Recombinant interferon alfa-2b combined with a regimen containing doxorubicin in patients with advanced follicular lymphoma. Groupe d'Etude des Lymphomes de l'Adulte

BACKGROUND

Interferon alfa and cytotoxic drugs have synergistic effects in patients with non-Hodgkin's lymphoma. In 1986, we designed a clinical trial to evaluate the benefit of concomitant administration of recombinant interferon alfa with a regimen containing doxorubicin in patients with follicular non-Hodgkin's lymphoma.

METHODS

The trial involved 242 patients with advanced low-grade follicular non-Hodgkin's lymphoma selected on the basis of clinical, radiographic, and biologic criteria. All patients were treated with a regimen consisting of cyclophosphamide, doxorubicin, teniposide, and prednisone (CHVP), given monthly for six cycles and then every two months for one year. After randomization, 123 patients also received interferon alfa-2b at a dosage of 5 million units three times weekly for 18 months. The remaining 119 patients received chemotherapy alone.

RESULTS

As compared with the patients treated with CHVP only, the patients treated with CHVP plus interferon alfa had a higher overall rate of response (85 percent vs. 69 percent, P = 0.006), a longer median event-free survival (34 months vs. 19 months, P < 0.001), and a higher rate of survival at 3 years (86 percent vs. 69 percent, P = 0.02). Granulocyte toxicity was greater in the patients treated with CHVP plus interferon alfa than in those treated with CHVP alone. There were no treatment-related deaths. Interferon alfa had to be stopped because of toxic effects (fatigue and hepatitis) in 13 patients (11 percent).

CONCLUSIONS

The addition of interferon alfa to a regimen containing doxorubicin increased the rate of response, event-free survival, and overall survival in patients with advanced follicular non-Hodgkin's lymphoma, without serious toxicity, although some patients were unable to tolerate the side effects.

Prognostic significance of received relative dose intensity in non-Hodgkin's lymphoma patients: application to LNH-87 protocol. The GELA. (Groupe d'Etude des Lymphomes de l'Adulte)

BACKGROUND

To evaluate the effects of chemotherapy dose intensity (DI) on outcome in patients with aggressive lymphoma, the received relative DI (received RDI) is usually calculated using Hryniuk's model. We applied this model to a selected patient subgroup included in the LNH87 protocol (LNH87-2 protocol), who had been treated with the ACVB induction regimen.

PATIENTS AND METHODS

Patients aged < 55 who had at least one of the following prognostic factors: performance status (PS) > or = 2, number of extranodal sites > or = 2, tumor burden > or = 10 cm, bone marrow or central nervous system involvement, and Burkitt's or lymphoblastic histologic subtype, were included in this study. Actual DI was calculated using the definition of DI as mg/m2/week previously described by Hryniuk.

RESULTS

Eighty-seven of the 311 patients included in the study (28%) presented a RDI below 70% of the theoretical DI. We demonstrated a decreased response rate (65% vs. 79%, p = 0.01) and shorter overall 2-year survival (61% vs. 72%, p = 0.02) in patients receiving a DI < 70%. This difference was still significant when the multiparametric analysis was used (p = 0.004).

CONCLUSION

Results obtained when this model was applied to aggressive lymphoma patients included in the LNH-87 protocol led to the demonstration of a strong relationship between received RDI and survival.

Nasal T-cell lymphoma: a clinicopathologic entity associated with peculiar phenotype and with Epstein-Barr virus

Recent evidence has shown that most nasal lymphomas (NL) are associated with a T-cell phenotype and are thus called nasal T-cell lymphomas (NTCL), but little information is available about the T-cell receptor (TCR) expression. The presence of Epstein-Barr virus (EBV) genome has been recently reported in NTCL in Oriental populations in which NL and EBV-associated tumors are more common and in occasional Occidental cases. This prompted us to investigate lymphoma biopsies from 7 non-Oriental patients with NTCL for the expression of natural killer (NK) and T-cell antigens, including TCR proteins, for the presence of EBV-encoded latent membrane protein (LMP) using immunohistochemistry and for the presence of EBV DNA and Epstein-Barr early region (EBER) RNA using in situ hybridization (ISH). Six cases displayed a CD3-, TCR alpha beta-, TCR gamma delta-, CD2+, CD7+, CD5-, CD4-, CD8-, CD56+ phenotype, suggesting that these tumors may be peripheral T-cell lymphomas (PTCL) with extensive loss of T-cell antigens and expression of the NK-cell (CD56) antigen or, alternatively, NK-cell neoplasias. The remaining case was a gamma delta PTCL, as shown by the CD3+, TCR gamma delta+ phenotype and the biallelic gamma and delta TCR gene rearrangements. Using ISH, EBER RNA transcripts were detected in tumor cells in all cases and EBV DNA was shown in the 6 tested cases. In all cases, tumor cells expressed LMP. These findings support the concept that NTCL constitute a distinct group of lymphomas that, in addition to their peculiar clinical features, exhibit an unusual TCR "silent" CD56+ or TCR gamma delta+ phenotype and harbor the EBV. In view of the LMP transforming potential, these data suggest that EBV may play a role in the pathogenesis of NTCL.

Detection of multiple myeloma involving the spine: efficacy of fat-suppression and contrast-enhanced MR imaging

OBJECTIVE

To determine the efficacy of fat-suppressed sequences and contrast-enhanced MR imaging for the detection of focal spinal lesions caused by multiple myeloma, we obtained MR images in 32 patients with newly diagnosed myeloma who had back pain.

