Chronic myelocytic leukemia terminating in blast cell crisis with lymphoblastic characteristics

A child with chronic myelocytic leukemia (CML), Philadelphia chromosome positive, developed a non-T cell, non-B cell, acute lymphocytic leukemia (ALL) during her blast cell crisis. The diagnosis was suggested by light microscopy and supported by histochemical stains and transmission electron microscopy. Immunologic studies showed the presence of a non-T, non-B leukemic blast population--indistinguishable from the most common form of ALL (null cell type). Markedly elevated terminal deoxynucleotidyl transferase (TdT) activity was found. The findings support the hypothesis that the primary cell involved in CML is a stem cell with pluripotential characteristics; frequently the blast cell proliferative phase terminates in acute myeloblastic leukemia, but it may also terminate in ALL. The TdT activity may be evidence of leukemic transformation and not necessarily related to the thymic origin of the lymphocytes.

Unique leukemic non-T/non-B lymphoid cell lines (REH and KM-3): absence of MLR-S and presence of suppressor cell activity for normal T-cell response

The present study unequivocally demonstrates that leukemic non-T/non-B lymphod cells from three cell lines (NALL-1, NALM-6 and NALM-16) possess a strong stimulating capacity in "one-way" mixed lymphocyte reaction (MLR-S), while leukemic cells from two non-T/non-B cell lines (REH and KM-3) possess no MLR-S. It is speculated that leukemic non-T/non-B lymphoid cells with MLR-S may represent less differentiated leukemic B cells and leukemic non-T/B lymphoid cells without MLR-S may represent less differentiated leukemic T cells. The REH or KM-3 cells without MLR-S also act as suppressor cells on normal T lymphocyte response to mitogen and allogeneic cells by secreting a potent suppressor activity. The MOLT-4 leukemic T lymphoid cells with no MLR-S, on the other hand, do not act as suppressor cells on T lymphocyte response. The soluble factor(s) secreted by the REH or KM-3 cell line is non-toxic to T lymphocytes and heat-sensitive. A significant suppression of T lymphocyte response is still observed, even when the active material is only present for one hour prior to the addition of PHA or it is added several days after the beginning of cultures. The biological and physico-chemical nature of this active material has not been defined. Further studies are currently in progress for biological and physico-chemical characterization and isolation of the active material.

Use of stimulating capacity of mixed lymphocyte reaction (MLR-S) as a possible marker for the cell-origin of null-cell acute lymphoblastic leukaemia

The recent introduction of surface marker analysis indicates that the T-cell ALL represents 15--25%, the B-cell ALL represents less than 5% and the null-cell ALL represents more than 70% of cases. The origin of leukaemic null-cells is at present not clear. The present study shows that fresh leukaemic cells from five patients with null-cell ALL exerted a strong stimulating effect while the leukaemic cells from three patients with null-cell ALL failed to stimulate in 'one-way' MLR. Cultured leukaemic cells from three null-cell lines (NALM-16, NALL-1 and MOLT-10) consistently exerted a strong stimulation while leukaemic cells from one null-cell line (REH) exerted little or no stimulation on allogeneic lymphocytes. Leukaemic null-cells from the NALM-,6 line exhibited a lesser but significant stimulation in 'one-way' MLR. These observations lead us to speculate that leukaemic null-cells which possess a stimulating capacity may represent less differentiated leukaemic B lymphoid cells (early B-cell precursors) and leukaemic null-cells which possess no stimulating capacity may represent less differentiated leukaemic T lymphoid cells (early T-cell precursor).

Stimulating capacity of blast cells from patients with chronic myelocytic leukaemia, in blastic crisis in 'one-way' mixed lymphoycte reaction: lack of evidence for T lymphoblastic conversion

