Cytokine Gene Expression in a Case of B-Cell Chronic Lymphocytic Leukemia (B-CLL) With an Unusual Expansion of T Cells at Presentation
We present a case of a 60 year old male with lymphadenopathy, hepatosplenomegaly and leucocytosis with lymphocytosis. At presentation, his WBC was 15.1x109/L with 75% lymphocytes; these were mainly T-cells with an atypical morphology, and a small monoclonal population of B cells, κ type. RT-PCR of immunoglobulin genes showed a monoclonal rearrangement of the IgM type. Elf-1, bcl-2, IL-1α and ß, IL-2, IL-4 and IL-6 genes were constitutively expressed to varying degrees, and superinduced upon mitogenic stimulation of the cells. Bandshifts with the lymphotropic transcription factors NF-kB, AP-1 and NF-AT, gave profiles typical of the T-cell leukemia Jurkat and not of normal (ex-vivo) T-cells or B-CLL cells, ex-vivo or stimulated. Bone marrow histology revealed a diffuse infiltration of lymphocytes, and immunohistochemistry on bone marrow sections the presence of both B and T-cells in almost equal proportions. At this stage a double (T/B) CLL was suspected. The patient was treated with alkylating agents and went into remission. Three months later, and while still on drugs, the patient’s WBC was found to be 5.43x109/L and immunophenotyping revealed a complete change of his T/B cell ratio. RT-PCR showed that the patient’s CD2 cells expressed none of the above genes but IL-4 when induced, and his CD19 cells IL-6 and IL-1ß when induced. The expreddion of IgM remained monoclonal, confirming the clinical observation of B leukemia development.
KeywordsGlycerol Lymphoma EDTA Leukemia Agarose
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