212 The Lymphocyte and Lymphocytic Tissue 



malaise, anorexia, lymphadenopathy, anemia, and a white blood cell count 

 of 30.000 with a differential count showing primarily medium-sized lympho- 

 cytes. A biopsy at this time (Fig. MAC, D) demonstrated that about three 

 quarters of the marrow was composed of sheets of monomorphous medium- 

 sized lymphocytes identical to those seen in the peripheral blood of acute 

 lymphatic leukemia. The patient failed to respond to prednisone therapy 

 and died in June, 105'.). 



Evaluation of Histopatholocy 



From a synthesis of my own experience and that in the literature, it would 

 seem that when the dominant cell type was a small lymphocyte and the 

 follicular pattern well preserved, prognosis has been most favorable and 

 therapy was probably not indicated. 



As the dominant cell type shifted to a medium-sized lymphocyte or 

 reticulum cell, both prognosis and response to therapy became poorer. In- 

 volvement of the marrow and a consequent change to subacute or acute 

 leukemia indicated a poor response to therapy and a poor prognosis. Anday 

 and Schmitz 1 have recorded the only case in which a transition to leukemia 

 reversed spontaneously or following therapy. Since a change to a more 

 malignant pattern may occur at any time, serial biopsies afford the most 

 satisfactory means of assessing the patient's status. 



Chronic Lymphatic Leukemia 



Classic Concept 



According to classic description, chronic lymphatic leukemia is a disease 

 ( haracterized by hepatosplenomegaly, lymphadenopathy, anemia, thrombo- 

 cytopenia, and marked leukocytosis due to an absolute rise in the lympho- 

 cyte count. In this type of case, Minot and Isaacs 40 reported an average 

 survival of three to five years both in patients receiving radiation therapy as 

 well as in those not given specific therapy. Much more recently, Tivey 53 

 has reported a somewhat shorter average survival, adding that longevity in 

 chronic myelogenous leukemia and chronic lymphatic leukemia is compa- 

 rable. This comparatively poor prognosis in chronic lymphatic leukemia 

 noted by Tivey has not been consistent with my observations. By including 

 all patients with chronic lymphatic leukemia in a single category, this author 

 has not made due allowance for the prognosis for the individual patient as 

 determined by the biology of his disease. It is little wonder that Osgood, 20, 42 

 whose patients formed the basis for Tivey's study, recommended the same 

 type of therapy for all patients regardless of the type of chronic lymphatic 

 leukemia manifested. 



