Hairy cell leukaemia: surface markers and functional capacities of the leukaemic cells analysed in eight patients

Treatment of hairy cell leukemia-variant with cladribine

Hairy cell leukemia-variant (HCL-V) is an extremely rare chronic B-cell lymphoproliferative disorder clinically and morphologically distinct from classic hairy cell leukemia (HCL). HCL-V is thought to represent a hybrid between prolymphocytic leukemia and HCL, the nucleus more closely resembling a prolymphocyte and the cytoplasm a hairy cell. The clinical course of HCL-V is aggressive with short survivals. Since single courses of cladribine have profound activity in HCL, inducing durable complete responses in 91% of patients, we administered cladribine to 4 patients with HCL-V over a 7-year period. During this time interval 357 patients with classic HCL received cladribine at Scripps Clinic. Each patient received cladribine at 0.1 mg/kg per day by continuous intravenous infusion for 7 days, repeated at 28-day intervals depending on response status. The 4 patients ranged in age from 28 to 70. Two presented with B-symptoms, 1 had peripheral adenopathy, and all 4 displayed massive splenomegaly. Peripheral blood counts were notable for lymphocytosis associated with mild anemia and thrombocytopenia. Only 1 of the 4 patients had received prior treatment. Peripheral blood immunophenotypic analysis revealed monoclonal B cells with expression of CD11c in 3 patients, lack of CD25 expression in 3 patients and expression of CD103 in all but 1 patient. The number of cladribine courses administered ranged from two to five. Of these 4 patients, 1 (25%) achieved a complete response and 2 (50%) partial responses, for an overall response rate of 75%. Three patients underwent splenectomy after cladribine. Cladribine is an active agent in HCL-V albeit with a lower response rate than in classic HCL. The role of other treatment modalities, such as splenectomy, interferon-alpha, and 2'-deoxycoformycin, alone or in combination with cladribine awaits further evaluation.

Lasting remissions in hairy-cell leukemia induced by a single infusion of 2-chlorodeoxyadenosine

2-Chlorodeoxyadenosine is a simple purine nucleoside that has previously been shown to be effective in the treatment of low-grade malignant disorders of lymphoid tissue, including chronic lymphocytic leukemia and non-Hodgkin's lymphoma. Because of these encouraging results, we treated 12 patients with another low-grade B-cell neoplasm, hairy-cell leukemia. The patients received 2-chlorodeoxyadenosine (0.1 mg per kilogram of body weight per day) by continuous infusion for seven days. All the patients responded to treatment. Eleven had complete remissions characterized by the normalization of peripheral blood and bone marrow and disappearance of tumor masses. The longest remission has been 3.8 years. None of the patients have relapsed, and the median duration of remission has been 15.5 months. No serious toxic reactions occurred as a result of 2-chlorodeoxyadenosine therapy. These results suggest that 2-chlorodeoxyadenosine may be the most effective therapy available for hairy-cell leukemia. The administration of 2-chlorodeoxyadenosine resulted in a higher rate of complete remission than is observed with interferon alfa, and it required no maintenance therapy. Its toxicity may be lower than that of deoxycoformycin, and the responses were achieved with single courses of treatment.

