CORRESPONDENCE

nosis of PNH. Nine of those pa- tients had a second clonal myelopathy. In their review of the literature, the authors found fewer than 30 patients with PNH and other associated myelopathies. We were unable to find a single case of PNH in association with non- Hodgkin’s malignant lymphoma. We have seen such a patient in our hospital, and we would like to re- port it to you.

A 77-year-old woman was admit- ted to Humana Hospital Phoenix with symptoms of nausea, loss of appetite, weaknqs, night sweats, chills, and a general feeling of ill health. After an extensive evalua- tion, she was found to be experi- encing the following abnormalities: (1) panytopenia, (2) absolute retic- ulocytosis, (3) ferritin level (repeat) of greater than 29,000, (4) positive tie test for hemosiderin, (5) pos- itive sucrose hemolysis test, (6) re- duced haptoglobin with no evi- dence of liver failure, and (7) hepatosplenomegaly.

On physical examination the pa- tient had no masses or peripheral lymphadenopathy. Hepatosplen- omegaly was clinically identifiable.

A bone marrow test was per- formed that demonstrated non- specific grandomata, but did not reveal any evidence of lymphoma.

The patient underwent a rapidly downhill course, and died. An au- topsy revealed non-Hodgkin’s ma- lignant lymphoma (T-cell type), in- volving the liver, spleen, lymph nodes, and bone marrow.

The association of a clonal myelopathy and malignant lym- phoma has been reported in the past.2 However, the occurrence of a PNH defect in the red cells of a patient witgh malignant lymphoma has not. The occurrence of a PNH defect in the red cells of a patient with malignant lymphoma may be a manifestation of the interaction of a primitive hematopoietic stem cell with a cytokine produced mal- itgnant lymphocytes. Further analyses of interactions between

the immune system and early bone marrow stem cells may enable us to conflrm this hypothesis. Certainly, the presence of two dis- eases in the same patient is an- other possibility.

ROBERT D. LIGORSK~, D.o., F.A.C.O.I.

STEVENSCHAFFNER+M.D. JEFFREYOLWER; M.D. DANIEL OLNER, M.D. DANIELLAVINE, M.D.

Phoenix, Arizona

1. Graham DL, Gastineau DA. Paraxysmal noctural henoglobinuria as a marker for clonal myelopathy. Am J Med. 1992;93:671-674. 2. Ligorsky RD, et al. Acute myelomonocytic leukemia in a patient with malignant lymphoma and macroglobulinemia. Cancer. 1977;13:1156.

Submitted January 21, 1993, and accepted March 26, 1993

Serum Beta 2-Microglobulin in Adult Acute Lymphocytic Leukemia

To the Editor: Kantarjian and colleagues’ pro-

vide an interesting insight into the value of beta 2-microglobulin as an independent variable for survival and for central nervous system dis- ease in adult acute lymphocytic leukemia (ALL). l Their study is an- other step forward in the increas- ingly appreciated significance of this polypeptide as an important tumor marker.

The investigators comment on the scarcity of data regarding the prognostic value of serum beta 2- microglobulin in ALL. In this re- gard, I would like to draw their at- tention to some other published work on the subject.

Vorob’ev and Sidnev,Z studying the concentration of serum beta 2- microglobulin in 141 patients with acute leukemia, found increased levels in all varieties of acute leukemia compared with controls, and established a direct correla- tion between the concentration of beta 2microglobulin and the phase of the disease.2 Vorob’ev’s

and Sidev’s data suggest that this marker is useful both in determin- ing when complete remission oc- curs and for the early diagnosis of relapse in this condition. Vorob’ev and associates also evaluated the importance of beta 2-microglobu- lin in the detection of specific involvement of the kidney in vari- ous forms of acute leukemia, and found higher levels in patients with leukemic kidney involvement (5.54 -I 3.50 mg/L) than in those without renal involvement (2.77 f 1.07 mg/L).3 Leukemic renal in- volvement occurred in 93.3% of patients with serum beta 2-n& croglobulin values above 6.0 mg&.

In a serial study, Storti and co- workers4 observed a rise in cere- brospinal fluid (CSF) beta 2-n& croglobulin 4 to 8 weeks before any leukemic cell could ‘be de- tected by microscopy in the CSF.4 In association with the findings of Kantarjian et al,’ a combination of serum and CSF beta 2-micro- globulin may be invaluable in assessing the risk for development of central nervous system involvement in ALL, together with the early detection of this compli- cation.

&AYANAND, M.D. Nassau County Medical Center

East Meadow, New York

1. Kantarjian HM, Smith T, Estey E, et al. Prognostic significance of elevated serum beta 2. microglobulin levels in adult lymphocytic leukemia. Am J Med. 1992;93:599-604. 2. Vorob’ev VG, Sidnev BN. The clinical importance of the radioimmunological determination of beta 2- microglobulin in acute leukemia patients (Russian). Terapevticheskii Arkhiv. 1990;62:20-23. 3. Vorob’ev VG, Trunava EM, Borovkov NN. Beta 2- microglobulin in the diagnosis of specific involvement of the kidneys in acute leukemias (Russia). Laboratornoe Delo. 1990;10:31-34. 4. Storti S, Pagan0 L, Marra R, et al. Cerebrospinal fluid beta P-microglobulin: a reliable index of leukemic infiltration of the central nervous system. Stand J Hematol. 1986;37:301-305,

Submitted January 6, 1993, and accepted February 12, 1993.

396 April 1994 The American Journal of Medicine Volume 96