Current concepts in immunology: Cell-surface markers in lymphoproliferative disease

Lack of TdT and Immunoglobulin and T-Cell Receptor Gene Rearrangements in Hodgkin's Disease

To study the pathogenesis of Hodgkin's disease (HD), which today remains obscure, we have undertaken a combined experimental approach: determination of TdT and molecular analysis of rearrangements of immunoglobulin heavy chain (IgH), T-cell receptor (TCR) beta chain and the T-cell rearranging gamma (TRG) genes. TdT determination indicate would the presence of immature cells that are not detected in the normal lymphnode; molecular analysis of the rearrangements of these genes would reveal the presence of even a small monoclonal population of both T and B lineages in the lymphnodes. We believe that the combination of these two types of analysis can indicate whether an expanding lymphoid clone is responsible for this disease. TdT determination was negative in all 41 cases tested. Gene rearrangements were studied in 10 cases for IgH and TCR beta genes and in 5 cases for the TRG gene. No abnormal band beside the germ-line ones was detected in any of our cases, ruling out the presence of a minor neoplastic population. We can explain these results in at least three ways: first, the neoplastic population could represent less than 1% of the total, thus escaping detection by current techniques; second, the neoplastic population is not lymphoid in nature or is composed of mature cells that do not rearrange Ig and TCR genes and therefore belongs to a true non-B, non-T lineage; third, the pathogenesis of HD is completely different from that of non-Hodgkin's lymphomas (NHL) and does not involve the clonal expansion of a cell frozen at a particular maturative stage as is thought to happen in most NHL.

Immunophenotyping of normal lymphocytes

We report the data of direct and indirect immunofluorescence labelling of peripheral blood mononuclear cells obtained from 40 normal controls and nine patients having blood tests for non-haematological disorders (PNHD controls) using flow cytometric analysis. Polyclonal and monoclonal antibodies were used to define the expression of cell surface antigen of T cells, their subsets, B cells, natural killer cells (NK) and myeloid cells. Normal values of absolute number and percentages of each of the populations of mononuclear cells were established and were sufficiently reproducible to be of clinical use. The percentages of positive values of T cells, T-cell subsets, and B cells in ten normal controls when mononuclear cells were used, were comparable to those using whole blood lysis, APAAP immuno-alkaline phosphatase, and E and M rosettes. The results obtained were similar in both the normal and PNHD controls. In most instances the percentage recovery of identified T, B and NK cells was complete. Currently we are using the results as reference values for lymphoid sub-populations in normal controls.

In situ hybridization detection of light chain mRNA in routine bone marrow trephines from patients with suspected myeloma

A method for the detection of immunoglobulin light chain mRNA by situ hybridization has been applied to routine bone marrow trephines, from patients suspected of having multiple myeloma. The principle aim was to define monoclonal populations even in cases lacking a paraprotein or an obvious atypical plasma cell proliferation. The expression of light chain mRNA in plasma cells in routine bone marrow trephines from 14 patients with suspected myeloma was studied. Plasma cells in the marrow ranged from 4% to 99%. Clonal populations based on light chain restriction were delineated in 12 patients, using biotinylated probes to kappa and lambda mRNA and visualized using an alkaline phosphatase/fast red naphthol capture method. Normal tonsil and bone marrow trephines were used as controls. In situ hybridization was found to be a specific, safe and rapid technique. It could be applied to both fixed and fresh tissue. It was found to lack the background staining of interstitial immunoglobulin, particularly in sclerotic cases, which is so often encountered with immunocytochemistry. Additionally, this technique will type plasma cell neoplasms (undetected by routine immunocytochemistry) in post-transcriptional block or non-secretory myeloma.

Assessment of clonality in gastrointestinal cancer by DNA fingerprinting

DNA fingerprinting with three different probes (33.15, 33.6, and alpha-globin 3'HVR) was investigated as a method for the determination of clonality in gastrointestinal tumors. In 29/44 carcinomas the tumor DNA showed clonal somatic mutations that were not seen in the corresponding peripheral blood and normal mucosa samples. The changes consisted of either novel fingerprint bands, losses of bands, or both. The probe 33.15 yielded the highest rate of abnormal DNA fingerprints (21/44 carcinomas). Sequential use of the probes increased the number of cases where clonal fingerprint markers could be detected. One out of five colorectal adenomas also showed a clonal loss of a fingerprint band. In two cases of gastric cancer, DNA from the metastatic tumor had a different DNA fingerprint from that found in the primary carcinoma. DNA fingerprinting offers a novel approach to determining clonality in tumors and may prove useful for the study of tumor progression.

Quantitation of mu mRNA by in situ hybridization reveals a correlation between B-maturation associated antigens and IgM gene activation in acute lymphatic leukemias

Acute lymphatic leukemias, expressing the common acute leukemia antigen were investigated for expression of early T- and B-cell associated markers and the activation of the gene for the heavy chain of the immunoglobulin M. The gene activation as determined by quantification of the mu mRNA with a fluorochrome labeled gene probe in situ in individual cells showed a wide spectrum of positivity which was correlated to increasing expression of B-maturation markers. There was also a correlation between the amount of cellular immunoglobulin as determined by immunofluorimetry. Quantitation of mRNA in individual cells may allow to determine the degree of gene activation in antigenically defined individual cells and may thus contribute a new tool for classification of normal and malignant cells.

