Lymphoproliferative disease of "LAK cell" precursor large granular lymphocytes in association with celiac disease

We have investigated a case of lymphoproliferative disease of large granular lymphocytes (LDGL) occurring in association with celiac disease, anemia, neutropenia, and carcinomas of the endometrium, breast, and skin. The large granular lymphocyte (LGL) proliferation was monoclonal, T cell in origin, with T cell receptor beta-chain gene rearrangement, and a CD3+, CD8+, CD16+/- phenotype. In spite of the high frequency of LGL, natural killer (NK) cell activity was absent. Stimulation with interleukin-2 in vitro, however, resulted in high lymphokine-activated killer (LAK) cell activity against NK-resistant targets. The T-cell nature of the LAK precursor cells is in contrast to the majority seen in normal peripheral blood. Therapeutic trials of cyclosporin A, low-dose cyclophosphamide, and levamisole were unsuccessful in reducing transfusion requirements. This case is unique in the association of LDGL with celiac disease. It is also unique in that the patient had been followed for several years prior to the onset of the LDGL. The case extends the list of lymphoproliferative disorders documented to be associated with celiac disease and, conversely, adds to our knowledge of lymphoproliferative disorder of LGL and its "dysimmune" manifestations.

The Family Physician's Role in Managing Chronic Leukemia

This article provides a brief update on the clinical approach to chronic myelogenous leukemia and chronic lymphocytic leukemia, based on advances in pathbiology and the effect of new concepts on treatment policies. These disorders were selected because family physicians take most responsibility for the day-to-day management of these most common forms of chronic leukemias.

Use of the MTT assay for rapid determination of chemosensitivity of human leukemic blast cells

A microcytotoxicity assay employing a tetrazolium salt has been adapted for testing the response of human leukemic blast cells to a variety of chemotherapeutic agents. After exposure to various concentrations of drugs, the viability of fresh leukemic blast cells was measured using a tetrazolium salt, MTT, which is converted to blue formazan crystals by living cells. The amount of formazan produced was quantitated using a microtitre plate spectrophotometer. In the present study, optimal conditions for chemosensitivity testing of human leukemia samples were determined, and the relative chemosensitivity of five patient samples was tested.

A simple method for analysis of DNA histograms in human myeloid cells perturbed by stimulators of DNA synthesis

In the past, phase fractionation has been used as a determinate of the level of stimulation of cells perturbed by stimulators and inhibitors of DNA synthesis. This method has, in our hands, proven to be insensitive and unreliable with human myeloid cells. A new method of analysis is described in this paper which involves utilization of the magnitude of the slope of a line fit to the mid-portion of S phase as an index of the level of stimulation of cultured human myeloid cells. This method is fast, reliable and simple to implement on an inexpensive microcomputer.

Lithium and hematopoiesis

Some of lithium's effects on blood cell formation suggest that the element may be of value in treating hematologic disorders. Lithium enhances granulopoiesis and thereby induces neutrophilia. Two possible mechanisms of action are suggested: a direct action on the pluripotent stem cells, or an inhibition of the suppressor cells (thymus-dependent lymphocytes) that limit hematopoiesis. Lithium also inhibits erythropoiesis. Although most studies use concentrations at or above pharmacologic levels there is evidence that lithium plays a role in normal cell metabolism.

Factors influencing in vitro production of colony-stimulating factor by mononuclear leukocytes from humans

The purpose of this study was to identify factors that influence the production of colony-stimulating factor by leukocytes of humans. The use of nonadherent light-density bone marrow cells is semisolid agar cultures to assay the concentrations of colony-stimulating factor in the supernatant of monocyte and mononuclear leukocyte cultures made it possible to distinguish between colony-stimulating factor, which stimulates colony-forming cells directly, and monocyte-dependent stimulating activity, which acts indirectly, by increasing the monocyte production of colony-stimulating factor. Colony-stimulating factor was not detectable in the cytosol of monocytes; that detected in culture must, therefore, have been newly synthesized. Synthesis was enhanced independently by heat-inactivated human serum and by semipurified serum fractions enriched with monocyte-dependent stimulating activity. The kinetics of the production of colony-stimulating factor in the presence and absence of monocyte-dependent stimulating activity indicated that the latter facilitated monocyte production of the former. Factors released from neutrophils were shown to reduce the production of colony-stimulating factor and thr proliferation of colony-forming cells and thus may provide a feedback control mechanism limiting the proliferation of neutrophils.

