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Benign monoclonal B cell lymphocytosis--a benign variant of CLL: clinical,
immunologic, phenotypic, and cytogenetic studies in 20 patients
T Han, H Ozer, M Gavigan, R Gajera, J Minowada, ML Bloom, N Sadamori, AA Sandberg, GA Gomez and ES Henderson
From 1951 through 1978, we have seen 20 cases of stage O chronic
lymphocytic leukemia (CLL) without disease progression for 6.5-24 years.
The cohort included 7 males and 13 females, aged 48-77 years at the time of
diagnosis. None presented with anemia, thrombocytopenia, or neutropenia nor
developed cytopenias during follow-up. Mean total lymphocyte count in these
patients was 20,100/microL, with ranges from 10,000 to 43,700 at the time
of diagnosis, and was 20,600, with ranges from 1,000 to 47,200, at last
follow-up. Of 12 patients studied, 8 and 4 were phenotyped as heavy chain
mu delta- and mu-type, respectively, with 7 kappa- and 4 gamma-type (no
light chain was detectable in one patient). Of 13 patients studied, one had
a slightly elevated IgG level and two had slightly depressed serum IgA and
IgM levels. All patients had positive delayed hypersensitivity responses to
at least one of five skin test antigens. Each of seven patients studied for
an in vitro leukocyte thymidine uptake had a low level of [3H]thymidine
incorporation. Nine of 12 patients studied had elevated total T cells, and
the remaining 3 had normal T cell counts. In vitro unseparated lymphocyte
response to phytohemagglutinin showed normal kinetics of DNA synthesis,
with a peak response on day 3 or 4 of culture in 4 and slightly or
moderately depressed and/or delayed kinetics in 8 patients studied.
Cytogenetic analyses by Q- or G-banding techniques of polyclonal B cell
mitogen-stimulated lymphocytes in all six patients studied showed normal
karyotypes. These data are consistent with a previously undescribed
syndrome involving a monoclonal B cell lymphocytosis, a prolonged
asymptomatic or benign clinical course, and essentially normal humoral and
cellular immunity and normal karyotype. Our observations indicate that
these 20 patients with stage O CLL have a benign clinical course and that
they may also be designated as benign monoclonal B cell lymphocytosis (
BMBL ), a benign variant of CLL.
Volume 64,
Issue 1,
pp. 244-252,
07/01/1984
Copyright © 1984 by The American Society of Hematology
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