Cytosine arabinoside in the treatment of T-cell acute lymphoblastic leukemia

The place of cytosine arabinoside (araC) in the treatment of T-cell acute lymphoblastic leukemia was studied by measuring nucleoside transport sites and the conversion of araC to its triphosphate (araCTP) in lymphoblasts from the peripheral blood of two patients, who were then treated with araC. Equilibrium binding of 3H-nitrobenzylmercaptopurine riboside (3H-NBMPR), a specific ligand of the nucleoside transporter, gave 16,510 to 29,400 sites/cell for T-lymphoblasts on presentation or early in relapse compared with 2730 +/- 1570 sites/cell for non-T-lymphoblasts. Accumulation of araCTP from 1 microM araC was four times greater in T-cell than non-T-cell lymphoblasts. One patient was treated with araC (100 mg/m2 daily x 7 days, continuous intravenously) at the time of her first leukemic relapse and complete remission was achieved with this single agent. When this patient relapsed and developed advanced disease the T lymphoblasts showed a 75% reduction in their ability to accumulate araCTP which paralleled a reduction in 3H-NBMPR binding. The second patient achieved complete remission with araC given in low dose (15 mg twice daily by subcutaneous injection) for 21 days at the time of a localised relapse in the mediastinum and pleura. These studies suggest that araC may have a place in the therapy of early stage T-lymphoblastic disease.

Small noncleaved follicular center cell lymphoma: Burkitt's and non-Burkitt's variants in the US. II. Pathologic and immunologic features

The morphologic criteria for the two variants of small noncleaved follicular center cell (SNC FCC) lymphoma in the Lukes-Collins classification, Burkitt's (BL) and non-Burkitt's variants (NBL), were evaluated and related to the results of multiparameter laboratory and clinical studies. Forty-two patients were studied: 25 cases were classified as BL according to World Health Organization (WHO) criteria. Seventeen cases were classified as NBL on the basis of greater variability in nuclear size and shape, more prominent nucleoli, and greater variation in the amount of cytoplasm. Neoplastic follicles were present in three cases of BL and two of NBL, indicating an FCC origin for this lymphoma. Electron microscopic examination confirmed the light microscopic features. Immunoglobulin (Ig) monoclonality, as demonstrated by immunofluorescence (surface Ig) and/or immunoperoxidase staining for cytoplasmic immunoglobulin (CIg), was demonstrated in 21 of 24 (87.5%) of BL and 13 of 16 (71%) of NBL. Clinically, BL presented more frequently in extranodal sites and with gastrointestinal involvement than NBL. Bone marrow involvement was more common in NBL patients. Both groups had advanced stage disease at diagnosis. The median survival was 10.5 months in BL and 7.7 months in NBL. The results of this study indicate that BL and NBL are biologically related variants of SNC FCC lymphoma but have different presentations, which may be clinically significant.

Acute lymphocytic leukemia: correlation of clinical features with immunocytochemical classification

Many immunologic studies of acute lymphocytic leukemia (ALL) during the past decade have demonstrated the close correlation of immunologic phenotypes of ALL subclasses with the clinical presenting features and prognosis. However, the clinical application of conventional immunologic techniques had been very limited because of the requirement of a fresh sample to prepare the mononuclear cell suspensions for study. We studied 81 cases of ALL using immunoperoxidase stain for nuclear terminal deoxynucleotidyl transferase (TdT) and immunoalkaline phosphatase stain for surface markers (using monoclonal antibody J5 for common ALL antigen [CALLA], Leu-1 for pan-T antigen, and B1 for pan-B antigen) on air-dried smears. The cases were classified as common ALL (TdT+, CALLA+, pan-T-, and pan-B-) (41 cases), null-ALL (TdT+, CALLA-, pan-T-, and pan-B-) (19 cases), T-ALL (TdT+, CALLA-, pan-T+, and pan-B-) (nine cases), B-ALL (TdT-, CALLA-, pan-T-, and pan-B+) (six cases), pre-B-ALL (TdT+/-, CALLA+, pan-T-, and pan-B+) (four cases), or pre-T-ALL (TdT+, CALLA+, pan-T+, and pan-B-) (two cases). This subtyping of ALL correlated well with known clinical presenting features, prognosis, chromosome analysis in 35 cases with an abnormal clone, and conventional immunologic typing in 38 cases. The data suggest that these simple and practical immunocytochemical stains can be used for immunologic subclassification of ALL.

Immunoglobulin gene rearrangements in adult non-Hodgkin's lymphoma

Southern blotting was employed to analyze the immunoglobulin heavy and light chain genes and the gene for the T cell receptor beta chain in genomic DNA derived from the tumor specimens of 120 adults with pathologically classified and immunotyped non-Hodgkin's lymphoma and B cell chronic lymphocytic leukemia. In a consecutive series of 100 patients, one or two rearranged heavy chain genes could be detected in each of the 80 samples expressing clonal surface immunoglobulin. The kappa gene was rearranged in 70 percent of kappa-bearing tumors and in 23 percent of lambda-bearing specimens. Furthermore, a rearranged immunoglobulin gene was also observed in 21 of 29 lymphomas (nine from the consecutive series and 20 selected for surface immunoglobulin-negative status) in which B cell lineage was in doubt because of absent clonal surface immunoglobulin. These findings indicate that most cases of lymphoma and lymphocytic leukemia in adults are of B cell lineage, even when phenotypic evidence is inconclusive. The exceptional cases (only 3 percent in the consecutive series) were of either follicular lymphoma or diffuse large cell (histiocytic) lymphoma subtype; the lineage in cases of diffuse lymphocytic lymphoma or chronic lymphocytic leukemia was never in doubt. Although the convenience of surface marker analysis assures its continuing clinical application, gene study resolves indeterminate cases and extends the understanding of the pathogenesis of lymphoproliferative disease.

