can also be identified. MBL has been shown to be a precursor state for CLL, but most MBL clones are quite small and apparently have minimal potential to progress of CLL or other B-cell lymphoproliferative disorder (B-LPD). The investigation of MBL as a precursor state for CLL will likely lead to important insights into mechanisms of disease pathogenesis. The review will cover clinical and translational aspects of MBL, with a particular emphasis on the prevalence of MBL; the relationship between MBL, CLL, and other B-LPDs; and the capacity of MBL to modulate the normal B- and T-cell compartments.
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Affiliation(s)
- Mark C Lanasa
- Department of Medicine, Duke University Medical Center, Box 3872, 1 Trent Drive, Morris Building Room 25153, Durham, NC 27710, USA.
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Lanasa MC. Novel insights into the biology of CLL. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2010; 2010:70-76. [PMID: 21239773 DOI: 10.1182/asheducation-2010.1.70] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Significant advancements in the care of patients with chronic lymphocytic leukemia (CLL) have occurred over the past decade. Nonetheless, CLL remains incurable outside of allogeneic transplantation. CLL is the most common leukemia in the United States and Europe, and new treatments and therapeutic strategies are clearly needed. To address this need, the pathogenesis of CLL has been an area of intense ongoing investigation. These international efforts illuminate a complex biology that is reliant on the interplay of inherited, environmental, and host factors. This broad review will discuss the recent advances in our understanding of CLL biology including the elucidation of inherited and acquired genetic changes; the role of the B-cell receptor and B-cell receptor signaling; CLL cell kinetics; and the interactions in the microenvironment between CLL cells, other immune cells, and stromal elements. This improved understanding of disease pathogenesis is facilitating the development of novel therapeutic treatment strategies.
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MESH Headings
- Humans
- Kinetics
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Models, Biological
- Receptors, Antigen, B-Cell/genetics
- T-Lymphocytes/pathology
- Tumor Microenvironment/genetics
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Affiliation(s)
- Mark C Lanasa
- Division of Medical Oncology, Duke University Medical Center, Durham NC 27710, USA.
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Crockard AD, Alexander HD, Stephenson CF, McCrea P, Desai ZR, Morris TCM, McNeill TA. An Analysis of Circulating CD4 Lymphocyte Subpopulations in B-Cell Chronic Lymphocytic Leukaemia. Leuk Lymphoma 2009; 3:127-33. [DOI: 10.3109/10428199009050986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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5
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Katrinakis G, Kyriakou D, Alexandrakis M, Sakellariou D, Foudoulakis A, Eliopoulos GD. Evidence for involvement of activated CD8+/HLA-DR+ cells in the pathogenesis of neutropenia in patients with B-cell chronic lymphocytic leukaemia. Eur J Haematol 1995; 55:33-41. [PMID: 7615048 DOI: 10.1111/j.1600-0609.1995.tb00230.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
B-cell chronic lymphocytic leukaemia (B-CLL) is often associated with peripheral blood cytopenias resulting, in most cases, from bone marrow infiltration, hypersplenism, or circulating autoantibodies. The present study was undertaken to investigate the possible involvement of a cell-mediated suppression of granulopoiesis in these patients. We studied two groups of patients, 8 neutropenic and 26 non-neutropenic, defined by the arbitrarily taken cutoff count of 2000 neutrophils/microliters. We found that neutropenic patients had higher numbers of peripheral blood CD3+, CD8+ and CD57+ cells, and higher numbers of activated CD8+/HLA-DR+ cells than the non-neutropenic ones. A negative correlation between CD8+ cells and circulating neutrophils, and a suggested negative correlation between CD8+/HLA-DR+ cells and circulating neutrophils were noted in the patients studied. Furthermore, we investigated the capacity of immunomagnetically isolated CD8+ cells to inhibit in vitro colony formation by normal granulocyte/macrophage colony-forming units (CFU-GM) and we found that inhibition was more pronounced when CD8+ cells, added in the culture, were derived from neutropenic than from non-neutropenic patients. The degree of colony inhibition correlated with the number of circulating neutrophils and the numbers of CD8+ and CD8+/HLA-DR+ cells in the patients studied. Since tumour necrosis factor-alpha (TNF-alpha) has been reported to be involved in myelosuppression, we also investigated the capacity of isolated CD8+ cells to release this cytokine into the culture supernatant fluids, and we found that comparable amounts of TNF-alpha were produced after stimulation in both neutropenic and non-neutropenic patients. Elevated serum TNF-alpha concentrations were noted only in a number of neutropenic and non-neutropenic patients. All these data taken together provide strong evidence that a T-cell subpopulation of activated CD8+/HLA-DR+ cells may be involved in the pathogenesis of neutropenia, at least in a subset of B-CLL patients, suppressing myelopoiesis by a TNF-alpha-unrelated mechanism. Efforts to isolate this cell subpopulation by flow cytometry for further analysis and a better understanding of its effect on myelopoiesis in patients with B-CLL are in progress in our laboratory.
