Susan L. Melvin

New chromosomal translocations correlate with specific immunophenotypes of childhood acute lymphoblastic leukemia

Cytogenetic analysis of leukemic cells obtained at diagnosis from 122 patients with childhood acute lymphoblastic leukemia (ALL) disclosed chromosomal translocations in 36 cases. Two new nonrandom translocations were identified and found to be associated with specific immunophenotypes of the disease. The first, identified in 4 of 16 cases of T-cell ALL positive for sheep erythrocyte receptors (E+), involved the short arm (p) of chromosome 11 and the long arm (q) of chromosome 14 and was designated t(11;14) (p13;q13). The second, found in 7 of 23 cases with a pre-B-cell phenotype, involved the long arm of chromosome 1 and the short arm of chromosome 19; it was designated t(1;19) (q23;p13.3). A third abnormality involving a common breakpoint on chromosome 12 (band p 12) was also identified. These two new differentiation-specific translocations suggest a mechanism for aberrant expression of genes that influence lymphoid cell growth and development, as well as leukemogenesis.

Acute leukaemia with mixed lymphoid and myeloid phenotype.

Summary Three children with acute leukaemia had blasts that expressed both lymphoid and myeloid markers. The blasts met immunological criteria for acute lymphoblastic leukaemia (ALL)—common ALL antigen+, HLA‐DR+, terminal deoxynucleotidyl transferase+–but their cytochemical features, including positive myeloperoxidase and Sudan black B, were those of acute nonlymphoblastic leukaemia (ANLL) as defined by the French‐American‐British Group. 30% of the blasts from one of two patients tested reacted with a monoclonal antibody specific for nonlymphoid cells (MCS‐2). The wide overlap in the percentages of blasts expressing lymphoid or myeloid markers indicates that some leukaemic cells in each child had a mixed phenotype. There were no consistent cytogenetic findings, and the Philadelphia chromosome was not present. Complete remission was induced by treatment effective for either ALL (two patients) or ANLL. These three cases appear to represent a rare leukaemia subtype that we have designated acute leukaemia with mixed lymphoid and myeloid phenotype. Its recognition may be important in treatment, since two patients achieved remission with standard therapy for ALL. These cases demonstrate further the phenotypic heterogeneity that may be seen in leukaemic cell differentiation.

Unfavorable presenting clinical and laboratory features are associated with calla-negative non-t, non-b lymphoblastic leukemia in children

Twenty-four (5.7%) of 424 children with newly diagnosed acute lymphoblastic leukemia (ALL) were found to have blast cells that expressed HLA-DR antigens but not the common ALL antigen (CALLA), E-rosette receptors, T-cell antigens, or cytoplasmic or surface immunoglobulins. Each of the eight cases tested expressed the B-cell associated antigen B4, but not B1 or B2 antigen. Myeloid-associated antigens were not present in any of the 10 cases tested. By comparison with common (CALLA+ B-cell precursor) ALL, patients having this immunophenotype were more likely to be children less than 2 yr of age (p less than 0.001), to have higher initial leukocyte counts (p less than 0.001), and to have blast cells with a DNA index less than 1.16 (p = 0.05), a pseudodiploid karyotype (p = 0.01) and a chromosomal translocation (p = 0.003). The presence of any chromosomal translocation in these CALLA- ALL was related to measures of increased leukemic cell burden including higher leukocyte counts, larger liver and spleen sizes and higher serum lactic dehydrogenase levels. While the patients were entered into several treatment arms of two protocols, the CALLA- cases appeared to have lower remission rate (p = 0.06) and shorter event-free survival time (p = 0.05) than did those with common ALL. The association with clinical and laboratory features of known adverse prognostic significance provides some explanation for the poor treatment outcome of CALLA- ALL.

A monoclonal antibody (SJ-9A4) to P24 present on common alls, neuroblastomas and platelets - I. Characterization and development of a unique radioimmunometric assay.

