Evaluation of the circulating and splenic lymphocyte subpopulations in patients with non-Hodgkin lymphomas and Hodgkin's disease using monoclonal antibodies

Parameters associated with sperm quality prior to chemotherapy in lymphoma patients

Sperm quality in lymphoma patients may be reduced even prior to initiation of chemotherapy. The objective of this study was to examine the relationship between lymphoma prognostic factors and sperm quality prior to chemotherapy. A retrospective cohort study was conducted in a Hadassah Medical Center sperm bank and the Hematology department. The cohort included 101 Hodgkin's and 90 non-Hodgkin's lymphoma patients that underwent sperm cryopreservation before chemotherapy between 1998 and 2015. Known lymphoma prognostic factors were compared between patients with normal and impaired sperm parameters. The Prognostic Score Ratio (PSR), an index representing the number of negative lymphoma prognostic measures that found in a lymphoma patient, was additionally calculated and compared between the groups. Among the prognostic factors of lymphoma, the following factors were found to be associated with impaired sperm parameters-low albumin (p < 0.001) and haemoglobin (p < 0.001) levels, B symptoms (p = 0.021) and PSR (p < 0.001). Logistic regression showed significant association of albumin and haemoglobin with reduced sperm quality (OR = 2.7 and OR = 13.5, p < 0.05; respectively). To conclude, low albumin and haemoglobin levels are related to reduced sperm quality. The linkage between these prognostic factors and sperm quality may be related to a general inflammatory status.

Pure red cell aplasia after chemotherapy for Hodgkin's lymphoma: in vitro evidence for T cell mediated suppression of erythropoiesis and response to sequential cyclosporin and erythropoietin

Acquired pure red cell aplasia (PRCA) has been associated with various lymphoproliferative conditions but its occurrence with Hodgkin's disease is rare. We report a case of PRCA occurring immediately following the completion of induction chemotherapy in a patient with Stage IIIB nodular sclerosing Hodgkin's disease. In vitro erythroid colony studies documented evidence for T cell mediated suppression of erythropoiesis and lack of a serum inhibitor. Addition of cyclosporin to the in vitro cultures stimulated erythroid colony growth. Following in vivo treatment with cyclosporin peripheral blood CD4/CD8 ratios returned to normal. However, serum erythropoietin levels were inappropriately low. Subsequent treatment with erythropoietin induced a reticulocytosis and transfusion independence. Since discontinuing the erythropoietin, the patient has been able to maintain a hemoglobin of 100 g/L. This case illustrates that red cell aplasia occurring in the setting of Hodgkin's disease may be due to T cell mediated suppression of erythropoiesis. A response to cyclosporin may be masked by inappropriately low erythropoietin levels.

Dyspermia in men with localized Hodgkin's disease. A potentially reversible, immune-mediated disorder

Localized Hodgkin's disease (HD) is curable in the great majority of patients. However, common programs of chemotherapy for this disease render most men permanently azoospermic. In studies of seminal cryopreservation prior to treatment, it has been recognized that many men with HD are dyspermic at diagnosis. It is hypothesized that this abnormality reflects a change in the cellular regulation of spermatogenesis; specifically an alteration in the balance between distinct sub-populations of lymphocytes which normally either inhibit or stimulate the production of sperm. This change in regulation within the testes is believed to be part of a systemic perturbation which is unrelated to the extent of HD but is potentially reversible with effective treatment of the primary disease. Recognizing the distinction between sperm analyses and fertility status, it is proposed that radiotherapy of localized HD, delivered in a manner that is not toxic to the male gonad, will restore useful spermatogenesis in patients who are dyspermic (and probably subfertile) before treatment is initiated.

Cyclophosphamide decreases O6-alkylguanine-DNA alkyltransferase activity in peripheral lymphocytes of patients undergoing bone marrow transplantation

O6-alkylguanine-DNA-alkyltransferase (ATase) levels were measured in extracts of peripheral blood lymphocytes taken at various times during chemotherapy from 19 patients with various haematological malignancies. Seven patients with advanced Hodgkin's disease received preparative treatment consisting of cyclophosphamide (1.5 g m-2, daily) administered on days 1 to 4 and BCNU (600 mg m-2) on day 5 prior to autologous bone marrow rescue (ABMR) delivered on day 7. Treatment in the remaining 12 patients consisted of cyclophosphamide (1.8 g m-2, daily) given on days 1 and 2 followed at day 4 with total body irradiation (TBI) administered in six fractions over the subsequent 3 days to a total dose of 1200 cGy prior to bone marrow transplantation. In the Hodgkin's group, significant decreases in ATase activity were seen during the cyclophosphamide treatment, and the median ATase nadir was 32% (range 0% to 57%) of pretreatment levels following 4 days of cyclophosphamide. In one patient, no ATase activity was detectable following the 4th cyclophosphamide treatment. ATase activities decreased further after BCNU administration to a median of 19% (range 0% to 32%) of pretreatment levels. Extensive cyclophosphamide-induced reduction of lymphocyte ATase levels was also seen in the other group of 12 patients treated with cyclophosphamide/TBI: postcyclophosphamide median ATase nadir was 35% (range 12% to 78%) of the pretreatment levels. No ATase depletion was seen when cyclophosphamide (up to 10 mM) was incubated for 2 h with pure recombinant human ATase in vitro whereas ATase activity was reduced by 90% on preincubation with 100 microns acrolein or with greater than 1 mM phosphoramide mustard. This suggests that a cyclophosphamide-induced decrease in ATase levels in human peripheral lymphocytes in vivo may be due to depletion mediated by the production of intracellular acrolein. Since ATase appears to be a principal mechanism in cellular resistance to the cytotoxic effects of BCNU and related alkylating agents, these observations suggest that a cyclophosphamide-induced reduction in ATase activity may be an additional factor in the effectiveness of the combined sequential therapy.

