Impaired synthesis of immunoglobulin in patients with chronic lymphocytic leukemia

Targets and strategies for T-cell based vaccines in patients with B-cell chronic lymphocytic leukemia

T-cell based immunotherapies might be a novel option for the treatment of B-cell chronic lymphocytic leukemia (B-CLL), a disease characterized by a prolonged natural course. Different strategies of active immunotherapy have been tested in vitro to enhance a specific T-cell response against tumor cells and an anti-leukemic effect has been observed in B-CLL patients after allogenic stem cell transplantation. Several antigens have been characterized as tumor/leukemia associated antigens (T/LAAs) in B-CLL with the potential to elicit specific anti-tumor response encompassing idiotype immunoglobulin, oncofetal antigen-immature laminin receptor protein (OFAiLRP), survivin, as well as fibromodulin, the receptor for hyaluronic acid mediated motility (RHAMM/CD168) and the murine double-minute 2 oncoprotein (MDM2). This study presents an overview of possible targets and genetherapeutical maneuvers for future immunotherapies of B-CLL patients and summarizes recent clinical vaccination trials with dendritic cells (DCs) for B-CLL.

Immunologic monitoring in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is characterized by progressive defects in humoral- and cell-mediated immunity. These defects are manifested as a propensity to develop infections with encapsulated bacteria, and less frequently, with gram-negative enterics. In addition, reactivation of viruses such as herpesvirus is not uncommon. Treatment of the disease further exacerbates immunosuppression by depleting immune effectors and broadening the spectrum of potentially offending pathogens. Risk of infection can potentially be reduced by administration of intravenous immunoglobulin and use of prophylactic antibiotics for individuals who are at high risk. Current work focuses on development of cellular and cytokine therapy to facilitate immune reconstitution in patients with CLL, thereby reducing morbidity and mortality and potentially improving survival.

Humoral immunodeficiency in chronic lymphocytic leukemia: role of CD95/CD95L in tumoral damage and escape

B cell chronic lymphocytic leukemia (B-CLL) is the most frequent hematological neoplasm in the human adult life. This tumor is often associated with hypogammaglobulinemia and infections. This review focuses on recently reported mechanisms underlying the humoral immunodeficiency occurring in B-CLL. Tumoral cells provoke several alterations to normal regulatory T cells, which, in turn, can impair the correct maturation of B cells. In addition, the direct inhibitory effect of B-CLL cells on immunoglobulin (Ig)-secreting plasma cells (PC) may account for the humoral immunodeficiency. This phenomenon is mediated by the interaction of CD95L molecules expressed by B-CLL cells with the death receptor CD95 that is up-regulated on patients' PC, leading to PC apoptosis and subsequently to hypogammaglobulinemia. Furthermore, the presence of CD95L on B-CLL cells could play an additional role in tumoral immune-escape, as reported in other neoplasms.

Dysregulation of CD30+ T cells by leukemia impairs isotype switching in normal B cells

Chronic lymphocytic leukemia (CLL) is associated with impaired immunoglobulin (Ig) class-switching from IgM to IgG and IgA, a defect that leads to recurrent infections. When activated in the presence of leukemic CLL B cells, T cells rapidly up-regulate CD30 through an OX40 ligand and interleukin 4 (IL-4)-dependent mechanism. These leukemia-induced CD30+ T cells inhibit CD40 ligand (CD40L)-mediated S mu-->S gamma and S mu-->S alpha class-switch DNA recombination (CSR) by engaging CD30 ligand (CD30L), a molecule that interferes with the assembly of the CD40-tumor necrosis factor receptor-associated factor (TRAF) complex in nonmalignant IgD+ B cells. In addition, engagement of T cell CD30 by CD30L on neoplastic CLL B cells down-regulates the CD3-induced expression of CD40L. These findings indicate that, in CLL, abnormal CD30-CD30L interaction impairs IgG and IgA production by interfering with the CD40-mediated differentiation of nonmalignant B cells.