We report the development and characterization of SJ-9A4, a monoclonal antibody (MoAb) produced against common acute lymphoblastic leukemia (C-ALL) cell lines. SJ-9A4 reacted with C-ALL, B-cell chronic lymphocytic leukemia (B-CLL), platelets and C-ALL neuroblastoma (NB) and the K562 cell lines. It had no significant reactivity with erythrocytes, granulocytes, circulating T or B lymphocytes, monocytes, granulocytic cell lines or a Ewings sarcoma cell line. SJ-9A4 was shown to recognize the same region as two other MoAb to the p24 antigen, BA-2 and DU-ALL-1, as demonstrated by their ability to inhibit the binding of labeled SJ-9A4 to NALM-1 and NB cells. Other MoAb: J5, PI 153/3 and monoclonal anti-HLA-DR antibodies gave no inhibition. A solid phase indirect radioimmunometric assay (IRA) was developed which enabled the detection of P24 from C-ALL cells, utilizing its ability to bind the Ricinus communis agglutinin (RCA1) or wheat germ agglutinin (WGA) and SJ-9A4 simultaneously. When BA-2 and DU-ALL-1 were used in place of SJ-9A4, similar IRA results were obtained. Using the RCA1/SJ-9A4-IRA, P24 from as few as 1.6 X 10(4) cells of a C-ALL cell line could be detected; however, similar extracts of NB cell lines were negative despite high levels of SJ-9A4 binding to intact cells. The presence of P24 in NB extracts was demonstrated by (1) preincubation of NB extracts with SJ-9A4 which blocked MoAb binding to P24 and (2) immunoadsorption of P24 from solubilized membranes of 35S-methionine (met) labeled NB cells. Treatment of NB cells with neuraminidase did not result in IRA binding when either RCA1 or WGA were used as the solid phase lectin indicating that the differences in lectin affinity are not due to over sialation of NB membrane glycoproteins. These findings demonstrate a difference in the glycosylation of P24 from C-ALL and NB cells.

Some fixation reagents reduce or abolish the detectability of Ia-antigen and HLA-DR on cells.

The effect of paraformaldehyde (PF), glutaraldehyde (GT), methanol (ME), ethanol (ET) and acetone (AC) fixation on the detectability of Ia antigens on murine and rat peritoneal exudate (PE) and resident peritoneal (RP) macrophages (M phi), and on detectability of HLA-DR antigens on human blood leukocytes (HBL) and human splenic M phi (HSM phi) was examined. Ia-antigen on Mø from H-2k mice was detected by a rosetting assay using erythrocytes (E) to which a monoclonal antibody (MoAb) reactive to Ia.2 (E anti-Ia.2) had been coupled, and by the direct binding of 125I-labeled anti-Ia.2. The antigen was detected on Wistar/Furth (W/Fu) rat RPMø splenocytes (SC) by rosetting with E coupled with a MoAb to the murine determinate Ia.17, which cross-reacts with an Ia-like molecule on cells from the W/Fu strain. HLA-DR framework determinants were detected on HBL and HSMø by the binding of 125I-labeled MoAb and by an avidin-biotinylated peroxidase procedure. Exposure of murine PEMø or RPMø to 1% PF or 0.5% GT for 15 min at room temperature reduced 125I-anti-Ia.2 binding and E anti-Ia.2 rosetting by at least 60%; the radioimmunoassay was more affected by the fixatives than was the rosetting assay. Further, PEMø were more sensitive to the effect of PF fixation than were RPMø. Treatment of freshly isolated RPMø with 1% PF reduced the proportion of Ia-bearing cells detected by the rosetting assay by greater than 50%. Culturing alone did not affect the detectability of Ia on RPMø as assessed by the rosetting test, but cultured RPMø were more sensitive to the effects of FX fixation than fresh cells except when lymphokine from Con A-stimulated murine SC was included in the culture medium. Similar losses of HLA-DR were recorded when HBL and HSMø were exposed to PF, GT, ME or ET, but brief (less than 20 s) treatment with cold AC did not appreciably reduce antigen detectability. Procedures in which fixation takes place after the primary antibody binding step did not result in an appreciable loss of detectable Ia. Thus, commonly used fixatives affect the detectability of Ia and Ia-like antigens on a variety of cells. Results obtained from assays on cells treated prior to the primary antibody binding step, therefore, must be interpreted with caution.

Sudan black B positive acute lymphoblastic leukaemia

Summary. The presence of greater than 3% Sudan black B (SBB) positivity in leukaemic blasts has been considered diagnostic of acute non‐lymphocytic leukaemia (ANLL). A rare report has indicated that this finding may not be specific for ANLL. In order to determine whether SBB could be found in acute lymphoblastic leukaemia (ALL) the data on 350 patients with newly diagnosed ALL were reviewed. Six patients (1.6%) were found to have 5% or greater SBB positive blasts. The diagnosis of ALL was supported by morphology, cytochemistries, immunologic markers, therapeutic response, and in one case immunoglobulin gene rearrangement. It is important to recognize the fact that SBB is not specific for AML and may be found in the blasts of patients with ALL.

