Normal counterparts of hairy cells and B-prolymphocytes in the peripheral blood. An ultrastructural study with monoclonal antibodies and the immunogold method

Hairy cell leukemia: an update

Hairy cell leukemia is an indolent, chronic B-cell lymphoproliferative disorder comprising approximately 2 to 3% of all adult leukemias in the United States. Hairy cells are clonal expansions of mature, activated B-cells. They co-express CD11c, CD19, CD20, CD22, CD25, and CD103. Hairy cells possess clonal immunoglobulin gene rearrangements and express monoclonal surface immunoglobulin of either IgG or multiple heavy-chain isotypes. Treatment of hairy cell leukemia should be considered for symptomatic patients. It is indicated in patients with significant neutropenia, anemia, thrombocytopenia, symptomatic splenomegaly, constitutional symptoms due to hairy cell leukemia, or recurrent serious infections. Many treatments exist, including cladribine, pentostatin, interferon-alpha, splenectomy, rituximab (mabthera), and BL-22 immunotoxin.

Distinct morphophenotypic features of chronic B-cell leukaemias identified with CD1c and CD23 antibodies

Morphological criteria usually applied to diagnose various subtypes of B-cell chronic lymphoid leukaemia are largely subjective. Immunophenotyping of 61 relevant cases using a selected panel of monoclonal antibodies (mAb), showed that CD1c and CD23 mAb were able to separate B-cell chronic lymphocytic leukaemia (B-CLL) from other chronic B-cell lymphoproliferative diseases. Lymphocytes of B-CLL were CD1c-, CD23+, whereas those of other types of chronic B-cell leukaemia were CD1c+/-, CD23-, and CD38/-. Non-B-CLL cases had a significantly higher amount of large peroxidase-negative (unstained) cells analyzed with an automated blood cell counter (Technicon H6000). This type of volumetric assessment allowed a separation between typical and "atypical" B-CLL, which otherwise were both CD1c-, and CD23+. These combinations of phenotypic markers corresponded to well-defined haematopathologic entities, conventionally diagnosed on peripheral blood (PB) and bone marrow smears, and on histologic sections of lymph nodes and spleen.

Further characterization of prolymphocytic leukemia cells as a tumor of activated B cells

Peripheral blood mononuclear cells from 24 patients with prolymphocytic leukemia (PLL) were isolated using a Ficoll-Hypaque gradient and stained by indirect immunofluorescence using a wide panel of monoclonal antibodies against B cell restricted and associated antigens, including HLA DR (Ia), CD19, CD21 (C3dR) surface membrane immunoglobulin (Slg), CD10 (CALLA), C3b, B5, CD25 (TAC), PCA1, T9, and T10. The cells were also tested for the FMC7, defined previously on PLL cells and the RAB1, a newly described hairy cell leukemia antigen. Thirteen out of the 24 samples expressed with variable intensity all the above antigens. While Ia, CD19, CD20, FMC7, and RAB1 were strongly or moderately expressed in all, the complement receptors (CD21 and C3b) were only weakly expressed in 12 cases; and the activation antigens B5, TAC, T9, T10, and PCA1 were found with variable intensity in two-thirds of the cases. In 50% of the cases tested, the CD5 antigen (usually strongly expressed on B CLL cells) was weakly to moderately expressed. These findings (absence or weak expression of complement receptors with variable expression of activation antigens) suggest that the PLL cells are activated B cells. When stimulated in vitro by anti-mu and TPA, (phorbol ester) tumor cells showed a decrease in CD21 and Slg and a stronger expression of CD25, T9, T10, and PCA1, with evidence of Ig secretion in four out of the seven cases studied. This confirms that the PLL cells arrested at an advanced stage of differentiation progressed narrowly to more differentiated cells. In view of our findings, we believe that the term prolymphocytic leukemia is inaccurate to define the stage of cell differentiation, and we suggest calling the disease preplasmacytic leukemia.

Analysis of T-cell-derived factors with the use of B-prolymphocytic leukemia cells

Mononuclear cells of five patients with B-prolymphocytic leukemia were tested for their functional capacities in vitro after stimulation. Leukemic B cells from these patients have a mature phenotypic marker profile and can be obtained in high numbers from peripheral blood. B cells of all five patients proliferated in response to phorbol myristate acetate. In one patient, this proliferation was strongly enhanced by the addition of T-cell-conditioned medium. Conditioned medium by itself or interleukin 2 in the presence or absence of the phorbol ester was not active. This enabled us to develop an assay for a B-cell growth factor different from interleukin 2. Next to their proliferative capacities, we found that malignant B cells of three of the five patients secreted large amounts of IgM when stimulated with pokeweed mitogen or interleukin 2 in the presence of allogeneic T cells. In the absence of these allogeneic cells, neither pokeweed mitogen nor interleukin 2 had any effect. However, T-cell-conditioned medium as well as the supernatants of two T-cell hybridomas induced strong IgM production in the absence of T cells. Thus, neoplastic B cells of some patients with B-prolymphocytic leukemia can be stimulated to proliferation and differentiation in vitro and can be used as an assay and model system to study the effect of T cells and/or T-cell factors in human B-cell activation.