This study evaluates residual disease in 28 B‐cell chronic lymphocytic leukemia (B‐CLL) patients who obtained a clinicohematologic remission after intensive chemotherapy. Sixteen of 28 patients (57%) ...showed a normal number of circulating B‐lymphocytes, as demonstrated by the low percentage of mouse rosette‐forming cells (M‐RFC), surface immunoglobulins (SIg), and CD24‐postive cells. Clinically, a lower number of relapses occurred in this group of patients compared to those with a persistent expansion of peripheral B‐cells (P < 0.05). In order to assess monoclonality of the residual peripheral B‐cell population, the distribution of SIg light chains was investigated on the B‐cell‐enriched fraction of 15 of these 16 cases. Only six of them had a k:λ ratio which ranged between 1.7:1 and 3:1, whereas the remaining patients still displayed a clearly imbalanced k:λ Ig light chain distribution. On the other hand, the analysis of the configuration of the Ig heavy chain gene region, performed in nine cases (including five of the above six cases), showed the persistence of a rearranged pattern in all cases tested but one. Therefore, residual monoclonal B‐cells were found also in the majority of cases which displayed the lowest k:λ ratio, a normal bone marrow lymphocytosis and a long‐tasting clinical remission. Studies at the DNA level confirm that a remission is rarely achieved in this disease in spite of intensive and prolonged chemotherapy. Nonetheless, the follow‐up of B‐CLL patients by conventional immunologic markers may be helpful to better define response to therapy and to predict the occurrence of clinical relapse.
In 7 cases of chronic B-cell lymphoproliferative disorders-6 chronic lymphocytic leukaemias and 1 non-Hodgkin lymphoma in leukaemic phase--which co-expressed T-cell markers (CD3, CD2) the clonal ...origin was investigated at the DNA level. In accordance with the diagnosis, all cases showed a monoclonally rearranged configuration of the immunoglobulin genes. On the contrary, the T-cell receptor beta chain gene always retained a germ-line organization. These findings demonstrate that B-cell chronic lymphoproliferative disorders which co-express T-cell-related markers are truly composed of monoclonal B-cell elements.
A case of non-Hodgkin's lymphoma with leukemic spread in a patient affected with homozygous sickle cell disease is reported. This association has not been previously described. A correlation between ...the malignancy and the hemoglobinopathy could not be etiologically ascertained; therefore, an alternative explanation to a chance event cannot be offered.
In vitro stimulation of peripheral blood lymphocytes from ten patients with chronic lymphocytic leukaemia (CLL) was investigated under various culture conditions. It was confirmed that the mitogenic ...reactivity of whole cell populations (PBL) was delayed and depressed. When CLL rosette-forming cells (RFC) were stimulated, their 3H-thymidine uptake was increased, but the pattern of the response was similar to that of whole PBL, thus suggesting some impairment of these cells. Furthermore, in order to evaluate the possible recruitment of B cells, generally thought to be unresponsive, some co-culture experiments were performed in which 10(4) normal lymphocytes and 10(5) CLL whole PBL or RFC-depleted cell populations were stimulated with mitogens. An amplified response of the CLL lymphocytes was obtained in all co-cultures, and this effect was more evident when specific T cell stimulants were used; autologous CLL T lymphocytes, on the contrary, failed to display such a 'synergic' effect. These results indicate that normal lymphocytes are able to recruit a large number of CLL lymphocytes in the mitogenic response; furthermore, the fact that in co-cultures of CLL T-depleted fractions a better response was obtained with T cell mitogens suggests that the definition of CLL as a clonal expansion of unresponsive 'B' lymphocytes may be inadequate.
The aim of the study was to establish the role exerted by some soluble factors in B-CLL disease mechanisms. Serum levels of sIL2R, sCD23, sICAM-1, IL6 and sCD14 were detected in 47 B-CLL patients. ...Thirty-seven out of the 47 cases were in advanced/progressive stage, while the remaining 10 patients were defined as smouldering B-CLL. Twenty normal controls provided the reference values. Serum samples of 24 out 37 advanced/progressive cases were measured before and six months after the start of chemotherapy. The advanced /progressive patients showed significantly higher levels of sIL2R, sICAM-1 and sCD23 as compared to normal subjects. Furthermore, sIL2R, sICAM-1 and IL6 values were significantly higher in advanced /progressive B-CLL than in smouldering B-CLL patients. A statistically significant difference was found between smouldering B-CLL and controls for sCD14 only. sIL2R and sICAM-1 levels directly correlated with total tumor mass (TTM) score, sCD23 with both TTM score and lymphocytosis, and sCD14 with IgG serum values. sIL2R and sCD23 levels lowered significantly after chemotherapy, but only sCD23 and TTM variations after chemotherapy were closely correlated. sCD23 may be considered the only indicator of tumor mass, while the other soluble factors can be released through different mechanisms. In particular, sICAM-1 seems to correlate with the ability of the tumor to spread, while the sCD14 increase could indicate a role for this soluble factor in preventing infections in B-CLL patients.
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