[Clinical usefulness of the immunophenotypic study of circulating lymphocytes in leukemic lymphoproliferative diseases]. / Considerazioni sulla utilità clinica dello studio immunofenotipico dei linfociti circolanti nelle malattie linfoproliferative leucemizzate.

The immunophenotypes (IF) on peripheral lymphocytes of 24 B-CLL in different stage, 2 PLL and 14 leukemic B-non Hodgkin lymphomas were investigated. As regard to B-CLL and PLL, the results are similar to those reported so far. In stage A and B of B-CLL the IF appear less variable than in advanced stages where a decrease of CD21+ and an increase of both CD25+ and CD38+ lymphocytes were observed. In the lymphocytic, small cleaved cell lymphomas and splenic lymphomas, the peripheral IF correspond to the theoretical ones of respective lymphoma tissues. On the contrary they disagree in three cases of large cells, mixed small and cleaved cell, immunoblastic lymphomas. These features are discussed.

The discriminating analysis in the differential diagnosis of monoclonal gammopathies.

The clinical diagnosis is not always easy in monoclonal gammopathies. Therefore we used discriminating analysis to obtain diagnosis statistically sure. The parameters considered were kappa-lambda ratio, marrow plasma cells percentage and labeling index, CD3, CD4, CD8 lymphocytic absolute values. The plasma cells percentage and their labeling index make the differential diagnosis between MM and MGUS or SMM and MGUS feasible and quite correct. Additional immunological parameters should be used for the diagnosis between SMM and MM.

Kappa/lambda ratio on peripheral blood lymphocytes and bone marrow plasma cell labeling index in monoclonal gammopathies.

Bone marrow plasma cell labeling index (L.I.), kappa/lambda ratio, CD4+ and CD8+ subpopulations were studied in patients with smoldering multiple myeloma (SMM), active myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS). The loss of the light chain isotype suppression (LCIS) and a high labeling index (L.I.) allowed us to distinguish all MM patients from SMM patients. On the contrary, a low L.I. and a normal kappa/lambda ratio were found in most kappa and lambda MGUS. A significant difference in the kappa/lambda ratio was noted between MGUS and K-SMM. A significant decrease in CD4+ and a significant increase in CD8+ were not observed in patients with LCIS. The kappa/lambda ratio together with the plasma cell L.I. could be useful parameters for distinguishing active MM from SMM, especially in the cases with a border line L.I.

Lymphocyte populations and T cell subpopulations in blood of patients with non-Hodgkin lymphomas.

Lymphocytic populations and T cell subsets were studied in the blood of patients with nonleukemic non-Hodgkin lymphoma. A statistically significant decrease of both the T lymphocytes and the OKT4-, OKT8-binding cells was detected in low-grade malignant lymphomas (LGML). A significant decrease of the T cell population and of the OKT4-binding cells was also found in high-grade malignant lymphomas (HGML); in these, the OKT8-binding cells were not lowered. The amount of the circulating B lymphocytes was not found to be altered both in HGML and in LGML.

Spontaneous complete remission of CLL. Report of a case studied with monoclonal antibodies.

A case of complete spontaneous remission of CLL in a 76-year-old woman is reported. Despite the complete remission, the study of the peripheral blood T lymphocytic subsets by the aid of monoclonal antibodies has showed, however, that the ratio between helper-induced and suppressor cytotoxic T cells is still impaired (0.81) as we can see in overt B-CLL. The cause of the remission and its possible connection with the imbalanced distribution of the T lymphocytic subsets is discussed.

Chemotherapy of advanced non-Hodgkin lymphomas: a report of 35 cases.

Thirty-five patients with stage III and IV non-Hodgkin lymphomas, classified according to Lennert have been treated by combination chemotherapy (CVP). Total remission (complete plus partial) was obtained in 68.5% of the cases and complete remission in 28.5%; 73% of the favorable types and 55% of the unfavorable histologic types achieved tumor response: the difference was not statistically significant, perhaps because of the limited number of cases. Median survival was 14 months for the unfavorable histologic types and 28 months for the favorable types; longer survivals were obtained in patients who achieved complete remission. CHOP regimen after CVP in patients refractory to this type of treatment was not satisfactory in our patients.

Monoclonal immunoproliferative disorder of B-lymphocytes IgD/lambda changing from chronic lymphocytic leukaemia to myeloma and plasmacytic leukaemia pattern.

An immunoproliferative disorder with M component IgD/lambda and a strong decrease of the other Ig classes in the serum is reported. The peculiarity of this disorder consists in the shift from a predominant chronic lymphocytic leukaemic pattern, at the beginning, to a true myeloma with plasmacytic leukaemia IgD/lambda several months later. The possibility of the removal, in this case, of the initial precocious block with derepression or 'switch on' in transformation of the malignant lymphocyte clone and, consequently, change of a type of malignant lymphoma into another more evoluted and more malignant type is discussed.