SUBJECTS AND METHODS

All patients had biopsy-proved myeloma and had MR imaging at the painful level of the spine. Spin-echo T1-weighted, T2-weighted, and short TI inversion-recovery (STIR) images; dynamic ultrafast low-angle shot (turbo-FLASH) images after IV injection of a bolus of paramagnetic contrast material; and contrast-enhanced T1-weighted images were obtained. We qualitatively compared the signal intensities and contrast enhancement of focal lesions with those of the surrounding vertebral bodies.

RESULTS

Multiple lesions were detected in all but two of the 32 patients. On T2-weighted and STIR images, all lesions had homogeneously high signal intensity. On T1-weighted images, the lesions were visible as hypointense areas compared with surrounding bone in all except four patients, in whom the lesions were isointense or hyperintense. All tumor nodules enhanced on turbo-FLASH images obtained in the arterial phase. No additional lesions were seen on STIR or contrast-enhanced images. MR findings resulted in a change in the staging of the disease in one patient and led to prompt treatment in five patients with epidural involvement.

CONCLUSION

MR imaging appears to be helpful in detecting spinal involvement in patients with multiple myeloma. The diagnosis of spinal lesions is best achieved by using either fat-suppressed or T2-weighted images. Although myeloma lesions enhanced in all patients, contrast material appears to be of no value for the detection of additional lesions.

MR appearance of multiple myeloma of the spine before and after treatment

OBJECTIVE

The aim of this study was to describe the changes in the MR appearance of painful lesions of the spine before and after treatment in 18 patients with multiple myeloma and to correlate these changes with the clinical response to treatment.

SUBJECTS AND METHODS

Eighteen patients with multiple myeloma and tumor nodules in the spine had MR imaging of the same site in the spine before and after treatment. Unenhanced T1- and T2-weighted spin-echo images, dynamic ultrafast low-angle shot (turbo-FLASH) images before and after IV bolus injection of paramagnetic contrast material, and contrast-enhanced T1-weighted spin-echo images were obtained. Characteristic signal and contrast enhancement before and after treatment were compared and were correlated with clinical data and the results of immunochemical and pathologic tests.

RESULTS

Changes in signal intensity and enhancement of the lesions occurred after treatment in 14 of 18 patients. The characteristics of the lesions after treatment had three patterns: (1) rim enhancement or no enhancement of the lesions, (2) early enhancing lesions associated with other nonenhancing lesions or lesions with rim enhancement, and (3) no change from the enhancement pattern seen before treatment. In 13 of 18 patients, these patterns correlated well with the response to treatment. A discrepancy was observed in five patients.

CONCLUSION

The MR appearance of spinal myeloma is different before and after treatment. MR images, particularly contrast-enhanced images, may be helpful in monitoring the response to treatment of focal bone lesions of myeloma.

[Role of x-ray computed tomography in the follow-up of the course of Hodgkin's disease]

Fourteen files of patients having had Hodgkin's disease have been analyzed retrospectively to assess the justification of systematic surveillance after complete remission has been achieved. The data of successive CT exams, compared with the findings of clinical and biological studies performed on the same dates, confirm the primordial role of imaging, since computed tomography was predictive for 7 of 18 events (14 relapses and 4 second progressions). The occurrence of subphrenic recurrence in 3 cases for which the initial site was mediastinal leads to discussing the merits of a yearly thoraco-abdomino-pelvic examination during the two years following complete remission.

Autologous hematopoietic stem cell transplantation in intermediate and high grade non-Hodgkin's lymphoma: a review

High dose therapy with or without hematopoietic stem cell rescue has been widely used in the past decade for treating aggressive Non-Hodgkin's lymphoma. Recent data in high and intermediate grade lymphoma were reviewed. Evidence that dose intensity is a critical factor for remission in poor prognosis lymphoma has been accumulated, although the impact on survival has not been clearly established through randomized studies. Intensive treatment with autologous bone marrow transplantation (ABMT) have been reported in more than 1,000 relapsing patients in non randomized trials. For those who are still sensitive to salvage chemotherapy, at 5 years a 40% probability of disease free survival has been uniformly noted. ABMT is accepted by most centers as the treatment of choice for relapsing lymphoma. Consequently, very few randomized studies testing ABMT vs. conventional chemotherapy such as the PARMA protocol are in progress. In patients achieving complete remission, ABMT has been proposed for consolidation in a group of lymphoma sharing adverse prognostic factors with a high risk of relapse. Results from pilot studies were encouraging. However, interim analysis of the large randomized trial LNH87, did not show at the present time an advantage for ABMT performed after CR when compared to conventional chemotherapy. Such a strategy should be only proposed in prospective studies. For patients who did not achieve CR after conventional treatment, but who are still sensitive to chemotherapy, ABMT may improve the results. Pilot studies as well as recent randomized study are in support of this approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Low grade B cell mucosa associated lymphoid tissue lymphoma of the stomach: clinical and endoscopic features, treatment, and outcome

