CD39 expression on T lymphocytes correlates with severity of disease in patients with chronic lymphocytic leukemia

INTRODUCTION

Chronic lymphocytic leukemia (CLL) is a B-cell disorder, but it is also associated with abnormalities in T-lymphocyte function. In this study we examine changes in T-lymphocyte CD39 and CD73 expression in patients with CLL.

METHODS

Blood samples were drawn from 34 patients with CLL and 31 controls. The cells were stained for CD3, CD4, CD8, CD19, CD39, and CD73 and analyzed by flow cytometry.

RESULTS

Overall, patients with CLL had a higher percentage of CD39(+) T lymphocytes than did controls. The percentage of cells expressing CD39 was higher in both CD4(+) cells and CD8(+) cells. Higher CD3/CD39 expression was associated with a later disease stage. No correlations between T-lymphocyte CD39 levels and CD38 or Zap-70 expression were observed. In contrast, the percentage of T lymphocytes and B lymphocytes that expressed CD73 was decreased in patients with CLL. Average B-lymphocyte CD73 expression was decreased in CLL because the majority of CLL clones were CD73. However a minority of CLL clones were CD73(+), and patients with CD73(+) clones tended to have earlier stage disease.

CONCLUSION

T-lymphocyte CD39 and CD73 expression may be useful prognostic markers in patients with CLL. Expression of CD73 on the malignant cell population in CLL may be a marker of better prognosis.

CD39 activity correlates with stage and inhibits platelet reactivity in chronic lymphocytic leukemia

Background

Chronic lymphocytic leukemia (CLL) is characterized by accumulation of mature appearing lymphocytes and is rarely complicated by thrombosis. One possible explanation for the paucity of thrombotic events in these patients may be the presence of the ecto-nucleotidase CD39/NTDPase-1 on the surface of the malignant cells in CLL. CD39 is the major promoter of platelet inhibition in vivo via its metabolism of ADP to AMP. We hypothesize that if CD39 is observed on CLL cells, then patients with CLL may be relatively protected against platelet aggregation and recruitment and that CD39 may have other effects on CLL, including modulation of the disease, via its metabolism of ATP.

Methods

Normal and malignant lymphocytes were isolated from whole blood from patients with CLL and healthy volunteers. Enzyme activity was measured via radio-TLC assay and expression via FACS. Semi-quantititative RT-PCR for CD39 splice variants and platelet function tests were performed on several samples.

Results

Functional assays demonstrated that ADPase and ATPase activities were much higher in CLL cells than in total lymphocytes from the normal population on a per cell basis (p-value < 0.00001). CD39 activity was elevated in stage 0–2 CLL compared to stage 3–4 (p < 0.01). FACS of lymphocytes demonstrated CD39 expression on > 90% of normal and malignant B-lymphocytes and ~8% of normal T-lymphocytes. RT-PCR showed increased full length CD39 and splice variant 1.5, but decreased variant 1.3 in CLL cells. Platelet function tests showed inhibition of platelet activation and recruitment to ADP by CLL cells.

Conclusion

CD39 is expressed and active on CLL cells. Enzyme activity is higher in earlier stages of CLL and decreased enzyme activity may be associated with worsening disease. These results suggest that CD39 may play a role in the pathogenesis of malignancy and protect CLL patients from thrombotic events.

The hematological complications of alcoholism

Alcohol has numerous adverse effects on the various types of blood cells and their functions. For example, heavy alcohol consumption can cause generalized suppression of blood cell production and the production of structurally abnormal blood cell precursors that cannot mature into functional cells. Alcoholics frequently have defective red blood cells that are destroyed prematurely, possibly resulting in anemia. Alcohol also interferes with the production and function of white blood cells, especially those that defend the body against invading bacteria. Consequently, alcoholics frequently suffer from bacterial infections. Finally, alcohol adversely affects the platelets and other components of the blood-clotting system. Heavy alcohol consumption thus may increase the drinker's risk of suffering a stroke.

The association of thrombocytopaenia and Lyme disease

The association of asymptomatic thrombocytopaenia in six patients with acute Lyme disease is described. Recovery from thrombocytopaenia occurred shortly following antibiotic therapy. Patients residing in endemic areas for Lyme disease who present with flu-like symptoms and laboratory findings of thrombocytopaenia should prompt suspicion of acute Lyme disease. Appropriate clinical studies should be undertaken to confirm the diagnosis.

Life-threatening haemorrhage in a patient with rheumatoid arthritis and a lupus anticoagulant coexisting with acquired autoantibodies against factor VIII

A case history of a patient with RA and a lupus anticoagulant coexisting with an acquired inhibitor to factor VIII is described. The factor VIII inhibitor was heralded by life-threatening haemorrhage which followed an invasive procedure.

The association of erythrocytosis and chronic lymphocytic leukemia

The authors report the clinical course of three patients with well-documented chronic lymphocytic leukemia (CLL) and concomitant erythrocytosis. Associated disorders included immune cytopenias, Hashimoto struma and Richter syndrome. Durable complete remissions of CLL have occurred in two patients. Inasmuch as a chance association of these two relatively rare hematologic disorders is unlikely, the available information suggests that a pluripotent stem cell with the capacity to differentiate into lymphoid and erythroid pathways is the most attractive hypothesis.

