title: [The prognostic value of smudge cells (Gumprecht shadows) in chronic lymphocytic leukaemia].
abstract: BACKGROUND
  Smudge cells (Gumprecht shadows) are chronic lymphocytic leukaemic cells ruptured during peripheral blood smear preparation. It has been demonstrated to be linked to reduced expression of the cytoskeletal protein vimentin and its inverse correlation with the clinical outcome of the disease.
  
  
  OBJECTIVE
  Investigation of the percentage of smudge cells, CD38-, ZAP-70-positive cells and the time to treatment in patients with chronic lymphocytic leukaemia.
  
  
  METHODS
  Authors investigated the percentage of smudge cells, CD38- and ZAP-70-positive cells in the peripheral blood of 50 patients with chronic lymphocytic leukaemia and their correlation with the time to treatment.
  
  
  RESULTS
  21 patients required treatment in the follow-up period. Their median smudge cell percentage was 9.9%, while it was 26.8% in the non-treated group. The cut-off value of smudge cell positivity was set to 20%. 59.3% of the patients with less than cut-off had to be treated in the follow-up time compared to 21.7% of patients with more smudge cells. These findings were similar to the prognostic value of CD38 and ZAP-70. The necessity of treatment increased to 75-77.8% with the combination of investigated markers. The time to treatment was 19 months when smudge cells were less than 20%, but above 20% it was 36.15 months. In case of low smudge cell percentage and CD38 positivity the time to treatment was 14.14 months and in case of high smudge cell percentage and CD38 negativity it was 32.92 months. In discordant cases the time to treatment was 18.43 months. The authors also present a case report that demonstrates the relationship between the percentage of smudge cells and apoptotic cells with annexin V and 7-AAD staining.
  
  
  CONCLUSIONS
  Estimation of smudge cells on a blood smear could be a simple and cheap prognostic test in chronic lymphocytic leukaemia with sensitivity similar to CD38 and ZAP-70 estimation. Combination of these tests raised the sensitivity of their prognostic value.
authors.affiliation: Jósa András Oktatókórház Egészségügyi Szolgáltató Nonprofit Kft. Hematológiai Osztály Nyíregyháza Szent István. szerafin@josa.hu
authors.forename: László
authors.initials: L
authors.lastname: Szerafin
authors.forename: János
authors.initials: J
authors.lastname: Jakó
authors.forename: Ferenc
authors.initials: F
authors.lastname: Riskó
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Hevessy
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000032:analysis*; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood / Q000473:pathology* / Q000628:therapy; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014746:Vimentin / Q000032:analysis*; D051746:ZAP-70 Protein-Tyrosine Kinase / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D008562:Membrane Glycoproteins; D014746:Vimentin; D051746:ZAP-70 Protein-Tyrosine Kinase; C497261:ZAP70 protein, human; C498154:CD38 protein, human; D051997:ADP-ribosyl Cyclase 1