Hairy cell leukemia: clinical features and therapeutic advances

Hairy cell leukemia (HCL) is a rare chronic lymphoproliferative disorder which has been extensively studied over the past decade. Much has been learned regarding the diagnosis, natural history, biology, and treatment of this unique neoplasm. The disease most commonly affects middle aged men and characteristic clinical features include splenomegaly, cytopenias, and usually the presence in the peripheral blood of distinctive 'hairy cells' with irregular cytoplasmic projections. Diagnosis can usually be confirmed by bone marrow biopsy. Although the natural history can be extremely variable among patients, complications are usually referable to the cytopenias, with anemia and infection being most frequent. In addition to pyogenic infections, patients are susceptible to unusual organisms including atypical mycobacterium, legionella, and fungi. The requirement of red blood cell transfusion, severe granulocytopenia or thrombocytopenia, frequent infections, or painful splenomegaly are all indications for treatment. Splenectomy is the standard initial treatment of choice. However, in the past few years there have been exciting major advances in the therapeutic modalities for HCL. Recombinant alpha-interferon is highly effective, with beneficial responses occurring in close to 90% of patients. The Food and Drug Administration has recently approved the use of interferon for HCL. This represents the first time a biological response modifier has been approved for the treatment of human disease. In addition, preliminary results with the adenosine deaminase inhibitor, 2'deoxycoformycin (dcf), have been encouraging. Further clinical trials are required in order to determine the optimal sequential treatment strategy for HCL. The exact mechanisms of action of both interferon and dcf in HCL remain to be elucidated. A better understanding of the unusual features of the hairy cell and the underlying biological effect of these two agents in HCL may have important applications in other hematologic and non-hematologic malignancies.

Fc-receptors for IgE on human lymphocytes. Detection with a rosetting assay using a recombinant human/mouse IgE antibody and characterization with monoclonal antibodies

Two monoclonal antibodies, M-L25 and M-L47, were produced against the human lymphoid Fc receptor for IgE (Fc epsilon R). These antibodies were identified by their ability to selectively inhibit the binding of IgE to Fc epsilon R+ lymphoid cells as demonstrated by a newly developed IgE rosetting assay. In this method, NIP coated ox erythrocytes were complexed with a NP-specific recombinant chimeric human/mouse IgE antibody and employed as indicator cells for the detection of Fc epsilon R+ cells. The anti-Fc epsilon R antibodies stained 4.6 +/- 2.3% of normal peripheral blood mononuclear cells, 0.4 +/- 0.3% of T cells, 22.2 +/- 11.7% of the non-T cell fraction, and 34.9 +/- 2.9% of tonsil cells. Less than 0.1% of monocytes, basophilic and eosinophilic granulocytes, platelets, and thymus cells were labelled. This indicates an antigenic heterogeneity of the low affinity Fc epsilon R on lymphocytes and the Fc epsilon R found on monocytes, platelets, and eosinophilic granulocytes. The lymphoid Fc epsilon R was immunoprecipitated by M-L25 from the lysate of surface iodinated lymphoid cells. Three polypeptide chains were identified having an apparent MW of 40, 82, and 100 kd under non-reducing, and of 42, 115, and 145 kd under reducing conditions, suggesting a multichain structure of the human lymphoid Fc epsilon R.

Hairy cell leukemia

Hairy cell leukemia is a chronic lymphoproliferative disorder that has been recognized as a separate clinical pathologic entity for the last 25 years. After a decade of discussions about the origin of the neoplastic cell, it has now been well established that hairy cells represent a certain, rather mature stage of B-cell differentiation. Evidence for this has been derived from studies using immunophenotyping with monoclonal and polyclonal antibodies, cytochemistry, and immunoglobulin gene rearrangement. For many years, splenectomy was the only therapy of proven value in hairy cell leukemia. For patients who showed insufficient response to the operation, chemotherapy with low-dose alkylating agents was moderately successful, whereas polychemotherapy often resulted in excessive toxicity. More recently, therapy with alpha-interferon has been shown to be very promising, whereas deoxycoformicin may be an attractive alternative. These new advances in immunology and therapy are reviewed.

Transferrin receptors on tumor and bone marrow cells: lack of involvement as target structure for natural killer cells

Two different experimental approaches based on the specificity of monoclonal antibodies (mAbs) have been taken to verify the hypothesis that the transferrin receptor (TfR) on proliferating cells serves as a common target structure for natural killer (NK) cells. Thus, by the lysostrip technique the TfR was removed from the surface of K562 and Molt4 tumor cells by incubation with two different anti-TfR mAbs. The effect of removal of the TfR was controlled by uptake of radiolabeled transferrin, and by binding of non-cross-reacting monoclonal anti-TfR receptor antibodies. Though the modulation of TfR on the membrane of viable cells was nearly complete, the cells remained fully susceptible to NK lysis. The second approach consisted in removal of TfR-bearing cells from bone marrow cell suspensions by an indirect rosetting technique. Using mAbs bound to ox erythrocytes the rosetted TfR-bearing cells could be removed from bone marrow cell suspension by density centrifugation with an efficiency of greater than 99%. It could be shown that both fractions, TfR+ and TfR- cells, could be lysed to the same degree by NK cells. Thus, the evidence obtained speaks against a role of TfR as a recognition structure for NK cells.

