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Título
Low-count monoclonal B-cell lymphocytosis persists after seven years of follow up and is associated with a poorer outcome
Autor(es)
Materia
MBL
Haematology
Fecha de publicación
2018-07
Editor
European Hematology Association (La Haya, Países Bajos)
Citación
Haematologica 2018 Volume 103(7):1198-1208
Resumen
[EN]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 leukemialike)
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 Bcell
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.
URI
ISSN
0390-6078
DOI
doi:10.3324/haematol.2017.183954
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