Prognostic significance of lymphocyte morphology in patients with advanced chronic lymphocytic leukemia treated with first line therapy of fludarabine + prednisone

Francesca Romana Mauro, Massimo Gentile, Francesca Mancini, Diana Giannarelli, Anna Guarini, Maria Stefania De Propriis, Raffaella Cerretti, Robin Foa

Research output: Contribution to journalArticle

Abstract

Background and Objectives. Chronic lymphocytic leukemia (CLL) is characterized by clinical, immunophenotypic and morphologic heterogeneity. The morphologic pattern of CLL lymphocytes at diagnosis has been associated with likelihood of different prognoses, while its prognostic significance at the time of disease progression is uncertain. Design and Methods. In 69 previously untreated patients with advanced CLL the morphology of peripheral blood (PB) lymphocytes was retrospectively analyzed prior to therapy with fludarabine (FD: 25 mg/m2 × 5 consecutive days every 4 weeks) and prednisone (P: 40 mg/m2 × 5 consecutive days every 4 weeks). Two groups of patients were identified: the first one characterized by typical CLL morphology (T) and ≤11% of atypical lymphocytes, and the second one characterized by >11% of atypical lymphocytes (A). The second group was further subdivided into a group characterized by prolymphocyte prevalence (Ap) and into a group characterized by mixed cell morphology (Amc), with a prevalence of large-sized lymphocytes and/or small, cleaved lymphocytes and/or lymphoplasmocytoid cells with or without shaped nucleus. Results. Forty-two patients (61%) showed a T morphology and 27 (39%) an A morphology. The latter group included 14 patients with an Ap morphology and 13 with an Amc morphology. Two thirds of patients with A morphology showed an immunophenotypic score of 3-4. No significant differences in the distribution of clinical features prior to therapy were observed within the three morphologic groups (T, Ap, Amc), except for a higher lymphocyte count in the Ap group (p55 years) and CLL duration (≤12 vs >12 months) emerged as significant and independent prognostic factors of survival probability. Interpretation and Conclusions. The results of this study indicate that about one third of CLL patients with advanced disease have an atypical morphology and that about two thirds of patients with A morphology also show a low immunophenotypic score. The morphologic pattern at the time of progression does not allow identification of prognostic subgroups of patients with different response rates to first line therapy with FD + P.

Original languageEnglish
Pages (from-to)602-608
Number of pages7
JournalHaematologica
Volume87
Issue number6
Publication statusPublished - 2002

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B-Cell Chronic Lymphocytic Leukemia
Prednisone
Lymphocytes
Therapeutics
T-Cell Prolymphocytic Leukemia
Hospital Distribution Systems
fludarabine
Lymphocyte Count
Disease Progression
Survival

Keywords

  • Chronic lymphocytic leukemia
  • Fludarabine
  • Morphology
  • Prednisone

ASJC Scopus subject areas

  • Hematology

Cite this

Prognostic significance of lymphocyte morphology in patients with advanced chronic lymphocytic leukemia treated with first line therapy of fludarabine + prednisone. / Mauro, Francesca Romana; Gentile, Massimo; Mancini, Francesca; Giannarelli, Diana; Guarini, Anna; De Propriis, Maria Stefania; Cerretti, Raffaella; Foa, Robin.

In: Haematologica, Vol. 87, No. 6, 2002, p. 602-608.

Research output: Contribution to journalArticle

Mauro, Francesca Romana ; Gentile, Massimo ; Mancini, Francesca ; Giannarelli, Diana ; Guarini, Anna ; De Propriis, Maria Stefania ; Cerretti, Raffaella ; Foa, Robin. / Prognostic significance of lymphocyte morphology in patients with advanced chronic lymphocytic leukemia treated with first line therapy of fludarabine + prednisone. In: Haematologica. 2002 ; Vol. 87, No. 6. pp. 602-608.
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T1 - Prognostic significance of lymphocyte morphology in patients with advanced chronic lymphocytic leukemia treated with first line therapy of fludarabine + prednisone

