Immunologic Approaches to the Classification and Management of Lymphomas and Leukemias

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1 Immunologic Approaches to the Classification and Management of Lymphomas and Leukemias

2 Cancer Treatment and Research WILLIAM L MCGUIRE, series editor Livingston RB (ed): Lung Cancer ISBN Humphrey G Bennett, Dehner LP, Grindey GB, Acton RT (eds): Pediatric Oncology ISBN DeCosse 11, Sherlock P (eds): Gastrointestinal Cancer ISBN Bennett 1M (ed): Lymphomas 1, including Hodgkin's Disease ISBN Bloomfield CD (ed): Adult Leukemias ISBN Paulson DF (ed): Genitourinary Cancer ISBN Muggia FM (ed): Cancer Chemotherapy 1. ISBN Humphrey G Bennett, Grindey GB (eds): Pancreatic Tumors in Children ISBN Costanzi 11 (ed): Malignant Melanoma ISBN Griffiths CT, Fuller AF (eds): Gynecologic Oncology ISBN Greco AF (ed): Biology and Management of Lung Cancer ISBN Walker MD (ed): Oncology of the Nervous System ISBN Higby Dl (ed): Supportive Care in Cancer Therapy ISBN Herberman RB (ed): Basic and Clinical Tumor Immunology ISBN Baker LH (ed): Soft Tissue Sarcomas ISBN Bennett 1M (ed): Controversies in the Management of Lymphomas ISBN Humphrey G Bennett, Grindey GB (eds): Adrenal and Endocrine Tumors in Children ISBN DeCosse 11, Sherlock P (eds): Clinical Management of Gastrointestinal Cancer ISBN Catalona WI, RatliffTL (eds): Urologic Oncology ISBN Santen RJ, Manni A (eds): Diagnosis and Management of Endocrine-Related Tumors ISBN Costanzi 11 (ed): Clinical Management of Malignant Melanoma ISBN X. Wolf GT (ed): Head and Neck Oncology ISBN Alberts DS, Surwit EA (eds): Ovarian Cancer ISBN Muggia FM (ed): Experimental and Clinical Progress in Cancer Chemotherapy ISBN Higby DJ (ed): The Cancer Patient and Supportive Care ISBN X. Bloomfield CD (ed): Chronic and Acute Leukemias in Adults ISBN Herberman RB (ed): Cancer Immunology: Innovative Approaches to Therapy ISBN Hansen HH (ed): Lung Cancer: Basic and Clinical Aspects ISBN Pinedo HM, Verweij 1 (eds): Clinical Management of Soft Tissue Sarcomas ISBN Higby DJ (ed): Issues in Supportive Care of Cancer Patients ISBN Surwit EA, Alberts DS (eds): Cervix Cancer ISBN lacobs C (ed): Cancers of the Head and Neck ISBN MacDonald IS (ed): Gastrointestinal Oncology ISBN RatliffTL, Catalona WI (eds): Genitourinary Cancer ISBN Nathanson L (ed): Basic and Clinical Aspects of Malignant Melanoma ISBN Muggia FM (ed): Concepts, Clinical Developments, and Therapeutic Advances in Cancer Chemotherapy ISBN Frankel AE (cd): Immunotoxins ISBN Bennett 1M, Foon KA (eds): Immunologic Approaches to the Classification and Management of Lymphomas and Leukemias ISBN

3 Immunologic Approaches to the Classification and Management of Lymphomas and Leukemias edited by JOHN M. BENNETT University of Rochester Cancer Center Rochester, New York USA and KENNETH A. FOON Department of Internal Medicine University of Michigan Ann Arbor, Michigan USA KLUWER ACADEMIC PUBLISHERS BOSTON / DORDRECHT / LANCASTER."

4 Distributors for North America: Kluwer Academic Publishers, 101 Philip Drive, Assinippi Park, Norwell, MA 02061, USA for the UK and Ireland: Kluwer Academic Publishers, Falcon House, Queen Square, Lancaster LAI lrn, UK for all other countries: Kluwer Academic Publishers Group, Distribution Centre, P.O. Box 322, 3300 AH Dordrecht, The Netherlands Library of Congress Cataloging in Publication Data Immunologic approaches to the classification and managment of lymphomas and leukemias I edited by John M. Bennett and Kenneth A. Foon. p. cm. - (Cancer treatment and research) Includes bibliographies and index. ISBN-13: e-isbn-13: DOl: / Lymphomas-Immunological aspects. 2. Leukemia-Immunological aspects. 3. Lymphomas-Classification. 4. Leukemia- Classification. 5. Immunodiagnosis. 6. Antibodies, Monoclonal- Therapeutic use. I. Bennett, John M., II. Foon, Kenneth A. III. Series. [DNLM: 1. Leukemia-classification. 2. Leukemia-therapy. 3. Lymphoma-classification. 4. Lymphoma-therapy. WI CA693/WH ] RC280.L9L ' dc DNLM/DLC for Library of Congress Copyright 1988 by Kluwer Academic Publishers Softcover reprint of the hardcover 1 st edition 1988 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publishers, Kluwer Academic Publishers, 101 Philip Drive, Assinippi Park, Norwell, MA 02061, USA.