Evidence by radioimmunoassay that mitogen-activated human blood mononuclear cells secrete significant amounts of light chain Ig unassociated with heavy chain

The culture supernatant (CS) Ig of PWM-activated human blood mononuclear cells was quantitatively determined using a panel of nanogram-sensitive radioimmunoassays (RIAs) that separately measured IgG, IgM, IgA, total kappa Ig, and total lambda Ig. After initial RIA quantitation, separate CS aliquots were exposed to either a polyisotypic anti-heavy (H) chain or a nonimmune IgG solid-phase immunoabsorbent, and then reassayed for Ig content. The reassay results revealed that the anti-H chain-absorbed CS aliquots retained significant amounts of kappa and lambda Ig, but yet had a virtual absence of isotypic IgG, IgM, and IgA. Comparisons of the absorbed CS aliquots suggested that as much as one-fourth to one-third of the total secreted L chain Ig in PWM-activated cultures lacked RIA-detectable associated H chain. This unexpected finding of significant amounts of unbound L chain in mitogen-stimulated cultures raises important theoretical issues relative to the functional role of secreted free L chain and the prospects that free L chain levels may represent useful quantitative markers of B-cell stimulation.

Direct monoclonal antibody rosetting. An effective method for weak antigen detection and large scale separation of human mononuclear cells

A direct monoclonal antibody rosetting technique is described which serves as a simple, reliable, and very sensitive method for the detection of surface antigens on human leukocytes. In this technique the discriminative monoclonal anti-leukocyte antibodies are directly coupled to ox erythrocytes (oxE) by use of CrCl3. The procedure can be applied to the effective separation of mononuclear cell subsets. By choosing a gradient of appropriate density labeled cells are either isolated in high purity or quantitatively eliminated. This technique proved to be particularly suitable for the large scale purification of autologous or allogeneic bone marrow transplants where either leukemic cells or T cells have to be completely eliminated without damaging sensitive stem cells.

Characterisation of a new cell line (CJ18) from a patient with 'hairy' cell leukaemia

A cell line (CJ18) has been established from the peripheral blood of a patient with hairy cell leukaemia (HCL) in a leukaemic phase. They grow slowly in large clumps with a doubling time of 3-4 d. 8% show positivity for surface immunoglobulin G and a small percentage (5%) are positive for intracytoplasmic immunoglobulin. They are B1,Ia1 positive and CALL, TdT and OKM1 negative. Although they are Epstein Barr Virus Nuclear Antigen (EBNA) positive they have several features not found in other EBNA positive B lymphoblastoid cell lines which suggest they may be derived from the patient's leukaemic hairy cells. They are strongly positive for tartrate resistant acid phosphatase, esterase positive, contain numerous lysosomes and are able to phagocytose sheep red blood cells after exposure to tetradecanoyl-12, 13-phorbol acetate (TPA). Following exposure to retinoic acid and TPA they adhere to plastic with numerous slender processes, a feature seen in HCL cells.

Central nervous system involvement in hairy cell leukemia

A patient with central nervous system involvement by hairy cell leukemia is reported. Hairy cells were identified in the cerebrospinal fluid by electron microscopy and by tartrate-resistant acid phosphatase positive staining. Intrathecal treatment with methotrexate resulted in neurologic improvement, but was complicated by Cryptococcus neoformans meningitis. The leukemic phase of the disease was later successfully controlled by treatment with alpha interferon. Surface marker studies indicated a B- and T-cell phenotype of the hairy cells.

