Characterization of malignant lymphomas in leukemic phase by multiple differentiation markers of mononuclear cells

Correlation with clinical features and conventional morphology
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      Peripheral blood and bone marrow cells of 38 patients with malignant lymphoma in the leukemic phase were defined by multiple immunologic markers and determination of the enzyme terminal deoxynucleotidyl transferase (TdT). Despite shared B cell markers (surface immunoglobulins, binding of aggregated immunoglobulin G [IgG]) distinctions could be made between the cells of patients with chronic lymphocytic leukemia (CLL) and those of patients with other B-lymphoproliferative disorders on the basis of morphology, intensity of surface immunofluorescence and number of mouse rosette-forming cells (MRFC). In 15 patients with CLL, the mean value for MRFC was 47.5 per cent, differing significantly (p < 0.001) from the value found in 10 patients with non-CLL B-cell leukemic lymphomas (7.5 per cent) and in normal control subjects (4 per cent ± 3/mean ± 1 SD). Of 11 patients with leukemic diffuse poorly differentiated lymphocytic lymphoma (DPDL), four had cells that formed spontaneous rosettes with sheep erythrocytes (T cells), and seven had a predominance of null cells. TdT activity was present in six of six patients studied, including three patients each with the null and T cell proliferations. This group of 11 patients with leukemic DPDL was characterized clinically by prominent mediastinal involvement in 10, a median age of 29 years and a median survival of 12 months. Malignant cells of two patients with leukemic diffuse histiocytic lymphoma seemed to be of B cell origin, as they were characterized by monoclonal surface immunoglobulin M (IgM) of kappa light chain type. Leukemic cells in the remaining two patients were characterized by a prominent Fc receptor, which might be considered evidence of a monocytic disorder. These data further support the usefulness of cell marker analysis in delineating the heterogeneity of cellular types involved in leukemic and lymphomatous disorders, and suggest its eventual clinical usefulness in the diagnosis and prognosis of these disorders.
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