AU - Mauro, Francesca Romana

AU - Gentile, Massimo

AU - Mancini, Francesca

AU - Giannarelli, Diana

AU - Guarini, Anna

AU - De Propriis, Maria Stefania

AU - Cerretti, Raffaella

AU - Foa, Robin

PY - 2002

Y1 - 2002

N2 - Background and Objectives. Chronic lymphocytic leukemia (CLL) is characterized by clinical, immunophenotypic and morphologic heterogeneity. The morphologic pattern of CLL lymphocytes at diagnosis has been associated with likelihood of different prognoses, while its prognostic significance at the time of disease progression is uncertain. Design and Methods. In 69 previously untreated patients with advanced CLL the morphology of peripheral blood (PB) lymphocytes was retrospectively analyzed prior to therapy with fludarabine (FD: 25 mg/m2 × 5 consecutive days every 4 weeks) and prednisone (P: 40 mg/m2 × 5 consecutive days every 4 weeks). Two groups of patients were identified: the first one characterized by typical CLL morphology (T) and ≤11% of atypical lymphocytes, and the second one characterized by >11% of atypical lymphocytes (A). The second group was further subdivided into a group characterized by prolymphocyte prevalence (Ap) and into a group characterized by mixed cell morphology (Amc), with a prevalence of large-sized lymphocytes and/or small, cleaved lymphocytes and/or lymphoplasmocytoid cells with or without shaped nucleus. Results. Forty-two patients (61%) showed a T morphology and 27 (39%) an A morphology. The latter group included 14 patients with an Ap morphology and 13 with an Amc morphology. Two thirds of patients with A morphology showed an immunophenotypic score of 3-4. No significant differences in the distribution of clinical features prior to therapy were observed within the three morphologic groups (T, Ap, Amc), except for a higher lymphocyte count in the Ap group (p55 years) and CLL duration (≤12 vs >12 months) emerged as significant and independent prognostic factors of survival probability. Interpretation and Conclusions. The results of this study indicate that about one third of CLL patients with advanced disease have an atypical morphology and that about two thirds of patients with A morphology also show a low immunophenotypic score. The morphologic pattern at the time of progression does not allow identification of prognostic subgroups of patients with different response rates to first line therapy with FD + P.

AB - Background and Objectives. Chronic lymphocytic leukemia (CLL) is characterized by clinical, immunophenotypic and morphologic heterogeneity. The morphologic pattern of CLL lymphocytes at diagnosis has been associated with likelihood of different prognoses, while its prognostic significance at the time of disease progression is uncertain. Design and Methods. In 69 previously untreated patients with advanced CLL the morphology of peripheral blood (PB) lymphocytes was retrospectively analyzed prior to therapy with fludarabine (FD: 25 mg/m2 × 5 consecutive days every 4 weeks) and prednisone (P: 40 mg/m2 × 5 consecutive days every 4 weeks). Two groups of patients were identified: the first one characterized by typical CLL morphology (T) and ≤11% of atypical lymphocytes, and the second one characterized by >11% of atypical lymphocytes (A). The second group was further subdivided into a group characterized by prolymphocyte prevalence (Ap) and into a group characterized by mixed cell morphology (Amc), with a prevalence of large-sized lymphocytes and/or small, cleaved lymphocytes and/or lymphoplasmocytoid cells with or without shaped nucleus. Results. Forty-two patients (61%) showed a T morphology and 27 (39%) an A morphology. The latter group included 14 patients with an Ap morphology and 13 with an Amc morphology. Two thirds of patients with A morphology showed an immunophenotypic score of 3-4. No significant differences in the distribution of clinical features prior to therapy were observed within the three morphologic groups (T, Ap, Amc), except for a higher lymphocyte count in the Ap group (p55 years) and CLL duration (≤12 vs >12 months) emerged as significant and independent prognostic factors of survival probability. Interpretation and Conclusions. The results of this study indicate that about one third of CLL patients with advanced disease have an atypical morphology and that about two thirds of patients with A morphology also show a low immunophenotypic score. The morphologic pattern at the time of progression does not allow identification of prognostic subgroups of patients with different response rates to first line therapy with FD + P.

KW - Chronic lymphocytic leukemia

KW - Fludarabine

KW - Morphology

KW - Prednisone

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