Ultrastructural localization of immunoglobulins in hairy cell leukemia

Neoplastic cells from 13 cases of hairy cell leukemia were investigated for immunoglobulin production and lysozyme activity by an electron-immunoperoxidase technique. In 10 cases cytoplasmic immunoglobulins were found, but lysozyme activity was absent in all cases. Immunoglobulins were detected in the perinuclear space and endoplasmic reticulum and at the surface of hairy cells. Of the cases in which immunoglobulins were detected in hairy cells, nine were positive with IgM antiserum and one with IgG antiserum. The immunoglobulins were monoclonal in all cases; six were positive with lambda antiserum and three with kappa antiserum. The class and type of surface immunoglobulins were identical to those of cytoplasmic immunoglobulins in the hairy cells. These results support the conclusion that hairy cells are commonly derived from immunoglobulin-producing B cells at an earlier stage of differentiation than plasma cells.

The effect of tetradecanoyl-12, 13-phorbol acetate on 'hairy' cells

Hairy cell leukaemia (HCL) cells on exposure to the tumour promoter tetradecanoyl-12,13-phorbol acetate (TPA) undergo a striking morphological change in culture, with the formation of long, slender cytoplasmic processes, and adhere to the plastic surface. By time lapse photography this change is seen to start within 10 min of exposure to the TPA and is characterised by slow but continuous extension and retraction of the processes. Apparent phagocytosis of sheep red cells but not of sensitised human red cells occurs. This response to TPA is prevented by cytochalasin D but not by 13 cis-retinoic acid. Lymphocytes from normal individuals and patients with chronic lymphocytic leukaemia and lymphoblasts from a patient with acute lymphoblastic leukaemia reacted by adhering to each other in small aggregates but did not adhere to the plastic surface. Monocytes adhere to plastic surfaces and respond to TPA by extension and retraction of cytoplasmic folds differing from the long slender processes formed by the HCL cells. Thus HCL cells are different in their response to TPA from both normal lymphocytes and monocytes.

Hairy cell leukemia has a B-cell genotype

The phenotype and, by inference, the cell of origin of some lymphocytic neoplasms has been defined by surface marker studies; however, the precise cellular origin of other neoplasms of the lymphoid system is still unknown. For example, with reference to hairy cell leukemia (HCL), cell marker data has been used in support of a monocytic, a T cell, or a B cell origin. If hairy cell leukemia is a B cell-derived neoplasm, the controversy may be resolved by genotyping the cells, using the rearrangement of immunoglobulin genes as a marker of the B cell nature of the process. Rearrangement of these genes is detected using the Southern blot technique and cloned probes specific for the JH segment of the immunoglobulin genes. In this study, the arrangement of the immunoglobulin genes was analysed in normal tissue, in two accepted B cell lymphomas and in nine cases of hairy cell leukemia. DNA from peripheral blood leukocytes (two patients) and from the spleen (seven patients) revealed a discrete new JH restriction fragment length in the leukocytes of hairy cell leukemia cases. The presence of rearranged restriction fragments is interpreted as evidence of the existence of clonal B cell populations. Three of six samples had rearranged kappa light chain fragments. We conclude that most cases of hairy cell leukemia have a B cell genotype. The use of genotyping has wider application in the analysis of hematological malignancies.

Platelet surface antigens: analysis by monoclonal antibodies. I. Antibodies. I. Immunological and biochemical studies

Monoclonal antibodies were produced against human platelets. Four antibodies (PA1, PA2, PA3 and PA4) reacted specifically with platelets and megakaryocytes, but not with peripheral blood lymphocytes, granulocytes, erythrocytes or monocytes. The antibodies belonged to the mouse IgG subclass 2a (PA1, PA2, PA3), or 1 (PA4) respectively. PA1 and PA4 did not precipitate, their antigens have not yet fully been characterized. PA3 was directed against the glycoprotein (Gp) complex IIb/IIIa; PA2 precipitated Gp IIb/IIIa, and, in addition, Gp Ia. PA4 revealed specificity against the human platelet alloantigen Zw(a).

