Low-count monoclonal B-cell lymphocytosis persists after seven years of follow up and is associated with a poorer outcome
EHA Learning Center. Criado I. Jul 1, 2018; 224112
Topic: 3Aj Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)
Mr. Ignacio Criado
Mr. Ignacio Criado
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Co-Authors: Arancha Rodríguez-Caballero, M. Laura Gutiérrez, Carlos E. Pedreira, Miguel Alcoceba, Wendy Nieto, Cristina Teodosio, Paloma Bárcena, Alfonso Romero, Paulino Fernández-Navarro, Marcos González, Julia Almeida, Alberto Orfao

Abstract: Low-count monoclonal B-cell lymphocytosis is defined by the presence of very low numbers of circulating clonal B cells, usually phenotypically similar to chronic lymphocytic leukemia cells, whose biological and clinical significance remains elusive. Herein, we re-evaluated 65/91 low-count monoclonal B-cell lymphocytosis cases (54 chronic lymphocytic leukemia-like and 11 non-chronic lymphocytic leukemia-like) followed-up for a median of seven years, using high-sensitivity flow cytometry and interphase fluorescence in situ hybridization. Overall, the clone size significantly increased in 69% of low-count monoclonal B-cell lymphocytosis cases, but only one subject progressed to high-count monoclonal B-cell lymphocytosis. In parallel, the frequency of cytogenetic alterations increased over time (32% vs. 61% of cases, respectively). The absolute number of the major T-cell and natural killer cell populations also increased, but only among chronic lymphocytic leukemia-like cases with increased clone size vs. age- and sex-matched controls. Although progression to chronic lymphocytic leukemia was not observed, the overall survival of low-count monoclonal B-cell lymphocytosis individuals was significantly reduced vs. non-monoclonal B-cell lymphocytosis controls (P=0.03) plus the general population from the same region (P≤0.001), particularly among females (P=0.01); infection and cancer were the main causes of death in low-count monoclonal B-cell lymphocytosis. In summary, despite the fact that mid-term progression from low-count monoclonal B-cell lymphocytosis to high-count monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia appears to be unlikely, these clones persist at increased numbers, usually carrying more genetic alterations, and might thus be a marker of an impaired immune system indirectly associated with a poorer outcome, particularly among females.

Article Number: 1198

Doi: 10.3324/haematol.2017.183954

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