Pattern of Leukaemias in a Tertiary Care Hospital - A 5 Years Retrospective Study of 103 Cases.

Objective: To study the distribution of various types of leukaemia in the RIMS Hospital in terms of types, age, sex and among various ethnic groups. Material and Method: It’s a retrospective study carried out in the department of Pathology, Regional Institute of Medical Sciences (RIMS) Hospital over a five years period between November 2006 and October 2011. Diagnosis was based on peripheral blood count, peripheral blood smear and bone marrow examination for morphology along with cytochemistry study whenever required. FAB classification is followed in the study. SPSS software package, version 16, was used for statistical analysis. Result: Out of total 103 cases, 49cases (47.6%) were children and adolescents and 54 cases (52.4%) were adults. Age range was 9 months to 79 years with a mean age of 31.2 years. Among the children and adolescents, 30 cases were males and 18 cases were females (M: F ratio 1.7:1). In the adults 34 cases were males and 21 cases were females with M: F ratio 1.6:1. Overall male female ratios was 1.6:1. Out of 103 cases, 85.4% were of of acute leukaemia and rest were chronic leukaemia (14.6%). Acute leukaemia was the most common leukaemia in all age groups. Of all leukaemia cases reported, maximum cases were of acute myeloid leukaemia (AML). Acute lymphoblastic leukaemia (ALL) is the most common type of leukaemia in the children (60.7%) and adolescents (52.3%). AML (66.7%) is the most common acute leukaemia in adults. Among ALL, L2 is the most common variant (82.3%) and in AML, M3 is the most common (38.8%). Chronic leukaemia was more common in adult (80%) than children and adolescents. Out of total 12 cases of the chronic leukaemia reported in adults, 10 were of chronic myeloid leukaemia (CML), 2 were chronic lymphocytic leukaemia (CLL). The maximum cases of leukaemia were among Meitei community (64%) followed by tribal community (28%) and minimum in Muslims (8%). Conclusion: In this study, acute leukaemia was the most common leukaemia in all age groups. Of all leukaemia cases reported, maximum cases were of AML and minimum cases were of CLL. Chronic leukaemia was more common in adult. In children, majority of cases were ALL and chronic leukaemia was rare. Leukaemias were more common in males. Meitei community was affected the most.

Expression of low molecular weight proteins in patients with leukaemia / Expresión de las Proteínas de Bajo peso Molecular en Pacientes con Leucemia

The current study is conducted to observe the differences in the level of low molecular weight proteins in the sera of patients with leukaemia in comparison to healthy subjects (control group). The sera of patients with leukaemia showed 15 peaks in the densitometric curve in comparison to the seven peaks of the controls. The peaks in the experimental samples that coincide with those in the control were of 134.14, 113.15, 76.06, 63.25, 48.07, 22.85 and 16.47 kDa molecular weights, respectively. Most of the new peaks appeared between the proteins of molecular weight 36-29 kDa in the experimental groups. Mean density of the 134.14 kDa protein band showed an increase in the protein in experimental groups I and II only whereas 113.15 and 22.85 kDa protein were increased in all experimental groups of patients with leukaemia. The expression of 76.06 and 63.25 kDa protein fraction was downregulated in the patients with leukaemia. A decline in the level of the protein of 48.07 kDa was observed in patients with leukaemia except in Group I. Unlike the other protein fractions, the level of the protein of 16.47 kDa was significantly (p < 0.05) increased with a maximum density in Group II. Intergroup (experimental) comparison revealed an increasing pattern of95.44 and 89.21 kDa with maximum level in Group III sera. However, the protein fractions of 38.07 and 34.94 kDa varied in the serum with maximum density in Group IV Protein fractions of 32.92 and 31.24 kDa were expressed in all age groups of patients with leukaemia with a maximum density in Group III whereas the percentage densities of 14.42 and 13.56 kDa protein were quite different. This preliminary study will provide a basis to study the role of different proteins in patients with leukaemia.

