title: Deciphering leukemic B-cell chronic lymphoproliferative disorders.
abstract: Diagnosis of leukemic B-cell chronic lymphoproliferative disorders (B-CLPD) is a frequent challenge in hematology. In this multicentric study, we prospectively studied 165 new consecutive leukemic patients with B-CLPD selected on the basis of Royal Marsden Hospital scoring system < or =3. The primary aim of the study was to try to decipher the atypical cases and identify homogenous subgroups. Overall, morphological examination contributed to diagnosis in only 20% cases, all of them CD5 negative. Thirty additional cases were CD5 negative suggestive of leukemic marginal zone lymphoma in most cases. The significantly poorer survival of the 26 cyclin D1 positive cases justifies recommending its systematic determination among atypical B-CLPD. CD20 expression segregated clearly two subgroups among CD5 positive cyclin D1 negative B-CLPD. The 17 patients with the CD20 dim profile represent a homogeneous subgroup very close to typical B-cell chronic lymphocytic leukemia (B-CLL) on morphological, phenotypical and cytogenetical criteria. In contrast, the subgroup of 51 patients with a CD20 bright profile is heterogeneous. Their significantly lower p27 expression level suggest the presence of a proliferative component, underlying a more aggressive disease. Further genomic studies are warranted to establish their precise nature. These cases should not be included in the same therapeutic trials as B-CLL.
authors.affiliation: Laboratoire d'Hématologie, CHU Brest, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Ugo
authors.forename: Nathalie
authors.initials: N
authors.lastname: Leporrier
authors.forename: Véronique
authors.initials: V
authors.lastname: Salaun
authors.forename: Rémi
authors.initials: R
authors.lastname: Letestu
authors.forename: Isabelle
authors.initials: I
authors.lastname: Radford-Weiss
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ramond
authors.forename: Joelle
authors.initials: J
authors.lastname: Nataf
authors.forename: Martine
authors.initials: M
authors.lastname: Guesnu
authors.forename: Françoise
authors.initials: F
authors.lastname: Picard
authors.forename: Chantal
authors.initials: C
authors.lastname: Brouzes
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Perrot
authors.forename: Françoise
authors.initials: F
authors.lastname: Valensi
authors.forename: Vincent
authors.initials: V
authors.lastname: Levy
authors.forename: Florence
authors.initials: F
authors.lastname: Ajchenbaum-Cymbalista
authors.forename: Xavier
authors.initials: X
authors.lastname: Troussard
mesh_terms: D000368:Aged; D018951:Antigens, CD20 / Q000096:biosynthesis; D018956:CD5 Antigens / Q000096:biosynthesis; D002453:Cell Cycle; D015331:Cohort Studies; D019938:Cyclin D1 / Q000096:biosynthesis; D050760:Cyclin-Dependent Kinase Inhibitor p27 / Q000096:biosynthesis; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D016393:Lymphoma, B-Cell / Q000145:classification / Q000175:diagnosis* / Q000235:genetics*; D008232:Lymphoproliferative Disorders / Q000145:classification / Q000235:genetics* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D018951:Antigens, CD20; D018956:CD5 Antigens; D019938:Cyclin D1; D050760:Cyclin-Dependent Kinase Inhibitor p27