Recurrent chromosome changes at 3p21 in Epstein-Barr virus-transformed cells derived from human prolymphocytic leukemia

Cytogenetic studies of Epstein-Barr virus-transformed lymphoblastoid cells obtained from a patient with prolymphocytic leukemia revealed the cells to contain recurrent chromosome aberrations involving band 3p21. The in vivo leukemic cells from which the cell lines originated contained a der(3)t(3;17?)(p21;q11?) and a der(13)t(13;3)(q34;p21), as well as numerical (-Y, -8, and -17) and other structural [8p- and der(8)t(8;?)(q13?;?)] changes. The cells in established culture showed additional chromosome aberrations involving band 3p21 of the previously normal and abnormal chromosomes 3. After 200 days of culture, the cells contained a new translocation, i.e., t(3;14)(p21;q32). The cells showed further chromosomal breakage and reunion at band 3p21 at later passages. The affected chromosomal band (3p21) is close to one of the constitutive fragile sites, i.e., 3p14.2. Northern blot analysis of the messenger RNA of the cultured cells did not show an increased or altered expression of the c-raf-1 protooncogene (located at 3p25) when compared with the mRNA of Epstein-Barr virus-transformed lymphoblastoid cell lines from normal subjects with a normal karyotype. Also, the established cells did not show DNA rearrangements or RNA alterations of the c-myc gene.

B cell growth factor-induced proliferation of hairy cell lymphocytes and inhibition by type I interferon in vitro

Malignant B cells from hairy cell leukemia (HCL) patients are unable to proliferate when stimulated with standard B cell mitogens. Using chromatographically purified B cell growth factor (BCGF), HCL can be stimulated to proliferate as assessed by incorporation of tritiated thymidine [3HTdR] into DNA. Proliferation was found to be time dependent, with no detectable 3H-TdR incorporation in up to three days of culture, and significant stimulation evident at days 6 and 10. The presence of 10% BCGF in culture was an absolute requirement for HCL proliferation; however, this BCGF-induced DNA synthesis could be further augmented by the addition of anti-immunoglobulin heavy chain antibodies. BCGF-induced proliferation was abrogated in six of six patients by addition of 1,000 U/mL of recombinant alpha 2-interferon (IFN) at day 0, although 1,000 U/mL of recombinant gamma-IFN had no inhibitory effect in five of six patients studied. Specific cellular receptors for type I IFN were demonstrated in HCL by inhibition of binding of 125I-alpha 2-IFN by a 40-fold excess of unlabeled alpha 2 or beta IFN with no inhibition by unlabeled gamma-IFN. These data demonstrate that malignant HCL lymphoblasts express specific type I IFN receptors and that type I, but not type II IFN, can inhibit growth factor-induced DNA synthesis by hairy cells in vitro. They further suggest a direct antiproliferative mechanism of action for IFN in HCL and predict equivalent clinical activity by either alpha or beta, but not gamma IFN in this malignancy.

Bone formation within porous hydroxylapatite implants in human periodontal defects

Tissue samples from three subjects who had periodontal defects treated with a porous hydroxylapatite implant were investigated using light microscopy and scanning electron microscopy. The 3-month specimen showed connective tissue infiltration through the pores and a narrow zone of bone formation present along the walls of the pores. At 4 months, continued evidence of bone deposition was present with osteocytes, osteoblasts and organization of collagen fibers apparent throughout the implant. The 6-month implant had further evidence of continued bone formation with lamellar bone being the major component within the pores.

Treatment of early--stages I and II--nodular, poorly differentiated lymphocytic lymphoma

Twenty-nine patients with Stages I and II nodular, poorly differentiated lymphocytic lymphoma were treated with radiation therapy or radiation therapy plus chemotherapy. Twenty-two patients with Stage I received radiation to the involved field, the other seven with Stage II received total lymphoid radiation. Complete remission was achieved in all 29. There were no differences in remission duration or survival according to treatment modality. Five of 29 (17%) patients relapsed. No relapses were observed after 5 years. Ten patients died; one patient died of lymphoma, and nine others died in continuous complete remission of various other causes. Sixty-six percent of the patients were alive at 74-160 months (median 118 months). Involved field radiation with or without chemotherapy was well tolerated, producing acceptable toxicity. Substantially more toxicity was observed after total lymphoid irradiation and although cures were also achieved, less toxic treatment programs should be investigated. The low rate of relapse observed in early stages of this lymphoma in this and in other studies is suggestive that cures might be achieved in nearly one-half of the patients presenting in early stage.

Sequential chromosome abnormalities in B cell chronic lymphocytic leukemia: a study of 13 cases

The chromosomal constitution of stimulated lymphocytes in 13 patients with B cell chronic lymphocytic leukemia (B-CLL) were sequentially examined using polyclonal B cell activators (PBA), i.e., Epstein-Barr virus (EBV), lipopolysaccharide W from E. coli (LPS), pokeweed mitogen (PWM), and protein A from Staphylococcus aureus (PA). Of the 11 patients (44 samplings) with abnormal clones, 2 patients had only trisomy 12, 6 patients had trisomy 12 plus other clonal abnormalities, such as +8, +9, +16, +18, 6q-, 15q+, and t(4;15), and the remaining 3 cases had various clonal abnormalities other than trisomy 12, such as trisomy 3, 8, 20, 21, and insertion of #7 and #12. These findings suggest that even though trisomy 12 may be a common abnormality in B-CLL, various other abnormal clones may also be present in vivo for relatively long periods of time. It appears that stimulated lymphocytes in patients with previous therapy tend to show chromosome abnormalities more frequently than those in untreated patients.