A retrospective study of the clinical and endoscopic features of low grade gastric lymphomas of mucosa associated lymphoid tissue (MALT) in 16 patients together with treatment and outcome was undertaken. Immunohistochemical studies of fresh tissue easily distinguished MALT lymphoma from benign reactive lymphoid hyperplasia (pseudolymphoma) and showed that tumour cells had the characteristic phenotype indicative of their origin from MALT. Persistent epigastric pain was the main presenting complaint, and was often associated with acute bleeding, anaemia, or weight loss. Eight patients had a past history of recurrent peptic ulcers or gastritis. The endoscopic appearance suggested malignancy in only half the cases and was compatible with gastritis or a benign peptic ulcer in the remainder. There was extragastric involvement of other mucosal sites in eight patients (mainly the lung, but also the parotid gland and small bowel), but rarely was bone marrow and never the spleen or peripheral lymph nodes affected. Conservative treatment with long term cyclophosphamide was effective in both stage I and stage IV disease, and all the patients are alive after a median follow up of 4.5 years. These findings confirm that low grade gastric MALT lymphomas are usually indolent tumours with non-specific endoscopic aspects and show that dissemination to other mucosal sites was more frequent than previously reported. Monochemotherapy could be an effective alternative treatment to surgery.

Clinical and biological analysis of peripheral T-cell lymphomas: a single institution study

Peripheral T-cell lymphoma (PTCL) accounts for 15-20% of non-Hodgkin's lymphoma in the Western World. Clinical, histopathologic, phenotypic and genotypic data were received from 33 cases of PTCL referred to our institution. The median age order was 50 years, 78% were males, and 18% had a history of a preceding disorder of the lymphoid system. 60% had stage 4 at diagnosis and B symptoms were also present in 60%. The most frequent sites of extranodal involvement were bone marrow (54%), liver (45%) and skin (33%). Twenty-eight of 33 cases were histologically classified according to the Working Formulation (most in the diffuse mixed and large-cell subgroups) and the Kiel updated system. Phenotypic and genotypic studies of malignant cells showed a considerable heterogeneity with respect to the expression of either T-cell receptor (TCR) alpha beta and gamma delta and pan-T differentiation molecules. Of the studied cases 63% expressed TCR-alpha beta. All five patients with PTCL of the TCR-gamma delta subtype had a peculiar extra-nodal presentation. The vast majority of cases expressed an abnormal T-cell phenotype with respect to the expression of pan-T antigens, including the lack of expression of the TCR-associated CD3 molecule in 2 cases. Rearrangements of the TCR beta and/or delta-chain genes showed clonality in 21 of the 23 studied cases. Twenty-five patients were treated with a multiagent chemotherapy regimen with curative intent and the remainder received a less intensive palliative regimen. Only 9 patients achieved CR (8 of whom had received an anthracycline-containing regimen) and the 4-year survival rate was 25%.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification of a new galactanase from Penicillium oxalicum catalysing the hydrolysis of beta-(1----5)-galactofuran linkages

An endo beta-(1----5)-galactofuranase from Penicillium oxalicum has been purified 91-fold. The enzyme is a basic glycoprotein with a pI 7.9 and 20% (w/w) carbohydrate content, galactose being the principal sugar. The apparent Mr of the enzyme estimated by denaturing gel electrophoresis was 77,000. The optimum pH was 5.0, and the enzyme was stable over the pH range 4.0-7.5. This enzyme hydrolyses specifically (1----5)-linked beta-D-galactofuranose residues in homo- and heterogalactans, but did not hydrolyse o-nitrophenyl galactose and beta-(1----5)-galactofuranbiose. Km and Vmax. values were 1.2 mg.ml-1 and 0.55 mumol.h-1 respectively when Eupenicillium crustaceum beta-(1----5)-galactofuran was used as substrate. The enzyme showed high affinity for different separation gels and proteins. The enzyme specificity and its mode of action showed that it could be an useful tool for analysing the fine structure of polysaccharides.

Cutaneous lymphomas other than mycosis fungoides: follow-up study of 52 patients

Cutaneous lymphomas other than mycosis fungoides (MF) represent a rare and heterogeneous group of lymphomas. Their clinical behavior remains largely unknown. In this study, the clinical and immunohistologic characteristics and follow-up data of 52 well-documented cases of cutaneous lymphomas other than MF, presenting with initial cutaneous lesions, were reviewed. Twenty-seven patients presented with skin disease alone (stage IE), and 25 patients had concurrent cutaneous and extracutaneous disease (stage IV). The tumors were grouped into high-grade lymphomas (HGLs; 21%), intermediate-grade lymphomas (IGLs; 58%), and low-grade lymphomas (LGLs; 21%). A B-cell phenotype was most often expressed by cutaneous lymphomas (73%), particularly by stage IE lymphomas (85%). Among 13 cases of T-cell lymphomas, loss of one of the pan-T-cell antigens was detected in all cases but one. The clinical course of cutaneous lymphoma was closely dependent on stage and histologic subtype but not on T-cell or B-cell phenotype. Of 20 patients with stage IV HGL or IGL, 13 were treated by polychemotherapy with curative potential. Their median survival was 37 months. Fourteen patients with stage IE HGL or IGL were treated by radiotherapy alone. Nine patients (69%) relapsed within 2 years posttreatment. Seven of them relapsed in the skin outside the initial site involved, suggesting that radiotherapy alone is not an adequate treatment for these patients. Preliminary results concerning seven other patients with stage IE IGL or HGL treated by an initial third-generation polychemotherapy regimen are presented.

