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Abstract
Chronic lymphocytic leukemia (CLL) is the form of leukemia which occurs most frequently in Western countries. Its etiology is unknown, and no relationship with viruses or genes has been demonstrated. Epidemiological data suggest that genetic and ambiental factors might be of some significance. Clinical features of CLL are due to the accumulation of leukemic cells in bone marrow and lymphoid organs as well as the immune disturbances that accompany the disease. The prognosis of patients with CLL varies. Treatment is usually indicated by the risk of the individual patient, which is clearly reflected by the stage of the disease. In the early stage (Binet A, Rai O) it is reasonable to defer therapy until disease progression is observed. By contrast, because their median survival is less than five years, patients with more advanced stages require therapy. For almost 50 years, no major advances in the management of CLL, which has revolved around the use of alkylating agents, have been made. In recent years, the therapeutic approach in patients with CLL has changed as a result of the introduction of combination chemotherapy regimens and, in particular, purine analogues. The latter are already the treatment of choice for patients not responding to standard therapies, and their role as front-line therapy is being investigated. Bone marrow transplants are also being increasingly used. It is to be hoped that in years to come the outcome of patients with CLL will be improved by these advances.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Prognosis
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Affiliation(s)
- E Montserrat
- Postgraduate School of Hematology Farreras Valentí, Department of Medicine, University of Barcelona, Hospital Clinic, Spain
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2
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Abstract
There exists a wide variety of lymphoid leukemias derived from B and T lymphocytes. These diseases have distinct immunologic and biologic features as well as varied responses to therapeutics. The most common lymphoid leukemia is chronic lymphocytic leukemia (CLL) which is a clonal proliferation of a subset of B cells expressing the CD5 antigen. Prolymphocytic leukemia is usually derived from B cells and shares some features with CLL but is clearly a distinct entity. Hairy-cell leukemia is a B cell malignancy that is uniquely responsive to a variety of biologic and chemotherapeutic agents. Waldenström's macroglobulinemia is a B cell malignancy that secretes immunoglobulin M (IgM) and may present with the hyperviscosity syndrome. Other B cell malignancies that less commonly present as leukemias include non-Hodgkin's lymphomas such as follicular lymphoma or mantle zone lymphoma. Multiple myeloma may rarely present or evolve into a plasma cell leukemia, typically in far advanced disease. T cell malignancies that may present as chronic lymphoid leukemias, and in the past have often been referred to as T cell chronic lymphocytic leukemia, are large granular lymphocytic leukemia, adult T cell leukemia/lymphoma, Sézary cell leukemia and rare cases of non-Hodgkin's lymphoma that are T cell derived and may present or evolve into a leukemic phase. There is also a rare T cell counterpart of prolymphocytic leukemia. Distinguishing these diseases is critical for optimal care of these patients.
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Affiliation(s)
- K A Foon
- Lucille Parker Markey Cancer Center, Department of Internal Medicine, University of Kentucky Medical Center, Lexington 40536-0093, USA
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3
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Sthoeger ZM, Sthoeger D, Shtalrid M, Sigler E, Geltner D, Berrebi A. Mechanism of autoimmune hemolytic anemia in chronic lymphocytic leukemia. Am J Hematol 1993; 43:259-64. [PMID: 7690517 DOI: 10.1002/ajh.2830430406] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a malignant clonal expansion of CD5+B lymphocytes. The CD5+B lymphocytes have been postulated to produce autoantibodies. CLL patients may demonstrate features of autoimmunity including autoimmune hemolytic anemia. However, the origin of the autoantibodies causing the hemolysis is not clear. The present studies were performed to determine whether these autoantibodies are the products of the neoplastic B-CLL clones. Immunoglobulins (Ig) were eluted from washed red blood cells (RBC) obtained from two CLL patients at the time they had autoimmune (DAT-direct antiglobulin test-positive) hemolytic anemia. The light chain phenotypes of these eluted autoantibodies were determined and found to be monotypic with exact correlation to the light chain expressed on the surface of the B-CLL clones. Elutions from RBC of DAT negative patients or normal volunteers failed to demonstrate measurable amounts of Ig. In contrast, Ig eluted from RBC obtained from SLE patients with DAT positive hemolytic anemia found to be polyclonal autoantibodies exhibiting both light chain types. Furthermore, CD5+B lymphocytes obtained from the same two CLL patients (DAT+) produce, in vitro understimulation with phorbal myristate acetate (PMA), monoclonal antibodies which react and bind to RBC. Thus these studies provide direct evidence demonstrating that the antibodies causing the autoimmune hemolytic anemia in our two CLL patients are the products of the B-CLL neoplastic clones.
