Relation of Bone Marrow Findings to Serum Protein Changes in Lymphosarcoma, Chronic Lymphocytic Leukemia and Hodgkin’s Disease

In order to correlate the electrophoretic alterations in the serum proteins and the findings in the bone marrow, with particular reference to atypical lymphocytic forms and plasma cells, 14 cases of lymphosarcoma, six of chronic lymphocytic leukemia and six of Hodgkin’s disease were studied. No numerical relationship could be found between the degree of lymphoid atypia and the changes in serum globulin. A correlation, however, was apparent between the plasma cell concentration in the bone marrow and the changes in the serum gamma globulin, inasmuch as pronounced hypergammaglobulinemia occurred in all four cases of malignant lymphoma associated with bone marrow plasmacytosis (ranging from 2.8 to 12.8 per cent) and hypogammaglobulinemia of moderate to marked degree was present in five of the six cases of malignant lymphoma in which plasma cells were virtually absent in the bone marrow. When the findings of the fixed sections of the marrow are included, plasmacytosis was demonstrated in bone marrow in eight of 10 cases in which serum gamma globulins were elevated.

In two cases, serum globulins were qualitatively abnormal. In one, a case (case 15) of Hodgkin’s disease, a small fraction of electrophoretically homogeneous globulin was noted. In the other, case 5, in which the histologic diagnosis was lymphocytic lymphosarcoma, macroglobulins constituted 40 per cent of the serum proteins, and Bence Jones proteinuria was associated. Predominantly mature plasmacytosis of 12.8 per cent was present in the bone marrow. This case may be regarded as illustrative of the interrelationship between myeloma and lymphosarcoma and supports the view²¹ that, clinically and morphologically, transitional forms occur between lymphatic tumors and plasmacytomas.

On the basis of this material, it is suggested that in cases of lymphosarcoma, Hodgkin’s disease and chronic lymphocytic leukemia, alterations in the plasma content of the bone marrow, either as reactive plasmacytosis or as virtual absence of plasma cells, appear to be a major pathogenetic factor in the occurrence of hypergammaglobulinemia and hypogammaglobulinemia, respectively.

Hypogammaglobulinemia was observed in three of six cases of chronic lymphocytic leukemia; two of 14 cases of lymphosarcoma; and one of six classified as Hodgkin’s disease. Conversely, quantitative increases in the gamma globulin level occurred in none of the six cases of chronic lymphocytic leukemia; in six of 14 cases of lymphosarcoma (including two of three classified as lymphosarcoma, reticular cell type), and in three of the six cases of Hodgkin’s disease.