It has long been suggested that the blastic transformation in some patients with Ph1-positive chronic myelocytic leukaemia (CML) may be lymphoid in nature. It has recently been postulated that some patients with CML may undergo a T lymphoblastic crisis because the leukaemic blasts from these patients have high terminal deoxynucleotidyl transferase (TdT) activity and that some patients may undergo a non-T/non-B lymphoblastic crisis since leukaemic blasts from a majority of morphologically lymphoid type CML-BC cases react with antiserum specific for non-T/non-B acute lymphoblastic leukaemia (ALL). The present study shows that leukaemic blasts from each of six patients with Ph1-positive chronic myelocytic leukaemia-blastic crisis (CML-BC) exerted a strong stimulation on allogeneic lymphocytes in 'one-way' mixed lymphocyte reaction. There was no apparent difference in stimulating capacity between morphologically myeloid type (four cases) and lymphoid type (two cases). The stimulating capacity of leukaemic blasts from patients with CML-BC was quite similar to that of blasts from all patients with acute myeloblastic leukaemia (AML) and from some patients with non-T/non-B type ALL. Leukaemic blasts from a patient with T-cell type ALL and cultured leukaemic T lymphoblastoid cells (2 lines) consistently failed to stimulate while cultured leukaemic null-cells (4 lines) consistently exerted a strong stimulation in 'one-way' mixed lymphocyte reaction. These observations suggest that leukaemic cells from patients with CML-BC, morphologically lymphoblastic type, are not T lymphoblasts although the possibility that these cells are non-T/non-B lymphoblasts cannot be ruled out entirely.

Effects of radiochemotherapy and splenectomy on cellular immunity in long-term survivors of Hodgkin's disease and non-Hodgkin's lymphoma

Thirty-six patients treated for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) who had been in complete remission and off all therapy for greater than two years were examined for evidence of immunosuppression. All patients were found to have marked depression of their lymphocyte blastogenic response to phytohemagglutinin (PHA) and of their skin test responses. No abnormalities of serum protein or immunoglobulins were found. T cells were significantly lower than normal in patients who had had Hodgkin's disease, but not in those who had had NHL. B cells, on the other hand, were significantly elevated in both groups. Splenectomy elevated the total lymphocyte count, while those who had not had a splenectomy had lower than normal lymphocyte counts. B cells were elevated while T cells tended to be lower in both splenectomy and nonsplenectomy groups, though only in the nonsplenectomized patients did this reach statistical significance. PHA response tended to be higher in patients with less advanced disease and less extensive treatment than in those with more advanced disease and more extensive treatment, although there was no statistically significant difference. Skin test response though, was shown to correlate well with both stage of disease at diagnosis and extent of treatment.

T-lymphocyte dependency of B-lymphocyte blastogenic response to phytomitogens

Human peripheral blood T and B lymphocytes were separated by a method based on the stable rosette formation of T lymphocytes with neuraminidase-treated sheep erythrocytes, followed by centrifugation over a Ficoll-Hypaque gradient. Monocytes were isolated from the T-depleted B lymphocyte preparation by allowing the monocytes to ingest iron particles and by subsequent centrifugation over a Ficoll-Hypaque gradient. The T lymphocytes responded extremely well to PHA and very well to PWM, while the B lymphocytes were unresponsive to either PHA or PWM. However, when the B lymphocytes were cultured together with irradiated autologous or allogeneic T lymphocytes (1:1, 1:2 or 1:4 ratio), both PHA and PWM became mitogenic to B lymphocytes. Irradiated T lymphocytes alone did not respond to either PHA or PWM, indicating that the 3H-thymidine incorporation seen in the mixed-cell culture was due to the activation of unirradiated B lymphocytes. The B lymphocytes failed to respond to these phytomitogens in the presence of lower concentrations of irradiated T lymphocytes. The monocytes were found to be incapable of helping the B lymphocytes to respond to PHA or PWM.

Stimulating capacity of fresh and cultured human leukaemic lymphoid and myeloid cells in 'one-way' mixed lymphocyte reaction