Bone marrow histologic and immunohistochemical findings in peripheral. T-cell lymphoma: A study of 38 cases

The histologic and immunohistochemical findings in bone marrow (BM) biopsies from 38 patients with peripheral T-cell lymphoma (PTCL) are reported. Routine light microscopy showed that BM involvement was unequivocal in 12 cases and questionable in 14 cases. There was no histologic evidence of lymphoma in the remaining 12 cases. Immunohistochemistry performed on BM frozen sections demonstrated the T-cell origin of the infiltrating lymphoid cells in 24 of the 26 patients with unequivocal or questionable involvement. The malignant nature of these cells was suggested by demonstration of an aberrant T-cell phenotype identical to that observed in the other sites of involvement. In addition, in four of the 12 cases with apparently normal BM at routine light microscopy, immunohistochemistry revealed a minimal but phenotypically abnormal T-cell population, suggesting mild infiltration by lymphoma. These combined histologic and immunohistochemical data documented a high incidence (73%) of BM involvement by PTCL. In addition, a very peculiar sinusal pattern of BM involvement was found in five patients who presented an unusual type of hepatosplenic T-cell lymphoma expressing the gamma delta T-cell receptor. The present study demonstrates the high incidence of BM involvement by PTCL and emphasizes the value of frozen section immunohistochemistry to establish this diagnosis, especially when routine light microscopy findings are questionable.

Recombinative events of the T cell antigen receptor delta gene in peripheral T cell lymphomas

Recombinative events of the T cell antigen receptor (TCR) delta-chain gene were studied in 37 cases of peripheral T cell lymphoma (PTCL) and related to their clinical presentation and the expression of the alpha beta or gamma delta heterodimers as determined by immunostaining of frozen tissue samples. There were 22 cases of alpha beta, 5 cases of gamma delta, and 10 cases of silent TCR expressing neither the alpha beta nor gamma delta TCR. 5 different probes were used to examine the delta locus. The 22 cases of alpha beta PTCL displayed biallelic and monoallelic deletions; a monoallelic V delta 1 J delta 1 rearrangement was observed in 1 case and a monoallelic germ line configuration in 7 cases. The 5 cases of gamma delta PTCL displayed biallelic rearrangements: the productive rearrangements could be ascribed to V delta 1J delta 1 joining in 3 cases and VJ delta 1 joining in 2 cases according to the combined pattern of DNA hybridization with the appropriate probes and of cell reactivity with the TCR delta-1, delta TCS-1, and anti-V delta 2 monoclonal antibodies. In the VJ delta 1 joining, the rearranged V segments were located between V delta 1 and V delta 2. Interestingly, in the third group of 10 cases of silent PTCL, 5 cases were found to have a TCR gene configuration identical to that in the TCR alpha beta PTCL, as demonstrated by biallelic delta gene deletion. These 5 cases were CD3 positive. The 5 remaining cases showed a monoallelic delta gene rearrangement with a monoallelic germ line configuration in 4 and a monoallelic deletion in 1. Four of these cases were CD3 negative, which was consistent with an immature genotype the TCR commitent of which could not be ascertained. Finally, TCR gamma delta PTCL consisted of a distinct clinical morphological and molecular entity whereas TCR alpha beta and silent PTCL had a similar presentation.

CD3-T cell receptor modulation is selectively induced in CD8 but not CD4 lymphocytes cultured in agar

The CD3-T cell receptor (TcR) complex is central to the immune response. Upon binding by specific ligands, internalized CD3-TcR molecules increase, and either T cell response or unresponsiveness may ensue depending on the triggering conditions. Using semi-solid agar culture, we have shown previously that quiescent CD4 but not CD8 lymphocytes generate clonal colonies under phytohaemagglutinin stimulation. Here we have demonstrated that the agar induces selective CD3-TcR modulation in the CD8 and not in the CD4 subset. CD8 lymphocytes preactivated in liquid culture and recultured in agar with exogenous recombinant interleukin-2 generate colonies with a modulated CD3-TcR surface expression. The peptides composing the CD3-TcR complex are synthesized in CD8 colonies as well as in CD4; however, the CD3 gamma chain is phosphorylated at a higher level in CD8 colonies. A component of the agar polymer, absent in agarose, appears to be the ligand that induces differential CD3-TcR modulation in the CD8 subset. In contrast to agar culture, CD8 colonies can be derived from quiescent CD8 lymphocytes in agarose. These CD8 colonies express unmodulated CD-TcR. CD3-TcR modulation with anti-CD3 monoclonal antibody prior to culturing in agarose inhibits the colony formation. We conclude that given triggering conditions can result in both CD3-TcR modulation and inhibition of the proliferative response selectively in the CD8 lymphocyte subset and not in the CD4.