5 Table of Contents Foreword to the Series Preface List of Contributors Vll ix Xl 1. Immunologic approaches to the classification of lymphomas and lymphoid leukemias K.A. FOON, R.P. GALE, and R.F. TODD III 1 2. Immunologic approaches to the classification of non-hodgkin's lymphomas T.M. GROGAN, C.M. SPIER, L.C. RICHTER, and C.S. RANGEL Detection of central nervous system involvement in patients with leukemia or non-hodgkin's lymphoma by immunological marker analysis of cerebrospinal fluid cells H. HOOIJKAAS, H.l. ADRIAANSEN, and 1.1.M. VAN DONGEN Detection of residual disease in acute leukemia using immunological markers D.H. RYAN and 1.1.M. VAN DONGEN Radioimmunoscintigraphy of lymphoma with monoclonal antibodies 1.A. CARRASQUILLO and S.M. LARSON Radiolabeled antibodies in Hodgkin's disease S.E. ORDER Interferon therapy for lymphoproliferative disorders M.S. ROTH, P.A. BUNN, and K.A. FOON 231

6 VI 8. Monoclonal antibody therapy of lymphomas and leukemia M.S. KAMINSKI and K.A. FOON Autologous bone marrow transplantation in acute leukemia and lymphoma following ex vivo treatment with monoclonal antibodies and complement A.S. FREEDMAN, T. TAKVORIAN, L.M. NADLER, K.C. ANDERSON, S.E. SALLAN, and J. RITZ 265 Index 285

7 Cancer Treatment and Research Foreword Where do you begin to look for a recent, authoritative article on the diagnosis or management of a particular malignancy? The few general oncology textbooks are generally out of date. Single papers in specialized journals are informative but seldom comprehensive; these are more often preliminary reports on a very limited number of patients. Certain general journals frequently publish good indepth reviews of cancer topics, and published symposium lectures are often the best overviews available. Unfortunately, these reviews and supplements appear sporadically, and the reader can never be sure when a topic of special interest will be covered. Cancer Treatment and Research is a series of authoritative volumes which aim to meet this need. It is an attempt to establish a critical mass of oncology literature covering virtually all oncology topics, revised frequently to keep the coverage up to date, easily available on a single library shelf or by a single personal subscription. We have approached the problem in the following fashion. First, by dividing the oncology literature into specific subdivisions such as lung cancer, genitourinary cancer, pediatric oncology, etc. Second, by asking eminent authorities in each of these areas to edit a volume on the specific topic on an annual or biannual basis. Each topic and tumor type is covered in a volume appearing frequently and predictably, discussing current diagnosis, staging, markers, all forms of treatment modalities, basic biology, and more. In Cancer Treatment and Research, we have an outstanding group of editors, each having made a major commitment to bring to this new series the very best literature in his or her field. Kluwer Academic Publishers has made an equally major commitment to the rapid publication of high quality books, and world-wide distribution. Where can you go to find quickly a recent authoritative article on any major oncology problem? We hope that Cancer Treatment and Research provides an answer. WILLIAM L. MCGUIRE Series Editor

8 Preface Within the past decade advances in immunology have led to the identification of precise stages of lymphocyte differentiation: of both Band T subsets. Classifications of lymphoma, strictly on an immunologic basis, now parallel the more traditional morphologic schemes. Molecular probes that identify immunoglobulin gene rearrangement and T-cell receptor genes are readily available. Highly specific monoclonal antibodies, defining cell surface antigens, can be utilized for 'marrow purging' prior to autologous transplantation and for specific therapy, either alone or coupled with drugs, toxins, or radionuclides. In this volume we have addressed major diagnostic and therapeutic issues that confront investigators in the 1980s. We have focused on disorders of lymphocytes because of the explosive knowledge that has developed in this important arena of oncology. In Chapter 1, Foon, Gale, and Todd provide the latest information on the monoclonality of lymphomas and leukemias of lymphoid origin. The nomenclature refers to clusters of differentiation (CD) whenever possible. The tables are of major help in providing investigators with guidelines for classification purposes. Chapter 2, by Grogan and coworkers at Arizona, represents a monumental and successful effort to define all of the non Hodgkin's lymphomas by immunophenotype. It serves as a valuable resource for experimental and clinical pathologists. Hooijkaas and associates in Chapter 3, have provided an excellent overview of the power of detection of CNS involvement by neoplastic cells in lymphomas and leukemias. Their discussion includes the traditional morphologic approaches (cytocentrifuge), immunologic marker analysis, cytogenetics, flow cytometry, and gene rearrangements. The problem of overinterpretation of CALLA + cells is emphasized. TdT reactivity appears to be an important, if not necessary, ingredient of CNS involvement with lymphoid cells. Clearly, morphologic techniques have great limitation in being able to detect significant numbers of residual malignant cells in marrow aspirates. Can immunologic markers be utilized in 'early detection'? In Chapter 4, Ryan and van Dongen present data to suggest that detection of a leukemic cell burden of 10 9 cells may be possible. Assay systems include TdT and CD 10 (CALLA). Of interest is a comparison of techniques in both Rochester

