Abstract
A patient with asymptomatic chronic lymphocytic leukemia (CLL) and only moderate lymphocytosis has been followed for 2.5 years. Originally, surface membrane markers and response to T-cell mitogens (phytohemagglutinin, concanavalin A, A23187) indicated a T-cell neoplasm. Over time, these T-cell properties were gradually lost [e.g., cells forming sheep erythrocyte (E) rosettes decreased from 77 to 16%]. Concomitantly, an expanding chromosomally abnormal clone, including a 14q + marker, became demonstrable in peripheral blood cultures stimulated by T-cell mitogens. There has been no change in clinical course nor in the morphology of the circulating lymphocytes. The results indicate that membrane markers and chromosome patterns can change during the course of CLL, presumably reflecting the emergence of new subpopulations during clonal evolution of the disease. In this instance, clinical progression has not occurred simultaneously, and additional data are needed to determine the prognostic value of such longitudinal studies.
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