In-vitro infection of chronic lymphocytic leukemia cells by Epstein-Barr virus (EBV)

We sought to determine the potential of infecting lymphoid cells from patients with chronic leukemia (CLL) with Epstein-Barr virus (EBV) by testing for EBV receptors (EBVR) by flow cytometry, assessing for infectability of these cells by culturing with B95-8-derived virus, and staining for EB nuclear-associated antigens (EBNA) at various times post-infection. EBVR were present on 54-91% of lymphoid cells in seven cases of CLL and on 46% of prolymphocytic leukemia cells. Dynamic changes regarding EBNA positivity, morphology, and viability occurred post-infection with the virus. On day 2 only a few EBNA-positive lymphoblasts were observed. On days 11-21 positivity increased from 2 to 34% of cells. Simultaneously, the viable cell number declined to approximately 1/10th of original number. A significant proportion of the EBNA-positive cells corresponded to the original CLL cells. In 3 of 7 cases of CLL a Pan T-cell phenotype was demonstrated by Leu-1 monoclonal antibody testing. The infected cells did not react with two monoclonal antibodies, EBV-CS 1 and 4, which react with B-cell lymphoblastoid cell lines (B-LCL). Moreover, the B-LCL derived at 1-2 months post-infection of CLL cells did not express the Leu-1 antigen, but expressed EBV-CS 1 or 4 defined antigens. In the prolymphocytic leukemia, 64% of the cells showed EBNA positivity on day 7 and giant cells with huge round or multiple nuclei appeared which were EBNA-positive. CLL and prolymphocytic leukemia cells can be infected as demonstrated by EBNA-positivity. This infection does not lead to immediate transformation, but evokes lymphoblast and multinucleated giant cell production prior to the death of cells.

Near-triploid Ph-positive leukemia

Tetraploid populations have been observed in various types of leukemia, but relatively few reports exist of triploid cell populations in acute or chronic leukemia. We report two cases of Ph-positive leukemia with a modal triploid cell population. Examination of peripheral blood from a 3-year-old boy with Ph-positive acute lymphoblastic leukemia (ALL) and a 68-year-old male with Ph-positive chronic myelocytic leukemia (CML) in blastic crisis revealed modal populations of 72 and 63 chromosomes, respectively. G-banding analysis of both cases revealed the following: karyotypic instability (no clonality), dominant trisomy, and the random association of the Ph chromosome with gains and losses of chromosomes involved in this translocation. The cytogenetic evidence obtained suggests that the triploid cell populations were not derived from a duplication of a hypodiploid cell population, but resulted from random loss of chromosomes from tetraploid cell populations derived from duplication of pseudodiploid cells.

Two 14q+ chromosomes in malignant lymphoma: crucial cytogenetic changes on 14q

We encountered a 36-year-old white male patient with poorly differentiated lymphocytic lymphoma, whose lymph node cells showed a clonal cytogenetic change involving chromosome #14, i.e., 47,XY, + 2,der(14),t(14;14)(14pter----14q32;14q24----14q32++ +). In addition to this change, cells with a translocation between chromosomes #2 and another #14 [t(2;14)(q21;q24)], as well as a missing chromosome #8 were found. We have reviewed the literature dealing with two or more changes affecting chromosome #14 and discussed the importance of the cytogenetic change at band 14q32 in malignant lymphoma.

Cytogenetic studies of stimulated lymphocytes in hairy cell leukemia

Using a sister chromatid differentiation (SCD) technique, cell cycle analysis in lymphocytes from two patients with hairy cell leukemia (HCL) revealed it to be similar to cell cycle progression of normal lymphocytes stimulated with lipopolysaccharide W from Escherichia coli 0.55:B5 (LPS). It appears that LPS can readily stimulate the leukemic cells of HCL into mitosis. In the two cases of B cell HCL studied, one (case 1) was revealed to have an abnormal clone with a missing chromosome #22 that was related to the production of lambda-chains.

Clonal chromosome abnormalities in prison-acquired lymphoproliferative syndrome

Lymph nodes from five male patients with prison-acquired lymphoproliferative syndrome (PALS), which seems to be a prodrome of acquired immune deficiency syndrome (AIDS), were examined cytogenetically. Two had clonal chromosome abnormalities, i.e., 11q- and -11, and another had multiple nonclonal chromosome changes, including t(2p-;3q+),6q-,+12,14q+. These chromosome changes are also common in malignant lymphoma and suggest that the patients with PALS may be predisposed to develop malignant lymphoma.

The use of a porous hydroxylapatite implant in periodontal defects. I. Clinical results after six months

Twenty-five patients with advanced periodontal destruction were used in the study. Following initial therapy, two angular interproximal defects were selected in each patient. During flap surgery a porous hydroxylapatite implant shaped to fit the periodontal defect was placed in one defect, the other defect was used as nonimplanted control. The material used for implantation was a hydroxylapatite replicate of coral from the genus Porites, with a pore size of 190 to 220 micron. Clinical parameters were measured prior to flap surgery for each of the defects. An occlusal acrylic stent was used to give a stable reference point for pocket depth, attachment level and gingival margin height measurements. Also gingival fluid, gingival inflammation, plaque index and tooth mobility were recorded. Periapical radiographs using a standardized positioning device were also taken. At the time of surgery, the depth of the osseous defect and the height of the alveolar crest were recorded. After 6 months the clinical measurements were repeated and a re-entry surgery was carried out in 15 selected sites. Results showed that the porous implant produced statistically significant reduction in pocket depth, in the depth of osseous lesion, and a statistically significant gain in attachment level, as compared to control areas.

Coexistence of myeloid metaplasia with myelofibrosis and hairy-cell leukemia

A 42-year-old man with severe pancytopenia and myelofibrosis underwent splenectomy seven months after onset of his symptoms; the leukocyte, platelet, and hematocrit levels became normal. Myeloid metaplasia was identified in the liver and spleen. Progressive lymphocytosis started eight months after splenectomy, and after 66 months a florid hairy-cell leukemia was diagnosed; the circulating cells were B type with micro K surface markers. Anemia and thrombocytopenia reappeared and were controlled initially with daily prednisone; chlorambucil was later added. At that time, the peripheral blood had more than 150 megaloblastoid-appearing normoblasts per 100 leukocytes. The PAS stain was positive in 95% to 100% of these cells; the B-cell surface markers were no longer identified. Further treatment failed to control the lymphoproliferative and myeloproliferative syndromes; the patient died 99 months after splenectomy. On autopsy, infiltration by hairy-cell leukemia cells and erythroid precursors was observed in the bone marrow, liver, lymph nodes, and other organs.

