The prognosis of clinical monoclonal B cell lymphocytosis differs from prognosis of Rai 0 chronic lymphocytic leukaemia and is recapitulated by biological risk factors

Davide Rossi, Elisa Sozzi, Alessia Puma, Lorenzo De Paoli, Silvia Rasi, Valeria Spina, Alessandro Gozzetti, Maristella Tassi, Emanuele Cencini, Donatella Raspadori, Valeria Pinto, Francesco Bertoni, Valter Gattei, Francesco Lauria, Gianluca Gaidano, Francesco Forconi

Research output: Contribution to journalArticle

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Abstract

Monoclonal B-cell lymphocytosis (MBL) is an asymptomatic monoclonal expansion of 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 9/l and >3·7 × 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: 5·39, 95% confidence interval 1·98-14·44, P = 0·001). 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.

Original languageEnglish
Pages (from-to)64-75
Number of pages12
JournalBritish Journal of Haematology
Volume146
Issue number1
DOIs
Publication statusPublished - Jul 2009

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Lymphocytosis
Biological Factors
B-Cell Chronic Lymphocytic Leukemia
B-Lymphocytes
Lymphocytes
Phenotype
Survival Analysis
Fluorescence In Situ Hybridization
Karyotype
Multivariate Analysis
Confidence Intervals
Mutation
Infection

Keywords

  • Chronic lymphocytic leukaemia
  • FISH karyotype
  • Immunoglobulin genes
  • Monoclonal B-cell lymphocytosis
  • Prognosis

ASJC Scopus subject areas

  • Hematology

Cite this

The prognosis of clinical monoclonal B cell lymphocytosis differs from prognosis of Rai 0 chronic lymphocytic leukaemia and is recapitulated by biological risk factors. / Rossi, Davide; Sozzi, Elisa; Puma, Alessia; De Paoli, Lorenzo; Rasi, Silvia; Spina, Valeria; Gozzetti, Alessandro; Tassi, Maristella; Cencini, Emanuele; Raspadori, Donatella; Pinto, Valeria; Bertoni, Francesco; Gattei, Valter; Lauria, Francesco; Gaidano, Gianluca; Forconi, Francesco.

In: British Journal of Haematology, Vol. 146, No. 1, 07.2009, p. 64-75.

Research output: Contribution to journalArticle

Rossi, D, Sozzi, E, Puma, A, De Paoli, L, Rasi, S, Spina, V, Gozzetti, A, Tassi, M, Cencini, E, Raspadori, D, Pinto, V, Bertoni, F, Gattei, V, Lauria, F, Gaidano, G & Forconi, F 2009, 'The prognosis of clinical monoclonal B cell lymphocytosis differs from prognosis of Rai 0 chronic lymphocytic leukaemia and is recapitulated by biological risk factors', British Journal of Haematology, vol. 146, no. 1, pp. 64-75. https://doi.org/10.1111/j.1365-2141.2009.07711.x
Rossi, Davide ; Sozzi, Elisa ; Puma, Alessia ; De Paoli, Lorenzo ; Rasi, Silvia ; Spina, Valeria ; Gozzetti, Alessandro ; Tassi, Maristella ; Cencini, Emanuele ; Raspadori, Donatella ; Pinto, Valeria ; Bertoni, Francesco ; Gattei, Valter ; Lauria, Francesco ; Gaidano, Gianluca ; Forconi, Francesco. / The prognosis of clinical monoclonal B cell lymphocytosis differs from prognosis of Rai 0 chronic lymphocytic leukaemia and is recapitulated by biological risk factors. In: British Journal of Haematology. 2009 ; Vol. 146, No. 1. pp. 64-75.
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AU - Rossi, Davide

AU - Sozzi, Elisa

AU - Puma, Alessia

AU - De Paoli, Lorenzo

AU - Rasi, Silvia

AU - Spina, Valeria

AU - Gozzetti, Alessandro

AU - Tassi, Maristella

AU - Cencini, Emanuele

AU - Raspadori, Donatella

AU - Pinto, Valeria

AU - Bertoni, Francesco

AU - Gattei, Valter

AU - Lauria, Francesco

AU - Gaidano, Gianluca

AU - Forconi, Francesco

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N2 - Monoclonal B-cell lymphocytosis (MBL) is an asymptomatic monoclonal expansion of 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 9/l and >3·7 × 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: 5·39, 95% confidence interval 1·98-14·44, P = 0·001). 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.

AB - Monoclonal B-cell lymphocytosis (MBL) is an asymptomatic monoclonal expansion of 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 9/l and >3·7 × 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: 5·39, 95% confidence interval 1·98-14·44, P = 0·001). 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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