El presente estudio se realiza con elfin de observar las diferencias en el nivel de proteínas de bajo peso molecular en los sueros de pacientes con leucemia, en comparación con pacientes sanos (grupo control). Los sueros de los pacientes con leucemia mostraron 15 picos en la curva densitométrica en comparación con los siete picos de los controles. Los picos en las muestras experimentales que coincidieron con aquéllos en los controles fueron de 134.14, 113.15, 76.06, 63.25, 48.07, 22.85y 16.47 kDa de peso molecular, respectivamente. La mayoría de estos nuevos picos aparecían entre las proteínas de peso molecular 36-29 kDa en los grupos experimentales. La densidad promedio de la banda proteica de 134.14 kDa sólo mostró un aumento en los grupos experimentales I y II, mientras que las proteínas de 113.15 y 22.85 kDa experimentaron un aumento en todos los grupos experimentales de pacientes con leucemia. La expresión de las fracciones de proteína de 76.06 y 63.25 kDa experimentó una reducción negativa (downregulation) en los pacientes con leucemia. Se observó una disminución en el nivel de la proteína de 48.07 kDa en los pacientes con leucemia, excepto en el Grupo I. A diferencia de las otras fracciones proteicas, el nivel de la proteína de 16.47 kDa aumentó significativamente (p < 0.05) con una densidad máxima en el Grupo II. La comparación intergrupal (experimental) puso de manifiesto un patrón de aumento de 95.44 y 89.21 kDa con un nivel máximo en los sueros del Grupo III. Sin embargo, las fracciones proteicas de 38.07 y 34.94 kDa variaron en el suero con densidad máxima en el Grupo IV Las fracciones proteicas de 32.92 y 31.24 kDa se expresaron en todos los grupos etarios de los pacientes con leucemia con una densidad máxima en el Grupo III, mientras que las densidades porcentuales del porcentaje de las proteínas de 14.42 y 13.56 kDa fueron bastante diferentes. Este estudio preliminar proporcionará la base para estudiar el papel de las diferentes proteínas en los pacientes con leucemia.

Gingival inflammation and platelet count in patients with leukemia: preliminary results

Leukemia has been associated with oral manifestations. However, the available literature on this topic consists of mostly reports of cases, without data about the periodontal parameters that may be under the influence of hematologic factors. The aim of this cross-sectional study was to assess the correlation between the Gingival Index and Bleeding on Probing with the platelet count in patients with leukemia. Patients with diagnosis of any kind of leukemia, at any stage of treatment, having a minimum age of 14 years, treated at the Department of Hematology-Oncology of the University Hospital of Santa Maria, Brazil, between December 2009 and March 2010, were assessed. Excluded patients were: edentulous, with orthodontic appliances, with psychomotor disturbances, requiring antibiotic prophylaxis for the examinations, or those using medications associated with gingival swelling. Two trained and calibrated examiners evaluated the Plaque Index, Gingival Index (GI), Probing depth, Bleeding on Probing (BOP), and Clinical Attachment Loss. Hematologic data were collected from a blood test performed on the same day as the periodontal examination. Thirty-seven patients (26 males), aged between 15 and 80 years (mean age 41.7 ± 18.31) were evaluated. Correlation between platelet count and BOP (p > 0.05), or between platelet count and GI (p > 0.05), were both weak (Pearson's correlation coefficient r = 0.171 and r = -0.003, respectively) and not statistically significant. It can be concluded from the preliminary results that the low platelet count was not correlated with the higher prevalence of gingival and periodontal bleeding in patients with leukemia.

[Frequency of ABO and Rh blood groups in patients with acute leukemia]

There are some reports about probable association between acute leukemia and special blood groups. Frequency of ABO and RH blood group is different in each population. This study was done to determine frequency of ABO and Rh blood groups in patient with acute leukemia and healthy population. This case-control study was done on 214 patients [132 males, 82 females] that suffering from acute leukemia as case group and 117026 individuals healthy population who were voluntary blood donors as controls in Mashhad, Iran during 2001-07. Age, sex, ABO blood group and RH blood group were collected from hospital files for each cases. Furthermore the results of ABO and RH blood groups of controls were collected. Data were analyzed with Chi-Square, fisher test and Odd's ratio. The frequency of A, B, AB, O and RH blood groups in cases were 23.8%, 32.8%, 7.0%, 36.4% and 90.7%, respectively. The frequency of A, B, AB, O and RH blood groups in controls were 29.8%, 27.4%, 8.9%, 33.9% and 88.3%, respectively. Odds Ratio test didn't show association of ABO and RH blood groups with acute leukemia. Odds Ratio test showed association of B blood group with acute leukemia in females [OR=0.571, 95%CI: 0.358-.0908, P=0.021]. This study showed although there was not any association between ABO and RH blood groups and acute leukemia but probably females with B blood group are more susciptible toward acute lymphoblastic leukemia

Differential Blast Counts Obtained by Automated Blood Cell Analyzers / 대한진단검사의학회지