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Affiliation(s)
- G Katrinakis
- Division of Haematology, University of Crete School of Medicine, University Hospital of Heraklion, Greece
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Everaus H, Lehtmaa J, Luik E, Kŏdar H. Immune and hormonal changes in early-stage chronic lymphocytic leukemia patients. Ann Hematol 1992; 65:219-23. [PMID: 1457579 DOI: 10.1007/bf01703948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fifty-six previously untreated stage-I (according to Rai) chronic lymphocytic leukemia (CLL) patients were examined for their clinical data, immunological characteristics, and hormonal values. Dysfunction of T and B lymphocytes was demonstrated by changed lymphocyte blastogenic response to stimulation with phytohemagglutinin (PHA), concanavalin A (ConA), pisum sativatum agglutinin (PSA), wheat germ agglutinin (WGA), recombinant interleukin 2 (IL 2), and dextran sulfate (DxS); also by decreased immunoglobulin levels (IgG, IgA, IgE) and increased beta 2-microglobulin (beta 2-M) values. Simultaneously, dysregulation of the hypothalamic-pituitary-adrenal axis, immune system integration, imbalance of sex hormones, and changes in thyroid hormones were observed in the same group of patients. Disturbed immunohormonal interactions in early-stage CLL may be responsible for the pathogenetic mechanisms in this lymphoproliferative malignancy.
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Affiliation(s)
- H Everaus
- Department of Internal Medicine, University of Tartu, Estonia
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Abstract
The mechanisms underlying abnormal T-cell function in B-chronic lymphocytic leukemia (B-CLL) are unknown. We have studied B-CLL T-cell activation pathways in the rigorous absence of leukemic cells and with controlled numbers of accessory cells present. The responsiveness to added recombinant IL-1 and IL-2 was assessed. We have found that under optimal culture conditions B-CLL T cells had a normal PHA-induced proliferative response in terms of incorporated 3H-thymidine per T cell. Also the capacity of mitomycin-C treated B-CLL monocytes to support autologous T-cell mitogenesis was normal. However, a subtle difference between normal and B-CLL T cells emerged with respect to cytokine responsiveness. While the PHA response of purified normal T cells in the absence of monocytes was augmented by rIL-1, this could not be demonstrated for B-CLL T cells. A much greater degree of augmentation occurred with added rIL-2 in the case of both normal and B-CLL T cells. In the presence of 20% autologous monocytes rIL-1 and rIL-2 had no effect on mitogenesis. We conclude that B-CLL T cells have an abnormal profile of cytokine responsiveness which is consistent with observed abnormalities of subset distribution, and which may contribute to the clinical immunodeficiency in B-CLL.
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Affiliation(s)
- P G Briggs
- Department of Nephrology, Prince Henry's Hospital, Melbourne, Australia
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Terstappen LW, de Grooth BG, Segers-Nolten I, Greve J. Cytotoxic lymphocytes in B-cell chronic lymphocytic leukemia. A flow cytometric study of peripheral blood, lymph nodes and bone marrow. BLUT 1990; 60:81-7. [PMID: 1689193 DOI: 10.1007/bf01720512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The occurrence of cytotoxic lymphocyte subpopulations (i.e., CD 16+, CD 57+ and cytotoxic CD 8+) wa studied in the peripheral blood of 18 B-cell chronic lymphocytic leukemia (B-CLL) patients. The absolute numbers of CD 57+, CD 16+ and cytotoxic CD 8+ lymphocytes were increased in the peripheral blood of untreated patients as compared with healthy donors, suggesting a causal relation with the accumulation of malignant B-cells. For 5 B-CLL patients and 5 hematological normal donors, the lymphocyte subpopulations in peripheral blood, lymph nodes and bone marrow were determined. A significant immune response was observed in the lymph nodes of the patients, as reflected by the CD 3+ lymphocytes, which were 1.7-27 times larger in the patients lymph nodes than in their peripheral blood and bone marrow. In contrast, with peripheral blood this was mainly caused by an increase in CD 4+ lymphocytes. The CD 57 lymphocytes in the lymph nodes of the patients had abnormal orthogonal light-scattering signals and an abnormal density of CD 57+ receptors in comparison with their peripheral blood CD 57+ lymphocytes or the CD 57+ lymphocytes in the peripheral blood, bone marrow and tonsils of the hematological normal donors. This study shows that although a significant increase of cytotoxic lymphocytes in the peripheral blood of B-CLL patients is observed, the actual distributions of the non-malignant lymphocytes can be quite different at the actual tumor sites, i.e., bone marrow and lymph nodes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, Differentiation, T-Lymphocyte/analysis
- Bone Marrow Cells
- CD3 Complex
- CD4 Antigens/analysis
- CD57 Antigens
- CD8 Antigens
- Flow Cytometry