Clinical applications of gene probes in human genetic disease, malignancy, and infectious disease

Recent developments in recombinant DNA technology have made possible the production of gene probes consisting of cloned gene segments, cloned segments of DNA linked to genes, and synthetic gene fragments. Several methods have been developed by which these probes may be used for the diagnosis of human disease. This technology has been outstandingly successful for prenatal diagnosis and carrier detection in many genetic diseases. These methods have also been successfully applied to the analysis of human malignancies, by providing for the determination of cell lineage and clonality in lymphoid neoplasms. Finally, these methods have shown potential for rapid and sensitive diagnosis of some infectious diseases.

T-cell receptor gene rearrangements as clinical markers of human T-cell lymphomas

The ability to detect immunoglobulin-gene rearrangements has proved useful in confirming diagnoses of suspected B-cell lymphomas and in establishing their monoclonality. By analogy, we employed a cloned DNA probe for the beta chain of the T-cell receptor gene to determine whether gene rearrangements were present in human T-cell neoplasms representing various stages of T-cell development. Gene rearrangements were present in all cases of T-cell disorders except a single case of T gamma lymphocytosis, a disorder that has not been proved to be a clonal T-cell neoplasm. A germline gene configuration was present in all patients with non-T-cell neoplasms and in normal tissues from patients with T-cell lymphoma. The probe promises to be useful for confirming the pathological an immunologic diagnosis in difficult cases of T-cell disorders and for assessing the extent of disease.

A sensitive method for immunophenotyping stored leukemia and lymphoma cells with preservation of morphological detail

We describe a method by which density-separated mononuclear preparations of blood and bone marrow may be stored and batch-processed for immunophenotyping by the indirect immunoperoxidase (IP) technique. The method gives excellent preservation of cellular detail thus permitting clear morphological categorization of IP-positive and IP-negative cells. We compared the immunofluorescence (IF) and IP techniques for estimation of the proportions of cells displaying a variety of antigens; with normal blood cells the results were closely similar but with chronic lymphocytic leukemia (CLL) cells, IP was superior to conventional IF. Using 910 D7, a new anti-la antibody, we were able to observe directly the presence of la-positive lymphocytes and monocytes in normal peripheral blood and la-positive granulocyte precursor cells from 2 cases of chronic granulocytic leukemia (CGL) in transformation. The method is useful for immunophenotyping of cases of lymphoproliferative disorder (LPD) and for morphological identification of specific antigen-positive cells.

Normal values for the different classes of venous blood mononuclear cells defined by monoclonal antibodies

We present the data obtained from routine quantitation of normal venous blood mononuclear cells using 19 monoclonal antibodies against defined mononuclear cell surface antigens. The results indicate different values for percentage and absolute numbers of T lymphocytes and of T lymphocyte subsets depending on the monoclonal antibodies used to quantify these populations. In most instances the total number of identified cells was significantly less than the total number of recovered blood mononuclear cells, which suggests the existence in blood of a null cell population. Evidence is advanced to support previous observations that at least a proportion of this population is of B cell lineage, expressing cytoplasmic immunoglobulin but lacking other class or lineage specific markers. The value of a diverse monoclonal panel in routine quantitation of peripheral blood mononuclear cells is discussed.

New genetics of Burkitt's lymphoma and other non-Hodgkin's lymphomas

Recent progress in cytogenetics and molecular genetics allows striking new insight into Burkitt's lymphoma. In this B cell tumor, the oncogene c-myc located on the long arm of chromosome 8 translocates to one of three locations: adjacent to the immunoglobulin heavy chain gene on chromosome 14, adjacent to the gene for the kappa light chain of immunoglobulin on chromosome 2, or adjacent to the gene for the lambda light chain on chromosome 22. Nucleotide sequence analysis indicates that the translocated c-myc is usually upstream of an immunoglobulin constant region gene, although the exact position varies. In its new location, the oncogene is actively transcribed and may have escaped its normal control mechanisms. It can be no coincidence that this B cell lymphoma is intimately associated with a misadventure in the genetic underpinnings of the major event in B cell differentiation, the assembling of a functional immunoglobulin molecule. Similar genetic catastrophes probably account for the more common B cell lymphomas and could provide the basis of a coherent lymphoma classification.

Immunoperoxidase detection of T and B cells in blood compared with conventional methods

Peripheral blood T and B cells were enumerated in 26 normal adults by conventional immunological markers (erythrocyte rosette and surface membrane immunoglobulin) and by monoclonal markers (T11 and B1) using both membrane immunofluorescence of cells in suspension and immunoperoxidase staining of dried, fixed, cytocentrifuged cells after separation from blood by buoyant density centrifugation. The results of immunochemistry were determined independently from the results of erythrocyte rosetting and membrane immunofluorescence techniques. A high correlation was found between all three methods for enumerating T cells (erythrocyte rosetting, T11/immunoperoxidase, and T11/indirect immunofluorescence). Correlation was less good between the results of the three methods for enumerating B cells; surface membrane immunoglobulin and B1/indirect immunofluorescence techniques showed the highest correlation. The results suggested that B cells may be preferentially lost during the extensive cell washings entailed in the indirect immunofluorescence procedures. Immunochemical methods, using monoclonal antibodies, are useful for enumerating lymphocyte subsets in blood, particularly when permanent records are desired.