Expression of the alpha/beta and gamma/delta T-cell receptors in 57 cases of peripheral T-cell lymphomas. Identification of a subset of gamma/delta T-cell lymphomas

Fifty-seven cases of peripheral T-cell lymphoma were studied for cell expression of the T-cell receptor (TCR) chains, using monoclonal antibodies specific for the beta chain (beta F1) of the alpha/beta TCR, and for the delta chain (anti-TCR delta-1) of the gamma/delta TCR. Three different patterns were demonstrated: in 39 cases (69%), the phenotype (CD3+beta F1+TCR delta-1-) was that of most normal T cells. A second pattern was found on six cases (10%), which were of CD3+beta F1-TCR delta-1+ phenotype, and in which DNA analysis showed a clonal rearrangement of the delta locus in the five cases studied. It is suggested that these cases are the neoplastic counterpart of the small subpopulation of normal T cells that express gamma delta receptor. It is of considerable interest that these gamma delta lymphomas had unusual clinicopathologic presentations, as one case corresponded to a lethal midline granuloma and the five others to hepatosplenic lymphomas with a sinusal/sinusoidal infiltration in spleen, marrow, and liver. The fact that the distribution of the neoplastic gamma delta cells in the splenic red pulp resembles that of normal gamma delta cells reinforces the concept of a preferential homing of gamma delta T cells to this tissue. A third pattern (CD3 +/- beta F1-TCR delta-1-) was seen in 12 cases (21%), in which, by contrast to normal post-thymic T cells, no evidence of either alpha beta or gamma delta T cell receptor was found.

Polymerase chain reaction (PCR) amplification demonstrates the absence of human T-cell lymphotrophic virus (HTLV)-I specific pol sequences in peripheral T-cell lymphomas

HTLV-I seronegative patients in nonendemic areas have been described with T-cell proliferations the DNA of which contains specific HTLV-I viral sequences. We have looked for the presence of HTLV-I DNA sequences in 27 HTLV-I seronegative patients with peripheral T-cell lymphomas, distinct from adult T-cell leukemia (ATL), and four HTLV-I seropositive patients, three with an ATL and one with a tropical spastic paraparesis. Using HTLV-I pol specific primers, the genomic DNA from peripheral blood mononuclear cells and lymph nodes massively infiltrated by tumor cells was analyzed by the enzymatic gene amplification procedure. In contrast to the peripheral blood lymphocytes from the four HTLV-I seropositive patients, the peripheral T-cell lymphoma samples did not harbor HTLV-I pol sequences. The data show that the detection of HTLV-I nucleotide sequences by the polymerase chain reaction correlates with serologic analysis in this series.

Effect of beta-glucanases on Penicillium oxalicum cell wall fractions

The polysaccharidic effect of a purified 1,3-beta-glucanase, a purified beta-glucosidase, and of partially purified endo-1,3-beta-glucanase from autolysed Penicillium oxalicum cultures on cell wall isolate fractions from the same fungus were studied. Fractionation of 5-day-old cell wall gave rise to a series of fractions that were identified using infrared spectrophotometry. The fractions used were: F1, an alpha-glucan; F3, a beta-glucan; F4, a chitin-glucan; and F4b, a beta-glucan. The fractions were incubated with each of the enzymes and with a mixture of equal parts of the three enzymes and the products of the enzymatic hydrolysis were analyzed after 96 h incubation. The enzymes were found to degrade fraction F4b (beta-glucan); the greatest degree of hydrolysis was reached when the three enzymes were used together, suggesting the need for synergic action by these enzymes in the cell wall degradation process.

Nucleases in the autolysis of filamentous fungi

RNase and DNase activities were studied in seven fungi of the subdivisions Ascomycotina, Zygomycotina and Basidiomycotina during their autolysis, and extracellular and intracellular RNase and DNase were found. RNase specific activity reached higher levels than DNase specific activity in the culture liquid and mycelial extract, except in Aspergillus nidulans. Generally maximal RNase specific activities were observed at the onset of autolysis in the culture liquid. In the mycelial extract an increase in this activity with the incubation time was observed, except in A. nidulans and Coriolus versicolor. The highest values of DNase specific activities were found at the third day of autolysis in A. nidulans culture liquid and at the thirtieth day of autolysis in Schizophyllum commune mycelial extract. A possible relationship between the culture liquid pH during the autolysis of the studied fungi and the levels of DNase specific activity was observed.

Cephalosporin C acylase in the autolysis of filamentous fungi

Cephalosporin C acylase activity was studied using fluorescamine determination of free--NH2 groups produced in the deacylation of cephalosporin C by the enzyme. Fourteen fungi from different genera were studied and low extracellular cephalosporin C acylase activity was found in the genera Aspergillus, Fusarium and Penicillium. Forty one fungi of these genera were checked but not all presented acylase activity. The enzyme was generally found to be an extracellular enzyme and during the process of autolysis its activity increased with incubation time and with increasing pH of the medium. In no case was beta-lactamase activity detected. Penicillium rugulosum and Penicillium griseofulvum were identified as good cephalosporin C acylase producers. Deacetyl esterase activity was also detected in these fungi.

Purification and properties of a 1,3-beta-glucanase from Penicillium oxalicum autolysates

High 1,3-beta-glucanase activity was detected during autolysis in a culture medium containing Penicillium oxalicum. It was due to the combined action of four enzymes. The purification process for the major enzyme produced a homogeneous band in the SDS polyacrylamide gel that corresponded to a molecular weight of 79,400 daltons. The enzyme pI was 6.3 and it was only active against 1,3-beta-glucans, with a S0.5 of 0.23 mg ml-1 against laminarin. The enzymatic optima were found at pH 4 and 55 degrees C, and instability was evident when pH and temperature were altered. The enzyme was not active against oxidated laminarin and was barely inhibited by glucono-D-lactone. Hg2+, Ag+ and Fe2+ were effective inhibitors. The enzyme was adsorbed by concanavalin-A-sepharose.

