Monoclonal B cells in peripheral blood in non-Hodgkin's lymphoma. Correlation with clinical features and DNA content

Heat production rate in blood lymphocytes as a prognostic factor in non-Hodgkin's lymphoma

The heat production rate in peripheral blood lymphocytes was evaluated by direct calorimetry in 76 untreated adults with non-Hodgkin's lymphoma (NHL). Elevated values were recorded for 20 out of 54 patients with lymphomas of high or intermediate malignancy grade (37%) and for 1 out of 22 patients (5%) with low grade lymphomas (p = 0.01). Median survival was 39 months for patients with normal values and 8.5 months for those with elevated values (p = 0.005). In a subgroup of 38 patients with high or intermediate grade NHL stage III-IV, 17 patients with abnormally high lymphocyte heat production rates had a significantly shorter survival than 21 patients with normal values (p = 0.01). In a multivariate analysis the prognostic impact of lymphocyte heat production was superior to histologic malignancy grade, clinical stage and age.

Bone marrow and blood involvement by non-Hodgkin's lymphoma: a study of clinicopathologic correlations and prognostic significance in relationship to the Working Formulation

In a series of 172 patients with non-Hodgkin's lymphoma (NHL) classified according to the Working Formulation (WF) the overall incidence of bone marrow infiltration (BM+) at diagnosis was 39%: 59% for low-grade (LGML), 30% for intermediate-grade (IGML), and 25% for high-grade malignant lymphomas (HGML). The features most significantly correlated with the presence of BM+ were a low grade of histological malignancy, the degree of splenomegaly and high values of LDH, while those correlated with the extent of BM+ were a non-focal pattern of BM disease, the presence of blood involvement at diagnosis, and the degree of BM fibrosis. Blood involvement was detected at diagnosis in 13% of patients, and a further 16% developed a leukemic phase during the course of the disease. Blood involvement correlated significantly with splenomegaly, bulky disease, advanced clinical stage, and extent of BM+. The presence of BM infiltration 'per se' at diagnosis did not significantly affect prognosis. However, the extent of BM disease was correlated with a poorer outcome in IGML and HGML patients. Regarding peripheral blood involvement, in LGML patients only late leukemic conversions were significantly associated with a worse prognosis. In patients with IGML and HGML, either initial or subsequent blood involvement was correlated with significantly poorer outcome.

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.

Immunoglobulin heavy-chain gene rearrangement in peripheral blood mononuclear cells in non-Hodgkin's lymphomas--correlation with kappa:lambda analysis and clinical features

41 patients with non-Hodgkin's lymphomas were analysed to determine occurrence of B-cell monoclonality in peripheral blood mononuclear cells using two different methods: determination of kappa:lambda ratio by light microscopic immunofluorescence, and heavy-chain gene rearrangement by DNA-technique. In 21 patients (51%) clonal heavy-chain rearrangement was found in blood, whilst 18 of the patients (44%) showed and abnormal kappa:lambda ratio. Discordant results between the methods were observed in 5 cases. Clones with gene rearrangements suggesting blood involvement were found in 16/25 (64%) patients with low grade lymphomas, in 5/16 (31%) patients with high grade lymphoma, in 17/21 (81%) patients with bone marrow involvement, in 20/27 (74%) of stage III-IV lymphomas and in all of the 14 patients with a high lymphocyte count (greater than or equal to 5.0 X 10(9]. The conclusion was that clonal analysis by the DNA-technique is a more sensitive method than the kappa:lambda determination using immunofluorescence. Even though the method is time-consuming, it could prove to be valuable in selected cases.

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.