Deciphering leukemic B-cell chronic lymphoproliferative disorders.
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.
Ugo
Valérie
V
Laboratoire d'Hématologie, CHU Brest, France.
Leporrier
Nathalie
N
Salaun
Véronique
V
Letestu
Rémi
R
Radford-Weiss
Isabelle
I
Ramond
Sylvie
S
Nataf
Joelle
J
Guesnu
Martine
M
Picard
Françoise
F
Brouzes
Chantal
C
Perrot
Jean-Yves
JY
Valensi
Françoise
F
Levy
Vincent
V
Ajchenbaum-Cymbalista
Florence
F
Troussard
Xavier
X
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
D018951:Antigens, CD20; D018956:CD5 Antigens; D019938:Cyclin D1; D050760:Cyclin-Dependent Kinase Inhibitor p27