Beta-N-acetylglucosaminidase from Aspergillus nidulans which degrades chitin oligomers during autolysis

A hexosaminidase from autolyzed cultures of Aspergillus nidulans was purified 196 fold and characterized as a beta-N-acetylglucosaminidase (EC 3.2.1.30). The enzyme has a MW of 190000, a pI of 4.3, and optimum pH of 5.0 and is unstable at temperatures above 50 degrees C. The enzyme is a glycoprotein with 19.5% sugars, mannose being the principal component. It binds strongly to chitin. The enzyme hydrolyzes different substrates. The Ki with the competitive inhibitor 2-acetamido-2-deoxy-D-gluconolactone was independent of the substrate used. The enzyme was inhibited by Hg2+, Ag+, acetate and other organic anions. The kinetics of hydrolysis of chitin oligosaccharides from 2 to 6 units was studied by HPLC. This enzyme is an exoenzyme which degraded chitin oligomers gradually with the production of N-acetylglucosamine. The hydrolysis of N-N'-diacetylchitobiose was inhibited non-competitively by glucosamine and N-acetylglucosamine. In mixtures of chitin oligosaccharides, the hydrolysis of chitobiose was competitively inhibited by each of the other oligomers.

Mediastinal diffuse large-cell lymphoma with sclerosis: a condition with a poor prognosis

Twenty patients (17 women, three men) with mediastinal diffuse large-cell lymphoma with sclerosis are reported. At the time of diagnosis, the disease was confined to supradiaphragmatic areas in all patients but two, who had kidney involvement (seven were stage I, 11 were stage II, and two were stage IV). A B-cell phenotype was demonstrated in nine of the 11 cases that were analyzed for cell lineage. All patients received an anthracyclin-containing regimen followed by mantle radiotherapy. Analysis of pretreatment characteristics showed that only the extent of disease influences outcome. Moreover, achievement of complete remission (CR) after chemotherapy appears to be a major prognostic factor. Two-year survival was better in patients who reached CR after chemotherapy than in those who did not (100% versus 9%; p less than 0.0001). Overall 2-year and 7-year survival rates were 50% and 33%, respectively. Therefore, localized mediastinal large cell lymphoma with sclerosis should be considered a high-risk subtype of non-Hodgkin's lymphoma in which standard treatment approaches are unsuccessful.

Endochitinase from Aspergillus nidulans implicated in the autolysis of its cell wall

An endochitinase from centrifuged autolyzed cultures of Aspergillus nidulans has been purified 100 times. The enzyme has Mw 27,000, pI of 4.8 units, pH optimum around 5 pH units. It is unstable at temperature greater than 70 degrees C and does not have a cation requirement. It is inhibited by Hg2+, Cu2+, Ca2+ and Ag+ and it does not have muramidase activity. The enzyme depolymerizes chitin rapidly with production of high molecular weight polysaccharides, and then slowly degrades these with production of N,N'-diacetylchitobiose. The enzyme hydrolyzes N,N',N''-triacetylchitotriose with production of N,N'-diacetylchitobiose and N-acetylglucosamine and this hydrolysis is inhibited by other chitin oligomers and N-acetylglucosamine. This enzyme hydrolyzes in the same way the chitin obtained from the cell wall of Aspergillus nidulans.

Determination of cephalosporin-C amidohydrolase activity with fluorescamine

A spectrophotometric procedure for the assay of cephalosporin-C amidohydrolase activity, based on the determination of the 7-aminocephalosporanic acid (7-ACA) produced in the hydrolysis of cephalosporin-C by the enzyme, is described. This procedure can be used to detect 7-ACA over a range of 10 to 200 micrograms mL-1. The same method can be used as a fluorometric procedures with a 100-fold greater sensitivity. At pH 4.5 7-ACA produces a strong fluorophor with fluorescamine, detectable spectrophotometrically at 378 nm and fluorometrically at an excitation of 378 nm and emission of 495 nm. At this pH the fluorophors formed with cephalosporin-C, proteins and aminoadipic acid present minimal absorbance values. The conditions for maximal detection of 7-ACA in the presence of proteins, cephalosporin-C and aminoadipic acid have been determined.

Penicillin amidohydrolases in fungal autolysis

The production of penicillin G and penicillin V amidohydrolases or acylases (E.C.3.5.1.11) was studied during the autolysis of filamentous fungi in a mineral medium, and in the same medium with phenoxyacetic acid as inducer. In all the studied fungi, enzymes showing penicillin G and penicillin V amidohydrolase activities were found. Generally, an increase of these activities during fungal autolysis was observed. The presence of phenoxyacetic acid in the medium did not increase these activities. The activities found in the culture fluids were generally higher than that found in the mycelial extracts. Under these conditions, beta-lactamases (penicillinases) were not found. The fungi Alternaria alternata, Fusarium culmorum, Penicillium oxalicum, and the species Penicillium 222 were chosen to study penicillin G and penicillin V acylases. The enzymes were precipitated with tannic acid from the culture fluid of their autolyzed cultures. Some kinetic constants of these activities were determined.