Fresh normal peripheral blood B lymphocytes possess a strong stimulating capacity while fresh thymus cells or fresh peripheral T lymphocytes possess a weak, but significant stimulating capacity on allogeneic lymphocytes in `one-way' mixed lymphocyte reaction. Fresh leukaemic T lymphoid cells from patients with T-cell ALL or T-cell CLL exert little or no stimulation on allogeneic lymphocytes. Fresh leukaemic B lymphoid cells from patients with B-cell CLL or B-cell HCL, on the other hand, exert a lesser stimulation on allogeneic lymphocytes, as compared to that of normal B lymphocytes. Leukaemic myeloblasts from patients with AML or Ph<sup>1</sup>(+) CML-BP exert significantly higher stimulation than leukaemic lymphoid cells in `one-way' mixed lymphocyte reaction (P<0.05). Cultured leukaemic T lymphoid cells (MOLT-4) possess no stimulating capacity, cultured leukaemic B lymphoid cells (BALM-2) possess a moderate degree of stimulating capacity and cultured leukaemic, possibly myeloid, cells (NALM-1 and K562) possess vigorous stimulation on allogeneic lymphocytes. The stimulating capacity of NALM-1 or K562 cells is significantly higher than that of BALM-2 cells (P<0.01 or P<0.05, respectively) and that of MOLT-4 cells (P<0.001). These observations suggest that the stimulating capacity of leukaemic T or B lymphoid cells may have been completely or partially lost during the process of leukaemogenesis. Since we do not have an opportunity to study the stimulating capacity of normal myeloblasts, it is not known whether the stimulating capacity of leukaemic myeloblasts, which is found to be very strong on allogeneic lymphocytes, may have been modified during the process of leukaemogenesis.

Lymphoblastogenesis inhibitory factor produced by human lung cancer cell lines

A comparative study of the inhibitory effect of cell-free supernatants (CFS) from human lung cancer cell lines (ChaGo and PC-1) and from a human embryo fibroblast cell line on lymphocyte blastogenesis indicated that both lung cancer cell lines produce a large amount of the inhibitory factor while the production of such a factor from a control noncancer cell line is essentially very minimal or absent. The inhibitory effect of CFS of the lung cancer cell lines is not due to direct cytotoxicity. The inhibitory effect is found to be partially sensitive to heat treatment. A significant inhibition is still seen, even when the CFS of the lung cancer cell lines were present for 1 hour prior to the addition of phytohemagglutinin (PHA).

Impaired lymphocyte blastogenic response in patients with colon adenocarcinoma: effects of disease and age

The in vitro blastogenic response of 76 patients with colon adenocarcinoma and 29 age-matched normal healthy volunteers was compared. An age-related decline in cellular immunocompetence was observed in both the patient and control group. Within each age interval, the patients' blastogenic responses were lower than the controls' and the rate of decline of the blastogenic response in the patient group was greater in magnitude, suggesting that their disease state also contributed to loss of cellular immunocompetence. Thus, both increasing age and presence of tumor are factors that contribute to the decline the immunocompetence in patients with colon adenocarcinoma.

Establishment and characterization of leukemic T-cell lines, B-cell lines, and null-cell line: a progress report on surface antigen study of fresh lymphatic leukemias in man

Permanent human hematopoietic cell lines representing T-cell, B-cell and non T/non B (null-cell) leukemia have been established. Comparative analyses were made for their phenotype characteristics. A number of characteristics common within the 7 T-cell lines studied or distinct from other leukemia-type lines were described. Usefulness, validity and limitation of these findings are discussed in connection to the attempt at classification of ALL, CLL and blastic phase of CML. The great majority of CLL were SmIg+-B-cell leukemia and a single case of T-cell CLL was documented. Except 10% as T-cell ALL and a single case of B-cell ALL, the majority of ALL were found to be the non T/non B ALL. Nevertheless, little evidence was suggested from the present study in favor for a notion that the T-cell ALL and the non T/non B ALL are two distinct diseases.

Whole blood microculture assay of human lymphocyte function

A whole blood microculture assay is described for measuring lymphocyte reactivity to mitogenic and antigenic stimulants. This assay employs heparinized whole blood, serum-free culture medium, microtiter plates, and a Multiple Automated Sample Harvester (MASH). When this assay is compared to other leukocyte assays, its major advantages include (1) the utilization of fewer lymphocytes per microculture, thuus reducing the amount of blood required per test while increasing the number of test agents and replicate cultures which can be employed in any given experiment; (2) the conservation of mitogens, antigens, drugs, enzymes, hormones, lymphokines, and other test agents, some of which are either expensive of difficult to prepare in large quantities; (3) the elimination of lymphocyte isolation and purification procedures which may disrupt the relative proportion of T cells, B cells and antigen-processing cells; and (4) the application of an automated harvester which simplifies and expedites procedures required for processing cells for liquid scintillation counting.