BACKGROUND: Automated blood cell analyzers often read leukemic blasts as normal cells. In this study, we evaluated the 5-part differential patterns of blasts using automated analyzers to determine if they can differentiate among blast types. METHODS: Blood samples containing 10% or more blasts were collected from patients with acute leukemia (N=175). The 5-part differential count was conducted using DxH 800 (Beckman Coulter, USA) and XE-2100 analyzers (Sysmex Co., Japan), and the results were compared with manual differential counts, which was used as a reference method. RESULTS: The DxH 800 reported the 5-part white blood cell differential count in 98.9% of the cases. The XE-2100 provided an invalid automated differential count in 72% of the cases. Both analyzers counted most lymphoblasts as lymphocytes and most myeloblasts as monocytes. In 11 cases, the DxH 800 reported a 5-part differential count without a blast flag. CONCLUSIONS: Some automated analyzers are able to recognize and count blasts according to their characteristic cell types. Therefore, complete blood counts obtained automatically can provide valuable data for making provisional decisions regarding the lineage of leukemia cells before further investigation.

ABO genotyping in leukemia patients reveals new ABO variant alleles

The ABO blood group is the most important blood group system in transfusion medicine and organ transplantation. To date, more than 160 ABO alleles have been identified by molecular investigation. Almost all ABO genotyping studies have been performed in blood donors and families and for investigation of ABO subgroups detected serologically. The aim of the present study was to perform ABO genotyping in patients with leukemia. Blood samples were collected from 108 Brazilian patients with chronic myeloid leukemia (N = 69), chronic lymphoid leukemia (N = 13), acute myeloid leukemia (N = 15), and acute lymphoid leukemia (N = 11). ABO genotyping was carried out using allele specific primer polymerase chain reaction followed by DNA sequencing. ABO*O01 was the most common allele found, followed by ABO*O22 and by ABO*A103. We identified 22 new ABO* variants in the coding region of the ABO gene in 25 individuals with leukemia (23.2%). The majority of ABO variants was detected in O alleles (15/60.0%). In 5 of 51 samples typed as blood group O (9.8%), we found non-deletional ABO*O alleles. Elucidation of the diversity of this gene in leukemia and in other diseases is important for the determination of the effect of changes in an amino acid residue on the specificity and activity of ABO glycosyltransferases and their function. In conclusion, this is the first report of a large number of patients with leukemia genotyped for ABO. The findings of this study indicate that there is a high level of recombinant activity in the ABO gene in leukemia patients, revealing new ABO variants.

Blasts in peripheral blood sample of patients with acute leukemia; a comparative study by H1 and flow cytometry

Blast in peripheral blood and bone marrow is a diagnostic factor in acute leukemia, the percentage of blasts will be also important in patient management, particularly after chemotropy. Although conventional study of the cells by light microscopy is an essential step, however it is time consuming and the obtained results may vary from one to other. The H1 system that not only able to automatically differentiate all blood leukocytes, it is also calculate the percentage of blast cells. To evaluate the accuracy of results by the H1 on blast, the study was set to investigate that issus in comparison by CD45 dimly expressed cells [blasts] that computed by flow cytometry. Blood samples from 17 patients with acute lymphoid leukemia [ALL] and 31 patients with acute myeloid leukemia [AML] simultaneously were studied by H1 and flow cytometry using anti-CD4S and CD45/RALS gating. Blood samples from 50 patients with chronic lymphocyte leukemia [CLL] were used as negative controls. The mean values of H1-blasts for B-ALL, T-ALL and AML were 16.3%, 27% and 49.6%, respectively. This figures were 66.6%, 79.7% and 87% by flow cytometry. Both systems were not identified any blast in CLL cases. Analysis of blood samples by H1 in cases with CLL is trusty, but in cases with acute leukemia is unreliable. In comparison to flow cytometry, H1 is identified significantly [p<0.05] lower number of blast in acute leukemia

Monitoring of serum nitric oxide in patients with acute leukemia

Nitric oxide [NO] is a molecule required for many physiological functions, produced from L-arginine by NO synthases [NOS]. It is a free radical, producing many reactive intermediates that account for its bioactivity. Sustained induction of the inducible form of NOS [iNOS] in chronic inflammation may be mutagenic, through NO-mediated DNA damage or hindrance to DNA repair, and thus potentially carcinogenic. Due to the short half-life of NO, usually its end products [nitrate or nitrite] are measured as an index of NO production. There is evidence that expression of iNOS in tumor cells, including acute myeloid leukemia and chronic lymphocytic leukemia increased. In this study, the levels of nitrate and nitrite [nitric oxide products] in the serum of patients with acute leukemia were determined. The serum levels of these compounds were measured in 40 acute leukemia patients. The results of serum nitrite and nitrate of patients were compared with corresponding values obtained in 40 healthy volunteers. These results indicate that patients with acute leukemia had a significant increase in the serum level of nitrite and nitrate