Bone marrow histopathologic patterns and immunologic findings in B-chronic lymphocytic leukemia

In 82 patients with B-chronic lymphocytic leukemia, the correlations between the histopathologic bone marrow patterns (interstitial, nodular, mixed, and diffuse), serum immunoglobulin (Ig), and blood B-lymphocyte levels and T-lymphocyte levels have been analyzed. The most commonly lowered Ig class was IgM (43% of cases) followed by IgA (35%), and IgG (10%). There was a trend to a more frequent decrease of Ig levels when "advanced" bone marrow patterns (mixed + diffuse) were compared with the earlier ones (interstitial + nodular). The frequency of such a decrease was statistically significant for IgA class (P less than 0.01). The absolute number of blood T-lymphocytes was increased in the diffuse pattern (P less than 0.01).

Multienzymatic analyses of human malignant lymphomas. Correlation of enzymatic data with pathologic and ultrastructural findings in Burkitt's and lymphoblastic lymphomas

Enzyme activity measurements are of great relevance to the classification and biochemical characterization of the various types of leukemias, but they have been much less studied in solid lymphoid tumors. The authors report investigations in human lymphomas. The levels of the following enzymes were determined: terminal deoxynucleotidyl transferase (TdT), deoxyribonucleic acid polymerase alpha (DP alpha), adenosine deaminase (ADA), purine nucleoside phosphorylase (PNP), thymidine and uridine kinases (TK and UK, respectively), and thymidine phosphorylase (ThPh). Moreover, cytochemical investigations were done in the group of Burkitt's lymphoma (BL) and lymphoblastic lymphoma (LL), and ultrastructural studies were performed in seven of the nine LL of this series. These results were obtained: (1) TdT (90 cases) was highly specific for LL; eight of nine LL were positive, and all other histologic types were negative; the only TdT-, acid esterase (AcE) positive, nonconvoluted LL was probably related to TdT- normal medullary thymocytes, and had an unfavorable clinical course with resistance to a vincristine-and-prednisone-including treatment; (2) ADA (61 cases) could distinguish clearly between the high levels of LL and the low levels found in any other group of lymphomas; among LL, the highest values were found in T-cell-derived neoplasias, and the lowest value in a periodic acid-Schiff (PAS) positive, acid phosphatase negative case that showed the presence of large nucleoli at the ultrastructural analysis, a finding that is unusual for LL and possibly related to a more immature differentiation stage; (3) PNP (39 cases) values alone were not clinically relevant, but together with ADA levels, a subset of T-LL with high ADA:PNP ratio could be selected among LL; (4) DP alpha (61 cases), and TK and UK (37 cases) were found in concentrations reflecting the malignancy of the non-Hodgkin's lymphoma, and were more elevated in the high-grade malignant lymphomas; (5) ThPh (34 cases) was always elevated in Hodgkin's disease, but low in Burkitt's lymphoma and LL; thus, they had a high TK:ThPh ratio that could be useful in predicting clinical response to thymidine treatment. The authors think that taken together, multiple enzyme determinations could be useful in the characterization of human lymphomas.

Classification of patients with T-cell chronic lymphocytic leukemia and expansions of granular lymphocytes: heterogeneity of Italian cases by a multiparameter analysis

The peripheral blood mononuclear cells (PBMC) from 750 Italian patients with chronic lymphocytic leukemia (CLL) were evaluated in order to detect cases with T-cell expansions. The PBMC of 18 patients (2.4%) were found to be capable of rosetting with sheep red blood cells. Further characterization of these cells with a panel of monoclonal antibodies and other immunological and cytochemical tests led us to tentatively subdivide these 18 patients into three groups. The first one included 6 patients whose cells expressed a T-helper phenotype: they exhibited frequent skin involvement and an aggressive clinical course, and some of the patients in this group demonstrated chromosome abnormalities. On the other hand, group 2 (10 cases with expansions of granular lymphocytes and/or T suppressor-bearing phenotype cells) usually presented with a mild clinical course. These cases did not generally require therapy and a diagnosis of leukemia could not be unequivocally confirmed. Cells from the two remaining patients displayed both B-cell markers and E-rosetting ability, thus belonging to the rare group of false T-cell CLL. In fact, the clinical course and management of the latter cases were similar to those of classical B-CLL disease. In the first and second groups, mechanisms reported to be involved in mature T-cell proliferations (response to interleukin-2, production of interleukin-2 or interferon) were investigated, but the cells under study displayed neither growth ability nor lymphokine production in the above assays. In addition, these cells were negative with the anti-Tac monoclonal antibody that appears to recognize the receptor for interleukin-2. More importantly, none of these patients had serum antibodies to the recently described human T-cell leukemia/lymphoma virus (HTLV), possibly responsible for Japanese and West Indian adult T-cell leukemia (ATL) and for sporadic cases of ATL observed in other countries. Taken together, our results outline some differences between European and ATL patients. Furthermore, the data presented point out the heterogeneity of the disease and emphasize that an immunological classification and, in particular, the detection of a helper phenotype have relevant prognostic and therapeutical importance.