Salvage treatment for patient with multiple myeloma refractory to alkylating agents

Sixteen patients with multiple myeloma refractory to alkylating agents were treated with vincristine 0.25 mg/m2 i.v. on days 1 to 4 and prednisone 1 gm/m2 on days 1 and 3. Chemotherapy was repeated every 2 weeks. Of 15 evaluable patients, five achieved a partial response and four stable disease. Three patients with partial response and three with stable disease relapsed at 6, 7, and 16 and at 5, 9, and 10 months, respectively. The median survival for all patients was 10 1/2 months and it ranged from 1 to 21 + months. The median survival in responders was not reached at 13 months. Onset of antitumor effect was observed within the first 2 weeks. Symptomatic relief of bone pain was noted within 48 hours in responders and nonresponders. Improvement in bone marrow cellularity and decrease in plasma cell infiltration was documented in more than one-half of the responders. Tolerance to the treatment was good. No hematologic or other significant toxicity was observed.

Simultaneous low-dose radiation and low-dose chemotherapy in the treatment of advanced Hodgkin's disease

Simultaneous combination chemotherapy (CT) (BCNU 40 mg/m2, procarbazine 50 mg/m2, prednisone 40 mg/m2, and vincristine 1.4 mg/m2) with low-dose radiation therapy [(RT) 2000 rad] delivered to all areas of tumor involvement aside from the bone marrow was given to 28 patients with advanced Hodgkin's disease. Upon completion of RT and CT, the BCNU and procarbazine was increased by 100% until a total of six cycles of CT (with and without RT) were given. Eleven patients had received prior CT and had not achieved complete remission (CR) or had relapse from CT-induced CR within 1 year. Seventeen others had not had prior CT (7 had prior RT). Among the previously treated patients, one patient died in autopsy-proven CR during treatment. The other 10 patients achieved CR. Eight had relapsed at 4-36 months (median time to relapse, 6 months). Five patients died of Hodgkin's disease, three others died of status asthmaticus and pneumonia, radiation pneumonitis, and acute nonlymphocytic leukemia, respectively. Three patients are still alive (2 in continuous CR) at 28, 89, and 90 months. Among the previously untreated patients, four died during treatment, one of acute myocardial infarction, two of liver failure, and one of radiation pneumonitis. Twelve of the other 13 patients achieved CR. One of the CR died of pneumonia and sepsis 3 months after completion of treatment; two other patients relapsed at 10 and 15 months. Nine remain in continuous CR at 42-89 months of follow-up, (median follow-up, 81 months). Of 107 tumor areas treated with RT, in-field relapse occurred in two areas (1.9%). Hematologic tolerance to this treatment was good in both groups of patients. Radiation pneumonitis occurred in 50% of the patients whose lungs were irradiated, and it was fatal in two. By design or for other reasons, the median and mean doses of BCNU and procarbazine given to previously treated patients were 62% and 65.2%, respectively. In untreated patients, the median and mean doses of these two agents were 66.6% and 61.4%, respectively. There were no differences in dosage of these two agents between patients who remain alive in CR and those who relapsed and died. The potential of similar programs of radiation and chemotherapy is discussed.

Cytogenetic studies in 77 patients with chronic lymphocytic leukemia: correlations with clinical, immunologic, and phenotypic data

Cytogenetic analyses by G-banding and/or Q-banding techniques of polyclonal B cell mitogen-stimulated peripheral blood lymphocytes in 77 patients with chronic lymphocytic leukemia were carried out in the present study. Adequate metaphases were obtained in 65 patients (84%). Of 29 patients with abnormal karyotypes, ten (34%) had trisomy 12 as the sole abnormality, eight (28%) had trisomy 12 in combination with other karyotypic changes, and the remaining 11 had various karyotypic changes other than trisomy 12. There was a significant relationship between the abnormal karyotype and disease status, clinical stage, lymphocyte count, bone marrow infiltration pattern, monoclonal IgM gammopathy, and urinary monoclonal-free light chain status. Six of seven patients (87%) with trisomy 12 only had stage 0-11 disease, whereas all eight patients with trisomy 12 with other changes had stage III or IV disease (P less than .02). However, of nine patients with other karyotypic changes without trisomy 12, five had stage 0-II and four had stage III or IV disease. These observations suggest that trisomy 12 may be the primary or the earliest karyotypic change in a majority of aneuploid patients with chronic lymphocytic leukemia, and that other karyotypic changes in addition to trisomy 12 may develop as a result of clonal evolution, dedifferentiation, or therapy. Of nine patients in whom autopsy studies were carried out, four were found to have diffuse histiocytic lymphoma or Richter's syndrome (three with trisomy 12 in combination with other chromosome changes and one with normal karyotype). Our findings clearly demonstrate that cytogenetic study may be of value in the clinical and prognostic evaluation of patients with chronic lymphocytic leukemia.

Staging laparotomy and splenectomy in early Hodgkin's disease. No therapeutic benefit

In a prospective randomized study of treatment for early-stage Hodgkin's disease presenting above the diaphragm, 76 patients had staging by laparotomy (Group I) and 28 had staging by closed techniques (Group II). Treatment consisted of involved-field radiotherapy alone (44 patients), involved-field radiotherapy followed by chemotherapy (38 patients), total nodal radiotherapy alone (15 patients), or total nodal radiotherapy followed by chemotherapy (seven patients). On presentation, both groups had similar clinical features and similar treatment distribution. With similar follow-up (87 months), no significant differences in remission or survival were observed between Groups I and II: remission 59 versus 68 percent; survival 74 versus 92 percent; p value 0.27 and 0.09, respectively. Multiple areas of relapse were more frequently observed in Group I (11 of 32 had relapse) as compared with Group II (none of nine had relapse, p less than 0.082). In Group I, relapse in the abdomen was observed as an isolated event or as part of disseminated relapse in 12 percent of patients compared with 3 percent (one patient) in Group II with abdominal relapse alone. Seven patients in Group I and two patients in Group II died with Hodgkin's disease. Six other patients in Group I died with complete remission of non-Hodgkin's lymphoma (one patient), leukoencephalopathy (one patient), sepsis during chemotherapy (two patients), myocardial infarction (one patient), and cerebrovascular accident (one patient). Three other patients in this group had other secondary malignancies successfully controlled (histiocytic lymphoma, squamous cell carcinoma of the cervix, and malignant schwannoma). No second primary lesions or death with complete remission were observed in Group II. Staging laparotomy with splenectomy in early-stage Hodgkin's disease did not improve the duration of remission or survival or decrease the number of abdominal relapses compared with closed staging.