Frequência dos polimorfismos dos genes do TNF alfa e da MTHFR em um grupo de pacientes leucêmicos da cidade do Salvador-Ba / Frequency of gene polymorphisms of TNF alpha and MTHFR in a group of leukemia patients in Salvador-Ba

As leucemias são neoplasias hematológicas decorrentes do desequilíbrio entre as taxas de proliferação, maturação e apoptose das células hematopoéticas, comumente associadas com polimorfismos gênicos. Polimorfismos nos genes do TNFa e da enzima MTHFR têm sido associados como fatores de susceptibilidade para diversas patologias, inclusive neoplasias hematológicas. O presente estudo investigou a freqüência do polimorfismo -308 da região promotora no gene do TNFa, cuja variante genotipica AA está associada a níveis de transcrição elevados da citocina, e dos polimorfismos C677T e A1298C no gene da MTHFR, que estão associados com atividade enzimática reduzida. Para investigação dos polimorfismos foi utilizada a técnica de PCR-RFLP. Foram estudados 94 pacientes leucêmicos, sendo 66 portadores de LMC e 28 de LMA-M3, além de 100 indivíduos da população de Salvador. Dos 66 pacientes com LMC, cinco (7,6%) foram homozigotos para a variante genotipica menos comum (AA) do polimorfismo -308 do TNF. Essa freqüência foi de 3,7% entre os 28 portadores de LMA-M3 e de 3,0% entre os indivíduos do grupo populacional. Dentre os portadores de 66 LMC, dois (3,0%) foram homozigotos para a variante TT do polimorfismo C677T da MTHFR, sendo que foi encontrada frequência de 7,1% entre os portadores de LMA- M3 e de 6,0% para o grupo populacional. Para o polimorfismo A1298C da MTHFR, as freqüências encontradas para a variante CC foram de 4,5% entre os 66 portadores de LMC, 3,6% entre os 28 portadores de LMA-M3 e 5,0% entre os indivíduos do grupo populacional. Diante dos resultados obtidos, concluímos que os polimorfismos -308 (TNFa), bem como C677T e A1298 (MTHFR) parecem não interferir diretamente com os mecanismos de patogênese da LMC e LMA-M3.

Utility of white blood cell suspect flags and histogram pattern in the detection of acute leukemia by Advia-60 automated hematology analyzer.

Blood samples from patients with acute leukemia, when analyzed with automated hematology counters, tend to introduce inaccuracies in the automated differential count and can cause diagnostic confusion without providing definite clues to the presence of abnormal cells. We designed this study to assess the utility of white blood cell (WBC) flags and histogram pattern generated by Advia-60 automated hematology analyzer in the recognition and categorization of acute leukemia. Data printouts of 31 newly diagnosed cases of acute leukemia, 22 with acute myeloid leukemia (AML) and 9 with acute lymphoblastic leukemia (ALL) were reviewed. All cases of AML and ALL generated the WBC suspect blastflag M2 associated with two of the non blast suspectflags G1 and G2. Among the cases of AML, 95.5% of the WBC histogram patterns were definitive of the presence of abnormal cells and were indicative of the myeloid nature of cells. Only 44.4% of the histograms in the cases of ALL could be definitive of the presence of abnormal cells and 33.3% were indicative of their lymphoid nature. Significantly, 55.5% of the histograms in ALL were normal. The false positives for both AML and ALL were 10.5% when only WBC flagging was considered and were reduced to 0.05% when the flags were combined with histogram patterns for interpretation. Combined flagging and histogram recognition can be of aid in identifying cases of acute leukemia and the morphologist can then assess these samples further. This ensures that cases of acute leukemia, especially in high output laboratories, are not inadvertently missed.

FAB classification of leukemia: a cytochemical study.

The reproducibility of FAB classification for acute leukemia was assessed using the modified criteria of the FAB classification. Peripheral smears and bone marrow smears from 36 cases of acute leukemia stained with May-Graunwald-Giemsa were used for this purpose. Cytochemical stains used for this purpose were myeloperoxidase (MPO), Sudan Black B (SBB), Periodic acid Schiff's (PAS) and Alpha-naphthyl acetate esterase (ANAE). The concordance with morphology alone was 75% which improved to 92% when cytochemistry was included.