Lymphocyte subsets in the blood: a diagnostic window on the lymphoid system?

The assessment of peripheral blood lymphocyte numbers and ratios has been performed in almost every conceivable disease state, but do these values give any useful information about immune status? Jürgen Westermann and Reinhard Pabst try to answer this question and to put peripheral blood population assessments into the whole-body context.

Relationship between eosinophil density and T-cell activation markers in lymph nodes of patients with Hodgkin's disease

Hodgkin's disease (HD) is characterized morphologically by a variable infiltration of tissues by eosinophilic granulocytes. The lesions also contain numerous T cells, predominantly of the CD4+ immunophenotype. To investigate whether the presence or absence of tissue eosinophilia is related to the immunophenotype of the T cells, we studied 43 cases of HD (28 nodular sclerosing, ten mixed cellularity, and five unclassifiable) for the relative numbers of lymphocytes positive for CD2, CD3, CD4, CD5, CD8, CD25, CD38, T9, TQ1, HLA-DR, and beta F1, and for the number of eosinophils in tissue sections. By univariate and multivariate analysis, we determined that there was an inverse relationship between the number of eosinophils and the presence of TQ1+ (P less than .0005) and CD25+ (P less than .0005) lymphocytes. In addition, we observed that TQ1 stained the Reed-Sternberg cells in these lesions. We also determined that the T cells expressed HLA-DR more frequently in the nodular sclerosis subtype than in other subtypes of HD (P less than or equal to .0001). We therefore conclude that the degree of tissue eosinophilia in the lymph nodes of patients with HD may be explained, at least in part, by the immunophenotype of the T cells present in the affected lymph nodes.

The spleen in Hodgkin's disease. An immunohistochemical study of lymphocyte subpopulations and macrophages

Lymphocyte subpopulations and macrophages in 16 spleens from patients with Hodgkin's disease were analysed immunohistochemically using monoclonal antibodies of the Leu and the Ki M series. In non-involved splenic tissue there is an increase of T-lymphocytes with an increased T-helper/T-suppressor cell ratio, while Ki M-1, -2, -3 and -5-positive, i.e. phenotypically different macrophages, are reduced. These results indicate that involvement of the spleen in Hodgkin's disease is accompanied by changes with respect not only to lymphocyte subpopulations but also to cells of the mononuclear phagocyte system. The immunodeficiency associated with Hodgkin's disease is probably not solely due to lymphocyte dysfunction, since the disease may lead, at least in the spleen, to alterations in macrophages and accessory cells and this may contribute to the impairment of cell-mediated immunity.

Deficiency of mature B and T lymphocyte subsets in the blood of non-Hodgkin lymphoma patients

The expression of mature B-cell markers and T markers was determined in lymphocytes isolated from the peripheral blood (PBL) of 20 healthy and 51 patients with non-Hodgkin malignant lymphoma (NHL). The disease was classified as newly diagnosed, in remission, or being treated with chemotherapy and of low-, intermediate-, or high-grade malignancy. To avoid technical problems associated with artifacts involving cytophilic immunoglobulins (Ig), we defined mature B-cells by means of three criteria: a) expression of high surface density of Ig sufficient to allow polar movement of receptors to form a cap in an indirect immunofluorescence (IF) assay, b) expression of high density of the human leukocyte antigens DR (HLA-DR) under capped conditions, and c) expression of a 41H.16 marker exclusive to surface Ig+ B-cells. Percentages of PBL able to cap surface Ig (sIg) (lambda, K), HLA-DR (7H.3), and 41H.16 markers were significantly reduced (p less than 0.001) in all of the patients, regardless of treatment status, and the numbers of sIg+-capping cells were similarly reduced in the patients, regardless of the grade of malignancy. Studies with ring fluorescence showed mean percentages of cells expressing OKT3 and OKT4 determinants significantly reduced (P less than 0.001) but OKT8+ cells not significantly different from control. The OKT4/OKT8 ratio was reduced in all patients and did not differ significantly in relation to the degree of malignancy. We conclude that, in NHL, essentially all patients have severe abnormalities in the number of B- or T-cells needed for normal immune responses.

Immunohistology of the human spleen: an inventory of the localization of lymphocyte subpopulations

The immunohistochemistry of the cell population of the human spleen was studied. As controls, a strictly defined group of five specimens were used. This study stresses the need for the utmost care in this selection procedure. Using enzyme- and immuno-histochemistry the lymphocyte subpopulations were studied as to their localization in the several specific compartments in the red and white pulp. The findings were compared to those in idiopathic thrombocytopenic purpura, autoimmune haemolytic anaemia and Hodgkin's disease. In the controls a consistent pattern was found. There were specific changes in each of the disease groups consisting mainly of shifts between the compartments.

Natural killer cell activity during the course of disease in patients with Hodgkin's disease

Natural killer (NK) activity was investigated in 61 patients with Stage III and IV Hodgkin's disease during the course of disease and in 30 healthy age- and sex-matched healthy volunteers. The mean NK activity was significantly lower (P less than 0.001) in untreated patients and in patients in the active phase of the disease during treatment, compared with controls. There was a similar mean value of NK activity in normal subjects, compared with patients in clinical remission. NK activity correlated with the response to therapy. In patients responding to treatment, NK activity was increasing, reaching normal range in remission. The patients not responding to therapy showed gradual decrease of NK activity during the course of disease. These results suggest that the study of NK function might offer a helpful tool in following the clinical course and the efficacy of therapy, as well as for monitoring cancer patients from an immunologic viewpoint.