Adhesion Receptors on Peripheral Blood Leukemic B Cells. a Comparative Study on B Cell Chronic Lymphocytic Leukemia and Related
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Leukemia (1997) 11, 408–415 1997 Stockton Press All rights reserved 0887-6924/97 $12.00 Adhesion receptors on peripheral blood leukemic B cells. A comparative study on B cell chronic lymphocytic leukemia and related lymphoma/leukemias G Csanaky1, E Matutes2, JA Vass1, R Morilla2 and D Catovsky2 1Department of Pathology, University Medical School of Pe´cs, Hungary; and 2Academic Department of Haematology and Cytogenetics, The Royal Marsden Hospital, London, UK The expression of a series of adhesion receptors: L-selectins the same disease, or change during the clinical course of the (CD62L): Leu-8, several integrins (LFA-1: CD11a/CD18, VLA-4: disease. For example, in chronic lymphocytic leukemia (CLL), CD49d/CD29 and VLA-5: CD49e/CD29), ICAM-1(CD54) and the the most common of the B lymphoid disorders, clinical staging ‘homing receptor’ (CD44) were investigated by a dual color flow 4,5 cytometry in 56 cases of B cell disorders namely, 39 chronic systems not only consider the degree of anemia and lymphocytic leukemias (CLL), four hairy cell leukemia (HCL), thrombocytopenia, but also splenic and nodal infiltration as seven splenic lymphoma with villous lymphocytes (SLVL) and well as the number of nodal regions involved. Similarly, six other non-Hodgkin’s lymphoma (NHL). The functional dissemination of B-NHL may correlate with bulky disease activity of L-selectins was assessed with L-selectin ligand ana- and resistance to standard therapy. logs (polyphosphomonester core polysaccharide: PPME and fucoidin). Leukemic B cells were identified with phycoerythrin- Since these patterns have proven to be of clinical relevance, conjugated monoclonal antibodies (McAbs) anti-CD19, anti- it seems important to investigate the factors which may play kappa/lambda investigated simultaneously for the expression a role in the dissemination and tissue distribution in these of adhesion receptors estimated with fluorescein-isothiocyan- malignancies. In this context, analysis of interactions between ate (FITC) conjugated McAbs. The percentage of leukemic cells certain receptor and ligand molecules,6,7 which result in the expressing L-selectins (Leu-8) was high in CLL (52% of positive binding of lymphocytes to the endothelial cells and give them cases) and integrin expression (LFA-1, VLA-4, 5) was low (19 and 33%, respectively), while a reverse pattern, low Leu-8 the opportunity to leave the blood via the high endothelial (17%), and a high VLA-4 (77%), was observed in non-CLL cases. venules (HEVs) and enter into the secondary lymphoid organs, The expression of LFA-1 a-chain was variable in non-CLL may give some clues in the patterns of dissemination. Thus, cases, and the LFA-1 heterodimer was expressed on most the attachment of leukemic cells to the endothelium rep- clonal B cell in NHLs (92%). LFA-1 a-chain was detected on resents a crucial step in the spreading of such malignancies. b cells from only one HCL case, while 2 integrin was regularly Over the last few years, there have been a number of reports expressed on hairy cells. VLA-5 integrin was found on a rela- tively small number (26%) of mature B cell leukemias. A remark- on the expression and function of cell-adhesion molecules on able finding was the detection of ICAM-1 in all CLL cases albeit leukemic B cells, however, only few studies have focused on the number of positive cells was significantly lower (P , 0.05) the correlation between the expression of these molecules and compared to non-CLL cases. CD44 was expressed on a high the clinical and laboratory findings.8–16 number of neoplastic cells in all the investigated categories. In this study, we have analyzed circulating neoplastic cells There was no correlation between the expression of the from a variety of B cell diseases, namely CLL and hairy cell adhesion molecules and clinical and laboratory parameters except for CD18 which was expressed on a significantly leukemia (HCL) and B-NHL in leukemic phase for the (P , 0.05) higher number of leukemic cells in CLL with more expression of a number of adhesion molecules which advanced stages. This study demonstrates that even closely included: (1) L-selectins (CD62L) (their functional activity was related B cell leukemia/lymphomas have a certain well defined assessed by biotinylated ligand analogs); (2) some key dimeric and strictly variable adhesion profile which is characteristic of integrins such as LFA-1 (leucocyte function associated the disease entity and therefore, the adhesion profile may offer antigen-1: CD11a/CD18), VLA-4,5 (very late activated: additional information useful for differential diagnosis and study of disease pathogenesis. CD49d/CD29, CD49e/CD29); (3) the intercellular adhesion Keywords: B cell lymphoproliferative disorders; immunopheno- molecule-1 (ICAM-1: CD54) which belongs to the immuno- type; adhesion receptors globulin superfamily, as well as (4) the hyaluron binding pro- tein (homing