Immunophenotyping of acute leukemia in northwestern Iran

The significance of immunophenotyping is growing day by day. It provides basic information in regard to classification and prognosis of acute leukemia which helps the management of patients. This study was conducted to Identify CD markers in leukemic patients admitted to Tabriz, in northwestern Iran. Immunophenotyping of 60 patients with acute leukemia was determined. Patients with acute myelogenous leukemia [AML] were 42% of M2 type, 23.6% M3, 15.7% M4, 13% M1 and 5.7% M5. CD13 and CD33 were the most prevalent myeloid markers. T-lymphoid markers consisted mainly of CD7 and its occurrence was mostly in M2 and M4, and least in M3 subtypes. The most common lymphoid markers in patients with Tcell acute lymphoblastic leukemia [ALL] were CD2, CD3, CD7 and in those with B-cell ALL were CD10, CD19 and HLA-DR. The most prevalent myeloid markers in T-ALL were CD14, CD33 and CD13

Red cell enzymopathies in leukemias.

Red cell glucose-6-phosphate dehydrogenase (G6PD) and pyruvate kinase (PK) levels were estimated in patients with leukemias, to see if there was a consistent enzyme defect and correlation of enzyme levels with stage of the disease with prognostic assessment. G6PD levels were found to be significantly increased or decreased in majority of the patients with acute leukemias. Increased activity was seen in majority of the patients with L1 and decreased activity in L2 subtype of acute lymphocytic leukemia (ALL). In chronic myeloid leukemia (CML) G6PD activity was consistently increased, with levels being highly elevated in chronic phase and moderately in blast phase. Variation in G6PD activity was found to be related to the stage of disease and was of prognostic significance. PK was found to be normal or decreased. Fetal haemoglobin levels were also estimated in 30 patients with leukemias and were found to be elevated in most patients. Red cell G6PD may be useful for staging of the disease, as prognostic indicator and predictor of relapse.

1 and, 25-Dihydroxyvitamin D3 in acute leukaemias and lymphomas

1,25[OH]2 D3 was estimated, using a sensitive radioimmunoassay technique, in sera from 40 patients with recently diagnosed hematologic malignancies [10 [AML], 10 [ALL], 10 [NHL] and 10 [HD]] and 10 normal controls for comparison. All patients showed normal liver and kidney functions with normal serum calcium, phosphorus, PTH and calcitonin. Serum concentrations of 1,25 [OH]2 D3 were significantly lower than that for the control group [AML [16.1 pg/ml], ALL [18.1 pg/ml], NHL [19.6 pg/ml] and HD [21.5 pg/ml] versus 28.2 pg/ml for the control]. Moreover, the least serum concentrations of 1,25 [OH]2D3 were found in AML and ALL groups. No significant correlations were detected between serum calcium and 1,25[OH]2 D3 in any of the studied groups

Role of serum ferritin in assessment of disease activity in acute & chronic leukemia.

Serum ferritin (SF) was estimated using double antibody sandwich ELISA in 83 patients of acute and chronic leukemia at various stages of the disease. In 35 patients of acute lymphoblastic leukemia (ALL) in remission, the SF levels fell significantly from 550.63 ng/ml at presentation to 319.56 ng/ml but remained significantly higher than the control values of 46.14 ng/ml. In 28 patients of acute myeloid leukemia (AML), the SF values at 775.0 ng/ml were much higher than those in ALL patients and showed no decline with remission. This pattern was also seen in patients of chronic myeloid leukemia in blast crisis (CML-BC) with SF levels of 804.03 ng/ml at presentation and 717.43 ng/ml at partial remission. The values of SF were lowest in patients of CML in chronic phase ranging from 271.5 ng/ml to 332.12 ng/ml and showed no relationship with variation in total leucocyte count. No correlation was found between SF values and various clinical and laboratory parameters such as age, sex, fever, organomegaly, haemoglobin and total leucocyte count. Thus, while there appeared to be a correlation between remission and SF values in ALL, no such correlation existed between the activity of the disease and SF in other types of leukemia.

