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PubMedDate not supplied

Initial characterization of an anti-CD5 monoclonal antibody obtained from leukemic cells infiltrating lymphocytes.

BACKGROUND AND METHODS: CD5 is a monomeric glycoprotein expressed on normal and malignant T cells and on chronic lymphocytic leukemia cells. Murine anti-CD5 monoclonal antibodies (MAbs) were obtained using T cell lines, thymocytes, and blast cells from acute T lymphoblastic leukemia as immunogen. In the present report we describe an anti-CD5 MAb obtained from hybridization of mouse spleen lymphocytes immunized with blast cells from a patient with plasmocytoma who underwent leukemic transformation. RESULTS AND CONCLUSIONS: We demonstrate that this MAb arises from the CD5 determinant of lymphocytes disseminated among the leukemic cells. We present initial characterization of this MAb, which may represent a new CD5 epitope. Potentially, due to its efficient internalization through the cell membrane, this MAb might be used to deliver toxins to immunocompetent T lymphocytes for prevention of acute graft-versus-host disease (aGVHD) after bone marrow transplantation.

Antibodies, Monoclonal↗
PubMed1984

Relapse of acute myelogenous leukemia presenting as acute otitis externa. A case report.

The association of leukemia with auditory complications is an obscure, though an important one, especially from the therapeutic point of view. A case is presented of a relapse of acute myelogenous leukemia presenting as an acute otitis externa. The leukemic infiltrates in the external auditory canal are demonstrated by both light and electron microscopy. The otologic lesions in leukemias are reviewed and the importance of early diagnosis is emphasized, since the aural involvement may precede the clinical relapse of the leukemia, as in the current case. The value of computerized axial tomography of the ear and of tissue biopsy for diagnosis is stressed. The recognition of the presence of leukemic infiltrates in the ear causing otologic symptoms allows for the prompt institution of appropriate therapy.

Adult↗
PubMed1982

Brain involvement in chronic lymphocytic leukemia.

Cerebral infiltration due to chronic lymphocytic leukemia is rare. Leukemic infiltration of the brain can be diagnosed by computed tomography, and the response to treatment can be monitored. Leukemic cerebral infiltrates may occur as areas of variable attenuation that usually enhance following intravenous contrast medium administration. They can be differentiated from areas of leukoencephalopathy related either to the disease or treatment with drugs by their characteristic locations contiguous with cortical or ependymal surfaces, or adjacent to shunt tubing.

Aged↗
PubMed1981

Calcified cerebral necrosis following ALL therapy.

Calcified cerebral necrosis was an unusual finding at the autopsy of a 13-year-old girl who died after prolonged therapy for ALL. The patient had shown symptoms of progressive cerebral damage subsequent to a second cycle of prophylactic high-dose cytostatic therapy combined with cranial irradiation. Pathoanatomic examination revealed extensive florid recurrency of meningosis and leukemic encephalosis with scalloped calcified necroses measuring up to 5 cm, in the medullar layer of brain and cerebellum. Located predominantly near the ventricular area, encapsulated necroses showed many fibrous vessels with thickened walls and stenosed or obstructed lumina. The cerebral cortex remained largely unaffected by tissue destruction. Besides methotrexate toxicity and the enhancing effect of irradiation the vascular involvement was interpreted as a particularly important factor. Formal pathogenesis is attributed to combined chemo- and radiotherapy in parallel to leukemic infiltration of vascular walls and partial obstruction of lumina by tumor emboli. Wall damage, severe fibrosis, and consecutive nutritional defects result in the destruction of cerebral tissue. The preferential occurrence of necroses in cortex-adjacent medullar layers is explained by the relatively poor blood supply of this border zone between meningeal and intracerebral tissue, no safe conclusion can be drawn pathoanatomically with regard to the actually fatal factor, whether it is the leukemic infiltration of vascular walls, the effect of cytostatic agents, or that of irradiation. The proposed multifactorial pathogenesis of cerebral calcification may be supported by computed tomography (CT) intra vitam.

Adolescent↗
PubMed1982

Intestinovesical fistula in a patient with chronic lymphocytic leukemia: case report and literature review.