receptor: CD44). Findings have been correlated to the various disease categories and clinical and laboratory Introduction features such as nodal status, pattern of bone marrow infil- tration, lymphocyte count and progressive vs stable disease. B cell lymphoproliferative disorders encompass a variety of disease entities which can be distinguished on clinical and laboratory features.1,2 Peripheral blood involvement is, as a Materials and methods rule, present in cases of primary leukemias and may be present in B cell non-Hodgkin’s lymphoma (B-NHL), parti- Patients and cell samples cularly in some subtypes such as splenic lymphoma of villous lymphocytes (SLVL) which almost always constantly evolve Peripheral blood cells from 56 patients with a B lymphopro- with leukemia.3 liferative disorder which included: 39 CLL; eight of which had In addition, the dissemination pattern may also differ within more than 10% circulating prolymphocytes (CLL/PL); four HCL, three typical and one HCL-variant and 13 cases of B cell NHL in leukemic phase (.5 × 109/l lymphoma cells) were analyzed. The diagnosis was based on clinical, morphological Correspondence: G Csanaky, Department of Pathology, Marku- sovszky Teaching Hospital, Szombathely, Markusovszky u.3, Hun- and immunological features according to the French–Amer- gary, H-9700 ican–British (FAB) Cooperative Group proposals.1 Received 18 October 1996; accepted 27 November 1996 The clinical data were obtained from the patient files of the Adhesion receptors in mature B cell leukemia/lymphomas G Csanaky et al 409 Royal Marsden Hospital, and a questionnaire was sent to Preparation of biotinylated L-selectin ligand analogs physicians of outside hospitals to collect the relevant clinical (b-PPME and b-fucoidin) data. CLL patients were staged according to Binet and Rai.4,5 The 39 CLL patients included 18 males and 21 females (M/F Amino-derivatives of L-selectin ligand17 analogs, polyphos- ratio: 18/21) with a median age of 64 years (range: 41–91); phomonester (PMME)18,19 and fucoidin20 were first produced the four HCLs were all males with a median age: 50 years as described elsewhere,21 then these derivatives were biotinyl- (range: 42–56); and the B-NHL included seven SLVL (M/F: 4/3, ated with the use of biotinyl-N-hydroxysuccinimide ester median age: 66 years, range: 40–74) and six patients with (BNHS) similarly to some biologically active proteins, such as 22 B-NHL which included four mantle zone, one follicular and antibodies, lectins or polypeptide hormones. one lymphoplasmocytic lymphoma (M/F: 1, median age: 63 Briefly, commercial fucoidin (Sigma, St Louis, MO, USA) years, range: 53–81). was treated with a protease, then dialyzed against running and Nodal involvement (number and site of the involved lymph distilled water. The final product of the dialysis was run to node areas) was graded as follows: G1: no lymph node Sepharose 4B gel filtration, and a high molecular-weight enlargement; G2: one node, or one group of lymph nodes in carbohydrate peak was collected. a localized area; G3: involvement of two or more sites con- The PPME preparation started by a mild acid hydrolysis of H. holstii phosphomannan, then saturated by barium hydrox- tiguous along pathways of lymphatic drainage and limited to ide, and the barium salt of high molecular weight PPME was one side of diaphragm (eg neck and axillae); G4: two or more precipitated by ethanol. After the removal of barium by a cat- noncontiguous sites of involvement on both sides of dia- ion exchange resin, a sodium salt was obtained. The acid phragm; and G5: generalized dissemination (bone marrow, hydrolysis resulted in a pentasaccharide phosphonoester spleen and liver involvement were not considered). (PENT) which was also isolated from the supernatant of bar- The histological patterns of bone marrow infiltration were ium precipitation. Prior reduction with sodium borohydride recorded as nodular, interstitial, mixed (nodular and and mild periodate oxidation, PPME and fucoidin were interstitial) and diffuse. The degree of lymphocytosis was derivatized with hexanediamine. × 9 regarded as high when there were over 50 10 /l circulating The b-PPME and b-fucoidin were produced as follows: lymphocytes; lymphocyte doubling time (LDT) less than 12 20 mg of the amino-derivatives of PPME/fucoidin were dis- months was considered a bad prognostic indicator; anemia solved in 550 ml phosphate-buffered saline (PBS), and 10 mg , , × 9 (Hb 11 g/dl) and thrombocytopenia (platelets 100 10 /l) of BNHS in 200 ml dimethyl-sulfoxide (DMSO). Both solutions were also recorded. The progressive or non-progressive nature were mixed at room temperature, and the mixture was incu- of the disease was determined, considering if the patient bated overnight, then precipitated with three volumes of 95% required treatment for active disease. ethanol, and incubated again for 20 min at −20°C, decanted Peripheral blood mononuclear cells (PBMCs) were isolated and the precipitate was repeatedly washed with ethanol, cen- by Ficoll–Hypaque gradient centrifugation from samples trifuged and dried.