Immunological aspects of Burkitt's lymphoma

Burkitt's lymphoma in Iraq. Clinical and pathological study of forty-seven patients

The clinical and pathological features of 47 patients with Burkitt's lymphoma seen at the University of Baghdad Teaching Hospital over the years 1969-1977 are described. There were 30 males and 17 females with a mean age of 7.5 years. All patients presented with advanced disease; 44 were in Stage III and 3 in Stage IV, (1 with central nervous system involvement; 1 with bone-marrow involvement; 1 presented as acute leukaemia). The abdomen, with or without other sites, was involved in 42 patients. Thirty-four patients died within 18 months, 11 in the immediate post-operative period. Cyclophosphamide in variable dosages was administered to 29 patients with a good response in 15. The 3 patients with Stage IV disease died with poor response to therapy. Thus, in Iraq, a non-endemic area for the disease, Burkitt's lymphoma seems to have somewhat different clinical and pathological features from the endemic (African), or the rare, sporadic disease reported elsewhere.

Morphology of lymphatic cells and of their derived tumours

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[Humoral immune response--cervical cancer patients: lymphocytotoxic antibodies (author's transl)]

Sera of 120 cervical cancer patients as well as that of 116 healthy control persons were screened for lymphocytotoxic antibodies using microlymphocytotoxic tests variated in temperature and incubation time. In 76 of 120 cancer-sera (63.3%) lymphocytotoxic antibodies could be detected in comparison with 26 sera of 116 controls (22.4%); p less than 0.0005. With the differentiation into the stages of the disease the highest percentage of lymphocytotoxic antibodies was found in patients with stage 0 of cervical cancer. The presence of lymphocytotoxic antibodies in sera of cervical cancer patients suggest the possibility that this disease is an allotransplant as well as expression of an autoimmune process.

Current concepts of tumor immunology. II. Tumor immunodetection

A great deal of investigation is presently underway to develop methods of effectively assessing the status of an individual patient's immune system. Such methods might provide a means of early detection of tumor or of indicating prognosis so that treatment modalities may be tailored to individual patient needs. The cell-mediated response may be monitored using intradermal skin tests and in vitro lymphocyte stimulation and cytotoxicity tests. Humoral responses have been monitored using assays for antibodies against tumor specific as well as tumor associated antigens. Assays have been developed which are capable of detecting circulating fetal antigens in very small concentrations. Thus far no one assay technique has proven to be sufficiently sensitive nor specific to be clinically useful. However, by utilizing a battery of tests before, during and after treatment, it is possible to determine a great deal about individual patient response to treatment and prognosis. With so many investigators focusing upon this problem, it seems likely that more effective methods of immunodetection will soon be developed.

Coeliac disease, gluten-free diet, and malignancy

Two hundred and two patients with coeliac disease or idiopathic steatorrhoea previously reported from this unit have been reviewed after a further 10 years of follow-up. Of 20 more deaths, 10 were due to malignancy. A separate study was made of all patients with histologically confirmed coeliac disease seen to the end of 1972 and followed up to the end of 1974. Twenty-one of the 43 deaths in this series were due to malignant tumours, of which 13 were reticulum cell sarcomas. There was no evidence that patients showing sub-optimal clinical response to gluten withdrawal or persisting falt jejunal biopsies were more prone to die of cancer. A gluten-free diet did not appear to be effective in preventing malignant complications, but a longer follow-up of patients will be necessary to provide a final answer to this question.

Interaction of antibody and cell surface localized antigen

The changes occurring in the expression of a membrane-associated antigen following binding of specific antibodies and the fate of the bound antibodies were investigated. Daudi cells, carrying membrane 7S IgM molecules, were coated with radio-labelled anti-IgM antibodies and incubated under culture conditions at 37degrees C. Within 10 h, more than 80% of the cellbound radioactivity was shed from the cells into the culture medium. Concomitantly, IgM molecules were lost, as the cells had a diminished ability to bind a new aliquot of antibody. This phenomenon occurred also when the antibody was used at a low concentration, i.e. did not saturate the cell-surface antigens. The precipitability of the antibody released from the cells with 10% TCA and 40% saturated ammonium sulphate was lower than that of native antibody, indicating some degradation. Also, shed antibody could rebind to fresh Daudi cells less efficiently than native antibody. The presence of immune complexes in the culture supernatants was indicated by the following results: (1) some of the shed radioactivity could bind to IgM-negative but Fc receptor-bearing cells; and (2) immune precipitates of sheep anti-IgM shed from 3H-leucine labelled Daudi cells and of rabbit anti-sheep IgG antibodies contained 3H activity.

Continuous lymphoblastoid suspension cultures from cells of haematopoietic organs of baboons with malignant lymphoma--biological characterization and biological properties of the herpes virus associated with culture cells

The continuous lymphoblastoid cell lines KMPG-1 and SPG-2 producing baboon herpes virus (HVP) with morphological signs of herpes viruses have been established from haematopoietic organs of lymphomatous baboons. As distinct from H.simplex type I and II viruses HVP is not pathogenic for laboratory rodents. According to its physico-chemical and immunological properties HVP is related to the Epstein-Barr virus.

