248 The Lymphocyte and Lymphocytic Tissue 



Picena."' 5 At the risk of oversimplification, one might say that the larger the 

 dominant cell and the more delicate its standing characteristics, the poorer 

 the prognosis and the poorer the response to therapy. 



Architectural Pattern 



The architectural pattern of the malignant tissue ranked next to cytology 

 in importance. In general, the better the preservation of architecture, the 

 better was the prognosis. 7 - 59, ,; " Rappaport and colleagues' study in particular 

 indicated that preservation of follicular pattern was a better prognostic sign 

 than is loss of normal architecture. 45 



Fibrosis 



The role of fibrosis was difficult to evaluate. Some authors believed that 

 it has been associated with a relatively good prognosis, although the evidence 

 upon which this content was based was meager/- 7 ' 4; ' My own observations, 

 based primarily upon serial splenic biopsies, indicated that extensive 

 fibrosis was correlated with a lack of diminution of size of involved tissues 

 after any type of therapy, and with a poor prognosis as well. In the individual 

 patient there was progressive fibrosis during the natural history of that 

 patient's disease, and in this sense fibrosis was correlated with an increasingly 

 poorer response to therapy. 13 - 14 



Special Role of the Marrow 



Bone marrow has played a much neglected role in the evaluation of prog- 

 nosis, natural history, and feasibility of, and response to, therapy. Since the 

 introduction of radiotherapy, and especially in the more recent chemo- 

 therapeutic era of the last 15 years, we have become mesmerized by the guile- 

 less concept that destruction of the cell type characteristic of the malignancy 

 is the goal of treatment. Increasingly less attention has been paid to an ex- 

 tremely important aspect, the ability of the marrow to produce red cells, 

 white cells, and platelets in normal numbers under conditions that will 

 insure normal longevity of these formed elements in the circulating blood. 

 In addition, in the presence of hemorrhage or infection, the marrow must 

 be able to produce an increased number of these elements. Another func- 

 tion that was correlated with prognosis was that of the production of an 

 adequate antibody response when the need arose. Observation of patients 

 with lymphatic malignancies cannot help but impress the physician with 

 the importance of anemia, thrombocytopenia, neutropenia, and poor anti- 

 body response as major causes of disability and death. 



Conversely, there was no proof that an increase in lymphocytes in the 

 peripheral blood or marrow, except when they grossly replaced myeloid 

 tissue, had any real significance as a cause of disability or death. Nor was 