T and B lymphocytes. Exclusive role as responders and stimulators in human one-way mixed lymphocyte reaction

Four different combinations of one-way mixed lymphocyte reactions between human peripheral blood T and B lymphocytes (at a ratio of 1:1), purified by the E-rosetting technique, were carried our. A significant mixed lymphocyte reaction was observed only in a combination in which T lymphocytes, as responding cells, and B lymphocytes, as stimulating cells, were utilized. No significant mixed lymphocyte reaction was noted in the other three combinations of cells, using T or B lymphocytes as responders and T lymphocytes as stimulators, and also B lymphocytes as both responders and stimulators. Mixed lymphocyte reactions between T lymphocytes as responders (at constant concentration) and T and B lymphocytes as stimulators (varying proportions) showed that the response decreased proportionately with decreasing numbers of B cells and increasing numbers of T cells used as stimulators. Addition of increasing numbers of stimulating T cells to a constant number of stimulating B cells did not suppress or enhance the T-cell response to B cells. These observations indicate that the human peripheral blood T and B lymphocytes play an exclusive role as responding cells and stimulating cells, respectively.

Human thymus cells: blastogenic response to mitogens, antigens and allogeneic cells

Over 90 per cent of the thymus cells from each of twenty-six donors were T lymphocytes, identified by E-rosetting and less than 3 per cent of the cells were B lymphocytes identified by EAC-rosetting. With advancing age, the proportion of T lymphocytes decreased while that of B lymphocytes increased. The degree of (3H)thymidine incorporation of thymus cells was inversely proportional to the age of the thymus-cell donor. The PHA or PWM- induced blastogenic response of thymus cells gradually increased with advancing age when the response was expressed as the stimulation index. However, the actual rate of (3H)thymidine incorporation in all three groups was rather similar when cells were cultured with mitogens. The difference in stimulation index was due to the variation in incorporation rate in cultures without stimulants. The PHA response was approximately four-fold higher than that of PWM response. Thymus cell response to allogeneic lyphocytes, on the other hand, had no correlation with the age of thymus donor. The most surprising result in the present study was that the thymus cells from each of ten donors, aged 1-14 years, were incapable of responding to all four different recall antigens. Peripheral blood lymphocytes from nine to ten randomly selected age-matched children responded very well to one or more antigens.

T- and B-lymphocytes in chronic lymphocytic leukemia: correlation with clinical and immunologic status of the disease

T- and B-lymphocyte count were correlated with clinical and immunologic status of 59 patients with chronic lymphocytic leukemia. The mean total T-cell count was slightly lower than normal in patients in complete remission, within normal limits in those in partial remission, and significantly higher in those with active disease. The mean total B-cell count, however, was slightly elevated in patients in complete remission and those in partial remission, and markedly elevated in those with active disease. The T-cell count correlated well with the duration of disease in patients in remission: The mean count was within normal range in those patients with disease of less than 3 years, whereas for those patients with disease of 3-12 years, a significant reduction was observed. The T-cell count was well correlated with the status of skin test response of patients with either complete or partial remission; the B-cell count did not correlate with immunoglobulin levels in patients with this disease.

Adjuvant immunotherapy in bronchogenic carcinoma

Ten patients with locally far advanced bronchogenic carcinoma were treated with autologous tumor vaccine after a radical surgical resection. Three of 10 patients treated with tumor vaccine are alive (median survival of 26 months) whereas all nine patients in the control group are dead (median survival of 6.5 months). Active immunotherapy adjunct to radical surgery appeared to improve cellular immunity of the treated patients in the postoperative period, and the migration inhibition test indicated sensitization of treated patients against their tumor.

