258 The Lymphocyte and Lymphocytic Tissue 



'idiopathic" type, Henoch-Schonlein purpura, and leukocytic antibodies. In 

 a benign lymphoproliferative disorder — infectious mononucleosis — there is 

 a "heterophile" antibody against sheep red blood cells. Other viral infections 

 with lymphocytic proliferation as one feature show antibody reactions of 

 one sort or another. 



The lymphoproliferative disorders may be treated by x-ray and the alkylat- 

 ing agents, including nitrogen mustard, TEM, and Leukeran. These are 

 destructive agents both to lymphoid tissue as well as to the bone marrow 

 and must be used with considerable caution else severe cytopenias, some- 

 times irreversible, ensue. On the other hand, ACTH and the corticosteroids 

 are lymphocytolytic but not myelotoxic. When given in massive dosage in 

 acute lymphocytic leukemia, they may induce complete remissions. In 

 chronic lymphocytic leukemia they are often highly effective, at least 

 temporarily, in cases that have become refractory to the destructive agents 

 and in which bone marrow depression is present. The results with the cor- 

 ticosteroids in the chronic lymphoproliferative disorders, particularly when 

 large lymphoid masses, cachexia, and severe anemia are present, are often 

 very striking. With the use of large-dose corticosteroid therapy (prednisone, 

 50-100 mg. daily), the masses usually regress considerably, the systemic 

 symptoms disappear, and the anemia becomes greatly improved. In the cases 

 with autoimmune hemolytic anemia and hyperglobulinemia, the results are 

 dramatic. Experience with well over 50 cases of extensive, generalized chronic 

 lymphoproliferative disease now indicates that large-dose corticosteriod 

 therapy may well be the treatment of choice in many instances, not only 

 when resistance to x-ray and alkylating drugs has developed but even as the 

 initial procedure. From our detailed observations in recent studies, it seems 

 more than likely that the corticosteroids are lymphocytolytic agents with an 

 activity comparable to that of x-ray. Long-term therapy wih the cortico- 

 steroids is, of course, subject to various hazards, but alternation of these 

 materials with the alkylating agents may be helpful in this regard. 



Primary lymphosarcoma of the spleen is the commonest neoplasm of the 

 spleen. At first it simply presents as splenomegaly and later as hyper- 

 splenism with cytopenias but with a normal bone marrow. Eventually lymph 

 nodes, the bone marrow, and blood are involved, giving the picture of 

 leukemia, leukemic or aluekemic. The "moving picture" of the various 

 events in this neoplastic disorder is of considerable interest. Therapy differs 

 according to the stage of the disease and may include splenectomy, x-rays, 

 the alkylating agents, or the corticosteroids. 



No discussion of the treatment of the lymphoproliferative disorders would 

 be complete without emphasizing the importance of no therapy in some 

 cases, particularly in chronic lymphocytic leukemia of the benign, asympto- 



