Search

On the basis of the retrospective analysis of 405 patients, suggesting the clinical relevance of the Kiel classification of non-Hodgkin lymphomas (NHL), a prospective multicenter study was started on October 1st, 1975, by the Kiel Lymphoma Study Group in order to further clarify the clinical and prognostic features of the different lymphoma entities defined by this histopathologic scheme. Diagnostic protocol provides initial staging evaluation according to a modification of the Ann Arbor classification. Therapeutic approach is based on the hypothesis that, like Hodgkin's disease, NHL originate, at least in part, as localized lymphatic or extralymphatic tumors. Thus, extended field irradiation is performed in stages I and II (except for lymphoblastic lymphoma in children and young adults) whereas in the more advanced stages III and IV (except for stage III of centroblastic-centrocytic lymphoma) chemotherapy with additional radiotherapy is applied. Until June 1979, 815 patients entered the study (69.7% with NHL of low-grade malignancy). For the interim evaluation underlying the present and the other papers of this series data of 511 patients were available. Survival of patients with NHL of low-grade malignancy significantly exceeds that of patients with NHL of high-grade malignancy. NHL with good prognosis such as chronic lymphocytic leukaemia and centroblastic-centrocytic lymphoma can be differentiated from NHL with a poor course such as lymphoblastic and immunoblastic lymphomas. In addition, the existence of a third group with an intermediate prognosis comprising centrocytic and centroblastic lymphomas and, possibly, also LP immunocytoma is suggested. However, different initial slope of survival curves shows that this latter group of NHL is not homogeneous with regard to prognosis.

Peripheral blood cells from patients with acute leukaemia were stimulated in RPMI-medium with Phytohaemagglutinin (PHA) and/or Pokeweed-Mitogen (PWM). Samples of the cultures were taken at 3, 5 and 7 day intervals for cytological characterization. From 119 cultures from 65 patients 76 cultures from 47 patients could be analysed. Cultures stimulated with PHA and/or PWM showed in 43,4% a higher stimulation rate in comparison with cultures from normal persons. These findings are discussed in relation to the increased agar-colony growth of leukaemic cells after in vitro PHA-stimulation and transformation of blast cells.

Blood cells from 68 patients with untreated acute myeloid luekemia were cultured in RPMI-medium without stimulating factors up to ten days. The cultures showed in part maturation and proliferation to monocytes-macrophages, in part to promyelocytes, myelocytes and Pelger-like cells, in part we did not find any differentiation or the cultures were degenerated during the first days. Retrospectively we found that in the 16 blood cell cultures with capacity to differentiation into the monocyte-macrophages-system 5 patients had a smouldering leukemia. Our preliminary evidences suggest that the diagnosis "smouldering leukemia" is to be found with out in vitro culture system. Further analysis suggest that patients with acute leukemia whose blood cells have the capacity for maturation to monocytes-macrophages or to promyelocytes, myelocytes and Pelger-like cells have a better chance of achieving a complete remission and a longer median survival time.