Chronic lymphocytic leukaemia: experience in Benghazi, Libya

We conducted a study of 40 patients with chronic lymphocytic leukemia who were diagnosed over ten-year period at 7th april hospital, Benghazi, libya. There were 26 males [65%] and 14 females [35%]. Their mean age was 61.9years. the majority of patients presented with lymphadenopathy, anaemia, spleen or liver enlargement. Skin involvement, petechial haemorrhage were seen in a small proportion only. Disease was more advanced in 50% of cases at the time of diagnosis [Rai stage III and IV]. In fifteen patients there was no follow up, in 13 patients there was irregular follow up and the rest of the patients were regularly followed up. Seventeen patients were given chlorambucil and prednisolone. Seven patients received only chlorambucil and six patients received only prednisolone. Response to therapy was good in mild cases. Among the regular follow up cases, 4 patients died and pneumonia was the cause of death in 3 of them

Study of foetal antigen in haematological malignancy.

Forty patients with different varieties of leukaemia and lymphoma were studied before and after therapy. Red cells and lymphocytes from each patient were tested for foetal antigen by lectin-agglutination test. The antigen was detectable on red cells in all untreated cases, the highest titre being found in chronic myeloid leukaemia. The titre showed significant reduction after treatment in all cases. We conclude that foetal antigen on red cells is a useful diagnostic aid in haematological malignancy and is a good indicator of the outcome of therapy.

prognostic value of phosphohexose isomerase in childhood leukemia and lymphomas

Serum phosphohexose isomerase [P.H.I.] activity was measured in 12 children suffering from acute lymphoblastic leukemia [A.L.L.], 8 children having acute nonlymphoblastic leukemia [A.N.L.L.], 17 children suffering from non-Hodgkin's lymphoma [N.H.L.] and 20 aparently healthy children of comparable age and sex as controls. Significantly increased activity of P.H.I. was observed in children with leukemias and lymphomas compared to controls. Children with A.N.L.L. had significantly higher P.H.I. activity than those with A.L.L. Follow up of the children during various stages of therapy showed significant decrease of P.H.I. after induction of remission. The levels were evidently elevated again several months before clinical and/or hematological relapses. It could be concluded that P.H.I. can be helpful adjuvant marker in childhood leukemias and lymphomas. Also, it can of therapy and to detect the early relapse

Effect of leukaemic sera & cell-extracts on splenic colony counts (CFU-S).

Sera and leukaemic cell extracts from patients of acute leukaemia were evaluated for their effect on the repopulating ability of the pluripotent stem cells and erythroid differentiation by an in vivo splenic colony count (CFU-S) technique. Normal donor marrow cells of mice were treated with sera and cell extracts from patients of acute leukaemic and healthy controls and injected in the recipient mice. The CFU-S performed on the seventh day to assess repopulating ability of the stem cell showed consistently lower CFU-S counts in the test groups, with leukaemic sera (P less than 0.01) as well as leukaemic cell-extracts (P less than 0.001). The erythroid differentiation assessed by 59Fe uptake by the spleens also showed significantly reduced counts in the two test groups (P less than 0.01 and less than 0.001 respectively). The results indicate that both leukaemic sera and cell-extracts exert a significant suppressive effect on the repopulating ability of the stem cells and on their erythroid differentiation.

Serum immunoglobulins in leukaemia and malignant lymphoma.

The serum immunoglobulin levels were studied in 25 healthy control subjects and 23 cases of leukaemia (6 cases of acute lymphatic leukaemia, 5 cases of acute myeloid leukaemia, 2 cases of chronic lymphatic leukaemia and 10 cases of chronic myeloid leukaemia) and 17 cases of malignant lymphoma (13 cases of Hodgkin's lymphoma and 4 cases of non-Hodgkin lymphoma). The mean levels of IgG, IgA and IgM in 25 control subjects were 1573.56 +/- 91.45 mg/dl, 209.64 +/- 12.55 mg/dl and 109.81 +/- 10.03 mg/dl respectively, those in 23 cases of leukaemia were 1338.23 +/- 109.74 mg/dl, 195.53 +/- 20.72 mg/dl and 127.47 +/- 13.29 mg/dl respectively and those in 17 cases of malignant lymphoma were 996.99 +/- 99.50 mg/dl, 147.47 +/- 19.61 mg/dl and 129.35 +/- 19.95 mg/dl respectively. The mean levels of IgG and IgA were found to be decreased in cases of leukaemia with elevated levels of IgM, however, it was found to be insignificant (p less than 0.4). The mean IgG, IgA and IgM levels were found to be almost identical in different leukaemia irrespective of cytological types except in 2 cases of chronic lymphatic leukaemia which showed low levels of IgG and IgA. The mean levels of IgG and IgA were found to be significantly decreased in malignant lymphoma (p less than 0.02). IgM levels were found to be increased in 3 cases of non-Hodgkin lymphoma.