Impairment of thymus-derived lymphoid cell function in patients with basal cell carcinoma

The host-tumor relationships in 34 patients with basal cell carcinoma was investigated by characterizing thymus-derived (T) and bone marrow-derived (B) lymphoid subpopulations in the blood by cell surface markers and lymphoid function in vitro by proliferative responses to mitogenic and antigenic stimulation. Results were correlated with tumor stage. In patients with tumor present, the data demonstrate significantly (P less than .02) decreased responsiveness of T cells to the lectin mitogens phytohemagglutinin and concanavalin A, and further demonstrate significantly decreased responsiveness of T cells to antigens (P less than .001 for Candida antigen, P less than .05 for Staphylococcal filtrate and Streptococcal varidase). In patients who were grossly disease free after resection of tumors, there was no significant difference in these responses from normal. These results document, for the first time, impaired T-cell function in patients with basal cell carcinoma and suggest that the functional impairment is tumor induced.

Immunoglobulin-gene rearrangements as unique clonal markers in human lymphoid neoplasms

Immunoglobulin genes in their germ-line form are separated DNA subsegments that must be joined by means of recombinations during B-cell development. Individual immunoglobulin-gene rearrangements are specific for a given B cell and its progeny. We show that the detection of such gene rearrangements by Southern hybridization provides a sensitive marker for both clonality and B-cell lineage within lymphoid tissues lacking expression of definitive surface phenotypes. We have used these genetic markers in three ways: to establish a diagnosis of lymphoma in a neoplastic disorder of uncertain cell type, to show that some lymphomas that were previously classified as being of T-cell type in fact contain monoclonal B cells, and to detect clonal B-cell populations within lymphomatous tissues of uncertain immunotype and within an atypical lymphofollicular hyperplasia having no other clonal surface markers. These sensitive and unique indicators of clonality located directly at the DNA level are capable of providing insights into the cellular origin, early detection, and natural history of neoplasia.

Expansion of antigen-specific T cells from cerebrospinal fluid of patients with multiple sclerosis

We have expanded cerebrospinal fluid (CSF) T lymphocytes obtained from four patients with multiple sclerosis (MS). Fresh CSF cells were placed into culture with medium, interleukin-2, irradiated autologous peripheral blood mononuclear cells, and either myelin basic protein (BP) or measles virus antigen. Two CSF cell lines demonstrated a mild degree of antigen-specific proliferation to BP, a third reacted with measles virus, and the fourth demonstrated no known antigenic specificity. The percentage of HLA-DR + cells was increased in all four cell lines. The culture procedure has thus selected for a population of activated T cells, some of which demonstrate reactivity with antigens of potential relevance to the pathogenesis of MS.

A case of primary B-cell lymphoma of the breast. Light and electron microscopy, and immunologic cell markers

A case of primary non-Hodgkin's lymphoma of the breast was studied with light and electron microscopy and for immunologic cell markers. With light microscopy, the tumor was seen to be a poorly differentiated lymphocytic lymphoma, diffuse, according to Rappaport's classification. With electron microscopy, the tumor was seen to consist of a cytologically uniform cell population. The cells were characterized by irregularly shaped nuclei with infrequent cytoplasmic projections and "microvilli-like" structures, mimicking small cleaved follicular center cells. The immunologic cell marker study showed that the cells were positive for surface IgA and HLA-DR antigen; negative for SRBC receptors, Leu 1, Leu 2a, and Leu 3a antigens. The collective evidence indicated the tumor was of B-cell origin.

Analysis of cell surface proteins delineates a differentiation pathway linking endocrine and nonendocrine human lung cancers

We have previously determined that the cell surface protein phenotype distinguishes human small cell lung carcinoma (SCC), a neoplasm with endocrine properties, from non-SCC in culture. We now demonstrate that cloned cell cultures of human large cell undifferentiated lung carcinoma, established directly from a patient with mixed SCC and non-SCC, simultaneously express surface proteins characteristic of SCC and non-SCC lung cancer cells. Hence, SCC and a form of large cell carcinoma appear linked through a continuum of differentiation events that: (i) may explain clinically important transitions that occur between the major types of human lung cancer and (ii) provide evidence for a common cellular origin of endocrine and nonendocrine cells in the bronchial mucosa.

Cell-marker studies in CLL with monoclonal OKT antisera and lactic dehydrogenase isoenzyme analysis

In 16 patients with B-type CLL, the T and B cell compartment was analysed using the monoclonal anti-T-cell antisera OKT1, 3, 4 and 8 and the lactic dehydrogenase enzyme marker. Pertinent findings were: the presence on the CLL cells in 15 out of 16 patients of the antigen determined by the OKT1 antiserum, and, in all patients, a lower total LDH content on a per cell basis combined with a higher percentage-activity in the LDH-3 band as compared to the normal B-cell. Furthermore, the T-cell compartment was also disturbed in these patients, as the ratio of OKT4+ to OKT8+ cells was significantly depressed accompanied by a significant decrease of the LDH-1 percentage-activity in favour of LDH-3 and 4. These findings argue for the B-cell being immature and confirm the recent evidence that the T-cell compartment is changed in B-CLL.