Microvascular closure in malignant histiocytosis

Two patients with malignant histiocytosis were found to have capillary occlusion by aggregates of neoplastic histiocytes, in skeletal muscle in one, and in renal glomeruli in the other. One patient had clinical evidence of similar occlusions in the arterioles and capillaries of the ocular fundi. Occlusion of small vessels by tumour cells may explain the confusion of both patients.

Effect of lithium on granulopoiesis in culture

Lithium carbonate therapy is associated with polymorphonuclear leukocytosis. In vitro studies have shown that lithium ions stimulate formation of granulocytic colonies. In a study undertaken to determine how lithium acts, colony-forming cells uncontaminated by monocytes (which elaborate colony-stimulating factor [CSF] in vitro) were obtained by means of a two-step cell separation procedure. The effects of lithium on colony formation were then studied in (a) cultures stimulated by humoral CSF, (b) cultures in which monocytes were relied upon to synthesize CSF de novo and (c) unstimulated cultures. Lithium enhanced the action of CSF but did not stimulate colony formation in the absence of CSF. In monocyte-stimulated cultures, colony formation increased with lithium concentrations up to 1 mmol/L but this increase paralleled that in CSF-stimulated cultures and therefore was not due to increased CSF production by monocytes. At higher concentrations of lithium, colony formation decreased in the monocyte-stimulated cultures but increased in the CSF-stimulated cultures. A lithium concentration of 4 mmol/L gave the greatest enhancing effect on colony formation in CSF-stimulated cultures and a concentration greater than 1 mmol/L inhibited de novo synthesis of CSF by monocytes.

In vitro regulation of granulopoiesis in human leukemia: application of an assay for colony-inhibiting cells

We describe two assays to detect the action of colony-inhibiting cells. In the first assay, we used a simple density separation technique to remove dense neutrophils (PMN) from suspensions of blood and of bone marrow cells prior to culture in semisolid agar. Conditions were arranged to ensure that control suspensions of unseparated cells and test suspensions of buoyant mononuclear cells differed only in their content of neutrophils. The control and test suspensions contained equal numbers of mononuclear cells (and granulocyte precursors). Colony (and cluster) formation was invariably enhanced in neutrophil-depleted cultures of normal cells. In the second assay, dense PMN, treated by an adherence separation procedure, were recovered, and the non-adherent dense PMN were added back to PMN-depleted cultures. A reproducible dose-related decrease in colony (and cluster) formation to basal levels resulted. The inhibitory effect was identical when the PMN were added directly to the culture (overlayer) or to the underlayer. In PMN-depleted cultures obtained from patients with leukemia and other hemopoietic disorders, neither colony nor cluster formation was enhanced, and sometimes it was reduced. When we compared the effect of adding patient and normal non-adherent PMN to target cultures of normal and patient PMN-depleted cells, some leukemic PMN were noninhibitory. Our results suggest that abnormalities of cellular interactions in vitro detected in the first assay may have more than one explanation, as shown when they are subjected to the closer scrutiny possible with the second assay.

Relationship of colony-stimulating activity to apparent kill of human colony-forming cells by irradiation and hydroxyurea

Suspensions of human bone marrow cells were subjected to 137Cs irradiation in vitro and then cultured in semisolid agar medium. Cultures of irradiated cells were stimulated with colony-stimulating activity (CSA) of different potencies, and it was found that the amount of stimulation applied to cultures influenced the apparent kill of colony-forming cells (CFC). It was also found that the effects of irradiation on colony formation were not confined to CFC kill since medium conditioned by cells during irradiation exhibited stimulatory and inhibitory properties after treatment by 600 and 1000 rads, respectively. Studies in which irradiated cells were pretreated with hydroxyurea indicated that CFC in the DNA synthetic phase of the cell cycle were particularly sensitive to low doses of irradiation. The proliferative capacity of CFC surviving 1000 rads was undiminished as judged by their ability to form large colonies. Estimates of CFC kill by hydroxyurea were also affected by the level of CSA.

Isoimmune haemolysis in pathogenesis of anaemia after cardiac surgery

A patient who had received multiple transfusions developed antiglobulin-positive haemolytic anaemia due to a delayed haemolytic transfusion reaction. Many cases of haemolytic anaemia after cardiac surgery could be explained on this basis.