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/immunology
- Antigens, CD/analysis
- Autoantibodies/immunology
- Autoantibodies/metabolism
- Autoimmunity
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- CD5 Antigens
- Cells, Cultured
- Erythrocytes/pathology
- Fluorescent Antibody Technique
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
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Affiliation(s)
- Z M Sthoeger
- Department of Internal Medicine, Kaplan Hospital, Rehovot, Israel
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4
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Abstract
The precise delineation of biologic traits that distinguish normal hematopoietic cells from their malignant counterparts is of fundamental importance in understanding all aspects of hematologic malignancies. An increasingly sophisticated technologic battery has been utilized to dissect out these differences--primarily utilization of monoclonal antibodies, by immunoperoxidase, immunoalkaline phosphatase and flow cytometric techniques. An even more basic understanding of normal and malignant hematopoietic cells has begun to evolve as molecular biology begins to unravel gene misprogramming by Southern and Northern blot analysis and the polymerase chain reaction. These techniques not only help distinguish a normal cell from a malignant one, but characterize the malignant clone as B-lymphoid, T-lymphoid or myeloid and allow further subcategorization within these broad lineages. These distinctions are vital to the entire spectrum of basic and clinical research involving hematologic malignancies and are assuming an increasingly important role in their diagnosis, prognosis and treatment.
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Affiliation(s)
- L Vaickus
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263
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5
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Karfa S, Gopal R, Nadkarni JS. Immuno-phenotype and proliferative response of B-cell chronic lymphocytic leukemia. MEDICAL ONCOLOGY AND TUMOR PHARMACOTHERAPY 1990; 7:265-72. [PMID: 2149402 DOI: 10.1007/bf02987105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study examines the immunophenotypic profiles in both pretreated and treated CLL patients which could be useful from the prognosis point of view. Patients suffering from B CLL and having IgG markers were relatively more aggressive than cells bearing IgM phenotypes. Male predominance is observed in male/female ratio in this disease. B CLL showed heterogeneity by showing reactivity against various T cell markers such as CD5 (present on mature T cells) and also CD4 (T helper/inducer), CD8 (T suppressor/cytotoxic) and a very high percentage of Ia (HLA-DR). The proliferative response to cells to stimulation with PHA and PWM indicated that there is a primary defect in the capacity of these small lymphocytes to undergo a proliferative response due to an intrinsic defect in the B lymphocytes. This study also reflects a maturation arrest in the later developmental stage of B lymphopoiesis. The three findings which are novel are the difference in prognosis between IgG-IgM and IgG, the changes in T cell subsets and the mitogenic response.