A Model for Human B-Chronic Lymphocytic Leukemia in Human/Mouse Radiation Chimera: Evidence for Tumor-Mediated Suppression of Antibody Production in Low-Stage Disease

B-chronic lymphocytic leukemia (BCLL) is a lymphoproliferative disease that is characterized by clonal expansion of CD5+ B cells. BCLL is associated with secondary immunodeficiency and hypogammaglobulinemia. It has been suggested that T-cell dysregulation may play a role in the hypogammaglobulinemia and in the increased incidence of autoimmunity in BCLL patients. We attempted to transfer human peripheral blood mononuclear cells (PBMC) from BCLL patients in different stages of the disease into immunodeficient mice. PBMC from BCLL patients in stage 0, stages I to II, and stages III to IV were transplanted into the peritoneal cavity of lethally irradiated Balb/c or beige/nude/Xid (BNX) mice radioprotected with bone marrow (BM) from severe combined immunodeficiency (SCID) mice. Different engraftment profiles were found in the chimeric mice 2 weeks after transplantation of PBMC according to the disease stage of the BCLL donors. Infusion of PBMC from donors in stage 0 led to marked engraftment of human T cells, whereas the human tumor cells could hardly be detected. In contrast, chimeric mice receiving PBMC from patients in stage III to IV disease exhibited engraftment with a dominance of tumor cells, compared with a miniscule level of T cells. The ability of the engrafted cells to produce human Ig was also found to be correlated with the disease stage of the donor, although all donors had the same magnitude of hypogammaglobulinemia. Total human Ig production in the chimeric mice was normal in mice receiving PBMC from donors in stage 0, whereas in chimeric mice engrafted with PBMC from donors in stages III to IV almost no human Igs could be detected. This differential reconstitution of antibody production in the mouse model according to the stage of the patient's disease will allow further studies on possible cellular interactions between malignant and immune cells in BCLL.

Functional abnormalities in granulocytes predict susceptibility to bacterial infections in chronic lymphocytic leukaemia

Leukocyte functions were studied in 22 patients with chronic lymphocytic leukaemia (CLL) and were related to the patients' susceptibility to infections. In CLL patients with a history of infections, compared with CLL patients without infections or healthy controls, there were significant impairments of most granulocyte functions; random migration, N-formyl-methionylleucylphenylalanine (fMLP) and C5a stimulated chemotaxis and chemiluminescence response were decreased. No differences in these functions between CLL patients without infections and healthy controls were observed. Phagocytosis and intracellular killing of granulocytes were intact in all patients with CLL. By univariate analysis, neutrophil count and serum IgG level also predicted susceptibility to infections. By multivariate analyses, granulocyte chemotaxis and chemiluminescence remained as statistically significant predictors of infections. The lymphocyte functions (mitogen-induced lymphocyte proliferation and immunoglobulin production in vitro) were equally impaired in all patients with CLL and differed significantly from the respective functions in healthy control subjects. We conclude that impairments in granulocyte functions contribute to susceptibility to infections in CLL.

T-lymphocyte response to cytokines in B-chronic lymphocytic leukemia

The mechanisms underlying abnormal T-cell function in B-chronic lymphocytic leukemia (B-CLL) are unknown. We have studied B-CLL T-cell activation pathways in the rigorous absence of leukemic cells and with controlled numbers of accessory cells present. The responsiveness to added recombinant IL-1 and IL-2 was assessed. We have found that under optimal culture conditions B-CLL T cells had a normal PHA-induced proliferative response in terms of incorporated 3H-thymidine per T cell. Also the capacity of mitomycin-C treated B-CLL monocytes to support autologous T-cell mitogenesis was normal. However, a subtle difference between normal and B-CLL T cells emerged with respect to cytokine responsiveness. While the PHA response of purified normal T cells in the absence of monocytes was augmented by rIL-1, this could not be demonstrated for B-CLL T cells. A much greater degree of augmentation occurred with added rIL-2 in the case of both normal and B-CLL T cells. In the presence of 20% autologous monocytes rIL-1 and rIL-2 had no effect on mitogenesis. We conclude that B-CLL T cells have an abnormal profile of cytokine responsiveness which is consistent with observed abnormalities of subset distribution, and which may contribute to the clinical immunodeficiency in B-CLL.