9 x and Rotterdam suggesting that a double immunoflourescence assay may be more sensitive than a flow cytometry assay. In Chapter 5, Carrasquillo and Larson from NIH have brought their considerable radiological skills together with an informative treatise on a new diagnostic field, radioimmunoscintigraphy (RIS). The most widely used antibody has been TIOl for imaging T-cell lymphomas with a high specificity. The potential for using therapeutic isotopes (1 131 ) is discussed. Intravenous as well as intralymphatic injections are presented. The second half of our volume begins with a compact presentation by Professor Order (Chapter 6) on the first successful treatment of Hodgkin's disease with radiolabeled antibodies. A new concept of a 'biologic window' is presented. Utilizing 30 mci of antiferritin, 40% of refractory patients responded. Potential successor treatments with 90-Yttrium antiferritin and autologous marrow rescue are presented. In Chapter 7, a concise review of the status of interferon treatment for lymphoproliferative disorders is presented by Roth, Foon, and Bunn. In addition, the recent success of interferons in certain myeloproliferative diseases is highlighted. Considerable information is provided on mechanisms of action of the various interferon species. Kaminski and Foon, in Chapter 8, elaborate the several different types of monoclonal antibodies that have had demonstrable activity in clinical trials. Anti-idiotype as well as more general antibodies are discussed, including the problems and toxicities associated with such therapy. One final chapter (9), by Freedman and coworkers from the Dana-Farber Cancer Institute, provides an excellent overview of the current status of autologous bone marrow transplantation with in vitro treatment of bone marrow with 'J5 and J2' monoclonal antibodies. Survival data indicate an approximate 30% disease-free survival at five years, similar to allogeneic results. Similar studies with anti-bl antibody for relapsed non-hodgkin's lymphoma patients are presented as well. Preliminary results for the treatment of refractory AML appear promising. John M. Bennett Kenneth A. Foon editors

10 List of contributors ANDERSON, KC, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA ADRIAANSEN, HJ, Department of Immunology, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands BUNN, PA, Division of Medical Oncology, University of Colorado Health Science Center, 4200 East 9th Avenue, Denver, CO CARRASQUILLO, JA, Bldg 10, Room lc490, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD FOON, KA, Division of Clinical Immunology, State University of New York at Buffalo, Roswell Park Memorial Institute, 666 Elm Street, Buffalo, NY FREEDMAN, AS, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA GALE, RP, University of California, Center for Health Sciences, Los Angeles, CA GROGAN, TM, Department of Pathology, University of Arizona, Tucson, AZ HOOIJKAAS, H, Department of Immunology, Academic Hospital Rotterdam Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands KAMINSKI, M, Division Hematology/Oncology, University of Michigan, Ann Arbor, MI LARSON, SM, Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD NADLER, LM, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA ORDER, SE, The Johns Hopkins Oncology Center, Department of Radiation Oncology, Baltimore, MD RANGEL, CS, Department of Pathology, University of Arizona, Tucson, AZ RICHTER, LC, University of Arizona, Pathology Department, Tucson, AZ RITZ, J, Dana-Farber Cancer Institute, Division Tumor Immunology, 44 Binney Street, Boston, MA 02115

11 XII ROTH, MS, Simpson Memorial Institute, University of Michigan, Ann Arbor, MI RYAN, DH, Pathology/Lab Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY SALLAN, SE, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA SPIER, CM, Department of Pathology, University of Arizona, Tucson, AZ TAKVORIAN, T, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA TODD, RF III, Simpson Memorial Institute, 102 Observatory, Ann Arbor, MI48109 VAN DONGEN, JJM, Department of Immunology, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands

12 Immunologic Approaches to the Classification and Management of Lymphomas and Leukemias