T-suppressor cell chronic lymphocytic leukemia. Phenotypic characterization by monoclonal antibodies

A patient with long standing seropositive rheumatoid arthritis developed lymphocytosis which phenotypically involved the cytotoxic/suppressor T-lymphocyte population. There are 10 reported instances of this new disease entity described as "chronic T-cell lymphocytosis with neutropenia" or "chronic suppressor T-cell lymphocytic leukemia." The disease is characterized by hepatosplenomegaly, neutropenia, and the frequent presence of rheumatoid factor without clinical evidence of rheumatoid arthritis. Splenectomy in our patient, as well as in other instances where undertaken, has been ineffective in alleviating the neutropenia. The peripheral blood lymphocytes in our patient were OKT-3+, OKT-5+, OKT-8+, OKT-11+, cALL-, OKT-6-, TdT-. They possessed ADCC but no NK activity and did not suppress PWM-induced B-cell differentiation in spite of the presence of Fc receptor for IgG. Since the lymphocytosis of OKT-8+ cells appears to be clonal, it is suggested that the disease be designated chronic suppressor T-cell lymphocytic leukemia.

Benign monoclonal B cell lymphocytosis--a benign variant of CLL: clinical, immunologic, phenotypic, and cytogenetic studies in 20 patients

From 1951 through 1978, we have seen 20 cases of stage O chronic lymphocytic leukemia (CLL) without disease progression for 6.5-24 years. The cohort included 7 males and 13 females, aged 48-77 years at the time of diagnosis. None presented with anemia, thrombocytopenia, or neutropenia nor developed cytopenias during follow-up. Mean total lymphocyte count in these patients was 20,100/microL, with ranges from 10,000 to 43,700 at the time of diagnosis, and was 20,600, with ranges from 1,000 to 47,200, at last follow-up. Of 12 patients studied, 8 and 4 were phenotyped as heavy chain mu delta- and mu-type, respectively, with 7 kappa- and 4 gamma-type (no light chain was detectable in one patient). Of 13 patients studied, one had a slightly elevated IgG level and two had slightly depressed serum IgA and IgM levels. All patients had positive delayed hypersensitivity responses to at least one of five skin test antigens. Each of seven patients studied for an in vitro leukocyte thymidine uptake had a low level of [3H]thymidine incorporation. Nine of 12 patients studied had elevated total T cells, and the remaining 3 had normal T cell counts. In vitro unseparated lymphocyte response to phytohemagglutinin showed normal kinetics of DNA synthesis, with a peak response on day 3 or 4 of culture in 4 and slightly or moderately depressed and/or delayed kinetics in 8 patients studied. Cytogenetic analyses by Q- or G-banding techniques of polyclonal B cell mitogen-stimulated lymphocytes in all six patients studied showed normal karyotypes. These data are consistent with a previously undescribed syndrome involving a monoclonal B cell lymphocytosis, a prolonged asymptomatic or benign clinical course, and essentially normal humoral and cellular immunity and normal karyotype. Our observations indicate that these 20 patients with stage O CLL have a benign clinical course and that they may also be designated as benign monoclonal B cell lymphocytosis ( BMBL ), a benign variant of CLL.

Bone marrow infiltration patterns and their prognostic significance in chronic lymphocytic leukemia: correlations with clinical, immunologic, phenotypic, and cytogenetic data

Bone marrow biopsies were prospectively performed on 75 patients with chronic lymphocytic leukemia (CLL). There was a highly significant relationship (p less than 0.002) between clinical stages and bone marrow infiltration patterns. Ten (50%) of 20 patients with diffuse patterns died; the estimated median survival time for these patients was 87 months. In contrast, only six (11%) of 55 patients with nondiffuse patterns died; the estimated median survival time for these patients could not be computed. When both clinical stage and infiltration pattern were evaluated for survival, a highly significant association between clinical stage and survival time was still observed (p less than 0.003) whereas bone marrow infiltration pattern was no longer significant. A significant association was also observed between bone marrow infiltration patterns and absolute lymphocyte counts (p less than 0.0005), Fc-receptor-positive cells (p less than 0.002), 3H-thymidine uptake of leukocytes (p less than 0.01), serum alkaline phosphatase levels (p less than 0.05), monoclonal urinary-free light chain status (p less than 0.05), and cytogenetics of leukemic cells (p less than 0.05). These observations lead to the conclusion that in an overall prognostic evaluation of patients with CLL, although bone marrow histopathology may have no additional value over a well-established clinical staging system, as a whole, it may be of clinically predictive value in disease progression of patients with stage I and II.

Alterations in enzyme expression on 12-O-tetradecanoylphorbol-13-acetate-induced differentiation of chronic lymphocytic leukemia cells

Several enzyme activities were examined to establish a relationship between their expression and terminal differentiation of B-chronic lymphocytic leukemia (CLL) cells to plasma cells by 12-O-tetradecanoylphorbol-13-acetate (TPA). Although adenosine deaminase activity did not change significantly, thymidine phosphorylase and purine nucleoside phosphorylase increased 2-3-fold on TPA-induced differentiation of CLL cells. In addition, cytochemical reactions for non-specific esterase and acid phosphatase changed from very weak to intense on differentiation of CLL cells to plasma cells. The above markers, particularly cytochemical, could be useful for the classification of B-cell malignancies and for studying B-cell differentiation.

Lack of T cell antigen expression on hairy cells of B cell origin after in vitro exposure to PHA

The malignant monoclonal population in hairy cell leukemia (HCL) has been variously ascribed to be of myeloid, B, or even T cell origin. Recent data have been interpreted as suggesting that hairy cells (HC) may concomitantly or serially express both B and T surface determinants, a phenomenon which, if verified, would be unique among the lymphoproliferative malignancies. Data described here, however, demonstrate that (1) at least the majority of HCL are phenotypically of B cell derivation, and (2) the initial B cell phenotype is retained and solely expressed on cultured as well as phytohemagglutinin (PHA) activated monoclonal malignant HC.

