Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan-Mar;44(1):63-69.
doi: 10.1016/j.htct.2021.04.002. Epub 2021 May 27.

Smudge cells percentage on blood smear is a reliable prognostic marker in chronic lymphocytic leukemia

Abibatou Sall  1 , Moussa Seck  2 , Seynabou Fall  2 , Fatimata Bintou Sall  2 , Blaise Félix Faye  2 , Fatou Samba Ndiaye  2 , Macoura Gadji  2 , Saliou Diop  2 , Awa Oumar Touré  2 , Martine Raphaël  3
Affiliations

Smudge cells percentage on blood smear is a reliable prognostic marker in chronic lymphocytic leukemia

Abibatou Sall et al. Hematol Transfus Cell Ther. 2022 Jan-Mar.

Abstract

Objective: We evaluated the relevance of using the smudge cell percentage in the blood smear as a prognostic marker in CLL.

Methods: In this prospective study, 42 untreated Senegalese patients with CLL were enrolled. The diagnosis was established, based on the peripheral blood count and flow cytometry using the Matutes score. Cytogenetic aberrations, assessed by fluorescence in situ hybridization (FISH), were available for 30 patients, while the immunoglobulin heavy chain genes (IGVH) mutation status was performed by next-generation sequencing (NGS) in 24 patients. The SC percentage was determined in the blood smear, as previously described. Statistical analyses were executed using the GraphPad Prism 8.

Results: The mean age was 63 years (48 - 85) and the male: female sex ratio was 4.66. A low SC (< 30%) percentage was correlated with Binet stage B/C (p = 0.0009), CD38 expression (p = 0.039), unmutated IGVH status (p = 0.0009) and presence of cytogenetic abnormalities (for del 13q, p = 0.0012, while for other cytogenetic aberrations, p = 0.016). An inverse correlation was found between the SC percentage and the absolute lymphocyte count (r = -0.51) and patients with higher percentage of SCs had a prolonged survival. However, there was no correlation between the SC percentage and age (p = 0.41) or gender (median, 19% for males vs. 20% for females; p = 0.76).

Conclusion: When less than 30%, the SC was associated with a poor prognosis in CLL. Easy and affordable, the percentage of SCs in a blood smear could be a reliable prognostic marker, accessible to all CLL patients, mainly those in developing countries.

Keywords: Blood smear; CLL; Prognostic marker; Senegal; Smudge cells.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Blood smears of different CLL patients (x 100). A and B: different forms of SC (red arrows). C: SC with disrupted nuclear membrane (yellow arrows). D: Blood smear without SC. * represent the degree of significance. *: p = 0.01, **: p = 0.001, ***: p = 0.0001.Ns = not significant.
Figure 2
Figure 2
A: Simple linear regression between SC percentage and lymphocytes count. B: Percentage of SC in Binet stage A and Binet stages B/C. C: SC percentage depending on CD38 expression. D: SC percentage regarding the presence or absence of 13q deletion. E: SC percentage in patients with at least one C.A (Trisomy 12 and/or del 11q and/or del 17p). F: SC percentage in patients with unmutated or mutated IGVH status. G: Correlation between SC percentage and age. H: SC percentage depending on gender.
Figure 3
Figure 3
Kaplan-Meier survival curves of 42 CLL patients, regarding the SC percentage.
See this image and copyright information in PMC

References

    1. Rai K.R., Jain J. Chronic lymphocytic leukemia: Then and now. Am J Hematol. 2016;91:330–340. - PubMed
    1. Hallek M. Chronic lymphocytic leukemia: 2020 update on diagnosis, risk stratification and treatment. Am J Hematol. 2019;94:1266–1287. - PubMed
    1. Binet J.L., Auquier A., Dighiero G., Chastang C., Piguet H., Goasguen J., et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer. 1981;48:198–204. - PubMed
    1. Rai K.R., Sawitsky A., Cronkite E.P., Chanana A.D., Levy R.N., Pasternack B.S. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46:219–234. - PubMed
    1. Baliakas P., Mattsson M., Stamatopoulos K., Rosenquist R. Prognostic indices in chronic lymphocytic leukaemia: where do we stand how do we proceed? J Intern Med. 2016;279:347–357. - PubMed