- Humans
- Leukemia, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymph Nodes/cytology
- Middle Aged
- Receptors, Antigen, T-Cell/analysis
- T-Lymphocytes, Cytotoxic/immunology
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Affiliation(s)
- L W Terstappen
- University of Twente, Department of Applied Physics, Enschede, The Netherlands
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Apostolopoulos A, Symeonidis A, Zoumbos N. Prognostic significance of immune function parameters in patients with chronic lymphocytic leukaemia. Eur J Haematol 1990; 44:39-44. [PMID: 2137786 DOI: 10.1111/j.1600-0609.1990.tb00345.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We determined immune function parameters in 41 newly diagnosed patients with chronic lymphocytic leukaemia (CLL) and correlated these findings with the clinical data and the subsequent course of the disease. The ratio of helper to suppressor T cells (CD4/CD8), the proportion of circulating natural killer (NK) cells and the NK activity were significantly low in clinical stage B and C patients. Among patients presenting with advanced disease, those who subsequently had a more severe course, characterised mainly by frequent respiratory infections, were found to have at presentation a significantly lower CD4/CD8 ratio (x +/- SEM = 0.95 +/- 0.09, vs 1.28 +/- 0.14), a very low proportion of NK cells (4.78 +/- 0.85, vs 11.75 +/- 2.1%) and decreased amount of gamma-globulins (0.66 +/- 0.08, vs 0.97 +/- 0.09 g/dl), in comparison with patients with a much milder later course. These simple parameters of immune function seem to have prognostic value for patients with CLL.
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MESH Headings
- Antigens, CD/analysis
- Antigens, Differentiation, T-Lymphocyte/analysis
- CD4 Antigens/analysis
- CD8 Antigens
- Humans
- Killer Cells, Natural/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphocytes/cytology
- Neoplasm Staging
- Prognosis
- T-Lymphocytes/immunology
- T-Lymphocytes, Regulatory/immunology
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Affiliation(s)
- A Apostolopoulos
- Department of Internal Medicine, Patras University Medical School, Greece
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Terstappen LW, de Grooth BG, van Berkel W, ten Napel CH, van Reijn M, Greve J. The effects of splenic irradiation on lymphocyte subpopulations in chronic B-lymphocytic leukemia. Eur J Haematol 1988; 41:496-505. [PMID: 3264792 DOI: 10.1111/j.1600-0609.1988.tb00233.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We describe the effect of splenic irradiation (SI) (0.5-1 Gy weekly) on lymphocyte subpopulations for 7 patients with progressive B chronic B-lymphocytic leukemia (B-CLL). Using specific cellular characteristics we could distinguish normal from abnormal cells. The irradiation resulted in a decrease of lymph node size, reduction in spleen volume and decrease in peripheral blood lymphocytes. The one exception was a patient with a prolymphocytoid transformation of B-CLL. For 3 patients SI had to be interrupted or stopped because of severe cytopenia. Quantitation of malignant B cells and normal T lymphocytes revealed that the total irradiation dose which resulted in a specific decrease of malignant lymphocytes varied from patient to patient. Normal T-cell subpopulations, which were increased before SI, decreased to normal or abnormally low values during SI. In previously untreated patients, natural killer (NK) cell numbers decreased more rapidly than T-cell subpopulations. For 2 patients refractory to chemotherapy an increase of NK cells was observed upon SI.
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Affiliation(s)
- L W Terstappen
- Twente University of Technology, Department of Applied Physics, Enschede, The Netherlands
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Kurec AS, Baltrucki L, Mason DY, Davey FR. Use of the APAAP Method in the Classification and Diagnosis of Hematologic Disorders. Clin Lab Med 1988. [DOI: 10.1016/s0272-2712(18)30708-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Terstappen LW, de Grooth BG, van Berkel W, ten Napel CH, Greve J. Abnormal distribution of CD8 subpopulation in B-chronic lymphocytic leukemia identified by flow cytometry. Leuk Res 1988; 12:551-7. [PMID: 2459562 DOI: 10.1016/0145-2126(88)90084-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We studied the occurrence of T-cell subpopulations for patients with B-cell chronic lymphocytic leukemia. The CD8+ population was divided into CD8+ suppressor (CD8a+) and CD8+ cytotoxic (CD8b+) lymphocytes using difference in orthogonal light scattering. Average CD4+/CD8+ ratios determined for all patients were decreased. For individual patients this sometimes was not true. In contrast CD4+/CD8a+ ratios were markedly increased in all individual patients. The CD8+ lymphocytes appeared to consist mainly of CD8b+ lymphocytes. Moreover the CD8b+/CD8+ ratio correlated with clinical stage: untreated patients (stage 0 of Rai) have smaller CD8b+/CD8+ ratios than patients with advanced stages of Rai.
