Document jgdaze75R7a1aZ8wapj9Ym1rN

VoJ. M3|1 No: 33 CORRESPONDENCE 1303 meaul coloniuiion and no effect on bacteria (hat ore already pm* cni In the distal urethra. Further itudiet art clearly needed to de fine the inethodt of meatal preparation and catheter iniertion. at well at (Ully care, that might prevent bacteria from entering (he eatheteriied bladder by the catraluminal route. RtcHAKb A. CAKiaatni. M.D. Jotiv f. (mu, M.D. Micmau R Bam, M.D. Chaklu B. Sunn. M.D. Salt Laic City, UT (4133 Uniierxity of Utah i I. Stamcy 7A. Pathogenesis and treatment of urinary tract infcetioni. Baltimore: Williamt 0 Wilkins, 1910:6-1. 3. Garibaldi RA, Burke JP, Dickman ML, Smith C8. Factor! prcdispot- ing to bacteriuria during indwelling urethral calhctrri/alion. N Engl J Med. 1914: 391:313-9. 3. Warren JW, plan R. Thomas RJ. Rotner B. Kxss EH. Antibiotic irriga tion and cathcicr-auocialcd urinary tract infections N Engl J Med. 1911; 399:510-3. 4. Burke JP, Garibaldi R A, Brill MR. Jacobton JA. Conti M. Ailing DW. . Prevention or cathcter-auociatcd urinary tract infcetioni: efficacy of daily meatal care regiment. Am J Med. (in prcttl. IMMUNOLOGIC PHEN'OIYPE IN LAKGE-CE1.1. LYMPHOMA 7a On Editor: According to aurface-marlrr criteria, large-cell nonHodglin'c lymphomai are heterogencoui with retpcct to cell line age. A aiaable proportion, ranging from 20 to 60 per cent in aeveral reports,"* lack surface receptora atiociated with diflercntiated lym phoid celli and have the phenotype E`Smlg*CJF Some authors have referred to their celli at "null," although we prefer the detignation 'noneapreuive." In the August 1 ittue, Warnke and hit colleagues make the im portant observation that many nonrapreasive phenotypes have la or la-like antigens, presumably on the cell surface. T he authors con clude that the pretence of this antigen indicates a B-cell lineage for this subset of large-cell tumors. Since Smlg* phenotypes constitute the other major subset in large-cell lymphoma, the implication of (his finding is that the vast majority of large-cell lymphomas are in fact derived front B cells. We generally agree with the latter condolion on the basis of certain other lines of evidence. We would emphasise; however, that la or la-like antigens are rlearly hot found delusively on B cells, and therefore the authors' conclu sion is a cause of tome concern. In fact, it it well known that cer tain subsets of T cells, both normal and neoplastic, repress la antigens.'.^ The common denominators for la dpression seem to be imma turity and a high proliferativt rate. Thus, cultures ol normal and , neoplastic T cells stimulated by lectin or growth factor regularly oprett la antigens.* Since large-cell lymphomas generally have a high proliferative rate, it could be argued that thr expression uf la antigens could well indicate a T-cell lineage or could merely corre late with cell proliferation. T he fact that certain T-crll-diffrrrniialion antigens were not found on their la* tells is L-rt-Irvani. since B-crll markers were also not found In uur view, the evidence indi cating that noncaprcttivc large-cell lymphoma it dented Irom B cells remains speculative and inferential. Another cause for concern is the composition of patients in the Stanford study. Although the authors ih.ir.iilrri/c the studs croup as "uruclectcd." sis of their patients had longstanding niHlul.tr (lot. liculsr) lymphoma, one had "Lennrn's lymphoma." and thrrr had ttceivtd transplants. Onr wonders hosv rrpresentattse of patients with large-cell (hitiiix-ytir) lymphoma this group is It is well known that the composition of patients in a studs tnarkcdls influ ences the results. I he patient population destttbed abese is weighted heavily toward certain unusual large-crll subsets Sums, al differences between groups in this scries shuuid be sirssrd as ten tative and preliminary, particularly when tine t iimpaio the Mirsital chararie/iilics of the two small groups uf patients tt I anii eight subjects). Boston, MA 02111 Klcinsao A. Kruoius. M l) lufti-Xcw England Medical Center I. Bcrard CW, Jaffe EJ. Braylsn RC.ctal. Immunological markers of nonHodgkiltl lymphoma. Recent Results Cancer Ret. 1971; 64:1)1-43. 