Cell cycle analysis of stimulated lymphocytes of B-cell chronic lymphocytic leukemia

To clarify the cell cycle duration of stimulated cells in B cell chronic lymphocytic leukemia (B-CLL), sister chromatid differentiation (SCD) methodology was utilized. So-called polyclonal B-cell activators (PBA), i.e., staphylococcus bacteria strain Cowan I (Cowan I), pokeweed mitogen (PWM), Epstein-Barr virus (EBV), and lipopolysaccharide W from E. coli 055:B5 (LPS), were examined. Most metaphases on day 2 (48 hr) of culture were in first division (M1), and about half of the metaphases on day 3 (72 hr) of culture were in the second division (M2), and many of the metaphases on day 4 (96 hr) of culture were in the third division. These facts suggest that the optimal culture time for cytogenetic study of B-CLL should be 3 days or less to avoid in vitro artifacts.

Prognostic importance of cytogenetic abnormalities in patients with chronic lymphocytic leukemia

Chronic lymphocytic leukemia is recognized as having a variable prognosis, but its staging has depended exclusively on anatomical sites of involvement and the presence or absence of anemia and thrombocytopenia. The recent availability of techniques permitting cytogenetic analysis of malignant B lymphocytes led us to examine the karyotypic abnormalities in chronic lymphocytic leukemia and to correlate them with clinical stage, progression of disease, and survival. Of 53 patients with metaphases adequate for study who were followed for a minimum of one year, 21 (40 per cent) had abnormal karyotypes, of which trisomy 12 was the most frequent (25 per cent). Abnormal karyotypes were found to be significant correlates of advanced clinical stage (P less than 0.005) and of shortened survival (P less than 0.05). We conclude that cytogenetic analysis provides useful clinical and prognostic information in patients with chronic lymphocytic leukemia.

Large mediastinal mass in Hodgkin's disease. Results of two treatment modalities

Sixty-eight untreated patients with Hodgkin's disease (HD), stages I-III, presenting with a large mediastinal mass were treated as follows: patients with "good-risk HD" (lymphocyte predominant or nodular sclerosis and no "B" symptoms) stages I and II were treated by randomization with involved field radiotherapy (IF RT) or IF RT plus six cycles of combination chemotherapy (CT). Those with "poor-risk HD" (presence of B symptoms or with other histologic types) stages I and II and all patients with stage III were treated by randomization with total nodal radiation (TNR) or TNR + CT. Complete remission (CR) was achieved in 66/68 patients (97%) with the initial RT. A significantly longer duration of remission (p = 0.001), but not of survival (p = 0.08) was observed in patients treated with RT + CT compared to RT alone. Significantly longer duration of remission (p = 0.01), but not of survival, was observed in patients with good-risk stages I-II treated with RT + CT. In this category, remission and survival was better with RT + CT than with RT alone in stage III, but these differences were not statistically significant. In poor-risk patients stages I-II, a trend for longer remission and survival (not significant) was observed in patients treated with RT + CT; in stage III, both treatment modalities gave similar poor results. Both treatment modalities were well tolerated by most patients. One patients died with radiation pneumonitis shortly after completion of TNR. One patient developed a malignant schwannoma after treatment with IF RT, and another one developed acute nonlymphocytic leukemia after TNR + CT. Decrease in the transverse diameter of the heart without overt manifestations of cardiac disease was observed in 59% of the patients evaluated for this parameter.

Chromosomes and causation of human cancer and leukemia. LII. Chromosome findings in treated patients with B-cell chronic lymphocytic leukemia

The chromosomes of stimulated lymphocytes in 40 treated cases of B-cell chronic lymphocytic leukemia (B-CLL) were examined. The polyclonal B-cell activators (PBA) used were: pokeweed mitogen (PWM), Epstein-Barr virus (EBV), and lipopolysaccharide W from Escherichia coli 055:B5 (LPS). Thirty-three (83%) of the 40 cases contained an adequate number of metaphases that were suitable for banding. Of 15 cases with abnormal clones, 7 cases had trisomy #12. Occasionally, trisomy #1, 6q-, i(7q), 14q+, trisomy #16, and trisomy #18 were seen. In 5 cases, marker chromosomes of unknown origin existed. The findings indicate that trisomy #12 may be a unique and nonrandom karyotypic change in B-CLL.

Treatment of refractory lymphoproliferative diseases with daily, low-dose vincristine, continuous infusion of bleomycin, and high-dose prednisone

Vincristine 0.25 mg/m2 by IV push and bleomycin 5 units daily by continuous infusion were given on days 1, 2, 3 and 4, together with prednisone 1,000 mg/m2 po in 4 divided doses either on days 1, 3, 5, and 7 (6 patients) or on days 1 and 3 (11 patients) to 17 patients with various lymphoproliferative diseases who had failed their previous treatment program. Fourteen were leukopenic and/or thrombocytopenic. Of 10 patients with non-Hodgkin's lymphoma 2 achieved complete remission and 5 a partial response. Both patients with Hodgkin's disease achieved partial response. A decrease in plasma M protein (median decrease 51%) was observed in 3/3 patients with multiple myeloma and 2/2 with Waldenstrom's macroglobulinemia. Decrease in tumor cell infiltration by 48%, 58% and 100% was observed in 3 patients (2 with macroglobulinemia and 1 with myeloma) in the bone marrow. Leukopenia of less than 3,600/mm3 and thrombocytopenia of less than 70,000/mm3 reverted to normal in 5/7 and 7/10 patients, respectively. Remission duration ranged from 4 to 35+ weeks (median 17 weeks). Three patients had severe GI bleeding. Psychosis controlled by phenothiazines was observed in one, and bleomycin toxicity (anaphylaxis, skin rash, and lung toxicity, one each) was observed in 3 patients. No severe neurotoxicity was observed.

Comparative results with various polyclonal B-cell activators in aneuploid chronic lymphocytic leukemia

The mitotic index and number of abnormal metaphases of cells stimulated with the various B-cell polyclonal mitogens (PBA) in six B cell chronic lymphocytic leukemia (B-CLL) cases were evaluated. The PBA included tetradecanoyl-0-phorbol-13-acetate (TPA), staphylococcus bacterial strain Cowan I (Cowan I), pokeweed mitogen (PWM), Epstein-Barr virus (EBV), and lipopolysaccharide W from E. coli 0.55:B5 (LPS). TPA could stimulate only 1 of 12 samples. Even though Cowan I led to a relatively high mitotic index, abnormal clones were inconsistently obtained with this mitogen. PWM, EBV, and LPS appear to be the most desirable activators of B-CLL cells among the PBA used in this study.