Lethal midline granuloma (polymorphic reticulosis) and lymphomatoid granulomatosis. Evidence for a monoclonal T-cell lymphoproliferative disorder

Lymphomatoid granulomatosis (LG) and polymorphic reticulosis (PR), originally described as distinct entities, now are considered as a single disease process. Common histopathologic features include necrosis, vasculitis, and a granulomatous infiltrate. Such features have led to consider lymphomatoid granulomatosis as a systemic vasculitis; alternatively the possible emergence of an overt lymphoma has suggested that it could be a lymphoproliferative process. To investigate this later hypothesis, the authors analyzed the cellular infiltrate of tissue specimens from two patients with histologic features of LG. The analysis included the study of T-cell antigen expression and DNA rearrangement of the beta T-cell receptor gene. In one patient, the T-cell phenotype of infiltrating cells was abnormal because of antigen loss. In both patients, the cells contained rearranged DNA indicating the presence of a clonal T-cell proliferation. It is concluded that some cases of LG and PR, if not all, are related to a neoplastic T-cell lymphoproliferative disorder.

Hairy cell leukemia associated with large granular lymphocyte leukemia: immunologic and genomic study, effect of interferon treatment

The authors describe a patient who presented an association of hairy cell leukemia (HCL) and large granular lymphocyte (LGL) leukemia. An eventual relationship between these two rare entities is analyzed. Hairy cells (HCs) were present in the blood, bone marrow, and spleen. An excess of LGLs was found only in the blood and bone marrow. After splenectomy the patient received an alpha 2-interferon (alpha 2-IFN) treatment. The HCs surface phenotype was mu+delta+kappa+, CD20+, and CD25+. The LGLs consisted in CD3+, CD8+, HNK1+, WT31+ T lymphocytes. These were absent in the spleen. alpha 2-IFN treatment resulted in the disappearance of the HCs in the blood and bone marrow, whereas the LGLs remained unchanged. Before alpha 2-IFN treatment, peripheral blood cells, predominantly LGLs, exerted low cytotoxicity that increased up to a normal level after treatment. Using Southern blotting the authors studied the rearrangements of the T-cell receptor beta--chain (C beta) and gamma-chain (J gamma) genes and immunoglobulin heavy (JH)- and light (C kappa, C lambda)- chain genes. An unique JH and C kappa gene rearrangement was found in the blood and spleen, whereas C beta and J gamma gene rearrangements were present in the blood, not in the spleen. Under alpha 2-IFN treatment, the JH gene rearrangement fainted dramatically, in contrast to that of the C beta gene. The study of messenger RNA (mRNA) of the T cell receptor alpha and beta chains evidenced the 1.3-kilobase (kb) and 1.6-kb bands in the blood and their absence in the spleen. The patient was human T-cell leukemia virus (HTLV)-II negative by Southern analysis of blood and spleen cells. It is concluded that the LGL expansion was clonal and not reactive to the HCL. Although the authors cannot definitely exclude that both HC and LGL proliferations stem in a common leukemic precursor, their findings support an association of the two entities.

Activation by PHA of CD8 lymphocytes into clonal colony forming cells. Role of interleukin-1

Monoclonal T cell colonies can be grown in agar culture from quiescent T lymphocytes under PHA stimulation, provided that (1) a low number of T lymphocytes (less than or equal to 5 X 10(4)/ml) is seeded, (2) IL-2 is added to the culture, and (3) a high number of accessory B cells (greater than or equal to 5 X 10(5)/ml) is present in contact with the T lymphocytes. Under these culture conditions the colony progenitors can be ascribed to the CD4 subset, whereas CD8 lymphocytes do not generate colonies. This finding is surprising since both CD4 and CD8 lymphocytes may be cloned in liquid culture. We now report the appropriate conditions required to grow cytotoxic CD8 lymphocyte colonies in agar. CD8 colony growth is dependent upon IL-2-IL-2 receptor interaction and is inhibited by anti-IL-2 receptor antibodies. In addition to PHA, accessory B cells and IL-2, an additional signal provided by recombinant IL-1 is necessary for CD8 colony formation. Exogenous IL-1 can be replaced by irradiated CD4 lymphocytes which stimulate the expression of membrane IL-1 activity in the accessory B cells. In addition, colony growth from quiescent but not preactivated CD8 lymphocytes is inhibited by anti-IL-1 antibodies. Altogether, the data show that an IL-1 signal is required for the induction of IL-2 responsive IL-2 receptors on quiescent CD8 colony forming cells.

Failure of combination chemotherapy of advanced follicular (low-grade) non-Hodgkin's lymphoma

Twenty-two patients with Stage III and IV follicular non-Hodgkin's lymphoma were treated for 8 months by a chemotherapy regimen alternating between two different four-drug combinations (doxorubicin, teniposide, cyclophosphamide, prednisone; vincristine, cyclophosphamide, CCNU, prednisone). The overall response rate (complete and partial remission) was 68%. The complete remission rate was 23%. Twenty patients are alive, 50% of them are free of disease progression (median follow-up 76 months). It is concluded that our chemotherapy regimen is not satisfactory and that new therapeutic approaches are needed.

