Abnormal T-cell functions in B-cell chronic lymphocytic leukemia do not imply T-lymphocyte involvement in the leukemic process: report of a case with demonstrated "polyclonality" of T lymphocytes.

In a patient with chronic lymphocytic leukemia (CLL), we previously demonstrated by glucose-6-phosphate isoenzyme analysis that monoclonality was restricted to B lymphocytes. Isolated T cells expressed both isoenzymes and, therefore, were apparently not involved in the leukemic process. This report presents results of a functional analysis of the patient's T cells. Cutaneous anergy to a battery of skin tests was correlated with abnormal proliferative responses of isolated T cells to phytohemagglutinin and concanavalin A. The addition of sufficient numbers of autologous adherent cells restored mitogen responses to nearly normal levels. However, the patient's T cells failed to provide help for differentiation of allogeneic B cells in response to pokeweed mitogen. These data suggest that altered cellular immunity in CLL is not necessarily due to intrinsic T cell abnormalities. Reduced numbers of circulating accessory cells and/or an imbalance in T-cell subsets related to the expansion of the leukemic B-cell clone may play a significant role.