Spontaneous remission of leukemic lymphoproliferative disease

B-cell receptor, clinical course and prognosis in chronic lymphocytic leukaemia: the growing saga of the IGHV3 subgroup gene usage

The immunoglobulin heavy chain variable gene (IGHV) mutational status has been recognized as an important predictor of prognosis in chronic lymphocytic leukaemia (CLL) since 1999. More recently, other features of the B-cell receptor, such as stereotypy, have been identified as capable of refining the prognostic potential of IGHV status in the clinical assessment of CLL patients. In this context, different genes belonging to the IGHV3 subgroup, the most frequently used subgroup in CLL, have been shown to denote disease subsets that either display a bad prognosis (i.e. IGHV3-21, IGHV3-23) or are associated with particularly good clinical outcomes, including a highly stable/indolent clinical course, even prone to spontaneous regression (i.e. IGHV3-72, IGHV3-30). The present review focuses on the molecular and biological features of CLL-expressing specific genes belonging to the IGHV3 subgroup that are known to mark disease subsets with completely different clinical courses, and may be possibly related to CLL pathogenesis via antigen and/or superantigen involvement.

Spontaneous regression of chronic lymphocytic leukemia: clinical and biologic features of 9 cases

In chronic lymphocytic leukemia (CLL), spontaneous regressions are an exceptional phenomenon, whose biologic features are unknown. We describe 9 CLL patients who underwent a spontaneous clinical regression over an 11-year follow-up, despite a residual neoplastic clone detected by flow cytometry. CD38 and ZAP-70 were negative in all cases. Immunoglobulin heavy chain variable region (IgVH) genes, mutated in all 7 evaluable patients, were restricted to the VH3 family in 6, with the usage of V(H)3-30 gene in 2. The light chain variable region genes were mutated in 6 of 8 cases, with the use of V(kappa)4-1 gene in 3. Microarray analysis of CLL cells showed a distinctive genomic profile with an overrepresentation of BCR-related and ribosomal genes, regulators of signal transduction and transcription. The number of activated T lymphocytes expressing IFN-gamma, TNF-alpha, and IL-4 was similar between CLL in spontaneous regression and healthy persons. In conclusion, spontaneous clinical regressions can occur in CLL despite the persistence of the neoplastic clone, and the biologic features include negative CD38 and ZAP-70, mutated V(H)3-30 and V(kappa)4-1 genes. The peculiar gene profile suggests that BCR signaling may play an important role in this scenario as the most significant feature of the leukemic clone in regression.

T-prolymphocytic leukaemia with spontaneous remission

T-prolymphocytic leukaemia (T-PLL) is a rare dis-order with a poor prognosis. A 69-year-old man was diagnosed as having a small-cell variant of T-PLL according to the French-American-British classification by haematological, immunological and ultrastructural studies, although the cells had a CD7- phenotype and no chromosomal abnormality. He had no symptoms or organomegaly. The number of his lymphocytes, 53.7 x 109/l at the time of diagnosis, gradually decreased without therapy, and he was in complete remission 39 months later. A rearranged band in the T-cell antigen receptor-beta gene, which was detected at the time of diagnosis, decreased or disappeared. This is the first report of a T-PLL case with spontaneous complete remission.

Spontaneous regression of chemotherapy-refractory non-Hodgkin's lymphoma preceding the development of secondary leukaemia

In this report a rare case of spontaneous regression of a long-standing chemotherapy resistant low grade non-Hodgkin's lymphoma (NHL) of follicular small cleaved cell type is described. Extensive bulky lymphadenopathy substantially resolved, 7 months before the diagnosis of acute myelomonocytic leukaemia was established, in the absence of further treatment. It is possible that in this case the mutagenic effects of alkylating agents given during the course of the NHL reprogrammed lineage commitment in an early progenitor cell, deviating potential B-lineage cells along the myelomonocytic pathway.