Clinical significance of cytogenetic findings in untreated patients with B-cell chronic lymphocytic leukemia

The chromosome constitutions of stimulated lymphocytes in 21 untreated cases with B-cell chronic lymphocytic leukemia (B-CLL) were examined. So-called polyclonal B-cell activators, i.e., pokeweed mitogen, Epstein-Barr virus, and lipopolysaccharide W from E. coli 055:B5, were used. Four out of 21 cases showed abnormal clones with trisomy 12 and were started on therapy shortly after the diagnosis and cytogenetic examination. On the other hand, most cases without abnormal clones had not received treatment for relatively long periods before and after cytogenetic examination. These findings may indicate that cytogenetic results can be utilized as a parameter for treatment and prognosis in B-CLL.

Possible specific chromosome change in prolymphocytic leukemia

The chromosomes of unstimulated and stimulated blood lymphocytes from 5 cases with B-cell prolymphocytic leukemia (PLL) were examined following the use of polyclonal B-cell activators (PBA). Banding techniques revealed a common and specific chromosome abnormality to be present in each of the cases, which was due to a translocation between chromosomes 6 and 12 (t(6;12)(q15;p13]. The fact that this specific chromosome change has not been reported in other lymphoproliferative disorders may indicate that PLL is a distinct clinical entity and different from other lymphoproliferative disorders, whether it occurs de novo or complicates chronic lymphocytic leukemia (CLL).

Karyotypic findings in a case of prolymphocytic leukemia with a history of radiation exposure

Cytogenetic examination, utilizing B- and T-cell mitogens, of the peripheral blood lymphocytes of a patient with the prolymphocytic variant of chronic lymphocytic leukemia (CLL) and a history of radiation exposure revealed two abnormal clones. One clone with 48 chromosomes (+t(6;12),6q-, +12,14q+) may be derived from CLL cells, whereas the clone with 46 chromosomes and a ring #11 possibly originated from normal T and/or B cells affected by past irradiation.

Chromosomes and causation of human cancer and leukemia. LI. A hairy cell leukemia case with 14q+ and ring chromosomes: significance of ring chromosomes in blood disorders

What appears to be the first hairy cell leukemia case with a 14q+ anomaly is described. In addition to the 14q+ anomaly, a 6q- and a ring chromosome were seen in a blood sample stimulated with lipopolysaccharide, a B-cell mitogen. The clinical course of the present case was short, stormy, and had a poor response to therapy. The correlation between the clinical course and the presence of a ring chromosome in myelo- and lymphoproliferative blood disorders is discussed in relation to the various blood disorders with this karyotype anomaly described in the literature.

Clonal chromosome abnormalities in patients with Waldenström's and CLL-associated macroglobulinemia: significance of trisomy 12

We performed cytogenetic analyses by Q- and G-banding techniques of unstimulated or B-mitogen-stimulated spleen, bone marrow, and peripheral blood cells from six patients with malignant macroglobulinemia [two with Waldenström's macroglobulinemia (WM) and four with chronic lymphocytic leukemia associated macroglobulinemia (CLL-M)]. Normal karyotypes were obtained in two of the treated patients (one with WM in remission and the other with CLL-M in relapse). An extra chromosome 12 (trisomy 12) was observed in all four untreated patients. In patient no. 2 (K.R.) and no. 3 (F.G.) with CLL-M, an abnormal karyotype, with trisomy 12 as the only abnormality, was identified. In patient no. 1 (C.C.) with WM, there were two clonal chromosome changes, identified: 47, XX, -9, +12, plus marker chromosome and 48, XX, -9, +12, plus both marker and minute chromosomes. In patient no. 4 (R.M.) with CLL-M, a minute chromosome with or without loss of a G-group chromosome was seen in some metaphases without trisomy 12, in addition to metaphases with trisomy 12 alone. Each of the four untreated patients with WM or CLL-M had clonal chromosome abnormalities, suggesting that chromosome changes may be more frequently associated with WM or CLL-M than with typical CLL without macroglobulinemia. These observations also suggest that trisomy 12 may be the primary karyotypic change in malignant macroglobulinemia, whereas the appearance of the minute or marker chromosome as well as the loss of G-group chromosomes or chromosome no. 9 may be secondary karyotypic changes resulting from clonal evolution in these malignancies.

Clonal chromosome changes in stimulated lymphocytes of untreated human B-cell leukemias

The chromosome constitution of peripheral blood lymphocytes from nine cases of B-cell chronic lymphocytic leukemia and one case of B-cell prolymphocytic leukemia were studied at diagnosis following stimulation by B- and T-cell activators. Chromosome analysis with banding techniques revealed an extra chromosome 12 (trisomy 12) in 4 B-cell chronic lymphocytic leukemia cases and complicated abnormalities, i.e., trisomy 12, 6q-, 14q+, and a translocation between chromosomes 6 and 12, [t(6; 12)] in the prolymphocytic leukemia case. These findings suggest that trisomy 12 is a prototypic change in B-cell leukemia, particularly in B-cell chronic lymphocytic leukemia. Based on sister chromatid exchange studies of unstimulated lymphocytes, it appears that some leukemia cells with a normal karyotype not only divide but also proliferate in vitro.

Chromosome studies in stimulated lymphocytes of B-cell chronic lymphocytic leukemias

Using a sister chromatid differentiation technique, cell cycle study of stimulated lymphocytes of B-cell chronic lymphocytic leukemia (B-CLL) revealed their cell cycle progression to be similar to that of normal lymphocytes stimulated by T-cell and various polyclonal B-cell activators (PBA). The chromosome constitutions of stimulated lymphocytes in 62 patients with B-CLL were examined using PBA such as Epstein-Barr virus (EBV) and lipopolysaccharide W from E. coli 055:B5 (LPS). Of the 20 patients with abnormal clones, 11 patients had trisomy 12; other less common abnormalities were trisomy 1, 6q-, i(7q), 14q+, trisomy 16, trisomy 18, reciprocal translocations, and marker chromosomes of unknown origin. These findings indicate that trisomy 12 may be a unique and common karyotypic change in B-CLL. The fact that 3 out of 4 patients with marker chromosomes showed stage IV disease may indicate that a clone with a marker is a predictor of an unfavourable prognosis. The near correlation between trisomy 12 and kappa chains existed (0.05 less than p less than 0.10). Trisomy 12 was seen in all 5 patients with monoclonal paraprotein.

