Circulating immune complexes in patients with neoplastic disorders.

A group of 100 patients with various neoplastic disorders and 25 healty subjects were studied by the 125I-Clq and 125I-mRF inhibition tests for the presence of circulating immune complexes in the sera. The presence of circulating immune complexes was detected in 32 and 23% of the 100 patients by the 125I-Clq inhibition test and 125I-mRF inhibition test, respectively. A discrepancy between the two radioimmunoassays in cancer sera may suggest a possibility of the occurrence of quantatively different types of circulating immune complexes in neoplastic disorders.

Monoclonal IgG1 immunoglobulinaemia with strictly pH dependent cryoprecipitability.

A monoclonal IgG1 lambda protein with peculiar cryoprecipitable characteristics was found in the serum of a patient with advanced multiple myeloma. The cryoprecipitate was observed only when the serum was exposed to the air. Further studies defined this phenomenon as being strictly pH-dependent. No antiglobulin activity (rheumatoid factor) was detected in the cryoglobulin. The isoelctric focussing of isolated cryoglobulin showed four distinct fractions around the pH 7.8 zone, which was comparable to the pH at which the cryoprecipitate began to form. Electrostatic bonds probably contribute to the mechanism involved in the formation of cryoprecipitate in this case.

Vasculitis and Sjögren's syndrome with IgA-IgG cryoglobulinemia terminating in immunoblastic sarcoma.

Generalized lymphadenopathy and other manifestations of Sjögren's syndrome developed in a 68 year old woman with a long history of systemic vasculitis and arthralgia. An unusual immunologic feature was hypogammaglobulinemia and immunoglobulin A (IgA) monoclonal immunoglobulinemia with mixed IgA-IgG cryoglobulin. At autopsy, the histopathologic findings were compatible with immunoblastic sarcoma. The monoclonal IgA protein, found in serum, pleural and pericardial fluids, showed rheumatoid factor activity. Immunocytes from the immunoblastic sarcoma were found to be the source of the monoclonal IgA protein.

Leukemic myelomatosis (plasma cell leukemia).

Six cases of leukemic myelomatosis (plasma cell leukemia), are reported. A spectrum of leukemic plasmacellular proliferation was observed in this group: in two cases the plasmacytic leukemia was a terminal event of multiple myeloma, in one of a chronic lymphocytic leukemia, and in the remaining three cases the peripheral blood plasmacytosis was a presenting manifestation of an acute immunocytic dyscrasia. The clinical features, frequencies of extraosseous plasmacytic infiltrations, hypercalcemia and Bence Jones proteinuria, and cytomorphologic difficulties in differentiating plasmacytic from chronic lymphocytic leukemia are discussed.

Familial immunopathies: report of nine families and survey of literature.

Nineteen individuals are reported who represent nine familial instances of various immunopathies. Multiple myeloma was diagnosed in 10 members of five families, lanthanic (idiopathic) paraproteinemia in five members of two families and either myeloma or lanthanic paraproteinemia in four members of the remaining two families. The parent-child relationship occurred in three instances, siblings were affected in three, and first cousins in three families. Immunochemical studies revealed IgG paraprotein in nine cases; IgA in three; IgMl type in three subjects belonging to the same family; Bence-Jones protein in one case and biclonal paraproteinemia, IgGk plus IgAl in one. Three individual cases of lanthanic paraproteinemia, discovered in a prospective study of 76 relatives of subjects with immunopathies, suggest that there may be a higher frequency of immunopathies among family members than observed in the general population of comparable age. The published reports on familial paraproteinemias are reviewed..

Serum immunoglobulins, rheumatoid factor, and pneumoconiosis in coal miners with rheumatoid arthritis.

The occurrence and severity of pneumoconiosis were studied in 100 coal miners with rheumatoid arthritis (RA) and compared to findings in a geographically relevant survey of coal workers' pneumoconiosis. Contrary to European reports, miners with RA were not found to have an excessive frequency or severity of pneumoconiosis. In 55 of these men, serum immunoglobulin levels and rheumatoid factor were compared with data from matched RA patients with no history of silica exposure. The immunochemical results were unrelated to the stage of pneumoconiosis, nor did they differ from those in the control group.

Water-insoluble paraproteins with anticoagulant properties.

A 78-year-old woman, who had received steroid therapy for four years, had strikingly prolonged prothrombin time (PT) and partial thromboplastin time (PTT). The presumptive diagnosis was chronic hemolytic anemia. Platelet count and functions, fibrinogen, and factor XIII assays were all normal, but other factors assayed abnormally low; Sia water-dilution test was positive. When water-insoluble protein was removed by centrifugation, coagulation factors became normal. Dissolution of this precipitate in normal plasma caused marked prolongation of PT and PTT and lower factor assays. Serum electrophoresis showed a homogeneous M spike and an anomalous IgM, lambda-antigenic type in the gamma-globulin zone at point of origin. Ultracentrifugation of serum and of the precipitate showed 10% S17 and almost 100% S17 components, respectively. Five other patients with water-insoluble paraproteins were tested; two were clot-inhibitory.