title: A novel scoring system combining expression of CD23, CD20, and CD38 with platelet count predicts for the presence of the t(11;14) translocation of mantle cell lymphoma.
abstract: BACKGROUND
  Both chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) are CD5/19 positive. The t(11;14) MCL translocation is identified by fluorescent in situ hybridization (FISH) and can distinguish the two disorders. We attempted to identify flow cytometric and other markers predictive of a positive FISH test.
  
  
  METHODS
  We examined 100 atypical CLL/MCL cases for demographic, hematological, and cytometric variables, 96 were FISH tested for t(11;14) and four were known MCL.
  
  
  RESULTS
  Twenty-two cases were confirmed as MCL. Multivariate analysis identified four variables associated with MCL: thrombocytopenia (taken as Plt < 150 × 10⁹/L), CD23 negative, CD20 strong, and CD38 positive, with these variables a four-point score was devised. By ROC analysis, the MCL score was superior in differentiating MCL to the Marsden CLL score (AUC 0.95 vs. 0.78). MCL score ≥ 2 showed sensitivity 1, specificity 0.66, positive predictive value (PPV) 0.49, and negative predictive value (NPV) 1 for MCL. The score was then prospectively validated on an independent cohort of 44 cases of atypical CLL/MCL. No MCL had a score < 3. Validation PPV/NPV of score ≥ 3 were 0.5/1. Overall survival in MCL was shorter compared to t(11;14) negative patients (median 3.3 vs. 4.2 years, HR 2.2, 95% CI 0.87-5.5, P = 0.1).
  
  
  CONCLUSIONS
  The score described can be used to identify cases of CD5/19 positive lymphoproliferative disorders likely to be t(11;14) positive MCL.
authors.affiliation: Department of Haematology, Oxford Radcliffe Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX39DU, United Kingdom.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Medd
authors.forename: Nithiya
authors.initials: N
authors.lastname: Clark
authors.forename: Kevin
authors.initials: K
authors.lastname: Leyden
authors.forename: Susan
authors.initials: S
authors.lastname: Turner
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Strefford
authors.forename: Caroline
authors.initials: C
authors.lastname: Butler
authors.forename: Graham P
authors.initials: GP
authors.lastname: Collins
authors.forename: David J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: Wale
authors.initials: W
authors.lastname: Atoyebi
authors.forename: Chris S R
authors.initials: CS
authors.lastname: Hatton
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000378:metabolism*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018951:Antigens, CD20 / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D012372:ROC Curve; D017455:Receptors, IgE / Q000378:metabolism*; D014178:Translocation, Genetic
chemical_list: D018951:Antigens, CD20; D017455:Receptors, IgE; D051997:ADP-ribosyl Cyclase 1