The cellular content of non Hodgkin lymphomas: a comprehensive analysis using monoclonal antibodies and other surface marker techniques

Five samples of tonsil, 10 reactive lymph nodes and 65 consecutive cases of non-Hodgkin lymphoma (NHL) were evaluated in suspension phenotyping with the monoclonal antibodies alpha Leu-I, alpha Leu-2a, alpha Leu-3a, OKT1, OKT3, OKT4, OKT6, OKT8, W6/32, 26/114, DA-2, 2DI, J5, AN51 and OKT9 together with conventional surface marking by rosetting (E, Fc gamma, Fc mu, C3b, C3d) and staining for surface and cytoplasmic immunoglobulin (SIg, CyIg) heavy and light chain classes. The results confirm the reproductability and specificity of staining with monoclonal antibodies against T cells and T cells subsets. Evidence is presented for reactivity of alpha Leu-I antibody with SIg positive and Ia positive cells in some lymphomas (centroblastic centrocytic, lymphocytic and immunoblastic), and 2 cases showed evidence of marking with OKT3 on SIg positive cells in T cell predominant immunoblastic lymphoma. Lymphoblastic lymphomas of T cell type expressed the marker OKT6. On the basis of these results criteria for the diagnosis of T cell lymphoma are suggested. The monoclonal antibody J5, reactive with C-ALL antigen, showed variable positivity, occasionally strong in B cells in cases of centroblastic and centrocytic follicular lymphoma. Proportions of cells staining with the monoclonal antibody OKT9 showed a correlation between levels of cellular expression of transferrin (trf) receptor and the histological grade of malignancy, OKT9+ cells being elevated in high grade lymphomas, and in some cases of transforming lymphoma of low grade histological class. These results are discussed and indicate the advantage of employing a wide range of defined monoclonal reagents in the phenotypic evaluation of NHL.

Monoclonal antibody studies in B-cell chronic lymphocytic leukemia and allied disorders

Lymphocytes from 48 patients with B-cell chronic lymphocytic leukemia (B-CLL) and allied disorders were examined with a panel of monoclonal antibodies and conventional surface marker techniques. Surface immunoglobulin (SIg) and Ia-like antigen were regularly present on B-CLL cells. In addition, 24 of 32 specimens reacted with OKT1, a monoclonal antibody which detects both peripheral and thymic T cells, but reactivity was not observed with anti-T-cell monoclonal antibodies of more restricted specificity (OKT3, OKT4, OKT6, OKT8 or OKT11). Eighteen of 20 samples in which only SIgM was detected were OKT1-positive, while all 4 with only SIgG were OKT1-negative. Cells from patients with hairy cell leukemia were unreactive with OKT1, but resembled B-CLL lymphocytes in the presence of clonal SIg and Ia-like antigen. Neoplastic plasma cells lacked Ia-like antigen and frequently SIg (2 of 5), but cytoplasmic immunoglobulin was present, cells reacted with OKT10 (replicating lymphoid cells) and 2 of 5 with OKT9 (transferrin receptor) as well. Cutaneous T-cell lymphoma samples were reactive with the anti-T-cell monoclonal antibodies OKT1, OKT3 and OKT4 even when the sheep cell receptor could not be detected. Monoclonal antibodies can provide more certain diagnosis and superior resolution of cell lineage in these disorders than is possible by morphology alone.

Enzyme alterations in leukemic cells

Recently, much attention has been focused on various enzyme alterations found in leukemic cells. Most of the data generated thus far has involved the study of terminal deoxynucleotidyl transferase, the purine pathway enzymes, and hexosaminidase and other lysosomal enzymes. Differences in both total enzyme activities and isoenzyme patterns have been found to occur among the various leukemia types and subtypes. These changes may prove to be useful aids in diagnosing, classifying, detecting subclinical recurrent or residual disease, and as therapeutic determinants in hematopoietic neoplasia, especially in the lymphoid malignancies.

Hodgkin's disease of the nasopharynx

Malignant lymphoma of the Hodgkin's disease type involving the nasopharynx has been considered a rare entity. However, recent publications suggest that such involvement may not be uncommon. The authors describe their experience with two patients with histologically proven involvement of the nasopharynx by Hodgkin's disease. The diagnosis is difficult to establish. Histologic confirmation may require persistence and necessitates close cooperation with the pathologist. The prognostic significance of Hodgkin's disease involvement of the nasopharynx remains unknown. The otolaryngologist should be aware of these issues and be available to assist in the evaluation of the patient with lymphoma.

Treatment of prolymphocytic leukemia

Prolymphocytic leukemia is characterized by marked splenomegaly, distinctive cellular morphologic characteristics, and a poor clinical course. Five patients with typical PL were treated systematically with vincristine/prednisone, chlorambucil/prednisone, splenic irradiation, splenectomy, and other chemotherapy regimens. No patient responded to vincristine/prednisone. Two patients responded to chlorambucil/prednisone, and four patients had brief responses to splenic irradiation. Two patients underwent splenectomy, one of whom had a prolonged clinical remission. There were no complete remissions. No other chemotherapy combinations were of value. The median survival was 33 months. Recommendations are made to use chlorambucil/prednisone or splenic irradiation as initial treatment. Splenectomy should be considered in patients refractory to these modalities. The course of PL may be more protracted than originally reported.

