Lymphocytes from nineteen patients with chronic lymphocytic leukemia and two with lymphosarcoma with transformation to leukemia had membrane‐bound Ig, showing restriction for Ig class, IgG subclass, Gm allotype, and light chain class. IgM was found on cells from all patients except one, who had IgG. These data, together with results from lymphocyte stimulation in vitro with mitogens, and studies of rosette formation with sheep erythrocytes, suggested that tumor cells were products of monoclonal proliferation of B cells. Lymphocytes in chronic lymphocytic leukemia stained with concanavalin A and with antilymphocyte antiserum as strongly as normal lymphocytes. Lymphocytes from patiems with lymphosarcoma of the bone marrow or aleukemic chronic lymphocytic leukemia usually had a normal percentage of B lymphocytes in blood, but a tendency to restriction to one Ig class on B lymphocytes was seen, Blast cells from patients with acute lymphoblastic leukemia did not have membrane‐bound Ig. Lymphocytes from patients with lymphosarcoma of the bone marrow or aleukemic chronic lymphocytic leukemia and from those with acute lymphoblastic leukemia, reacted normally on stimulation in vitro with T lymphocyte mitogens.

We report 11 years experience with a modified version of a chemotherapy programme in use at the MRC Leukaemia Unit from 1982 to 1984, supplemented by allogeneic bone marrow transplantation in first relapse or second or later remission from 1985. 79 consecutive patients aged 15-60 years with newly diagnosed acute lymphoblastic leukaemia (ALL) were given induction chemotherapy. This included a standard DAT course (daunorubicin, cytarabine and thioguanine) applied as in acute myelogenous leukaemia approximately midway in the induction programme. A 3-year rotating maintenance programme consisted of combinations of cytotoxic drugs used in the induction therapy. CNS prophylaxis did not include CNS irradiation. Allogeneic BMT was not performed in first remission. The overall complete remission (CR) rate was 82% (65/79). 26 patients relapsed (seven first in the CNS). Seven patients underwent allogeneic BMT of whom six are alive and well with a mean observation time of 32 months (range 4-99 months) after transplantation. Three patients died in first CR. Estimated 5- and 8-year overall survival was 51% (95% confidence interval (CI) 39-63) and 47% (CI 33-61). For patients who reached CR, the corresponding figures were 63% (CI 50-76) and 57% (CI 41-73). Estimated disease-free survival in the remitters was 54% (CI 40-68) at 5 years and 44% (CI 28-60) at 8 years. Patient age below 25 years and white cell count below 15 x 10(9)/l at presentation were both found to improve the chance of overall survival.

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