Antigenic phenotype of splenic hairy cells

Hairy cell leukemia, a distinct clinical and morphologic lymphoproliferative disorder, is characterized by the proliferation of mononuclear cells of uncertain derivation. Attempts to identify the cell of origin have used studies either of functional capabilities or of membrane/cytoplasmic antigens. Only a few cases have been studied via monoclonal antibodies. Frozen sections of splenic tissue involved with hairy cell leukemia were studied with a variety of monoclonal antibodies having specificity for differentiation antigens using the avidin-biotinylated peroxidase complex technique. Conventional direct and indirect immunohistochemical study was used for immunoglobulin heavy and light chains. In all but one case, the neoplastic cells expressed monoclonal immunoglobulin. Although T cells were identified in persisting periarteriolar sheaths and occasionally admixed with red blood cells in pseudosinuses, phenotypic expression of intrathymic or peripheral T cell antigens by the proliferating neoplastic cells was not observed. Conversely, expression of B1 and HLA-Dr antigens by splenic hairy cells was documented in all 10 cases. Hairy cell leukemia cells did not express either monocyte antigens (M1 and MO2) or the antigens expressed by early (J5) and intermediate (B2) B cells or plasmacytoid lymphocytes and plasma cells (T10). These immunohistochemical results with monoclonal antibodies provide further evidence that hairy cell leukemia is characterized by a combination of antigens peculiar to mature B lymphocytes.

Hairy cell leukemia

Hairy cell leukemia is a malignancy with a variable course that can be relatively indolent or rapidly fatal. Alterations in the immune system are responsible for much of the morbidity and mortality from hairy cell leukemia. More than 60% of patients die from infection, and infections are both pyogenic and nonpyogenic. Many patients have transfusion requirements, and bleeding complications can also occur. Treatment strategies for hairy cell leukemia have evolved and are being modified as more is learned about the disease. Splenectomy is the initial treatment when patients become symptomatic, and if the disease progresses after splenectomy, chlorambucil offers good control in many patients. Radiation can be used for local palliation, as when complications such as bulky adenopathy or bone lesions occur. Initial studies using interferon in the treatment of hairy cell leukemia look encouraging, but more investigation is necessary before the role of interferon in treatment of hairy cell leukemia is determined.

Immunoglobulin synthesis in hairy cell leukaemia. Ultrastructural immunocytochemical study of 3 cases

3 cases of hairy cell leukaemia were studied with ultrastructural immunocytochemical methods using an anti human Ig HRPO-Fab fragment. Ig were detected on the cell surface, in the perinuclear cisterna and endoplasmic reticulum of hairy cells. Evidence of Ig in these sites demonstrates a B-lymphoid differentiation of the leukaemic cells.

Paraproteinaemia plus osteolytic lesions in typical hairy-cell leukaemia

Most cases of hairy-cell leukaemia (HCL) involve proliferations of neoplastic B lymphocytes. In rare cases, M-proteins or osteolytic lesions have been documented in patients with HCL. In this study two patients with typical HCL are reported in whom both paraproteinaemia and osteolytic lesions of the femoral neck developed. In one of the patients the production of the M-protein by hairy cells could be established. In the other patient, at autopsy no signs of myeloma were found. The hairy cells from inside the osteolytic lesion had the same immunological phenotype as hairy cells from the peripheral blood, the spleen, and other parts of the bone marrow. These cases once more confirm the B-cell nature of many cases of HCL, and show that hairy cells can have functional capacities usually attributed to much more mature B lymphocytes, i.e. plasma cells.

Glycosphingolipids of normal and leukemic human leukocytes

We have reviewed the studies on neutral glycosphingolipids and gangliosides of normal and leukemia human leukocytes. In this review, we examine (a) the glycosphingolipid composition of various leukocyte populations, (b) the differences in glycosphingolipids found among subsets of these cells, (c) the possible use of these compounds as markers of differentiation, and (d) the changes in glycosphingolipid composition that occur with leukemogenesis.

