Analysis and detection of B cell neoplasms

Cells from human B cell lymphomas were analyzed by means of the fluorescence-activated cell sorter (FACS) according to the amount of kappa (κ) or lambda (λ) immunoglobulins (Ig) on their surface. The crucial requirements for sensitive recognition of small numbers of tumor cells admixed in a normal population are described. Tumor cells were identified as an excess of cells bearing one light chain type ('clonal excess') at discrete levels of fluorescence intensity. Normal patterns of fluorescence staining are compared to those for tissues infiltrated with tumor. For B cell neoplasms with surface Ig of weak intensity, such as chronic lymphocytic leukemia, as few as %1 of the tumor cells admixed with normal cells could be detected; the bright surface fluorescence of cells from lymphoma permitted their recognition when only 0.1% of the tumor cells were present. FACS analysis was carried out on the peripheral blood of a series of patients with B cell lymphoma whose blood was normal by classic cytologic and cytochemical analysis. Nevertherless, circulating tumor cells were recognized in the majority of cases, suggesting that 'subclinical leukemia' is a common finding in B cell lymphomas.