Vasculitis in hairy-cell leukemia

Vasculitis associated with hairy-cell leukemia (HCL) has been reported occasionally. We determined the clinical and biological significance of this association by the retrospective study of a series of 50 patients with HCL, including nine patients with vasculitis. The development of vasculitis was not related to a variant of HCL on the basis of hematologic findings and survival. Vasculitis could occur at any time during the course of HCL, and was the circumstance for the diagnosis of HCL in three cases. Clinical and immunohistologic findings were those of hypersensitivity vasculitis in the nine patients. Infection was found to be an associated factor. Thus, eight of nine patients were infected at vasculitis onset, four died of their infection with no remittance of the cutaneous lesions, and three recovered from both infection and vasculitis. The monocyte deficiency in HCL is known to favor intracellular pathogen infection; however, we could not demonstrate that it also correlates with a decrease in the clearance of IgG-sensitized erythrocytes. Finally, vasculitis in HCL appears to be associated with a lasting infection in most cases.

Phenotypic and genotypic heterogeneity in large granular lymphocyte expansion

The cellular heterogeneity of large granular lymphocyte expansions has been illustrated by the phenotypic and genotypic findings in five patients. In one patient whose circulating cells were CD2+, CD3-, CD5-, CD7+, CD8-, CD11+, Leu7+, CD16+, and displayed strong natural killer activity, no rearrangement of the T cell receptor beta-chain gene and T cell rearranging gene gamma was detected. The four other patients presented with neutropenia without overt lymphocytosis. In these patients the circulating lymphocytes expressed a predominant T cell phenotype CD2+, CD3+, CD5+, CD7+, CD8+, Leu7+. In three of them the presence of a T cell clone was demonstrated on the basis of a unique pattern of rearrangement of the T cell receptor beta-chain genes.

High-grade malignant cutaneous plasmacytoma metastatic to the central nervous system. A case report with electron microscopy, immunohistological, and neuropathological studies

A case of high-grade malignant extramedullary plasmacytoma (EMP), unusual in its initial cutaneous localization and major involvement in the central nervous system rapidly resulting in death, is reported. Light- and electron-microscopic studies of a skin nodule revealed a high proportion of immature and mature plasmacytes. Immunohistological study revealed that both cells synthesized different amounts of a monotypic cytoplasmic kappa light chain. Neuropathological study revealed extensive infiltration of the leptomeninges and perivascular spaces as far as the deep parenchyma. In several places, effraction of vessels resulted in parenchymatous, tumor-like, plasmacytic infiltration. The findings of this case were compared with those of the few previously reported cases of EMP with initial cutaneous or intracranial localization, and with those of immunoblastic sarcoma occurring in some cases of myeloma.

Traumatic segmental bone defects in the upper extremity. Treatment with exposed grafts of corticocancellous bone

We treated twenty-two consecutive patients for an open fracture and segmental loss of bone in the upper extremity by delayed insertion of a graft of iliac corticocancellous bone. All of the wounds were left open and healed by secondary intention. Sixteen patients (nineteen grafts) had long-term follow-up. Ten injuries were secondary to a gunshot wound. The ten patients (twelve grafts) who had an injury to the hand were followed for an average of 24.1 months. No patient in this group had an infection, and all had primary union after an average of 13.3 weeks. Nine had a satisfactory result. The other six patients (seven grafts) had an injury to the arm or forearm and were followed for an average of 30.2 months. There were four non-unions, one refracture, and no persistent infections. The final result was satisfactory in five and unsatisfactory in one patient. Fourteen of the nineteen grafts were inserted within seventeen days after the initial injury. All nine of the grafts in the hand that were inserted early did well, but three of the other five (in the arm or forearm) became infected. The method that was used in the patients who had an open injury of the hand allowed early active motion and quick rehabilitation. The exposed cortical bone was not prone to infection. The technique has limited application in patients who have an open injury of the arm or forearm because of a high incidence of complications.

The kinetics of the autolytic phase of growth in cultures of Aspergillus niger

The kinetics of the autolytic phase of growth in cultures of Aspergillus niger has been studied. Two different autolytic periods could be distinguished. One, consisting of a rapid (exponential) loss (62%) of mycelial weight, occurred between 36 and 117 hours of incubation. A second, consisting of a slow autolysis, occurred between the 117th and the 190th hour of incubation; the mycelial loss here being 5%. Based on the degree of autolysis (alpha = 67.0%), 92.5% and 7.5% are lost during the first and the second autolytic periods, respectively.

A subset of OKT4+ peripheral T cells can generate colonies containing mixed progeny with OKT4+ helper and OKT8+ suppressor cells

The membrane phenotype of human T cell colony progenitors and that of their clonal progeny was studied for expression of the T4 and T8 determinants. Using clonal culture conditions, the colonies were grown in semi-solid agar medium from peripheral blood cells. Clonality was assessed using the glucose-6-phosphate-dehydrogenase isoenzyme marker. Combination of this marker with the culture of sorted cell fractions allowed us to ascribe the colony progenitors to a subset of OKT4+ lymphocytes. The progeny consisted of the mixture of single OKT4+, single OKT8+ and double OKT4+8+ cells, as determined by double staining. Double staining was performed on mass-harvested colony cells and on individual colonies expanded in liquid culture with fresh interleukin 2. Expression of the OKT8 positivity on colony cells deriving from OKT4+ progenitors required an interaction with radioresistant OKT8+ cells that were co-cultured with these progenitors. Furthermore, the functional capacities of the cell progeny were assayed on the pokeweed mitogen-driven immunoglobulin production by B cells. It was found that OKT4+ colony cells were helper whereas OKT8+ colony cells were suppressor cells. It is concluded that a subset of OKT4+ peripheral blood T lymphocytes can generate colonies containing both helper OKT4+ cells and suppressor OKT8+ cells.