22-1 The Lymphocyte and Lymphocytic Tissue 



although the white blood cell count has invariably been made to fall. As 

 long as small lymphocytes were the predominant cell, any form of cytocidal 

 therapy given in adequate dose has successfully reduced the size of abnormal 

 masses and lowered the white cell count by destroying lymphatic tissue but 

 has not necessarily produced a remission in the sense herein defined. 11 



Occasional cases under continuous therapy have had very prolonged and 

 benign courses. 4,; Similar results have been noted in patients without treat- 

 ment.^' Often the first evidence of anemia in a previously benign type of 

 chronic lymphatic leukemia has followed radiation or chemotherapy. 39 It is 

 obvious that we need more knowledge of the natural history of untreated 

 lymphatic leukemia. It is equally obvious that one cannot evaluate the effects 

 of treatment on patients with chronic lymphatic leukemia without first de- 



Fig. 17-10. Case 10, acute lymphatic leukemia. Bone marrow composed 

 primarily of monomorphous medium-sized lymphocytes, (x 650) 



termining the extent of marrow involvement in each patient. Considering 

 all patients with chronic lymphatic leukemia as a single group will efface the 

 very real differences between individual patients. 



OVERTREATMENT 



The subject of the response to therapy cannot be left without considera- 

 tion of the effects of overtreatment. 11 4T Case 9, a 60-year-old woman, had 

 lymphatic leukemia which was discovered accidentally in 1957 when she con- 

 sulted her physician because of anemia due to bleeding hemorrhoids. She 

 was overtreated with x-ray therapy and radiophosphorus in an attempt to 

 burn out the disease; pancytopenia, refractory to all treatment, resulted. 

 The patient became a hopeless invalid and required from . r > to 10 transfu- 

 sions a month for support. Figure \7-9A is a biopsy of the patient's marrow 

 to show the serous fat atrophy and severe hemosiderosis which resulted from 

 overtreatment. There was an almost complete absence of myeloid and lym- 

 phatic tissue. A few islands of erythroblasts and small lymphocytes were 

 demonstrable. Serous Eat atrophy, such as that seen here, has often followed 

 overzealous treatment. It signaled an extremely poor prognosis and was uni- 