3. Btouet J-C, Preud'Homrrc Jl. Flsndrin G. cl at. Membrane markers in histiocytic lymphoma (ret cvlum cell sarcoma). J Natl Cancer Inn. 1916: 36:6)1-3. 3. Aitenberg AC, Wilket BM, Long JC. tt at. Ctll surface phenotype in lymphoprotifenlivc disrate Am 3 Mtd. 1910. 61:306-1). 4. F'u SM. Chiorsui N, Wang C V. et al. Is-bcaring T lymphocytes in msn: their identification and role in the generation of allogeneic helper activi ty. J Esp Med. 1911: 141:1433-31. 5. Halpcr JP. Knowles DM. Wong CY- Is antigen tiprtttion by human malignant lymphoma: correlation with conventional Ismphoid markets Blood. 1910; 33:313-1). 6. De Wolf WC, Schtossmsn SF. Yunit EJ- DRw aniiitra react with acti vated T celli J Immunol. 1919; 123:1160-1. Die above letter was referred to the authori of the article in ques tion, three of whom offer thr following replv: 7e Mr Editor: Dr. Rudders generally agrees with our statement that "neoplasms that stain for la but not (nr thr T-cell antigens or for alpha-naphihylbutyraic rtterasc arc probably derived from B cells."1 Krvenheleis. hr cmphasiiet thit la or In-like antigens have been described on a number of cell types, including certain normal and neoplastic T cello. We and others have identified la on certain normal 7' celli and have alto identified In on a small number of T-cell lymphomas. However, in all the cases the la* Tcellt are easi ly identifiable by their compression of such T-cell markers as reac tivity with our antibody LI1FI2. Since the submission of our man uscript. we havt also identified several large-cell lymphomai that bear 7 -cell antigens. Thtie particular cases did not stain for la anti gens. We agree that the composition of patients in our study it not ideal. For this reason, we were cautious in imcrprriinc our flndmci and emphasired the importance of routine immunulncir phenotvp. ing and prospective studies. The patient with a prior looptv show ing "Lennert's lymphoma" and the three pmirnis who had received transplants were of course not included m our clinical anal ysis. Of (he six patients with a longstanding hitiorv of follicular lymphoma, three were in the lg` group and tluer were in the le` group. We are in the process of analvring a larger group ol patients with diffuse Isrge-eell lymphoma. It is of interest that Dr. Rudders has also presented preliminary data suggesting that Ig* large-cell lymphomai have more aggres sive clinical behavior.' Among hit 35 paiirmi with Stage III and IV Isrge-eell lymphoma. 10 patients were in complete remission after extensive treatment. Tht cells of six of thete III patients were "nonexpreatrve," and four of five long-term disease-free survivors also had "nonexpressivc" cells. We eagerly await data from large pro spective studies. Stanford. CA 94)03 Kiser* W.sxvgr. M l). knrutKP Mtitra. M.D. Kovalo l.tt v. M l). Stanford I'nivcrsity Medical Center I. Warnke R. Miller R.Grogan T. Pederson M. Dillcy J. lei) R. Immu nologic phenotype in 30 patients with diffuse laifc-ccll Isntphoma. N tn|l I Med. I960. 303.393-300. 3. Rudders RA. Ahl El Jr. Dcliellis RA. Surface marker and Lukct-Col- lint identity of long term docase free turnsole with ad>anecd large cell thisiuscyiict lymphomas Pioc Am Atoc Cancer Ret Am Sue Clin Oncol. 19X0. 31.463. abstract. M4(tKAKr;UtSO.tflLl;IUMA?rb To On Editor: The recent brief review of malignant mriiitbelioiiM in the |ulv 24 issue contains some points that arc disputable l)r Amman slates that "malignant mesothelioma* arc tl.itiificd with the tofi-titsur sarenmat " Rv whom' I hr t ..I..f ri.i. (omanimMoUirlinmat^itJJi^ArontaitMiHom^^oi^^ I nr tlcsignation o) sarcomatous tumor- oi liic pirurj m pcriioiirum as true sarcomas or as sarcomatous mesotheliomas mav be academic in terms of biolngic behavior, but such tumors arc unusual The 20 per cent figu'* *iun bsr aarenmaietos nsrirtthrlioma scents high. 8005 0035 PRODUCED BY FORD