[T-cell leukemias of adulthood]

T-cell prolymphocytic leukemia with an unusual phenotype CD4+ CD8+

A patient with T-cell prolymphocytic leukemia (T-PLL) is described. The outcome was poor, with death 8 months after diagnosis, despite several therapeutic interventions. The cells carried both CD4 and CD8 epitopes, but other thymocytic markers were absent. The spleen showed infiltration of CD4+ CD8+ prolymphocytes in the red pulp and in T-cell-dependent areas of the white pulp. Immunologic function studies revealed proliferation after stimulation with mitogens and even several antigens. However, in the mixed lymphocyte culture the T-PLL cells did not proliferate. Cytotoxic T-cells could not be induced. In T-non-T recombination experiments neither helper nor suppressor cell function was found for pokeweed mitogen-dependent plasmablast generation of normal B-cells. Cytogenetically, many abnormalities were found. Among them, 14q+; absence of chromosomes 8, 11, and 22; and the presence of large marker chromosomes and fragments.

Abnormal expansions of granular lymphocytes: reactive lymphocytosis or chronic leukemia? Case report and literature review

A case of chronic lymphoproliferative disorder is presented, wherein a morphologically homogeneous population of lymphoid cells displayed properties similar to those described for large granular lymphocytes (LGL). Besides their LGL-like phenotype (VEP 13+, OKM 1+, OKT 10+ Fc-IgG-receptor+, OKT 3-), the proliferating cells were cytotoxic to NK targets as well as to antibody-coated target cells. Clinically, our patient presented low-grade lymphocytosis, splenomegaly, neutropenia, hyperimmunoglobulinemia and recurrent infections. Based upon this and 32 similar cases reported in the literature, we conclude that lympho-proliferative disorders involving GL encompass a variety of clinical entities, ranging from reactive GL lymphocytoses to overt lymphocytic malignancies.

T-cell prolymphocytic leukemia with helper-cell phenotype and a review of the literature

The majority of published cases of prolymphocytic leukemia (PLL) have been of B-cell origin. Nineteen cases of PLL of T-cell type have been described, as has a single case of PLL having a surface phenotype with features of both B-cells and T-cells. This report presents a review of these cases and comparison with one case of T-cell PLL. By using specific monoclonal antibody technique, this case was subcategorized into helper-cell phenotype: E-rosette(+), SIG(-), Anti-T(+), Anti-B(-), Anti-monocyte(-), OKT3(+), OKT4(+), OKT6(-), OKT8(-), Ia(+), and Tdt(-). Cytochemical studies showed paranuclear acid phosphatase granules. Postmortem examination revealed a predominant T-cell zone infiltration by the leukemic cells in the spleen and lymph nodes, with involvement of multiple organs. The application of the monoclonal antibody technique, which can be standardized among different laboratories to subclassify lymphoproliferative disorders into functional subtypes, should lead to a better understanding and more effective treatment of this disease.

Subtypes of T-cell chronic lymphatic leukemia

Thirteen cases of T-cell chronic lymphatic leukemia (T-CLL) (including T-cell prolymphocytic leukemia) are presented. Five subtypes were distinguished according to morphologic and functional parameters of the leukemic cells: prolymphocytic; lymphocytic, small; lymphocytic, Sézary-like; lymphocytic, abundant cytoplasm; lymphocytic, abundant cytoplasm and granules. The subtype can be recognized by light and by electron microscopic investigation. Cytochemistry (APh and ANAE) may be helpful to delimit T-CLL from B-CLL, and acid phosphatase to recognize the subtype characterized by abundant cytoplasm and granules. Membrane marker investigations support the diagnosis of T-type CLL. When functional properties of the leukemic cells were tested, cells of one patient (T-PLL) were shown to help in B-lymphocyte differentiation and Ig-secretion, whilst the cells of a second patient (lymphocytic, abundant cytoplasm and granules) were proven to act as effectors in natural killing and antibody-dependent cytotoxicity. The T-helper lymphocyte nature of some of the leukemic cells was supported by demonstration of the Fc mu-receptor in three cases. In one of these patients, monoclonal IgM was detected in the serum. Response to therapy and prognosis were rather poor in this limited number of patients when compared with B-CLL.

Surface IgM kappa of prolymphocytic leukaemia cells with antibody activity to surface antigens of sheep and guinea-pig red blood cells

The immunological findings of a B-cell prolymphocytic leukaemia forming spontaneous rosettes with sheep (SRBC) and guinea-pig red blood cells (GPRBC) are reported. The B-cell lineage was revealed by Ia-like antigen, surface IgM kappa and lack of cytotoxicity of anti-human T-cell serum. Despite B-cell characteristics, prolymphocytes formed spontaneous rosettes with SRBC. Inhibition procedures demonstrated rosette formation to be the result of antibody activity of surface IGM to SRBC and GPRBC. Pretreatment of prolymphocytes with pronase or antibodies to mu or kappa-chains inhibited rosette formation. Furthermore, pre-treatment of SRBC with the patient's serum or IgM decreased rosette formation demonstrating circulating antibodies to antigen(s) of SRBC. Antigen(s) on SRBC and GPRBC are not related to Forssman or Paul Bunnel antigen.