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Affiliation(s)
- S Karfa
- Division of Laboratory Medicine, Tata Memorial Hospital, Parel, Bombay, India
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6
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Foon KA. Laboratory and clinical applications of monoclonal antibodies for leukemias and non-Hodgkin's lymphomas. Curr Probl Cancer 1989; 13:57-128. [PMID: 2659257 DOI: 10.1016/0147-0272(89)90018-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Important insights into leukocyte differentiation and the cellular origins of leukemia and lymphoma have been gained through the use of monoclonal antibodies that define cell surface antigens and molecular probes that identify immunoglobulin and T-cell receptor genes. Results of these studies have been combined with markers such as surface membrane and cytoplasmic immunoglobulin on B lymphocytes, sheep erythrocyte receptors on T lymphocytes, and cytochemical stains. After using all of the aforementioned markers, it is now clear that acute lymphoblastic leukemia (ALL) is heterogeneous. Furthermore, monoclonal antibodies that identify B cells, such as the anti-CD20 and anti-CD19 antibodies in combination with studies of immunoglobulin gene rearrangement, have demonstrated that virtually all cases of non-T-ALL are malignancies of B-cell origin. At least six distinct subgroups of non-T-ALL can now be identified. T-ALL is subdivided by the anti-CD7, anti-CD5, and antibodies that separate T lymphocytes subsets into three primary subgroups. Monoclonal antibodies are also useful in the subclassification of non-Hodgkin's lymphoma, and certain distinct markers can be correlated with morphological classification. Although monoclonal antibodies are useful in distinguishing acute myeloid from acute lymphoid leukemias, they have less certain utility in the subclassification of acute myelogenous leukemia (AML). Attempts to subclassify AML by differentiation-associated antigens rather than by the French-American-British (FAB) classification are underway in order to document the potential prognostic utility of surface markers. Therapeutic trials using monoclonal antibodies in leukemia and lymphoma have been reported. Intravenous infusion of unlabeled antibodies is the most widely used method; transient responses have been demonstrated. Antibodies conjugated to radionuclides have been quite successful in localizing tumors of less than 1 cm in some studies. Therapy trials with antibodies conjugated to isotopes, toxins, and drugs have shown promise. Purging of autologous bone marrow with monoclonal antibodies and complement in vitro has been used in ALL and non-Hodgkin's lymphoma; preliminary data suggest that this approach may be an effective therapy and may circumvent many of the obstacles and toxicities associated with in vivo monoclonal antibody infusion.
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Affiliation(s)
- K A Foon
- Division of Clinical Immunology, Roswell Park Memorial Institute, Buffalo, New York
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7
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Garcia C, Rosén A, Kimby E, Aguilar-Santelises M, Jondal M, Bjorkholm M, Holm G, Mellstedt H. Higher T-cell imbalance and growth factor receptor expression in B-cell chronic lymphocytic leukemia (B-CLL) as compared to monoclonal B-cell lymphocytosis of undetermined significance (B-MLUS). Leuk Res 1989; 13:31-7. [PMID: 2536870 DOI: 10.1016/0145-2126(89)90028-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The surface marker phenotype of lymphocytes derived from 12 patients with B-CLL was compared to that of lymphocytes from 10 patients with an other monoclonal but clinical benign form of B-cell proliferative disorder termed monoclonal B-cell lymphocytosis of undetermined significance (B-MLUS). A panel of well characterized monoclonal antibodies was used for the surface marker determinations. The mean total number of B cells (CD20) was 8.5 x 10(9)/1 in B-MLUS as compared to 44 x 10(9)/1 in B-CLL (p less than 0.001). B-CLL had a greater imbalance in T-cell subpopulations than B-MLUS and healthy controls. Total numbers of CD3+, CD8+ cells as well as cells expressing the NK-related antigens (CD16, Leu-7) and IL-2 receptor (CD25) bearing lymphocytes were statistically significant higher in B-CLL than in B-MLUS. Analyses of B-cell enriched populations showed that B-CLL represented B cells of an early maturation stage, whereas B cells from B-MLUS were more mature as judged by the loss of the CD21 surface marker. A larger fraction of B cells in B-CLL compared to B-MLUS exhibited a higher activation stage as revealed by the expression of the CD21, CD25 and CD35 structures as well as the FMC7 antigen.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal
- Antigens, Differentiation/analysis
- Antigens, Differentiation, T-Lymphocyte/analysis
- Antigens, Surface/analysis
- B-Lymphocytes/classification
- CD3 Complex
- CD8 Antigens
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Lymphocytosis/metabolism
- Middle Aged
- Phenotype
- Receptors, Antigen, T-Cell/analysis
- Receptors, Cell Surface/analysis
- Receptors, Fc/analysis
- Receptors, IgG
- Receptors, Interleukin-2/analysis
- T-Lymphocytes/analysis
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Affiliation(s)
- C Garcia
- Immunological Research Laboratory, Karolinska Hospital, Stockholm, Sweden
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8
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Luzzatto L, Battistuzzi G. Glucose-6-phosphate dehydrogenase. ADVANCES IN HUMAN GENETICS 1985; 14:217-329, 386-8. [PMID: 3887862 DOI: 10.1007/978-1-4615-9400-0_4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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