Binding of sheep erythrocytes in chronic lymphocytic leukemias of B-cell origin

Two patients with B chronic lymphocytic leukemia having leukemic cells that bind sheep red blood cells by different mechanisms are described. In the first case, rosette formation was mediated by the anti-sheep erythrocyte activity of a monoclonal surface IgMk, related to Forssman antigen. In the second, E-rosette formation was found to be independent of both surface immunoglobulins and the classic E-rosette receptor since the leukemic cells were recognized neither by the OKT-11 monoclonal antibody nor by other markers specific to T-cell lineage. Evaluation of these rare cases emphasizes that detection of surface immunoglobulins and spontaneous rosetting are not sufficient for the characterization of leukemic clones and raises some doubts concerning the use of available surface markers in the characterization of lymphoproliferative disorders.

Lectin staining of carbohydrates of haemic cells. III. The cells of Hodgkin's disease and other lymphomas

When stained for reactive sialyl groups with fluorescein-labelled Aprotinin (FLA), lymphocytes of three diffuse lymphomas were uniformly faintly fluorescent. The nodules of a nodular lymphocytic lymphoma showed dimly fluorescing lymphocytes surrounded by brightly fluorescing, apparently normal cells. The spleens of eight patients with Hodgkin's disease showed involvement in six cases. With FLA, the two uninvolved spleens contained only brightly fluorescing lymphocytes, whereas the foci of Hodgkin's lesions in the six spleens and in eight involved lymph nodes from a further eight patients contained varying proportions of brightly and dimly fluorescing lymphoid cells. Mononuclear Hodgkin's cells and bi- or multinucleated Reed-Sternberg cells fluoresced faintly. Fluorescein-labelled Ricinus communis agglutinin (FL-RCA) for galactose, and Concanavalin A (FL-Con A) for mannose or glucose, showed eosinophils, reticulin and collagen fibres especially in nodular sclerosing Hodgkin's disease, whereas all lymphocytes, Hodgkin and Reed-Sternberg cells stained faintly with either lectin. The reduction of reactive sialyl groups in malignant lymphocytes of lymphomas and Hodgkin's lesions is similar to that in lymphocytic leukaemias. It is suggested that in Hodgkin's disease these lymphocytes together with the Hodgkin and Reed-Sternberg cells represent the malignant component, whereas the brightly fluorescent normal lymphocytes, together with histiocytes, eosinophils (and neutrophils) represent a reactive component in the lesions. Similarly, the reactive lymphocytes in sarcoid lesions and sinus histiocytosis were brightly fluorescing.

J-chain-producing immunoblastic lymphoma in a case of Richter's syndrome. Immunohistochemical evidence for a gradual malignant transformation of a single B-cell clone and flow cytophotometric data

A 66-year old male with Richter's syndrome died 52 month after diagnosis of chronic lymphocytic leukaemia (CLL). The clinical course was characterized by a marked IgM hypoglobulinaemia which paralleled a chronically relapsing Herpes simplex infection. Autopsy showed a large retroperitoneal and intraabdominal tumour mass and well defined supradiaphragmatic lymphomas. Histological examination revealed a composite tumour consisting of CLL B-cell type (B-CLL) and immunoblastic malignant lymphoma of B-cell type (B-IbL). The lymphocytes bear mu-chains on their surface and to a lesser extend within their cytoplasm, the obviously defective immunoblasts produce J chains exclusively. Flow cytophotometric data seem to indicate an identical diploid stem line of the two tumours. The majority of the cells are in G0/1 phase. The CLL rarely produces mitoses, however, the IbL has a mitotic rate of 7% and a considerable proportion (33%) of cells in the phase of DNA-synthesis. This is the fourth malignant lymphoma and the second immunoblastic lymphoma to be reported that produces J chain in the absence of immunoglobulin.

T-cell chronic lymphocytic leukemia. Report of a case studied with monoclonal antibody

A previously healthy 74 year old woman presented with T-cell chronic lymphocytic leukemia, lymphadenopathy, hepatosplenomegaly and a mediastinal mass. The circulating lymphocytes were small to medium in size (some with convoluted nuclei) and W rosette-positive; they could be assigned to the inducer-helper subset of T cells with the acid of monoclonal antisera. These cells reacted with OKT3, which detects peripheral T cells; OKT4, which detects the inducer-helper subset of T cells; and OKT11, which detects the sheep cell receptor. It is noteworthy that they were also positive for the la-like antigen found on T cells only after activation. Microscopic examination of a lymph node biopsy specimen revealed a diffuse pattern of pleomorphic large cells characteristic of the T-cell lymphomas and lymphocytic leukemias reported from Japan. However, the lymph node cells lacked the T-cell differentiation antigens present on the circulating lymphocytes. The findings in this case provide insight into the pathogenesis of this unusual disorder and are relevant to our understanding of the spectrum of surface antigens in the more common malignant lymphomas.