Shedding of the common acute lymphoblastic leukemia antigen (calla) by lymphoblastoid cell lines

The release of common acute lymphoblastic leukemia antigen (CALLA) into culture medium by lymphoblastoid cell lines was studied. CALLA release was detected using a solid phase indirect radioimmunometric assay which combines the specificity of lectins and monoclonal antibodies and using immunoadsorption of labeled CALLA in spent medium from cells incubated with 35S-methionine. No CALLA was present in the medium of cells pulse-labeled at 37 degrees C, when they were placed at 4 degrees C, thus this is an active process. Sequential analysis of soluble CALLA revealed shedding of CALLA to be associated with cell growth.

Evidence for clonal evolution in pre-B-cell leukaemia

Summary. This case study provides evidence for clonal evolution in pre‐B‐cell leukaemia. At diagnosis, the lymphoblasts from a 3‐year‐old boy were morphologically subtyped as L1 (French–American–British classification). Their immunophenotype was CALLA+, CIgM+, SIg‐, TdT+, and the karyotype was pseudodiploid with a 1;19 translocation. Striking shifts were apparent when the child relapsed 16 months later. The morphologic subtype had changed to L3, CALLA and TdT had disappeared, and a consistent karyotype was lacking. The modal chromosome number had increased through clonal evolution to 85, the 1;19 translocation was retained, and a new marker, a 14q+ (partial duplication) appeared and was present in a majority of cells. These cytogenetic findings are characteristic of a transforming state. However, despite the loss of TdT, the appearance of classic L3 morphology and the acquisition of a 14q+ marker, the cells retained a predominantly pre‐B phenotype.

A monoclonal antibody (SJ-9A4) to P24 present on common ALLS, neuroblastomas and platelets — II. Characterization of P24 and shedding in vitro and in vivo

The release of soluble P24 antigen into culture medium by common acute lymphoblastic leukemia (C-ALL) and neuroblastoma (NB) cell lines was studied. P24 release by C-ALL cells was detected using a solid phase indirect radioimmunometric assay (IRA) which combines the specificity of lectins and monoclonal antibodies (MoAb) and using immunoadsorption of labeled P24 in spent medium from cells incubated with 35S-methionine (met). No P24 was present in the medium of cells pulse labeled at 37 degrees C when they were placed at 4 degrees C, thus this is an active process. P24 release by NB cells could not be detected by IRA, but could be detected by immunoadsorption of spent medium of metabolically-labeled cells. The absence of IRA activity of P24 from NB spent medium was due to decreased glycosylation and thus no binding to the lectins employed in the IRA was observed. This was confirmed by lectin affinity chromatography which showed that P24 in the spent medium from C-ALL cells bound Ricinus communis agglutinin (RCA1), wheat germ agglutinin (WGA), concanavalin A (Con A), and lentil lectin (LcH), but not peanut agglutinin (PNA). P24 from NB cell spent medium did not bind to any of these lectins. The lectin affinity of P24 derived from lymphoblasts is consistent with the presence of N-linked oligosaccharide chains having N-acetyl glucosamine residues, a mannose core, and a terminal D-galactose. P24 from C-ALL cell spent medium was present in the 35-45% fraction of a saturated ammonium sulfate (SAS) partition of spent medium. The P24 antigen was detected in the fractionated plasma of five patients with C-ALL at the time of diagnosis and was undetectable when the patients had achieved a complete remission. Plasma from 2 patients with P24 negative ALL, normal human plasma, and normal human serum had no detectable activity.

Genetic predisposition to acute lymphocytic leukemia in American blacks. A Pediatric Oncology Group study.

Recent reports have shown an association between genes lying within the major histocompatibility complex (MHC), particularly HLA and factor B (Bf), and acute lymphocytic leukemia (ALL) in white children. The frequencies of Bf and complement component C4 phenotypes in 90 black American children with ALL were examined to determine if a genetic association existed. The Bf and C4 results for the black children with ALL were compared with frequencies in healthy black Americans from the same geographic region. The BfF allele was carried by 95.6% of the black ALL patients compared with 86.1% of the controls (P = 0.017; relative risk = 3.5). In contrast, only 2.2% of the patients with ALL were homozygous for BfS compared with 9.8% of the controls (P = 0.043; relative risk = 0.2). These findings are similar to those observed in white American children. The C4A6 phenotype was found in 11.9% of the black children with ALL compared with 0.6% of the controls (P = 0.0026; relative risk = 22.7). These findings represent the first reported association of a particular allele whose gene lies within the MHC with ALL in black American children. The results suggest that the occurrence of ALL in black American children may be partially due to a genetic influence.