Studies on Acute Leukemia and Infectious Mononucleosis of Childhood. III. Incidence of Spontaneous Lymphoblastoid Transformation in Bone Marrow Cultures2

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Abstract
During a 5-year period, 757 fibroblastic bone marrow cultures from 373 children (482 cultures from 114 children with acute leukemia, 49 cultures from 48 children with infectious mononucleosis, 210 cultures from 195 children with various other diseases, and 16 cultures from 16 normal children) were studied to determine the frequency of occurrence and pattern of distribution of a spontaneous conversion to mixed cultures containing lymphoblastoid and fibroblastic cells—a phenomenon termed “spontaneous lymphoblastoid transformation of fibroblastic bone marrow cultures.” Lymphoblastoid transformation occurred in 59 of the 757 cultures studied. Of these, 19 were from 11 of the 114 (10%) children with leukemia—4 children yielding altered cultures more than once. The incidence was similar in cultures derived during relapse or remission. The incidence of lymphoblastoid transformation was much higher in cultures of children with infectious mononucleosis; 27 of the 48 children studied (56%) yielded altered cultures. In addition, the same changes were found in cultures of 13 of the 195 children (7%) with other disease entities, several diagnosed as presumptive infectious mononucleosis. None of the 16 normal children studied yielded transformed cultures. The close association of lymphoblastoid transformation with infectious mononucleosis, the absence of random distribution among the 482 cultures from the patients with leukemia, and the repeated occurrence in serial bone marrow cultures from only certain leukemia patients indicate that the phenomenon was characteristic for the individual bone marrow aspirate cultured and not due to random sampling of the population studied. Cytological examination did not reveal detectable differences in the altered cultures, regardless of the clinical diagnosis of the children from whom the cultures were derived.