Hodgkin's disease developing after spontaneous remission of chronic lymphocytic leukemia

We present a 71-year-old patient with chronic lymphocytic leukemia diagnosed 27 years ago. Initially, the disease was staged as Rai II and the patient suffered from secondary immunoglobulin deficiency. Nevertheless, no treatment was necessary at that time. Because of disease progression a single course of chemotherapy was given in 1984. During the following year there was a constant decline of the WBC, accompanied by normalization of the immunoglobulins; both have remained stable ever since that time. However, there was still residual bone marrow infiltration, indicating persisting CLL. In 1993 cervical lymphadenopathy occurred with acute onset. A diagnostic lymphadenectomy revealed Hodgkin's disease of the nodular-sclerosing subtype. The patient was staged as II-III according to the Ann Arbor Classification and underwent radiation therapy. Cytogenetic examination of the bone marrow revealed a normal karyotype with an inversion of chromosome 9. This case demonstrates the rate coincidence of two lymphoproliferative disorders in the same patient. The clinical course and the immunologic findings of this patient are presented, together with a review of the literature.

Clonal cell surface structures related to differentiation, activation and homing in B-cell chronic lymphocytic leukemia and monoclonal lymphocytosis of undetermined significance

Cell surface structures related to differentiation, activation and "homing" were identified on the leukemic cell clone in blood of 64 patients with a monoclonal B-cell lymphoproliferative disorder. Patients were selected with regard to clinical signs and symptoms of the disease. 39 patients had progressive chronic lymphocytic leukemia of B-cell type (B-CLL): 16 with lymph node enlargement and 14 with progressive lymphocytosis as the most prominent symptom, respectively. 1 patient had an isolated splenomegaly and 8 had symptoms from enlarged lymph nodes, lymphocytosis and/or splenomegaly. 25 patients had an isolated monoclonal B-cell lymphocytosis in blood and bone-marrow but no other signs or symptoms of the disease. The lymphocytosis in these patients was considered to be of "undetermined significance" and the term B-cell lymphocytosis of undetermined significance (B-MLUS) was used. Patients with a prominent lymphadenopathy and/or splenomegaly had CD22+ leukemic cells while in patients with a progressive lymphocytosis the B-cell clone expressed Leu-8. Thus, CD22 might be related to the homing capacity of B lymphocytes for lymphnodes and spleen, while Leu-8 might define a circulating B-cell subset. In B-MLUS about 50% of the monoclonal B cells co-expressed Leu8 which is consistent with a more differentiated phenotype compared to B-CLL with progressive lymphocytosis. The CD22 expression was mostly low in B-MLUS although a few patients showed high values. The expression of receptors for growth factors (CD23, CD25, CD71) was higher in B-CLL compared to B-MLUS patients (p less than 0.001), which is consistent with a difference in lymphocyte activation stage and/or response to growth factors.

Spontaneous remission in diffuse large cell lymphoma

A case of spontaneous remission in a Stage IIA diffuse large cell lymphoma is presented. Review of the literature suggests that whereas spontaneous regressions are a well-recognized phenomenon in indolent lymphomas, it is extremely rare in lymphomas of aggressive histologic subtype.

Spontaneous regression of non-Hodgkin's lymphoma: a report of nine cases

Seven previously untreated patients and two previously treated patients with advanced non-Hodgkin's lymphoma (Stages III and IV) and favorable histologic subtypes had spontaneous regression of their lymphomas. Regressions were either complete or partial and were frequently durable. Six of the seven patients who had spontaneous regression of their lymphomas prior to any therapy have yet to require treatment. Seven of the nine spontaneous regressions occurred in a group of 44 patients who were followed with initial therapy deferred. Six patients had regression of their lymphomas prior to any therapy and one patient had previously received a small field of radiation therapy. Temporary spontaneous regression of lymphoma may be common in selected patients with favorable histologies and advanced disease in whom initial therapy is deferred.

Spontaneous regression in non-Hodgkin's lymphoma

Two hundred and nine cases of non-Hodgkin's lymphoma have been analyzed retrospectively for the occurrence of spontaneous regression (SR). Complete, partial or minor SR was found in 18 out of 140 cases with nodular lymphoma and in 2 out of 69 cases with diffuse lymphoma. Thus, SR occurs far more frequently in nodular lymphoma than in the diffuse type. Within the nodular lymphoma group, SR is associated with long survival. It occurred in previously treated and untreated patients and in nodal and extranodal disease; the duration varied from a few weeks to many years but lasted one year or more in 7 cases with complete or partial SR.