Lymphoblastic lymphoma/leukemia with convoluted nuclei: the question of its relation to the T-cell lineage studied in 13 patients

This work is devoted to the analysis of the nature of lymphoblastic lymphoma/leukemia with convoluted nuclei which were initially described by Barcos and Lukes. Ultrastructural, cytochemical, and immunologic features of tumor cells were investigated in patients chosen according to known morphologic criteria. Through results of the E rosette test, the patients were divided into two groups (E+ and E-). In the E+ group, the predominant features were sex (only men), the mediastinal localization, and the focal positivity of the acid phosphatase reaction. Cytotoxicity tests with rabbit antihuman T-lymphocyte anti-serum confirmed the results of the E rosette test in the 3 patients of the E+ group who were tested and were also positive in 2 patients from the E- group (1 of these 2 patients had the characteristics found in the E+ group and can thus be related to this group; the other patient had none of these characteristics). This raises the question of a leukemia arising from a less differentiated T-cell but this interpretation is limited by the specificity of the anti-T-serum. Ultrastructural study defines more precisely the convoluted aspect but does not at present allow a distinction between the two groups.

Three different acid phosphatase patterns in leukaemic lymphoid T-cells

The acid phosphatase pattern was studied in leukaemic cells from 8 patients with T-cell leukaemia (5 ALL and 3 CLL). In 2 cases the enzyme activity was focal granular with paranuclear localization as earlier demonstrated by other authors, while--in contrast to these findings--the enzyme activity in 4 cases demonstrated universal granular distribution. Almost all the cells from each patient showed the same picture. In the last 2 cases a mixed focal and universal granular pattern was observed, where half the cells possessed the focal form and the other half the universal form of granular activity. The two first-mentioned patterns were observed in cases of T-ALL as well as of T-CLL, while the mixed pattern was seen only in cases of T-ALL.

The management of adult acute lymphoblastic leukaemia

The important advances made in recent years in the therapy of adult ALL have been reviewed. The definition of bad-prognosis patients has been improved and includes those with T-ALL, ABLL, and Ph1+ALL, in addition to those presenting with evidence of extensive disease. In contrast to childhood ALL, induction chemotherapy should include another drug (or drugs) in addition to VCR and prednisolone, and one of the anthracycline drugs (ADR or DNR) has been employed most frequently in this context. Such therapy should result in a CR rate of 70 to 75%. Similar to the experience in childhood ALL, the improvement in haematological response rate has led to an apparent increase in CNS leukaemia, and the need for adequate CNS prophylaxis is stressed. Despite these improvements, the outlook for adults with ALL is not yet as good as it is for childhood ALL. Controlled studies involving large numbers of patients are urgently needed to provide answers to a number of questions. In induction therapy, the use of higher drug dosage, the use of more and other drugs, and the use of an individual patient's risk factors to determine drug dosage, must be assessed. The benefits of consolidation therapy and the optimal duration and intensity of maintenance therapy have yet to be established. Methods of CNS prophylaxis other than cranial irradiation and IT MTX must be carefully studied. These important questions require that adult patients with ALL should be concentrated in centres capable of providing optimal overall care and, at the same time, able to conduct the necessary clinical trials.

Comparison of enzyme-cytochemical findings and immunological marker investigations in acute lymphatic leukemia (ALL)

APh-activity and PAS-positive deposits were studied in 50 cases of ALL, classified as T-ALL and O-ALL according to immunological marker investigations. Correlation between morphological features of the cells and APh and PAS reactions, as well as between morphology and immunological markers was not detected. APh-activity in general was stronger in T-ALL (R+ and R-), while PAS-content was more pronounced in O-ALL. The results suggest that cytochemical methods, especially APh and PAS reaction, are valuable to distinguish T-ALL from O-ALL but not reliable enough to replace immunological marker investigations.

Prolymphocytic leukaemia of T-cell type: immunological, enzymatic and ultrastructural morphometric characteristics

A case of prolymphocytic leukaemia with immunological characteristics of T-cell type is reported. Three noteworthy findings can be emphasized: the presence of C3 receptors on the T-prolymphocytes, the study of the acid-phosphatase isoenzymatic pattern, which showed an increased band 3 with absence of band 3b, and the morphometric ultrastructural investigation. Cytochemistry and ultrastructural morphometry may be useful for a more precise characterization of prolymphocytic leukaemia and help to distinguish it from other lymphoproliferative disorders.