A case of intestinovesical fistula secondary to leukemic infiltration is described. The patient was known to have chronic lymphocytic leukemia and had been receiving chemotherapy fo ten months. She presented complaining of nausea, vomiting and vague abdominal pain. She initially denied genitourinary tract symptoms, although admitting urinalysis revealed pyuria, hematuria and bacteriuria. Urine cultures repeatedly grew E. coli despite broad spectrum antibiotic therapy. She eventually developed fecalant material in her urine and pneumaturia. Cystoscopy revealed a fistulous tract. At surgery an ileovesical fistula was found and histopathology showed lymphocytic leukemic infiltration. Intestinovesical fistulas are uncommon. Congenital, traumatic, inflammatory and solid neoplastic etiologies are well established in the literature. No previous cases have been attributed to hematologic malignancies. Since higher remission rates and longer periods of remission are being achieved with chemotherapy, and since fistula symptomatology may present quite subtly, awareness of this association may expedite diagnosis.

Aged↗
PubMed1996

[MR relaxation times in diffuse bone marrow disorders: evaluation of their clinical usefulness in differentiation between leukemia and anemia].

T1 and T2 relaxation time measurements of the femoral marrow were performed in 20 patients with acute myeloid leukemia (AML) and 9 patients with iron deficiency or other severe anemia who had shown diffuse abnormal signals on MR imaging of the femoral marrow. The ability of T1 and T2 values to differentiate between leukemic infiltration and hyperplastic hematopoietic marrow was evaluated. T1 and T2 ratios (T1 abnormal marrow/T1 normal marrow and T2 abnormal/T2 normal) were calculated, and the ratios of T1 to T2 (T1/T2) and of the T1 ratio to the T2 ratio (T1 ratio/T2 ratio) were also analyzed. Diffuse infiltrative marrows revealed prolonged T1 relaxation times in all patients with AML and other severe anemia, and it was not possible to distinguish the two groups of diseases on the basis of T1 values. The T2 relaxation times varied widely in AML, but the mean T2 value of the AML group was not statistically significantly different from that of the anemia group. There were also no significant differences in the T1 ratio, T2 ratio, T1/T2, and the T1 ratio/T2 ratio between leukemic infiltration and hyperplastic hematopoietic marrow. We concluded that measurement of T1 and T2 relaxation times was of limited clinical importance for the histological characterization of diffuse bone marrow disorders.

Adult↗
PubMed1996

Experimental acute adult T cell leukemia-lymphoma is associated with thymic atrophy in human T cell leukemia virus type I infection.

Human T cell leukemia virus type I (HTLV-1) infection may lead to an acutely fatal adult T cell leukemia-lymphoma (ATLL), but HTLV-1-infected people usually remain asymptomatic. Why only certain HTLV-I infections lead to acute ATLL, which is characterized by leukemic infiltration of multiple organs and immune suppression, remains unknown. A readily accessible animal model in which the spectrum of consequences resulting from HTLV-I infection can be observed would greatly aid studies of this retrovirus. New Zealand White rabbits inoculated with either HTLV-1-infected CD25+ T cells or cell-free virus, were serially necropsied at different intervals after death or humane sacrifice. Tissues were preserved at necropsy or cultured in vitro and subsequently prepared for morphologic or molecular examination. Rabbits inoculated with RH/K34, a productively infected rabbit T cell line that contains a monoclonally integrated full-length HTLV-I provirus, developed acute ATLL-like biologically malignant lymphoproliferative disease with lymphocyte infiltration of viscera; lymphomas consisting primarily of monoclonal expansions of RH/K34 manifested a variety of diffuse pleomorphic histologic types. Concurrently, lymphoproliferative disease was associated with onset of thymic atrophy in the presence of rapidly increasing thymic proviral load. In contrast, rabbits given two other HTLV-1 inocula, originally derived (as was RH/K34) using the human T cell line MT-2 as virus source, also became infected but did not develop thymic atrophy or the ATLL-like disease. HTLV-1 infection, thymic atrophy, and leukemic infiltration similar to acute ATLL occurred reproducibly in a New Zealand White rabbit model independent of RH/K34 inoculum and host histocompatibility. Thymic atrophy in RH/K34-inoculated rabbits, but not in rabbits given other similar HTLV-1, was consistent with immunosuppression sufficient to prevent rejection of the inoculum. Although the short, 8-day course of the experimental ATLL precludes its having a molecular pathogenesis identical to the human condition, the systemic consequences of acute ATLL, including its association with thymic atrophy, are closely modeled.

Adult↗
PubMed1991

[Extramedullary manifestations among adult patients with acute lymphoblastic leukemia (ALL)].

