title: Absolute lymphocyte count with extreme hyperleukocytosis does not have a prognostic impact in chronic lymphocytic leukemia.
abstract: BACKGROUND/ AIM: The prognostic significance of hyperleukocytosis in chronic lymphocytic leukemia (CLL) remains uncertain. The aim of the present study was to evaluate the clinical characteristics and outcome of patients with CLL and white blood count (WBC) >150×10(6)/l at the time of diagnosis.
  
  
  METHODS
  Using the database of the Israeli CLL Study Group, which includes 1,507 cases, we identified 41 patients diagnosed with WBC >150×10(6)/l and analyzed the survival in the group that was 62 months compared to 174 months in patients without hyperleukocytosis (p<0.001). However, multivariate analysis demonstrated that the WBC count had no predictive value in relation to survival time. While in the entire patient cohort advanced age and Binet stage, presence of thrombocytopenia and ZAP-70 expression were independently associated with poor prognosis, these parameters lost their prognostic value in patients with hyperleukocytosis.
  
  
  CONCLUSIONS
  Although our results do not confirm that high initial levels of WBC are independently associated with shorter survival in CLL, the clinical course in these cases appears to be aggressive and conventional prognostic factors are not valid in this patient sub-group.
authors.affiliation: Kaplan Medical Center, Rehovot, Israel levsh@clalit.org.il.
authors.forename: Lev
authors.initials: L
authors.lastname: Shvidel
authors.affiliation: Rabin Medical Center, Petah-Tikva, Israel.
authors.forename: Osnat
authors.initials: O
authors.lastname: Bairey
authors.affiliation: Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Tadmor
authors.affiliation: Western Galilee Hospital, Naharyia, Israel.
authors.forename: Andrei
authors.initials: A
authors.lastname: Braester
authors.affiliation: Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Rosa
authors.initials: R
authors.lastname: Ruchlemer
authors.affiliation: Rambam Medical Center, Haifa, Israel.
authors.forename: Riva
authors.initials: R
authors.lastname: Fineman
authors.affiliation: Rabin Medical Center, Petah-Tikva, Israel.
authors.forename: Erel
authors.initials: E
authors.lastname: Joffe
authors.affiliation: Kaplan Medical Center, Rehovot, Israel.
authors.forename: Alain
authors.initials: A
authors.lastname: Berrebi
authors.affiliation: Hebrew University Medical School, Jerusalem, Israel.
authors.forename: Aaron
authors.initials: A
authors.lastname: Polliack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood* / Q000150:complications / Q000473:pathology; D007964:Leukocytosis / Q000097:blood* / Q000150:complications / Q000473:pathology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D051746:ZAP-70 Protein-Tyrosine Kinase / Q000096:biosynthesis
chemical_list: D051746:ZAP-70 Protein-Tyrosine Kinase; C497261:ZAP70 protein, human
keywords: Chronic lymphocytic leukemia; hyperleukocytosis; prognosis; survival