Farming and mortality from non-Hodgkin's lymphoma: a case-control study

A case-control study of non-Hodgkin's lymphoma (NHL) and its subtypes among males was conducted using computerized mortality listings from the State of Wisconsin for the years 1968-1974. Age, year of death, race, county of usual residence, marital status, and usual occupation were abstracted for the 774 records of male deaths due to NHL and a matched series of deaths due to other causes. The frequency of farming occupation among NHL cases was compared to the frequency among controls, and odds ratios (OR) were calculated. Farming was more common among cases than among controls (OR = 1.22). The association of NHL with farming occupation was greater among decedents under 65 years of age (OR = 1.7) than among those who were older. The younger decedents were at higher risk of reticulum-cell sarcoma (OR = 2.7) than of other cell types. The strength of the association increased over the 9-year study period. County levels of selected agricultural characteristics were used as surrogate measures of farming exposures in residence counties of farmers and were summarized by factor analysis. Major findings were of elevated risk among younger farmers for reticulum-cell sarcoma in counties high in summary measures of general agricultural activity (OR = 3.2), of small grain acreage and acres treated with insecticides (OR = 6.6), and of wheat acreage (OR = 4.4). Given the limitations of the data, further investigation of non-Hodgkin's lymphoma in farmers is warranted.

Bone biopsy in haematological disorders

Bone marrow biopsies are now widely used in the investigation and follow-up of many diseases. Semi-thin sections of 8216 undecalcified biopsies of patients with haematological disorders were studied. Observations were made on the cytopenias and the myelodysplastic syndromes, the acute leukaemias the myeloproliferative disorders, Hodgkin's disease and the malignant lymphomas including multiple myeloma, hairy cell leukaemia and angioimmunoblastic lymphadenopathy. Bone marrow biopsies are essential for the differential diagnosis of most cytopenias and for the early recognition of fibrosis which most frequently occurred as a consequence of megakaryocytic proliferation in the myeloproliferative disorders. Different patterns of bone marrow involvement were found in the lymphoproliferative disorders and both their type and extent constituted factors of prognostic significance. A survey of the literature is given and the conclusion is drawn that bone marrow biopsies provide indispensible information for the diagnostic evaluation and the follow-up of patients with haematological disorders.

Characterization of mononuclear phagocytes from the mouse, guinea pig, rat, and man

The present paper describes cytochemical, membrane, functional, and mitotic characteristics of monoblasts, promonocytes, monocytes, and macrophages of the mouse, guinea pig, rat, and man. For all of these species the results show that after staining for nonspecific esterase, with alpha-naphthylbutyrate as substrate, and for lysozyme, mononuclear phagocytes can be distinguished from other cells, e.g., T and B lymphocytes. However, it must be kept in mind that immature and mature granulocytic cells are also lysozyme positive. The presence of Fc and C receptors is dependent on the maturity of the cells and the duration of incubation in vitro; with respect to the former, an in vivo population of immature mononuclear phagocytes may have a lower percentage of positive cells than is the case in a mature population, and with respect to the latter, the percentage of positive cells rises during incubation. Phagocytosis of opsonized bacteria and red cells is a reliable criterion for the distinction between mononuclear phagocytes and other cell types, e.g. lymphocytes and fibroblasts. In all of the species studied, the majority of both immature and mature mononuclear phagocytes ingested particles opsonized with IgG; the proportion of phagocytosis of red cells via C3 receptors is usually very small. Incorporation studies with [3H] thymidine have shown that immature mononuclear phagocytes (i.e., monoblasts and promonocytes) divided and that monocytes and macrophages do not. The small number of macrophages that incorporate [3H] thymidine are immature mononuclear phagocytes which have very recently arrived in the tissues from the bone marrow. Comparison of mononuclear phagocytes in different organs of various species has shown unequivocally that these cells belong to one cell line, called the mononuclear phagocyte system.

Glutamine requirements for purine metabolism in leukemic lymphoblasts

The two pathways of purine metabolism that include glutamine-dependent reactions, purine synthesis de novo and guanine nucleotide synthesis, were studied in cultured lymphoblasts derived from patients with T cell (JM), B cell (BALL) or null cell (NALL) acute lymphoblastic leukemia (ALL). When glutamine was omitted from the incubation medium, purine synthesis de novo, measured by the incorporation of 14C-formate into purine compounds, was depressed to barely measurable rates in BALL and NALL cells, but proceeded at moderate though reduced rates in JM cells, when compared to synthesis in the presence of 2 mM glutamine. Similarly, the incorporation of 14C-hypoxanthine into guanine nucleotides was arrested at the glutamine-requiring XMP-aminase reaction in the BALL and NALL lines but not in the JM line, when exogenous glutamine was absent. The data suggest that glutamine deprivation, whether by omission from the culture medium in vitro or by glutaminase treatment in vivo, will have more profound biochemical consequences in B and null cell-derived ALL than in T All.

A comparative study of the effectiveness of different mitogens for karyotypic analysis in chronic B cell leukemia

In order best to study the karyotypic abnormalities of nine patients with chronic lymphocytic leukemia of B cell origin, we used a combination of T and/or B cell mitogens so as to achieve an optimal proliferative response. As assessed by DNA synthesis, and subsequent cytogenetic study, pokeweed mitogen (PWM) and protein A Sepharose (PROT A) appeared to hold promise as potent stimulators of neoplastic B lymphocytes. Lipopolysaccharide from E. coli (LPS) proved to be an ineffective mitogen. Phytohemagglutinin (PHA), while producing the highest stimulation indices by DNA assay, appeared to induce predominantly diploid metaphases. Pseudodiploid clonal abnormalities were noted in three out of nine patients, while another four patients showed random structural abnormalities, including translocations, which were indicative of damage. Presence of the A33 antigen, as determined by HLA typing, was noted in five out of nine patients. The increased frequency of this antigen in patients with chronic B cell leukemia is discussed.