Effect of the antitumor antibiotic chromomycin A3 on the humoral immune response in rats

Chromomycin A3 (250 mug/kg) suppressed the humoral immune response in rats against sheep erythrocytes when administered 48 h or later after antigenic stimulus. The antibiotic at this dose enhanced immunity when given along with or before antigen administration. The natural heterohemagglutinin levels in rabbits and guinea pigs were not affected by the antibiotic (10 mug/kg per day x 7).

American Burkitt's lymphoma: a clinicopathologic study of 30 cases. II. Pathologic correlations

Thirty cases of malignant lymphoma, undifferentiated, Burkitt's type are reviewed. An older median age and a predominance of presentation in abdominal and pelvic sites rather than in the jaw distinguishes this series of American patients from those reported from endemic regions in Africa. Bone marrow involvement invariably consisted of massive infiltration recognizable in smear, clot and biopsy preparations. Involvement of the central nervous system or bone marrow was always associated with short survival. In all eight long-term survivors lymphoma was apparently confined to a single site at presentation. At autopsy, the most consistent finding was widespread multiorgan involvement without predilection for lymphoreticular structures. The histologic appearance of the tumor changed after chemotherapy, varying from diffuse necrosis within 48 hours of initial therapy to extreme pleomorphism of tumor cells after 9 months of therapy. In one patient, there was almost complete absence of lymphoma at autopsy in an organ site shown clinically to have been extensively involved by tumor prior to treatment. The diagnostic and therapeutic implications of these findings are discussed.

American Burkitt's lymphoma: a clinicopathologic study of 30 cases. I. Clinical factors relating to prolonged survival

The presenting clinical characteristics and the results of therapy in 30 cases of American Burkitt's lymphoma are described. Five patients presented with localized disease. The abdomen was the most frequent site of involvement (19 cases). Serum lactic dehydrogenase (LDH) levels closely correlated with extent of tumor mass. Of the 22 patients treated with large doses of parenteral cyclophosphamide, complete remission was achieved in 13 (59 per cent). Of these only four have had a relapse, all within 12 months of treatment. The remainder are alive, free of disease and have not received any treatment for up to 80 months or more. The site and volume of tumor mass predicted for prolonged survival. None of the six patients with bone marrow or central nervous system involvement remained tumor-free. A complete remission was achieved in 8 of 9 patients with presenting LDH levels of less than 700 IU/ml and they have remained free of disease, whereas only 4 of 13 patients with LDH levels greater than 700 IU/ml had a complete response and 3 of these had a relapse within 12 months. In six cases, the massive tumor regression following chemotherapy was associated with serious metabolid consequences including hyperkalemia (six cases), hypocalcemia, hyperphosphatemia (one case) and lactic acidosis (one case). There were four sudden deaths in less than 48 hours after chemotherapy; two of these were attributable to hyperkalemia. In all cases therw were large tumor masses and/or elevated serum LDH levels.

In vitro immunological studies on East African cancer patients. II. Increased sensitivity of blood lymphocytes from untreated Burkitt lymphoma patients to inhibition of spontaneous rosette formation

Frozen aliquots of peripheral blood mononuclear cells from patients with Burkitt's lymphoma (BL) at various stages of the disease have been compared with samples from East African children who were healthy or who suffered from non-malinant disorders. Using the sheep-cell rosette test (which is believed to identify T-lymphocytes), we found a significant reduction in the proportion of rosette-forming cells (RFC) in the samples from untreated BL patients. After reduction of remission the difference between BL patients and controls was abolished. Rosette formation was more readily inhibited by anti-lymphocyte globulin (ALG) in samples from untreated BL patients than in controls. On induction of remission the rosette inhibition curve shifted towards the control values. The findings are compatible with the presence, in untreated BL, of a circulating factor which impairs the capacity of T-lymphocytes to form rosettes with sheep erythrocytes. It remains to be established whether the functional capacity of T-cells to protect the host against tumour proliferation is also impaired.

In vitro immunological studies on east african cancer patients. III. Spontaneous rosette formation by cells from Burkitt lymphoma biopsies

Spontaneous rosette formation was observed in eight out of nine Burkitt lymphoma biopsies. These were examined fresh and/or after culture in vitro for up to 48 h. The percentage of rosettes varied from 3.7% to 38%. There was a tendency for the percentage of rosettes to increase with time in tissue culture. It is suggested that the rosette-forming cells are T-lymphocytes infiltrating the tumour and functioning as a host defence mechanism against the proliferating tumour cells.

Distinct alkaline phosphatase in serum of patients with lymphatic leukemia and infectious mononucleosis

A distinct alkaline phosphatase (phosphatase N) was demonstrated in the serum of patients with acute lymphatic leukemia, chronic lymphatic leukemia, and infectious mononucleosis. This enzyme closely resembles that extracted from the thymus of mice with lymphoma or lymphatic leukemia, both in its electro-phoretic mobility and its substrate specificity. The phosphatase N activity was related to the clinical state of patients with lymphatic leukemia and disappeared with recovery from infectious mnononucleosis.