Chronic calcium antagonist use in carcinoma of the lung and colon: a retrospective cohort observational study

Detailed records were maintained prospectively of all medications taken by 719 patients with advanced carcinoma of the lung or colon. Of this total, a cohort of 19 patients was identified who had ingested incidentally either nifedipine, diltiazem, verapamil, or trifluoperazine in standard therapeutic doses for a minimum of one month and a mean of 5.8 months and median of three months. Treatment with these calcium antagonists was well tolerated and, upon comparison with otherwise comparable patients who did not ingest a calcium antagonist, appeared to be associated with certain favorable outcomes, including delayed tumor progression and prolonged survival. These preliminary findings suggest that beneficial effects of such drugs observed with chronic treatment in experimental animal tumor models may occur in human disease and that definitive prospective, randomized, clinical trials of calcium antagonists administered continuously in ordinary therapeutic doses are both feasible and justified.

Hematological complications of alcoholism

Numerous clinical observations support the notion that ethanol has multiple pathologic effects on hematopoietic tissue. The effects of alcohol on blood are diverse. The long-term ingestion of large quantities of ethanol has been shown to alter a substantial number of physiologic and biochemical variables. Abnormalities involving leukocytes, platelets, and erythrocytes may occur singly or in various combinations. Due to the frequent concomitant presence of alcohol-related hepatic disease, nutritional deficiencies, infection, and other chronic diseases, it is often difficult to distinguish the specific hematologic toxicities of alcohol ingestion from the hematologic toxicities of associated morbid conditions. Depressed hematopoietic cell formation (Table 2), increased destruction, and alterations in morphology and function of hematopoietic cells have been described.

Effect of mopidamol on survival in carcinoma of the lung and colon: final report of Veterans Administration Cooperative Study No. 188

Mopidamol (RA-233), a derivative of dipyridamole, is a phosphodiesterase inhibitor that has been shown previously to limit progression of malignancy in certain experimental animal models and in a pilot study in humans. RA-233 plus chemotherapy was compared with chemotherapy alone in a 5-year double-blind trial involving 719 patients with advanced carcinomas of the lung and of the colon. RA-233 treatment was associated with a statistically significant prolongation of survival in patients with non-small cell lung cancer (N-SCLC) limited to one hemithorax and with reduction in mean plasma fibrogen concentration. RA-233 was not toxic. The favorable effects on survival could not be explained by any factor other than the RA-233 treatment. In other tumor categories tested, no differences in survival were observed. These results suggest that RA-233 is useful in the treatment of N-SCLC of limited extent. They also suggest that therapeutic intervention aimed at modified intracellular pathways might constitute a novel investigative approach to the treatment of cancer.

Disseminated Kaposi's sarcoma without lymphocyte abnormalities

In a 24-year-old bisexual man with stage IV Kaposi's sarcoma, the typical immunologic alterations reported in other patients with disseminated Kaposi's sarcoma were not seen. Lymphopenia, a low helper-suppressor T-cell ratio, impaired lymphocyte responses to T- and B-cell antigens and mitogens, and abnormalities in cell-mediated immunity could not be demonstrated.

Cytoplasmic fragments causing spurious platelet counts in hairy cell leukemia: ultrastructural characterization

A patient with hairy cell leukemia had a spuriously elevated automated platelet count because of cytoplasmic fragments. The cytoplasmic fragments observed with electron microscopy were found in the same fraction as the platelets (platelet-rich plasma). Ultrastructural examination confirmed the hairy cell cytoplasmic origin of these fragments because of their obvious difference from platelet ultrastructure. Cytoplasmic fragments as a cause of spuriously high automated platelet counts should be considered in all cases of hairy cell leukemia. The blood smear can suggest these factitious events and should be used to confirm the platelet count. It is important to validate the automated platelet count even when reported values are within the normal range, since electronic counting may result in a spurious thrombocytosis or a spuriously normal count.

Alcohol-associated pancytopenia with hypocellular bone marrow

Two patients who presented with pancytopenia and bone marrow hypocellularity are described. Both patients had consumed alcohol in excess for many years, and one patient had previously presented with alcohol-associated thrombocytopenia and a hypocellular marrow. Marrow examinations revealed increased hemosiderin, vacuolated pronormoblasts and promyelocytes, and ringed sideroblasts. Serum and erythrocyte folate levels were normal. The marrow findings coupled with the long history of heavy alcohol consumption and documented alcohol-associated thrombocytopenia on two separate occasions in one patient, in the absence of known marrow toxins, support the notion that the marrow hypocellularity was alcohol associated.

Platelet aggregation in portal cirrhosis

Primary and secondary platelet aggregation in response to adenosine diphosphate was studied in 24 patients with portal (Laënnec) cirrhosis and compared with platelet aggregation in 14 normal subjects. In 12 patients with cirrhosis, platelet aggregation was diminished when compared to controls. Of the 12 patients with impaired aggregation, 6 had elevated levels of fibrinogen-fibrin degradation products (FDPs), 11 had thrombocytopenia, 10 had shortened euglobulin lysis times, 11 had prolonged bleeding times, 4 had hypofibrinogenemia, and all had prolonged thrombin clotting times. The data suggest that elevated levels of serum FDPs do not explain fully the impairment of platelet aggregation or the prolongation of the thrombin clotting time that was noted in patients with advanced liver disease. A possible explanation for the prolongation of the thrombin clotting time is the presence of "altered" plasma fibrinogen.

Childhood nephrosis followed by acute glomerulonephritis in adulthood

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