B-cell count and survival: Differentiating chronic lymphocytic leukemia from monoclonal B-cell lymphocytosis based on clinical outcome

Tait D. Shanafelt, Neil E. Kay, Greg Jenkins, Timothy G. Call, Clive S. Zent, Diane F. Jelinek, William G. Morice, Justin Boysen, Liam Zakko, Susan Schwager, Susan L. Slager, Curtis A. Hanson

Research output: Contribution to journalArticle

90 Scopus citations

Abstract

The diagnosis of chronic lymphocytic leukemia (CLL) in asymptomatic patients has historically been based on documenting a characteristic lymphocyte clone and the presence of lymphocytosis. There are minimal data regarding which lymphocyte parameter (absolute lymphocyte count [ALC] or B-cell count) and what threshold should be used for diagnosis. We analyzed the relationship of ALC and B-cell count with clinical outcome in 459 patients with a clonal population of CLL phenotype to determine (1) whether the CLL diagnosis should be based on ALC or B-cell count, (2) what lymphocyte threshold should be used for diagnosis, and (3) whether any lymphocyte count has independent prognostic value after accounting for biologic/molecular prognostic markers. B-cell count and ALC had similar value for predicting treatment-free survival (TFS) and overall survival as continuous variables, but as binary factors, a B-cell threshold of 11 × 109/L best predicted survival. B-cell count remained an independent predictor of TFS after controlling for ZAP-70, IGHV, CD38, or fluorescence in situ hybridization (FISH) results (all P < .001). These analyses support basing the diagnosis of CLL on Bcell count and retaining the size of the B-cell count in the diagnostic criteria. Using clinically relevant criteria to distinguish between monoclonal B-cell lymphocytosis (MBL) and CLL could minimize patient distress caused by labeling asymptomatic people at low risk for adverse clinical consequences as having CLL.

Original languageEnglish (US)
Pages (from-to)4188-4196
Number of pages9
JournalBlood
Volume113
Issue number18
DOIs
StatePublished - 2009

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Shanafelt, T. D., Kay, N. E., Jenkins, G., Call, T. G., Zent, C. S., Jelinek, D. F., Morice, W. G., Boysen, J., Zakko, L., Schwager, S., Slager, S. L., & Hanson, C. A. (2009). B-cell count and survival: Differentiating chronic lymphocytic leukemia from monoclonal B-cell lymphocytosis based on clinical outcome. Blood, 113(18), 4188-4196. https://doi.org/10.1182/blood-2008-09-176149