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Comparative Study
. 2009 Aug 20;27(24):3959-63.
doi: 10.1200/JCO.2008.21.2704. Epub 2009 Jul 20.

Brief report: natural history of individuals with clinically recognized monoclonal B-cell lymphocytosis compared with patients with Rai 0 chronic lymphocytic leukemia

Tait D Shanafelt  1 , Neil E Kay, Kari G Rabe, Timothy G Call, Clive S Zent, Kami Maddocks, Greg Jenkins, Diane F Jelinek, William G Morice, Justin Boysen, Susan Schwager, Deborah Bowen, Susan L Slager, Curtis A Hanson
Affiliations
Comparative Study

Brief report: natural history of individuals with clinically recognized monoclonal B-cell lymphocytosis compared with patients with Rai 0 chronic lymphocytic leukemia

Tait D Shanafelt et al. J Clin Oncol. .

Abstract

Purpose: The diagnosis of monoclonal B-cell lymphocytosis (MBL) is used to characterize patients with a circulating population of clonal B cells, a total B-cell count of less than 5 x 10(9)/L, and no other features of a B-cell lymphoproliferative disorder including lymphadenopathy/organomegaly. The natural history of clinically identified MBL is unclear. The goal of this study was to explore the outcome of patients with MBL relative to that of individuals with Rai stage 0 chronic lymphocytic leukemia (CLL).

Patients and methods: We used hematopathology records to identify a cohort of 631 patients with newly diagnosed MBL or Rai stage 0 CLL. Within this cohort, 302 patients had MBL (B-cell counts of 0.02 to 4.99 x 10(9)/L); 94 patients had Rai stage 0 CLL with an absolute lymphocyte count (ALC) < or = 10 x 10(9)/L; and 219 patients had Rai stage 0 CLL with an ALC more than 10 x 10(9)/L. Data on clinical outcome were abstracted from medical records.

Results: The percentage of MBL patients free of treatment at 1, 2, and 5 years was 99%, 98%, and 93%, respectively. B-cell count as a continuous variable (hazard ratio [HR] = 2.9, P = .04) and CD38 status (HR = 10.8, P = .006) predicted time to treatment (TTT) among MBL patients. The likelihood of treatment for MBL patients was lower (HR = 0.32, P = .04) than that of both Rai stage 0 CLL patients with an ALC less than 10 x 10(9)/L (n = 94) and Rai stage 0 CLL patients with an ALC more than 10 x 10(9)/L (n = 219; P = .0003).

Conclusion: Individuals with MBL identified in clinical practice have a low risk for progression at 5 years. Because B-cell count seems to relate to TTT as a continuous variable, additional studies are needed to determine what B-cell count should be used to distinguish between MBL and CLL.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Time to treatment/overall survival of 302 individuals with clinically recognized monoclonal B-cell lymphocytosis. CLL, chronic lymphocytic leukemia.
Fig 2.
Fig 2.
Time to treatment among 274 monoclonal B-cell lymphocytosis patients based on whether the clonal cell population was CD38 positive (n = 60) or CD38 negative (n = 214; P = .006).
Fig 3.
Fig 3.
Time from diagnosis to treatment for patients with monoclonal B-cell lymphocytosis (MBL; absolute lymphocyte count [ALC] ≤ 10 × 109/L; B-cell count < 5.0 × 109/L), low-count, Rai 0 chronic lymphocytic leukemia (CLL; ALC ≤ 10 × 109/L; B-cell count of 5.0 to 10.0 × 109/L), and Rai 0 CLL with ALC more than 10 × 109/L. The difference in time to treatment (TTT) between patients with MBL and low-count, Rai 0 CLL was statistically significant (P = .03). Patients with MBL also had a significantly longer TTT than Rai 0 CLL patients with an ALC more than 10 × 109/L (P < .001).
Fig A1.
Fig A1.
Flow diagram of disease classification of 1,814 individuals with clonal population of chronic lymphocytic leukemia (CLL) phenotype on peripheral-blood flow at Mayo Clinic in January 2000 and December 2006. ALC, absolute lymphocyte count; MBL, monoclonal B-cell lymphocytosis; SLL, small lymphocytic lymphoma.
See this image and copyright information in PMC

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