Control of granulopoiesis in man.III. inhibition of colony formation by dense leukocytes

Cellular feeder layers, prepared from normal blood leukocytes, usually stimulate human marrow to form colonies. A significant increase in the stimulating activity of unseparated leukocyte feeder layers is brought about following the removal of dense leukocytes in a manner which avoids enrichment of any remaining cell type. Restoration of dense leukocytes to a dense leukocyte depleted leukocyte feeder layer results in the reduction of stimulating activity to that of an unseparated leukocyte feeder; however, addition of dense leukocytes to unseparated leukocyte feeder layers has no effect on the stimulatory activity, over the range of concentrations used in this study.

Studies on control of granulopoiesis in man. II. Influence of circulating neutrophil count on release of labelled bone marrow cells

Leukocyte kinetic studies were performed by labelling neutrophilic leukocytes in vivo with radioactive diisopropylfluorophosphate and measuring the time taken for the label to traverse the myelocyte compartment, marrow granulocyte reservoir and blood (myelocyte-to-tissue transit time). Leukocyte specific activity (LSA) reached background levels within 17 to 22 days in normal subjects and more rapidly than normal in patients with neutropenia due to hypersplenism or marrow aplasia. When neutropenia was partially or completely corrected by splenectomy the label disappeared more slowly. In patients with stable neutrophilia the label disappeared slowly and a terminal plateau in the LSA curve was encountered. Analysis of LSA curves suggests that disappearance of labelled neutrophil cohorts is influenced by circulating neutrophil levels, not only by an effect on release of cells from the marrow granulocyte reservoir but also, directly or indirectly, by an effect on myelocyte proliferation.

Studies on control of granulopoiesis in man. I. Relationship of leukocyte colony-stimulating activity in vitro to neutrophil count in vivo

We examined the relationship of leukocyte colony-stimulating activity (CSA) in vitro to neutrophil count in vivo. Using a standard two-layer system, cultures of 10(6) leukocytes were assayed for their ability to stimulate colony formation by human bone marrow colony-forming cells. The total leukocyte CSA per ml (TLCSA) of blood varied directly with the blood neutrophil count in a group of patients with a wide range in blood neutrophil count, and in two patients recovering from neutropenia in whom serial observations were made. In the latter two patients the rise in TLCSA did not antedate the rise in blood neutrophil count, suggesting that blood leukocyte colony-stimulating factor (CSF) per se probably has little biologic significance. However, release into the circulation of cells which generate CSF could be an important way of controlling the amount of CSF acting within the marrow. In one patient the CSA of dialyzed serum increased after the rise in TLCSA, while undialyzed serum contained no CSA.

Studies on the exchange of leukocytes between blood and bone marrow in chronic myelogenous leukemia

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The mechanism of action of splenic irradiation in chronic myelogenous leukemia

The mechanism of action of splenic irradiation in the induction of a remission in chronic myelogenous leukemia was investigated in six patients using a leukocyte kinetic approach. The leukocytes were labelled in vitro with radioactive diisopropylfluorophosphate-32 and returned to the circulation. The effect of treatment on the rate of change of leukocyte specific activity was determined. The results suggest (1) that irradiation of the spleen damages granulopoietic cells as they cycle back and forth between the spleen, blood and other extravascular compartments; (2) that damage to exchangeable granulopoietic cells in transit through the irradiated spleen may explain the long remission often encountered after this form of therapy.

Studies on the longevity, sequestration and release of the leukocytes in chronic myelogenous leukemia

The intravascular life-span of leukocytes labelled in vitro with radioactive di-isopropylfluorophosphate was studied in 12 patients with chronic myelogenous leukemia (CML). In relapse, leukocyte specific activity (LSA) disappeared slowly; in remission, LSA curves approached normal and only a small proportion of LSA disappeared slowly. The level of maturation of the leukocytes that persisted in the blood was investigated by a leukocyte fractionation technique which excluded immature myeloid cells from leukocyte samples. The influence of extracorpuscular factors upon the pattern of disappearance of LSA was investigated by means of cross-transfusion experiments, and LSA curves obtained with in vitro and in vivo labelling were compared. The results suggest that: (1) the intravascular life-span of the mature leukemic neutrophil is prolonged in relapse and in remission; (2) intrinsically abnormal leukocytes are sequestered in an extravascular pool(s) but recycling occurs; (3) extracorpuscular factors modify the LSA curves; (4) exchange of leukocytes between intravascular and extravascular pools may not occur in relapse; and (5) the intravascular and extravascular pools constitute a self-sustaining pool(s) not replenished from a non-miscible precursor pool.