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Affiliation(s)
- L W Terstappen
- Twente University of Technology, Department of Applied Physics, Enschede, The Netherlands
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Hautekeete ML, De Bock RF, Van Bockstaele DR, Colpin GC, Berneman ZN, Peetermans ME. Flow cytometric analysis of T-lymphocyte subpopulations in B-cell chronic lymphocytic leukemia: correlation with clinical stage. BLUT 1987; 55:447-52. [PMID: 3499946 DOI: 10.1007/bf00367462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Several authors have studied the T-lymphocyte subpopulations in B-cell chronic lymphocytic leukemia (B-CLL), but previous studies were performed after preceding enrichment procedures, which are known to cause selective losses of certain subpopulations. To correct for this deficiency we used flow cytometric analysis, which enabled us to measure subpopulations directly on total blood samples. We studied T-lymphocyte subsets with OKT monoclonal antibodies in 45 patients with B-CLL. Serum levels of IgG, IgA and IgM were assayed simultaneously and findings were correlated with clinical stage (Rai classification). The absolute number of CD4-positive cells decreased in more advanced Rai stages, while the absolute number of CD8-positive cells increased, resulting in a progressive reduction in CD4/8 ratio. Results from patients in stages with equal prognosis (Rai I and II, Rai III and IV) were similar and when these results were grouped the observed differences were highly significant and clearly correlated with all prognostic groups.
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Affiliation(s)
- M L Hautekeete
- Department of Haematology and Blood Transfusion, University of Antwerp (UZA), Egedem, Belgium
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Geisler CH, Larsen JK, Plesner T, Hansen M, Hansen MM. Lack of prognostic significance of T-lymphocyte subset counts in B-cell chronic lymphocytic leukaemia. Eur J Haematol 1987; 38:67-74. [PMID: 3495452 DOI: 10.1111/j.1600-0609.1987.tb01427.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the 50 newly diagnosed, unselected, untreated B-CLL patients, the absolute numbers of blood T cells, T-helper cells, and T-suppressor/cytotoxic cells were by flow cytometric counting of mononuclear cells labelled with the monoclonal antibodies Leu5 (T cells), Leu3a (T-helper cells), and Leu2a (T-suppressor/cytotoxic cells). These estimations and the serum concentrations of IgG, IgA, and IgM were correlated to clinical stage (International Workshop System) and pretreatment observation time. For all patients together, the mean counts of Leu5+, Leu3+, and Leu2+ cells were significantly increased compared with the mean counts in 12 healthy controls (Mann-Whitney). In patients with advanced disease (stage B + C), both T-subset mean cell counts were significantly increased, whereas in patients with early-stage disease (stage A), although some high T-helper cell counts were noted, only the T-suppressor/cytotoxic mean cell count increase reached significance. Thus a trend was observed of a more frequent T-suppressor/cytotoxic cell predominance in early-stage disease, which is the opposite of the findings in most other prognostic studies. However, there was no significant difference in pre-treatment observation time according to T-helper: T-suppressor cell ratio below vs. above 1.0, irrespective of stage, whereas according to clinical stage, the pretreatment observation time in stage A was highly significantly longer than in stage B + C (logrank test). Thus, no independent prognostic significance of T-subset counts was found as judged by pretreatment observation time. No correlation was found between the occurrence of hypogammaglobulinaemia, T-subset ratios or T-subset counts.(ABSTRACT TRUNCATED AT 250 WORDS)
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el'Agnaf MR, Ennis KE, Morris TC, Robertson JH, Markey G, Alexander HD. Successful remission induction with deoxycoformycin in elderly patients with T-helper prolymphocytic leukaemia. Br J Haematol 1986; 63:93-104. [PMID: 2939873 DOI: 10.1111/j.1365-2141.1986.tb07499.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Two elderly patients with prolymphocytic leukaemia (PLL) of T helper phenotype were treated with the adenosine deaminase inhibitor--deoxycoformycin--and achieved remission. The first patient has remained in an unmaintained remission for over a year. The second patient, treated with a regime which produced less side effects, subsequently relapsed in skin and lymph nodes and died. In view of the rarity of this condition a multi-centre assessment of the effectiveness of deoxycoformycin is indicated. T-lymphocyte colony formation in both cases was found to be reduced. Co-culture of the patients' lymphocytes with nonadherent mononuclear cells from normal individuals also showed inhibition of T-colony formation indicating that lack of nutrients or accessory cells was not responsible for low T-colony forming capacity.
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