Serum Protein Changes in Malignant Diseases. I. The Acute Leukemias

A study of the serum protein changes and clinical events in acute myeloblastic and acute lymphoblastic leukemia was undertaken as a part of investigations on the effects of malignancies in man. In order to appraise the effects of the leukemic processes, an evaluation of the effects of disease type, activity, complications and therapy was also undertaken. Over a five-year period, clinical appraisal and electrophoretic serum protein analyses were compared 171 times in 82 patients with acute lymphoblastic leukemia and 64 times in 28 patients with acute myeloblastic leukemia.

Serum electrophoretic evaluation showed characteristic patterns in the two types of acute leukemia studied. Analyses conducted in the absence of fever, infection or liver disease typically revealed elevation of the gamma globulins in myeloblastic but not in lymphoblastic leukemia. Alpha-2 globulin elevation, however, was representative of active lymphoblastic leukemia. Serum albumin was significantly lowered, and the beta globulins component remained essentially normal in both myeloblastic and lymphoblastic leukemia. Alpha-1 and alpha-2 globulin values were notable for the wide range of values obtained.

Hematologic remission in some patients with acute lymphoblastic leukemia was associated with a return of albumin and alpha globulin values toward normal, but the total experience indicated a general persistence during remission of the abnormalities seen in active diseases.

Fever, in the absence of infection, was associated with elevation of the alpha-1 globulin component. Bacterial infection was associated with similar elevation of the alpha-1 globulin fraction and, in addition, a further fall in serum albumin levels.

Marked depression of the gamma globulins was unusual. The mild decreases encountered in lymphoblastic leukemia could not be related to the frequency of bacterial infection. Administration of antimetabolites or adrenal corticosteroids could not be shown to produce any direct effect on the serum electrophoretic components.