In 56 adult acute lymphoblastic leukemia (ALL) patients, 71% presented with extramedullary leukemic infiltration in lymphoid tissues (EML- spleen, liver, lymphnodes or thymus). EML was seen most often in patients with T-ALL (0.05 greater than p greater than 0.02) and in patients with high white blood counts (0.1 greater than p greater than 0.05). Surprisingly, these more often achieved complete remissions (0.1 greater than p greater than 0.05), of which both the duration and disease-free survival were longer. Thus, EML at diagnosis seems to be a favourable prognostic factor. At diagnosis, 23% of the patients had extramedullary leukemic infiltration in non-lymphoid tissue (EMIL-CNS, testis, skin, pleural cavities or gingiva). While more of these patients were of T-cell origin (61%, p less than 0.01), they were less likely to achieve CR, both the duration of remissions (p less than 0.01) as well as the disease free survival were shorter. Not unexpectedly, during the course of disease, the incidence of relapse localised at EMIL (the majority presenting in "sanctuary sites") increased, while that in the bone marrow decreased. Interestingly, in patients in CR presenting with EMIL, the first sign of relapse was unilateral peripheral facial paralysis in 60%. Finally, it should be stressed that the course of disease in patients presenting with simultaneous EML- and EMIL involvement was like that seen for EMIL patients. We conclude that while involvement of leukemia in EMIL represents a bad prognostic sign, the affection of leukemia in EML does not seem to confer a poorer prognosis, for adult ALL patients.

Adult↗
PubMed1994

[The larynx in lymphoproliferative and myeloproliferative diseases. Part II: Laryngeal autopsy findings and discussion].

Lymphoreticular neoplasms of the larynx are rare and comprise a heterogeneous group of tumors. A systematic survey of the literature and autoptic evaluation of the larynx in a relatively small number of patients with systemic lymphoreticular malignancies yielded the following findings: Primary tumors of the larynx must be clearly distinguished from laryngeal involvement by systemic or leukemic infiltrations. By far the most common primary hemopoietic tumors of the larynx are extramedullary plasmacytoma (about 90 cases published) and non-Hodgkin's lymphoma (NHL; about 65 cases published). Primary Hodgkin's disease, granulocytic sarcoma and mast cell sarcoma are extremely rare at this site. Plasmacytoma and NHL both preferentially involve the supraglottis. The subglottis is infrequently affected. Laryngeal plasmacytoma and NHL usually present clinically as localized stage IE and IIE tumors that exhibit no significant tendency to recur or generalize. The therapy of choice is local irradiation while chemotherapy should be reserved for recurrent or progressive disease. Prognosis is favourable in most cases of primary laryngeal plasmacytoma and NHL. Secondary involvement of the larynx by systemic lesions or leukemic infiltrations is usually associated with a very poor prognosis. The prognosis of patients with laryngeal involvement in acute or chronic myeloid leukemia is always poor. Although the histopathological diagnoses given in many case reports are often difficult to compare because of differences in terminology, there seems to be a marked preponderance of B-cell tumors of high-grade malignancy (centroblastic or immunoblastic lymphoma in the Kiel classification of NHL) that probably represents lymphomas originating from mucosa-associated lymphoid tissue (MALT).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[The larynx in lymphoproliferative and myeloproliferative diseases. I: An overview with special reference to primary laryngeal malignant lymphomas and plasmacytomas].

Lymphoreticular neoplasms of the larynx are rare and comprise a heterogeneous group of tumors. A systematic survey of the literature and autoptic evaluation of the larynx in a relatively small number of patients with systemic lymphoreticular malignancies yielded the following findings: Primary tumors of the larynx must be clearly distinguished from laryngeal involvement by systemic or leukemic infiltrations. By far the most common primary hemopoietic tumors of the larynx are extramedullary plasmacytoma (about 90 cases published) and non-Hodgkin's lymphoma (NHL; about 65 cases published). Primary Hodgkin's disease, granulocytic sarcoma and mast cell sarcoma are extremely rare at this site. Plasmacytoma and NHL both preferentially involve the supraglottis. The subglottis is infrequently affected. Laryngeal plasmacytoma and NHL usually present clinically as localized stage IE and IIE tumors that exhibit no significant tendency to recur or generalize. The therapy of choice is local irradiation while chemotherapy should be reserved for recurrent or progressive disease. Prognosis is favorable in most cases of primary laryngeal plasmacytoma and NHL. Secondary involvement of the larynx by systemic lesions or leukemic infiltrations is usually associated with a very poor prognosis. The prognosis of patients with laryngeal involvement in acute or chronic myeloid leukemia is always poor. Although the histopathological diagnoses given in many case reports are often difficult to compare because of differences in terminology, there seems to be a marked preponderance of B-cell tumors of high-grade malignancy (centroblastic or immunoblastic lymphoma in the Kiel classification of NHL) that probably represents lymphomas originating from mucosa-associated lymphoid tissue (MALT).(ABSTRACT TRUNCATED AT 250 WORDS)

Hodgkin Disease↗
PubMed2000

Diffuse calcinosis cutis in a patient with congenital leukemia and leukemia cutis.