Enhanced E- and EAC-rosette formation by neuraminidase

Pre-treatment by neuraminidase of lymphocytes obtained from peripheral blood of normal donors significantly enhanced E- and EAC-rosette formation. Of other lymphoid cells only spleen cells showed significant enhancement of E-rosettes. The EAC-rosettes slightly increased when the peripheral blood lymphocytes from patients with acute lymphoblastic leukemia or chronic lymphocytic leukemia and MOLT-4 lymphoid cells were pre-treated with this enzyme. The EAC-rosettes were not increased by neuraminidase treatment of phytohemagglutinin-induced blasts, thymus cells or spleen cells. Pre-treatment of peripheral blood lymphocytes with neuraminidase also increased the proportion of stable E-rosettes resistant to incubation at 37 degrees C and to vigorous shaking. Various concentrations of neuraminidase (1-100 U/ml) produced enhancement of E- and EAC-rosettes with the highest activity at 25 and 50 U/ml. Neuraminidase treatment of sheep red blood cells failed to increase the proportion of E-rosettes of peripheral blood lymphocytes. The increased rosette forming capacity induced by neuraminidase is probably related to changes in lymphocyte surface properties.

Enhancement of "one-way" human mixed lymphocyte reaction by cholinergic agents

"One-way" mixed lymphocyte reaction was not enhanced when the cells were allowed to be exposed to acetylcholine or carbamylcholine at a concentration of 0.01-1.0mumole/ml during the entire period of culture. It was thought to be due to cytotoxicity effect of these agents on responding cells. When the responding cells were incubated with cholinergic agents for 1 hr prior to washing the cells and setting up the mixed cell culture, "one-way" mixed lymphocyte reaction was enhanced. However, when the stimulating cells were similarly treated with either agent, no enhancement of "one-way" mixed lymphocyte reaction was observed. These observations indicate that cholinergic agent induces enhancement of mixed lymphocyte reaction by affecting only the responding cells and not the stimulating cells.

Human thymus cells. Excellent responders but poor stimulators in 'One Way' mixed lymphocyte reaction

Human allogeneic 'one-way' mixed lymphocyte reactions between thymus cells and thymus cells were entirely absent. Of twenty-one mixed lymphocyte reactions between peripheral blood lymphocytes as responding cells and thymus cells as stimulating cells, only eleven had a weak but significant reaction. In contrast, a highly significant response was observed in each of eighteen mixed lymphocyte reactions between thymus cells as responding cells and peripheral blood lymphocytes as stimulating cells and in each of eleven mixed lymphocyte reactions between peripheral blood lymphocytes and peripheral blood lymphocytes. These findings indicate that the thymus cells (T lymphocytes) possess excellent proliferative capacity, with little or no stimulating capacity, while peripheral blood lymphocytes (T and B lymphocytes), on the other hand, are good responders, as well as good stimulators, in the mixed lymphocyte reaction.

Thoracic duct cannulation in a patient with lung cancer

Previously the authors demonstrated limited effectiveness of tumor specific active immunotherapy adjunct to radical surgery in patients with lung cancer. In order to improve the therapeutic effectiveness, a patient with inoperable lung carcinoma was treated with a radical surgery, tumor vaccination, and "unblocking procedures" which consisted of splenectomy and throacic duct canulation. In vitro studies demonstrated the evidence of sensitization of the patient against his own tumor, removal of blocking factor by the thoracic duct fistual from the circulation.

Inhibition of mixed lymphocyte reaction by thoracic duct lymph: removal of inhibitory effect by thoracic duct drainage in lung cancer

The inhibitory effect of the thoracic duct lymph of a patient with lung cancer on the "one-way" mixed lymphocyte reaction without cytoxicity is unequivocally demonstrated. The effect seems to be dose related. A moderate inhibition of mixed lymphocyte reaction is still observed, even if the responding cells are preincubated in the thoracic duct lymph for 1 hr only prior to the addition of stimulating cells. The inhibitory effect of thoracic duct lymph on the mixed lymphocyte reaction is no longer evident when the material is added 1-4 days after the beginning of culture. These observations suggest that the mechanism of the inhibitory effect of thoracic duct lymph may be a simple attachment of inhibitory factors to the receptor sites on the responding lymphocytes, causing interference in cell to cell interaction. The inhibitory effect of thoracic duct lymph collected 1 week after the thoracic duct drainage on mixed lymphocyte reaction is significantly lower than that of thoracic duct lymph collected at the beginning of the procedure. This indicates that the blocking effect of thoracic duct lymph can be easily removed by this technique; which is technically feasible in man. The interrelationship of the tumor-specific blocking factor, thoracic duct drainage, and tumor growth pattern are discussed with respect to the potential usefulness of this procedure as adjuvant immunotherapy in the management of patients with neoplastic diseases.