Journal
BLOOD
Volume 113, Issue 18, Pages 4188-4196Publisher
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2008-09-176149
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Funding
- NCI [113408]
- Gabrielle's Angel Foundation for Cancer Research
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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 x 10(9)/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 B-cell 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. (Blood. 2009; 113: 4188-4196)
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