One hundred and twenty-nine patients with chronic lymphocytic leukemia (CLL) followed in our outpatient department for periods ranging from 6 months to 13 years were divided into five anatomico-clinical stages: stage 0 (peripheral and bone marrow lymphocytosis); stage I (stage 0 + lymph node enlargement); stage I1 (stage 0 + palpable spleen); stage 111 (stage I + 11); and stage IV (anemia or thrombocytopenia) . Analysis of actuarial survival curves revealed the following: 1) median survival of the entire population exceeded 114 months; 2) there was no difference between the curves of stage 0 and stage I patients, 3) there was a significant difference between survival for stage 111 and IV patients as compared with stages 0, I and I1 (p < 0.01); and 4) median survival for stage I11 and stage IV was 70 months; and 23 months, respectively. Age did not appear to be a prognostic factor. Prognosis was poorer in male patients and in those with a high initial lymphocyte count (50,000/mma), but this was due to the higher incidence of stages 111 and IV in this population ( p <

Reduced PBMC susceptibility to HIV-1 infection was associated with resistance to infection in exposed uninfected IDU. Distinct mechanisms are involved in in-vitro resistance and may contribute to the apparent protection from HIV-1 transmission in this systemically exposed population.

To define the medical characteristics of intravascular drug users in Ho Chi Minh City, Vietnam, we examined 280 men, of whom 235 were infected with human immunodeficiency virus (HIV), being treated in a rehabilitation center. The patients used mainly opium, often in shooting galleries (50%). The prevalence of oral candidiasis (58%) and zoster infection (20%) was high in HIV-seropositive patients, whereas oral hairy leukoplasia and Kaposi's sarcoma were absent. The prevalence of acquired immunodeficiency syndrome was 24%. More than 80% of the patients had infections with hepatitis C virus, hepatitis B virus, cytomegalovirus, or human T cell lymphotropic virus type-1. The CD4ϩ cell counts correlated well with viral load. Only HIV-1 subtype E was detected in the 30 patients tested. A cohort study of HIV-infected subjects in this population seems feasible, and would permit introduction of anti-retroviral therapy The large number of HIV-seronegative subjects sharing the same at-risk practices as the HIV-infected subjects raises the possibility of natural protection in this population.

Chronic lymphocytic leukemia (CLL) and normal human blood lymphocytes were investigated with regard to their membrane-associated light (L) chains. Peroxidase-labeled anti-kappa or anti-lambda antibodies were used to visualize by light microscopy the cells bearing L chain determinants. In addition, the activity of the enzyme coupled to the antibody was measured spectrophotometricly in order to determine the number of antigenic determinants on each positive cell. The results demonstrated that 16%-25% of lymphocytes from six normal control subjects were positive for kappa chains, and 4%-10% were positive for lambda chains. The average number of antigenic sites on the surface of each positive cell was calculated to be 90,000. Lymphocytes of each of the 14 CLL patients studied carried either kappa or lambda antigenic determinants on their surface, but not both; 50%-70% of the lymphocytes were stained. The average number of antigenic sites per positive CLL was calculated to be 9000. These results confirm previously reported studies indicating that CLL is a monoclonal proliferative disease. In addition, the quantitative results demonstrate that the CLL lymphocyte surface membrane bears, on the average, only 10% of the L chain determinants present on the normal lymphocyte.

We have recently proposed a new staging system for chronic lymphocytic leukaemia (CLL) in which patients with isolated splenomegaly are classified into a distinct stage (stage II). Twenty-three such patients (from two institutions) have been studied without recorded death in a follow-up of 18 months to 30 years. This favourable prognosis justifies separation of these 'pure splenic forms' (SCLL) which must be distinguished from what Galton has termed prolymphocytic leukaemia (PL). This distinction can be made on the basis of three criteria: (i) Clinically, SCLL has a slow uneventful course and neither anaemia and/or thrombocytopenia: (ii) cytologically PL can be distinguished from other forms of CLL though atypical forms of CLL may be confused with the former; and (iii) the study of surface membrane immunoglobulins (SmIg) showed that while lymphocytes from most patients with both PL and SCLL bore uniform SmIg, suggesting a monoclonal B-cell proliferation, there was a major quantitative difference in that whereas PL lymphocytes had a number of antigenic sites close to that of normal lymphocytes (mean: 82 000 sites per cell), SCLL lymphocytes had a drastically reduced number of sites. It is our opinion that this is an important criterion for the differential diagnosis between PL and SCLL.