Rosette and blastogenesis inhibition by plasma from Hodgkin's disease and other malignancies. Positive correlation in State I and II Hodgkin's disease

The simultaneous presence of both rosette- and mitogen-induced blastogenesis inhibitors was measured in the plasma from 29 patients with active Hodgkin's disease, 21 patients with advanced lung cancer, nine patients with diffuse histiocytic lymphoma, 25 patients with non-Hodgkin's lymphoma, and 17 patients with a variety of solid tumors. Only patients with active Hodgkin's disease consistently demonstrated factors which interfered with both rosetting and mitogenesis when normal allogeneic cells were utilized. While a similar proportion of patients with early and late Hodgkin's disease possessed plasma which could inhibit both tests, a significant correlation between these tests was observed only in Stage I and II disease. Varying degrees of inhibition of these tests was also observed when plasmas from patients with other malignancies were tested. Both lung cancer and histiocytic lymphoma plasma contained a factor which was capable of significantly inhibiting in the rosette assay when compared to normal human serum. Plasma from these patients also demonstrated inhibition of blastogenesis, but unlike Hodgkin's disease, no correlation between these activities could be demonstrated. Neither patients with diffuse or nodular lymphocytic lymphoma nor patients with solid tumors had significant plasma inhibition in either assay.

An improved method for T-cell depletion of allogeneic histoincompatible donor bone marrow

Acute graft-versus-host disease (GVHD) following allogeneic bone marrow transplantation is the most significant limiting factor preventing the widespread application of transplant therapy in acute leukemia and aplastic anemia. GVHD is mediated by T cells that contaminate harvested marrow in proportions ranging from 5-50% of the mononuclear cell population. T cell depletion (TCD) of large volumes of human marrow by E-rosetting for 24 h at 4 degrees C with modified sheep erythrocytes achieves removal of greater than or equal to 97% of all T cells, as judged by cytofluorographic analysis of the T-depleted bone marrow population with a broad panel of anti-T cell monoclonal antibodies, and abrogates functional T cell activity. Although T-depleted bone marrow cell recoveries were 2 logs below total harvested buffy coat cell numbers, the TCD mononuclear population was more than 99% viable and was enriched twofold for Ia+ cells as judged by cytofluorographic analysis. This method is at least the equivalent of those employing lectin column or monoclonal antibody/complement lysis techniques and is simpler to perform. Successful engraftment of adult patients can safely be obtained with as few as 4 X 10(8) total mononuclear cells following the 24-h procedure suggesting that prolonged or repeated T-depletion procedures do not interfere with stem cell engraftment. Preliminary results suggest that this method of TCD may ameliorate GVHD in histoincompatible transplants.

Non-Hodgkin's lymphoma phenotyping: problems in the use of heterologous and monoclonal antibodies

Cell suspensions or frozen sections of lymph node biopsies from 32 patients with non-Hodgkin's lymphoma (NHL) were studied for sheep erythrocyte (E)-binding under three conditions (Estandard, EAET, Egravity), Fc and C receptors, immunoglobulin (Ig) heavy and light chain class and reactivity with heterologous antisera to T cells (T-LCL), HLA-D (Ia-like) and common acute lymphocytic leukemia (c-ALL) antigens. Selected B and T cell lymphomas were also tested for reactivity with the monoclonal antibodies OKT 3, OKT 4, OKT 6, OKT 8, OKT 11A, Leu-1, Leu-2a, Leu-3a, Leu-4 and Leu-7. There were 26 B and 6 T lymphomas. Most B lymphomas were mu+ (81%), kappa+ (77%) and 31% were mu+ delta+. One of the T lymphomas arose in a patient with antecedent follicular small-cleaved (B) cell lymphoma. The most accurate marker for characterizing the immunologic phenotype in NHL was the clonal excess of kappa+ or lambda+ cells. Neither Estandard, EAET, Egravity or T-LCL were consistently reliable as sole reagents in identifying T-cell lymphomas, their individual scores often being lower than those of monoclonal pan-T cell reagents. HLA-D (Ia-like) antigen was noted in 89% of B and 50% of T lymphomas. The corresponding values for c-ALL antigen were 12 and 33%, respectively. The comparative scores in T-lymphomas between OKT 4 and Leu-3a for "helper-inducer" (HE) cells and OKT 8 and Leu-2a for "suppressor-cytotoxic" (SU) cells were not uniformly consistent. Four T lymphomas had a mixed HE/SU cell phenotype, one was HE, and another SU. Anti-T reactivity was detected in the neoplastic follicles of six of seven follicular lymphomas. The percentage of anti-T reactive cells within positive neoplastic follicles was usually small (5-15%) and of the same order as that noted within reactive lymphoid follicles (5-30%). High numbers (50-100%) of cells from five small lymphocytic B, three diffuse small cleaved cell B and six T cell lymphomas were also positive with one or more anti-T reagents, suggesting the presence of cross-reactive antigens that make phenotyping of lymphomas with monoclonal antibodies problematic. Reactivity with the monoclonal antibody Leu-7 (HNK-1), a putative NK-specific reagent, was seen in one of five B and three of five T lymphomas.

Enhancement of T lymphocyte proliferative response to mitogens by indomethacin in breast and colorectal cancer patients

The present study confirms previous observations that in vitro T lymphocyte proliferative response to mitogens is depressed in only some untreated patients with advanced or metastatic breast and colorectal cancer. Indomethacin, a prostaglandin synthetase inhibitor, at 1.0 microgram or 0.1 microgram/ml concentration significantly enhances the PHA, Con A or PWM response in these patients with breast and colorectal cancer (P less than 0.05 - P less than 0.01). Indomethacin has no mitogenic activity. Ethyl alcohol (0.01%), in which indomethacin is dissolved, also has no mitogenic or cytotoxic activity. Although the in vitro effect of indomethacin has been well-demonstrated, the in vivo effect of this agent on cell-mediated immunity in man has not yet been thoroughly investigated and thus, further studies of the effect of indomethacin administration on in vivo and in vitro cellular immunity seem warranted.

