A combined morphological and metabolic study has been made of the lymphoid cells in the blood during the immune response in man. Similar changes were observed in both primary and secondary responses to a number of different microbial antigens. The cellular response involved an increase in numbers of three types of cell; hyperbasophilic medium lymphocytes, plasma cells, and large lymphoid cells. The large lymphoid cells were about 20 µ in diameter with large nuclei, prominent nucleoli, and an intensely basophilic cytoplasm with numerous polyribosomes. About 30% of these cells were in the DNA synthetic phase of cell growth. Electron microscopy has shown that many of the basophilic medium-sized cells have sufficient well-organized endoplasmic reticulum to be included in the plasma cell series. The hyperbasophilic cells labeled more heavily with tritiated uridine and tritiated leucine than the normal small and medium lymphocytes from the peripheral blood of patients not under antigenic stimulation.
The evidence in this paper supports the argument that the atypical mononuclear cells first described by Türk and others in the blood of patients with infections are immunoblasts, plasma cells, and other reactive lymphoid cells representing a circulating population of lymphoid cells derived from lymphoid tissue responding to antigenic stimulation. The presence of such cells may be a valuable indication that an immunological reaction is in progress when direct proof is lacking.
Lymphopenia and monocytosis were found in one third of untreated myeloma patients but there was no correlation between the two. Half of the patients studied had an increase in medium basophilic lymphoid cells, and eight had a raised PAS score. Lymphocytes from the majority of untreated myeloma patients failed to respond to antigenic stimulation in vitro compared with age matched controls. Three patients were immunized but showed no increase in immunoblasts or rise in antibody titre. The findings strongly suggest that abnormal lymphocytes are present in the blood in myeloma. The failure of lymphocytes to respond to antigen provides an explanation for the lack of normal plasma cells and depressed antibody responses in myeloma.
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