Longitudinal studies of blood lymphocyte functions in non-Hodgkin's lymphoma

Fraction of S-phase cells in blood mononuclear cells in non-Hodgkin's lymphomas--correlation with clinical features and prognosis

A consecutive material of 111 untreated patients with non-Hodgkin's lymphoma was studied with respect to fraction of S-phase cells in blood mononuclear cells in relation to presence of monoclonal B cells in blood (MBCB). Fraction of S-phase cells was determined by flow cytometry and estimation of MBCB was performed by kappa:lambda analysis. The fraction of S-phase cells was significantly higher (p less than 0.001) in MBCB-positive cases (median 1.2%) than in the MBCB-negative (median 0.7%). MBCB-positive patients with S-phase values greater than or equal to 1.5% had a less favourable prognosis compared to those with less than 1.5% cells in S-phase (p = 0.01). In a Cox multiparameter analysis, advanced clinical stage, high-grade morphology and high fraction of S-phase cells in blood in MBCB-positive cases were independent, statistically significant, negative prognostic indicators. The results indicate that an elevated S-phase value in blood in non-Hodgkin's lymphoma constitutes a negative prognostic factor, probably reflecting proliferating tumour cells in blood.

Monoclonal B-cells in blood in non-Hodgkin lymphoma. Correlation with clinical features and prognoses

Presence of monoclonal B-cells in peripheral blood (MBCB) was studied in 132 previously untreated patients with non-Hodgkin lymphoma classified according to the Kiel classification. Detection of B-cells was performed by immunofluorescence microscopy, using antibodies against immunoglobulin light chains. Thirty-six patients (27%) were found to have MBCB. In the subgroup of low grade lymphomas 25/75 (33%) and in high grade lymphomas, 11/57 (19%) had MBCB. Presence of MBCB was correlated to clinical stage and 81% of the patients with MBCB were in stage IV. Twenty-two out of 36 (61%) patients with MBCB had normal lymphocyte counts (less than 5.0 X 10(9]. MBCB indicated a less favourable prognosis, mainly due to the close association with stage IV. It was concluded that studies of MBCB by this simple method are useful in detecting 'subclinical' blood involvement and valuable in the initial staging procedure as well as in the follow-up of the patients.

Blood clonal B cell excess (CBE) at diagnosis in patients with non-Hodgkin lymphoma (NHL). Relation to clinical stage, histopathology and response to treatment

Untreated non-leukemic (lymphocytes less than or equal to 4.0 X 10(9)/l) patients with non-Hodgkin lymphoma (NHL) of B cell type often show an excess of B cells in peripheral blood bearing the same light chain isotype as the lymph node tumor cells which may indicate a leukemic spread of the disease. The ratio between kappa- and lambda-bearing lymphocytes (normal range 1.0-3.3) was studied to evaluate the prognostic significance of clonal B cell excess (CBE) at diagnosis in 110 NHL patients. In total 43% had a CBE in peripheral blood. Fifty-two per cent of the patients in clinically advanced stages had CBE and 30% of the patients in stages I and II. CBE was detected in 49% of all patients with low-grade malignant lymphoma and in 32% with high-grade malignancy. Patients with a normal kappa:lambda ratio at diagnosis entered complete remission more often than those with CBE (P less than 0.01). In patients with high-grade but not with low-grade malignant lymphomas remission duration was longer for those with normal kappa:lambda distribution than for the patients with an abnormal ratio (P less than 0.01). Survival was not statistically significantly influenced.

Immunodeficiency and prognosis in patients with non-Hodgkin's lymphomas

Monocyte depleted blood lymphocyte subpopulations, their functions and relation to prognosis were studied in 68 untreated adult patients with non-Hodgkin's lymphomas classified according to the Kiel nomenclature. The median observation time was 48 months (range 41-60). The mean total blood lymphocyte and T (SRBC-rosetting) cell counts were significantly decreased as compared with age-matched controls (n = 57). Twenty-five per cent of the patients had a monoclonal blood B lymphocyte population. The spontaneous lymphocyte DNA synthesis, measured as incorporation of 14C-thymidine, was increased and the response to mitogen and antigen stimulation was decreased. Blood lymphocyte counts and functions before treatment were not related to the rates of remission or survival.

Mitogen induced blood lymphocyte DNA synthesis as a prognostic indicator in patients with non-Hodgkin's lymphomas in clinical remission

Monocyte depleted blood lymphocytes were analyzed in 28 patients with non-Hodgkin's lymphoma in early unmaintained complete clinical remission, in 8 long-term complete remission patients, and in 31 age-matched healthy controls, by SRBC rosetting and DNA synthesis induced by concanavalin A, pokeweed mitogen and PPD antigen. The median observation time from testing was 22 months (range 10-49 months). Early complete remission patients with a normal mitogen induced lymphocyte stimulation remained free of relapses. In contrast, patients who relapsed during the observation period had lymphocytopenia (p less than 0.05), reduced lymphocyte responses to mitogen (p less than 0.001) and to PPD antigen (p less than 0.05) as compared with healthy controls. Long-term complete remission patients did not differ from healthy controls with respect to lymphocyte counts and response to mitogen stimulation.