Post-therapeutic acute malignant myeloproliferative syndrome and acute nonlymphocytic leukemia in non-Hodgkin's lymphoma

In a prospective randomized study of treatment with radiation therapy (RT) or RT + chemotherapy (CT) for patients with non-Hodgkin's lymphoma Stages I-III, one patient developed an acute malignant myeloproliferative syndrome (AMMS) and four others acute nonlymphocytic leukemia (ANLL). There was correlation between the intensity of treatment and development of this complication: Among patients treated with local radiation with or without chemotherapy no cases of AMMS or ANLL were observed. However, patients treated with total lymphoid irradiation alone (TLI) had an observed to expected ratio of 162. Among patients treated with TLI plus CT this ratio increased to over 1000. The cytogenetic, clinical, and hematologic abnormalities of these patients are discussed.

Lack of autologous mixed lymphocyte reaction in patients with chronic lymphocytic leukemia: evidence for autoreactive T-cell dysfunction not correlated with phenotype, karyotype, or clinical status

In the present study, there was a complete lack of autologous MLR between responding T cells or T subsets and unirradiated or irradiated leukemic B cells or monocytes in all 20 patients with CLL, regardless of disease status, stage, phenotype, or karyotype of the disease. The stimulating capacity of unirradiated CLL B cells and CLL monocytes or irradiated CLL B cells was significantly depressed as compared to that of respective normal B cells and monocytes in allogeneic MLR. The responding capacity of CLL T cells was also variably lower than that of normal T cells against unirradiated or irradiated normal allogeneic B cells and monocytes. The depressed allogeneic MLR between CLL B cells or CLL monocytes and normal T cells described in the present study could be explained on the basis of a defect in the stimulating antigens of leukemic B cells or monocytes. The decreased allogeneic MLR of CLL T cells might simply be explained by a defect in the responsiveness of T lymphocytes from patients with CLL. However, these speculations do not adequately explain the complete lack of autologous MLR in these patients. When irradiated CLL B cells or irradiated CLL T cells were cocultured with normal T cells and irradiated normal B cells, it was found that there was no suppressor cell activity of CLL B cells or CLL T cells on normal autologous MLR. Our data suggest that the absence or dysfunction of autoreactive T cells within the Tnon-gamma subset account for the lack of autologous MLR in patients with CLL. The possible significance of the autologous MLR, its relationship to in vivo immunoregulatory mechanisms, and the possible role of breakdown of autoimmunoregulation in the oncogenic process of certain lymphoproliferative and autoimmune diseases in man are discussed.

Effects of source leukocyte collection on the immune system

This study was initiated in order to assess any immunologic effects that source leukocyte concentrate collection might have on double-bag plasmapheresis donors. Previous studies have shown that surveillance parameters, such as T versus non-T lymphocyte subpopulations, showed no abnormal values in donors with as many as 500 visits over a 12-year period. The present study demonstrates that the frequency and the total number of leukocyte donations do not effect the lymphocyte subpopulations and functions observed. No significant changes were noted for specific and nonspecific stimulation, natural killer (NK) cell activity, lymphocyte surface markers and a variety of functional parameters. For example, the apheresis donors manifested no differences in NK cell activity, human leukocyte interferon production, IgG synthesis by B cells and percent suppression of both IgG synthesis and mixed lymphocyte cultures, when compared to non-apheresed donors.

The presence of monoclonal cytoplasmic immunoglobulins in leukemic B cells from patients with chronic lymphocytic leukemia

It has generally been assumed that CLL B cells do not contain cytoplasmic immunoglobulin (Cylg), although these cells express surface membrane immunoglobulin (Smlg). The present study, in which Smlg and Cylg determinations were performed simultaneously using leukemia B cells from 20 patients with CLL, demonstrates that Cylg staining was detectable in each CLL cell population examined and that the intensity of cytoplasmic immunofluorescent staining in each instance was moderate to strong. Both Smlg and Cylg light chain determinations indicated monoclonality in all 20 cases. The heavy chain class of Smlg and Cylg in each CLL cell population was not uniformly comparable, however. The majority (15 cases) of CLL B cells contained mu heavy chain Cylg and mu and delta heavy chain Cylg was demonstrated in the remaining 6 cases. In contrast, the Smlg phenotypes appeared heterogeneous with both gamma and alpha chain determinants found associated with mu or mu and delta chains on the same leukemia cell populations. This apparent polyclonal Smlg staining pattern was most likely due to nonspecific adsorption of the patient's own serum Ig by Fc receptors on CLL B cells. It is concluded that the great majority of CLL B cells contain detectable Cylg and that Cylg determination is superior to Smlg phenotyping in documenting the monoclonality of CLL.

Combinations of methotrexate (COP or CHOP) in the treatment of previously untreated and treated lymphomas

A regimen consisting of two courses of methotrexate (MTX) with leucovorin rescue followed 1 week later by cyclophosphamide, vincristine, and prednisone (MTX-COP) was studied in ten patients with disseminated diffuse non-Hodgkin's lymphoma who had had no prior chemotherapy. A similar regimen with the addition of doxorubicin (MTX-CHOP) was used for patients who had had previous chemotherapy: 11 with diffuse non-Hodgkin's lymphoma and two with Hodgkin's disease. The response rate to initial MTX administration was 55%, and the clinical onset of effect was usually observed within 48 hours. Responses were observed in previously treated and untreated patients. The remission rate was 100% with both regimens. There were seven complete remissions with MTX-COP and six with MTX-CHOP. The median durations of remission were 23 and 13 months, respectively; median survival was not reached in either group. MTX was well-tolerated by both groups of patients without serious toxic effects. Overall, significantly more hematologic toxicity was observed in previously treated patients; however, no life-threatening toxic effects were observed in either group. The incorporation of MTX and other antimetabolites into schedules of chemotherapy for previously treated and untreated patients with non-Hodgkin's lymphoma is well tolerated and deserved further exploration.