Spontaneous alteration of idiotype in a monoclonal B-cell lymphoma. Escape from detection by anti-idiotype.

The surface immunoglobulin of B-cell neoplasms provides a specific point of attack for potential antibody therapy. The capacity of anti-idiotype antibody to home to the target neoplasm requires that the idiotype be unique and that it be expressed by every cell in the neoplastic clone. We describe the evolution of an altered idiotype in a follicular lymphoma that resulted in escape from laboratory detection by monoclonal anti-idiotype antibody. This was not due to the emergence of a second (biclonal) lymphoma, since all the neoplastic cells were otherwise identical both phenotypically and genotypically, as determined by flow cytometry and genomic DNA (Southern blot) hybridization, respectively. All cells expressed the same B-cell immunotype and bore a constant amount of IgMk. The demonstration of a single configuration of immunoglobulin-gene DNA confirmed monoclonality and established that the change in idiotype was not a result of new gene rearrangements but was more likely due to somatic mutation of the variable region--a process presumed to occur naturally in B cells. These data demonstrate the lability of idiotype expression and define a mechanism by which B-cell neoplasms may become unresponsive to anti-idiotype therapy.