Blood, 1960, Vol. 15, No. 1, pp. 114-129.
© 1960 American Society of Hematology, Inc.
Relation of Bone Marrow Findings to Serum Protein
Changes in Lymphosarcoma, Chronic Lymphocytic
Leukemia and Hodgkin’s Disease
ALTAN ONAT 1 and
TALBERT COOPER 1
1 Mayo Clinic and Mayo Foundation, Rochester, Minn.
In order to correlate the electrophoretic alterations in the serum proteins and
the findings in the bone marrow, with particular reference to atypical lymphocytic forms and plasma cells, 14 cases of lymphosarcoma, six of chronic
lymphocytic leukemia and six of Hodgkin’s disease were studied. No numerical
relationship could be found between the degree of lymphoid atypia and the
changes in serum globulin. A correlation, however, was apparent between the
plasma cell concentration in the bone marrow and the changes in the serum
gamma globulin, inasmuch as pronounced hypergammaglobulinemia occurred
in all four cases of malignant lymphoma associated with bone marrow plasmacytosis (ranging from 2.8 to 12.8 per cent) and hypogammaglobulinemia of
moderate to marked degree was present in five of the six cases of malignant
lymphoma in which plasma cells were virtually absent in the bone marrow.
When the findings of the fixed sections of the marrow are included, plasmacytosis was demonstrated in bone marrow in eight of 10 cases in which
serum gamma globulins were elevated.
In two cases, serum globulins were qualitatively abnormal. In one, a case
(case 15) of Hodgkin’s disease, a small fraction of electrophoretically homogeneous globulin was noted. In the other, case 5, in which the histologic diagnosis was lymphocytic lymphosarcoma, macroglobulins constituted 40 per cent
of the serum proteins, and Bence Jones proteinuria was associated. Predominantly mature plasmacytosis of 12.8 per cent was present in the bone
marrow. This case may be regarded as illustrative of the interrelationship between myeloma and lymphosarcoma and supports the view21 that, clinically
and morphologically, transitional forms occur between lymphatic tumors and
plasmacytomas.
On the basis of this material, it is suggested that in cases of lymphosarcoma,
Hodgkin’s disease and chronic lymphocytic leukemia, alterations in the plasma
content of the bone marrow, either as reactive plasmacytosis or as virtual
absence of plasma cells, appear to be a major pathogenetic factor in the occurrence of hypergammaglobulinemia and hypogammaglobulinemia, respectively.
Hypogammaglobulinemia was observed in three of six cases of chronic
lymphocytic leukemia; two of 14 cases of lymphosarcoma; and one of six
classified as Hodgkin’s disease. Conversely, quantitative increases in the gamma
globulin level occurred in none of the six cases of chronic lymphocytic leukemia; in six of 14 cases of lymphosarcoma (including two of three classified as
lymphosarcoma, reticular cell type), and in three of the six cases of Hodgkin’s
disease.
Submitted on March 5, 1959
Accepted on July 11, 1959
