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Peripheral blood lymphoid cells of 29 patients with acute lymphocytic leukaemia (ALL) at onset were studied for characterization of B and T membrane markers and phytohaemagglutinin responsiveness. 24 cases (83%) were classified as "null" cell ALL and 5 (17%) as T-cell ALL. No relationship could be found between cytological presentation and immunological classification. Moreover, no correlation has been demonstrated between clinical-immunological parameters and prognosis, indicating that in our series of patients, assessment of cell size and surface markers were not a reliable predictor of prognosis.

In this retrospective multicentric study, we report on early deaths (ie, those that occurred during the first month of treatment) in a total of 943 newly diagnosed ALL pediatric patients registered from 1976 to 1981 at 21 centers of the AIL- AIEOP . Objectives of this study were as follows: (1) to verify the incidence and the cause of early death in a wide population of children with ALL and (2) to elucidate factors associated with early death and therefore to identify "high-risk" groups of patients. Out of the 943 ALL patients, 39 (4.1%) early deaths were registered. Main causes were infection, 20 patients (51.3%); hemorrhage, 11 patients (28.3%); uric acid nephropathy, 2 patients (5.1%); cardiac failure, 3 patients (7.6%); syndrome of inappropriate antidiuretic hormone secretion, 1 patient. Two patients died during the first week of unknown cause. Thirteen factors measured at diagnosis and possibly influencing the early death rate were analyzed. Using the chi-square test, only three of these factors (age, mediastinum status, surface markers) appear to have any significant influence on the early death rate. We also tried to determine how therapy influences this process by analyzing variations in the early death rate, other factors being equal. Significant differences in the early death rates were encountered in AIEOP protocols using different induction regimens.

In 22 patients with ALL in first complete remission, who discontinued therapy after 3 years, longitudinal follow-up of immunological reconstitution was investigated by assessing serum immunoglobulin levels, number and mitogen responsiveness of B and T lymphocytes. Major modifications have been demonstrated for T cells both in terms of number and functionality, while B cells and serum immunoglobulins did not change significantly. Examining the behaviour of the patients one by one, it has been observed that recovery is often characterized by a remarkable rebound occurring from the 15th to the 18th month. Immunosuppression induced by antileukemic treatment appeared to be a transitory phenomenon, mainly limited to the first three months. Reconstitution was achieved, in almost all cases, within one year after treatment was stopped.

Three patients with acute lymphoblastic leukemia (ALL) and heterozygous for the Mediterranean variant of glucose-6-phosphate dehydrogenase (G6PD) have been investigated with the 2-deoxyglucose-6-phosphate (2dG6P) method to determine the number and type of progenitor cells in which the disease arose. A monoclonal origin was established for the lymphoblasts, while the other hemopoietic cell lines were not involved in the leukemic process.

A long-term culture of bone marrow lymphoblasts in a case of unclassified acute lymphoblastic leukemia is described. Cells lacking any lymphocytic marker in the early phase of the culture were gradually substituted by B cells showing a pattern of polyclonality. The culture supernatant contained high levels of immunoglobulins also showing interleukin 2 activity. Search for antigens related to the Epstein-Barr virus was negative. A clonal expansion of B cells versus spontaneous differentiation of unclassified leukemic cells is discussed; the long-term culture technique as a tool for a better evaluation of leukemic cells is suggested and discussed.