A subset of human cells isolated and characterized by monoclonal antibodies

Monoclonal antibodies were induced against leukemic T cells from a patient with chronic lymphocytic leukemia exhibiting natural killer (NK) activity. Two antibodies, termed T811 and M522, reacted by indirect immunofluorescence with distinct sub-populations of normal human mononuclear blood cells. The antibody T811 defines a surface antigen which is restricted to a subset of the T cell lineage. The antigen recognized by the second antibody, M522, is expressed on monocytes and polymorphonuclear leukocytes and, in addition, on 9-17% of nonadherent peripheral blood leukocytes (NAL). It is shown that the total NK activity of NAL is confined to the subset of cells expressing the M522-defined antigen. Moreover, the portion of NK cytotoxicity associated with T lymphocytes is mediated by a subpopulation which is characterized by the simultaneous expression of the T811- and the M522-defined antigens. This population comprises about 4% of NAL and could be isolated to a purity of greater than 85%.

Neutral glycosphingolipids in hairy cell leukemia

The neutral glycosphingolipids of hairy cells from a patient with hairy cell leukemia were chemically analyzed by thin-layer and gas-liquid chromatography, mass spectrometry, combined gas chromatography-mass spectrometry, and glycosidase treatment. These cells were found to have compounds containing one to four sugars with the following structures: Glc1 leads to 1Cer Gal beta 1 leads to 4Glc1 leads to 1Cer Gal alpha 1 leads to 4 Gal beta 1 leads to 4Glc1 leads to 1Cer GalNAc beta 1 leads to 3Gal alpha 1 leads to 4Gal beta 1 leads to 4Glc1 leads to 1Cer These compounds belong to the globo series of neutral glycosphingolipids and are similar to those found in human lymphocytes and chronic lymphocytic leukemia cells. They differ from the neutral glycosphingolipids found in human neutrophils and chronic myelogenous leukemia cells which are of the lactoneo and gala type. Neutral glycosphingolipids may be useful in classifying leukemias of uncertain origin.

Phenotypic changes of phytohaemagglutinin-stimulated hairy cells

Hairy cell leukaemia (leukaemic reticuloendotheliosis) appears to be a homogeneous and well defined disease on the basis of clinical presentation, light and electron microscopic features and cytochemical characteristics, but the study of immunological markers of hairy cells (HC) from many patients reveals apparent heterogeneity. The most common phenotype associates B-cell and monocytic properties: HC usually express monoclonal surface (and in certain cases cytoplasmic) immunoglobulins, receptors for IgM and IgG Fc, and mouse erythrocytes, and la-like antigens. Additionally, they are capable of phagocytosis, glass adherence, lysozyme and peroxidase synthesis. However, most of these features are not constant and cases have been reported in which HC fail to express one or more of these properties. In certain cases HC even display a T-cell phenotype, while, in others, features of both T and B cells are expressed. Moreover, in two recently studied patients, the phenotype of HC in the blood differed from that in the spleen (B + T in the blood and B in the spleen). These surprising discrepancies led us to hypothesize that HC from the same individual might be able to express different phenotypes following an appropriate stimulus. We therefore studied immunological parameters of HC stimulated by mitogens and the results indeed showed that after stimulation by phytohaemagglutinin (PHA) the cells switched from B to T or B + T phenotypes.

Hairy-cell leukaemia: an immunoperoxidase study of paraffin-embedded tissues

Paraffin sections of a variety of tissues from 12 patients with typical hairy-cell leukaemia (HCL) were stained for immunoglobulin heavy and light chains by the peroxidase-antiperoxidase (PAP) technique. Plasma cells were frequent, particularly in a lymph node from a severely infected patient. The reactive nature of the plasma cells of HCL was suggested by the fact that there was no restriction of light-chain expression, although viable hairy cells were shown to express monoclonal surface immunoglobulin. This, together with the absence by both light and electron microscopy of forms intermediate between hairy cells and plasma cells and the lack of ribosome-lamella complexes in the plasma cells, suggested that hairy cells do not differentiate into plasma cells. Although hairy cells are known to contain immunoglobulin, this was not demonstrable in hairy cells in the paraffin-embedded tissue. The PAP technique was also useful for demonstrating abundant splenic macrophages in HCL.