期刊
BRITISH JOURNAL OF HAEMATOLOGY
卷 146, 期 1, 页码 64-75出版社
WILEY
DOI: 10.1111/j.1365-2141.2009.07711.x
关键词
monoclonal B-cell lymphocytosis; chronic lymphocytic leukaemia; prognosis; immunoglobulin genes; FISH karyotype
类别
资金
- Ministero della Salute, Rome, Italy
- Ricerca Sanitaria Finalizzata, Regione Piemonte, Torino, Italy
- Progetto Alfieri, Fondazione CRT, Torino, Italy
- University of Siena, Italy
- Novara-AIL Onlus, Novara, Italy
- Siena-AIL Onlus, Siena, Italy
- AIRC, Milan, Italy
- Hairy Cell Leukemia Research Foundation, Illinois, USA
- Ricerca Finalizzata and 'Alleanza Contro il Cancro', Ministero della Salute, Rome, Italy
- AIL-Venezia, Pramaggiore, Italy
- Ricerca Scientifica Applicata, Regione Friuli Venezia Giulia, Trieste, Italy
- Helmut Horten Foundation, Lugano, Switzerland
- San Salvatore Foundation, Lugano, Switzerland
- Fondazione per la Ricerca e la Cura sui Linfomi, Lugano, Switzerland
- Associazione Franca Capurro per Novara Onlus
P>Monoclonal B-cell lymphocytosis (MBL) is an asymptomatic monoclonal expansion of < 5 center dot 0 x 10(9)/l circulating CLL-phenotype B-cells. The relationship between MBL and Rai 0 CLL, as well as the impact of biological risk factors on MBL prognosis, are unknown. Out of 460 B-cell expansions with CLL-phenotype, 123 clinical MBL (cMBL) were compared to 154 Rai 0 CLL according to clinical and biological profile and outcome. cMBL had better humoral immune capacity and lower infection risk, lower prevalence of del11q22-q23/del17p13 and TP53 mutations, slower lymphocyte doubling time, and longer treatment-free survival. Also, cMBL diagnosis was a protective factor for treatment risk. Despite these favourable features, all cMBL were projected to progress, and lymphocytes < 1 center dot 2 x 10(9)/l and > 3 center dot 7 x 10(9)/l were the best thresholds predicting the lowest and highest risk of progression to CLL. Although IGHV status, CD38 and CD49d expression, and fluorescence in situ hybridization (FISH) karyotype individually predicted treatment-free survival, multivariate analysis identified the presence of +12 or del17p13 as the sole independent predictor of treatment requirement in cMBL (Hazard ratio: 5 center dot 39, 95% confidence interval 1 center dot 98-14 center dot 44, P = 0 center dot 001). Overall, these data showed that cMBL has a more favourable clinical course than Rai 0 CLL. Given that the biological profile can predict treatment requirement, stratification based on biological prognosticators may be helpful for cMBL management.
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