Prednisolone Sensitivity and Cytology of Viable Lymphocytes as Tests for Chronic Lymphocytic Leukemia2

Abstract

The sensitivity in vitro of blood lymphocytes to prednisolone (11β,17,21 -trihydroxypregna-1,4-diene-3,20-dione) is proposed as a diagnostic aid in chronic lymphocytic leukemia. Tests were done on 31 patients with chronic lymphocytic leukemia or lymphosarcoma in leukemic phase, on 11 patients with absolute lymphocytosis, and on 50 control persons with normal hemograms. For the test, purified suspensions of blood lymphocytes were incubated with and without prednisolone (1 μg/ml) for 7 days. The number of viable lymphocytes were counted in the suspensions before and after incubation. The sensitivity of the lymphocytes was expressed by the percent effect produced by the prednisolone on the number of viable lymphocytes after 7 days of incubation. Tests showing 60 percent effect or more were considered positive and less than 40 percent negative. Positive tests were obtained in 25 of 31 patients with leukemia, in 2 of 11 patients with lymphocytosis, and in none of 50 individuals with normal hemograms. Negative tests were obtained in 3 of 31 patients with leukemia, in 44 of 50 control individuals, and in 8 of 11 patients with lymphocytosis. It is concluded that a positive sensitivity test indicated leukemic lymphocytes but a negative test did not exclude leukemia. Certain cytologic abnormalities seen by phase microscopy in viable lymphocytes before and after incubation were considered as indicative of leukemia. These abnormalities included prominent chromatin masses adherent to the nuclear wall, large, dark nucleoli, irregularity in the shape of cells, and thin, elongated cytoplasmic projections. These cytologic characteristics were present in most cells of 21 of 31 leukemic patients, in 2 of 11 patients with lymphocytosis, and in none of the control individuals.