Serial syngeneic transplantation of large granular lymphocyte leukemia in F344 rats

A spontaneous large granular lymphocyte (LGL) leukemia was serially transplanted in 92 male F344 rats kept under standard laboratory conditions. Serial transplantation into groups of four rats each resulted in a rapid reduction in the latent period of the disease. After 23 serial transplantations, F344 rats in groups that were injected intraperitoneally with 10(7) cells died between 12 and 16 days after transplantation. At necropsy, "transplanted" rats had enlarged mesenteric lymph nodes, thymus, and spleen. Neoplastic cells were detected in the spleen on day 3 and in peripheral blood on day 6. Extreme leukocytosis with leukemia was present on day 9. Severe hemolytic anemia coincided with a sharp increase in osmotic fragility on day 12. Splenic lymphoid depletion was observed histologically and confirmed by differential cell counts of isolated spleen cells. Analysis for surface markers of splenic lymphocytes by monoclonal antibodies and flow cytometry indicated that cells with T helper/inducer phenotypes were disproportionately decreased, while the number of T suppressor cells did not significantly change. The T helper/T suppressor lymphocyte ratio (normal = 2.09 +/- 0.35) was decreased on day 9 (0.76 +/- 0.10) and day 12 (0.25 +/- 0.04). Hemolytic anemia was not related to a decrease in the number of T suppressor cells. The passaged leukemia cell model should provide investigators with an easily maintained neoplasm of short latency with which to study pathogenesis of leukemia-related disorders.

T cells and CD45R expression in B-chronic lymphocytic leukemia

A major secondary immunodeficiency exists in B cell derived chronic lymphocytic leukemia (B-CLL) which involves both humoral and cellular immunity and is largely unexplained. Several T cell subset redistributions have been noted in B-CLL. We therefore examined in more detail the immunophenotype of T cells by assessing CD45R expression using a two-colour immunofluorescence technique. The proportion of CD45R+ cells among CD3+, CD4+ and CD8+ cells in B-CLL was significantly (p less than 0.001) higher than in corresponding normal cell populations. We also sought relationships between major T cell subsets and progress of disease and found strongly positive correlations between the total leukocyte count in B-CLL and numbers of CD3+, CD4+, CD8+ cells and monocytes. Further, in patients with clinically more advanced disease, CD3+ and CD4+ cells were present in higher numbers than in patients with less advanced disease (p less than 0.05). CD8+ cells, CD4/CD8 ratio, monocytes and total leukocyte count were not significantly different when comparing the less advanced and more advanced disease patients. An excess of CD45R+ suppressor-inducer T cells has implications for both B and T cell dysfunction and for disease progression.

Prognostic significance of immune function parameters in patients with chronic lymphocytic leukaemia

We determined immune function parameters in 41 newly diagnosed patients with chronic lymphocytic leukaemia (CLL) and correlated these findings with the clinical data and the subsequent course of the disease. The ratio of helper to suppressor T cells (CD4/CD8), the proportion of circulating natural killer (NK) cells and the NK activity were significantly low in clinical stage B and C patients. Among patients presenting with advanced disease, those who subsequently had a more severe course, characterised mainly by frequent respiratory infections, were found to have at presentation a significantly lower CD4/CD8 ratio (x +/- SEM = 0.95 +/- 0.09, vs 1.28 +/- 0.14), a very low proportion of NK cells (4.78 +/- 0.85, vs 11.75 +/- 2.1%) and decreased amount of gamma-globulins (0.66 +/- 0.08, vs 0.97 +/- 0.09 g/dl), in comparison with patients with a much milder later course. These simple parameters of immune function seem to have prognostic value for patients with CLL.

Centroblastic lymphoma of the thyroid supervening long-lasting chronic lymphocytic leukemia (B-CLL) demonstration of biclonality by immunohistochemical and gene rearrangement analysis

A 67-year-old woman suffering since 5 years from a so far nontreated B-CLL underwent hemithyroidectomy for a rapidly enlarging tumor. Histologically, the coincidence of a centroblastic lymphoma and thyroidal infiltration by the CLL was diagnosed. Immunohistology revealed typical immunoprofils for both, B-CLL and centroblastic lymphoma on the background of B cell differentiation antigens. The bitypical immunoglobulin light chain expression--lambda on the B-CLL cells and kappa on the centroblasts--suggested biclonality. This was confirmed by gene rearrangement analysis of peripheral leukemia cells and tumor tissue. Thus, the final diagnosis of a primary thyroidal lymphoma of the centroblastic type (stage IE) arising independently from a preexisting B-CLL was achieved. Consequently, the patient received local radiotherapy. In our opinion, the designation "Richter's Syndrome", readily applied in the literature, is inappropriate for this tumor constellation.