We report an unusual case of congenital leukemia with leukemia cutis (LC) and diffuse calcinosis cutis. A newborn girl presented with widespread dusky red and yellowish cutaneous nodules and papules. Bone marrow morphology was consistent with the diagnosis of acute monocytic leukemia of the FAB M5 type. Skin biopsy specimens confirmed the presence of a leukemic infiltrate and revealed calcium salt deposition in the papillary and reticular dermis. Calcinosis was diffuse in the whole skin but spared other organs. Vascular calcification was not present. Serum calcium levels oscillated between 2.5 and 2.86 mmol/l, and phosphorus, parathyroid hormone and 25-hydroxyvitamin D(3) levels were normal. There were diffuse osteoporosis and spontaneous fractures of small tubular bones. The patient responded to chemotherapy but, following consolidation treatment, developed sepsis and died at 120 days of age. Congenital leukemia is rare and LC is uncommon. Hypercalcemia may be a complication of leukemia, which leads to multiorgan metastatic calcification. Despite the absence of frank hypercalcemia, the presence of bone lesions suggests that the patient's calcinosis cutis was of the metastatic type. However, the cutaneous leukemic infiltrate may also represent a triggering factor for calcium deposition in the skin.

Acute Disease↗
PubMed1998

Mediastinal granulocytic sarcoma: a report of two cases.

We describe the cases of two patients who presented with granulocytic sarcoma with mediastinal involvement 15 and 21 months before development of acute myeloid leukemia. In both cases several bone marrow aspirates and trephine biopsy specimens, obtained at presentation and subsequently, revealed no evidence of leukemic infiltration. One case was originally misdiagnosed as large-cell non-Hodgkin's lymphoma, which resulted in inappropriate therapy. In both cases immunohistochemical staining revealed that tumor cells were positive for leucocyte common antigen but not for conventional B- or T-lymphoid-cell markers. Retrospective analysis revealed that tumor cells in both cases were positive for myeloid markers. Histopathologists should be aware that granulocytic sarcoma may occur in unusual extramedullary sites without evidence of bone marrow involvement. If inappropriate treatment is to be avoided, a diagnosis of granulocytic sarcoma should be considered when hemopoietic tumor cells do not stain with conventional antibodies against B- and T-lymphoid cells. Both histochemical and immunohistochemical staining should be performed in such cases to determine whether the cells are of myeloid lineage. A diagnosis of granulocytic sarcoma is not ruled out when bone marrow biopsy specimens show no evidence of leukemic infiltration.

Adult↗
PubMed1984

Hypothalamo-hypophyseal-testicular function in prepubertal boys with acute lymphoblastic leukemia following chemotherapy and testicular radiotherapy.

Hypothalamo-hypophyseal-testicular function was studied in twenty-eight prepubertal boys with ALL in clinical and haematological remission. Eighteen were treated with combined systemic chemotherapy (24-36 months) and the other ten, who had testicular leukemic infiltrates, received chemotherapy (38-60 months) and testicular radiotherapy (2 000 rad). Plasma levels of LH and FSH were measured before and after stimulation with LHRH (100 micrograms i.v.) and plasma levels of testosterone before and after stimulation with hCG (1 500 IU/48 h/7 doses). In patients treated with chemotherapy alone, mean basal LH and FSH, mean responses to LHRH stimulation and mean testosterone levels after stimulation with hCG did not significantly differ from those of the controls. Five of these patients who had normal testosterone values after three doses of hCG had testosterone values below the normal range after seven doses. In patients treated with chemotherapy and testicular radiotherapy, mean basal FSH and mean responses to LHRH stimulation were significantly higher than those of the controls. Testosterone values after stimulation with hCG were low in three and very low in the other seven. In both groups of patients data from testicular biopsies were consistent with functional results. We conclude that chemotherapy causes slight testicular damage, but chemotherapy and testicular radiotherapy produce severe testicular damage in patients with testicular leukemic infiltrates.

Child↗
PubMed2005

Leukemia and the nervous system.

Leukemia affects the central and peripheral nervous system. Neurologic complications are a consequence of direct leukemic infiltration, as occurs with leukemic meningitis, and due to complications of either antileukemic treatment (thrombocytopenic or disseminated intravascular coagulation-related intracranial hemorrhage, steroid myopathy, vinca alkaloid peripheral neuropathy) or immune compromise (Herpes zoster shingles or Aspergillus meningitis).

Antineoplastic Agents↗