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Blood, 30 April 2009, Vol. 113, No. 18, pp. 4188-4196. Prepublished online as a Blood First Edition Paper on November 17, 2008; DOI 10.1182/blood-2008-09-176149. This Article Full Text (PDF) All Versions of this Article: blood-2008-09-176149v1 113/18/4188    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Shanafelt, T. D Articles by Hanson, C. A. Search for Related Content PubMed PubMed Citation Articles by Shanafelt, T. D Articles by Hanson, C. A. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted September 5, 2008 Accepted October 17, 2008 B-cell count and survival: Differentiating chronic lymphocytic leukemia (CLL) from monoclonal B-cell lymphocytosis (MBL) based on clinical outcome Tait D Shanafelt*, Neil E. Kay, Greg Jenkins, Timothy G. Call, Clive S Zent, Diane F Jelinek, William G. Morice, Justin Boysen, Liam Zakko, Susan Schwager, Susan L Slager, and Curtis A. Hanson Mayo Clinic, Rochester, MN, United States * Corresponding author; email: shanafelt.tait{at}mayo.edu. The diagnosis of CLL in asymptomatic patients has historically been based on documenting a characteristic lymphocyte clone and the presence of lymphocytosis. There are minimal data regarding which lymphocyte parameter(absolute lymphocyte count[ALC] or B-cell count) and what threshold should be used for diagnosis. We analyzed the relationship of ALC and B-cell count with clinical outcome in 459 patients with a clonal population of CLL phenotype to determine whether the CLL diagnosis: 1)should be based on ALC or B-cell count; 2)what lymphocyte threshold should be used for diagnosis; 3)whether any lymphocyte count has independent prognostic value after accounting for biologic/molecular prognostic markers. B-cell count and ALC had similar value for predicting treatment free survival(TFS) and overall survival as continuous variables but, as binary factors, a B-cell threshold of 11x109/L best predicted survival. B-cell count remained an independent predictor of TFS after controlling for ZAP-70, IGHV, CD38, or FISH results(all p<0.001). These analyses support basing the diagnosis of CLL on B-cell count and retaining the size of the B-cell count in the diagnostic criteria. Using clinically relevant criteria to distinguish between MBL and CLL could minimize patient distress caused by labeling asymptomatic individuals at low risk for adverse clinical consequences as having CLL. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: The changing definition of CLL Gerald E. Marti Blood 2009 113: 4130-4131. [Full Text] [PDF] This article has been cited by other articles: W. G. Nieto, J. Almeida, A. Romero, C. Teodosio, A. Lopez, A. F. Henriques, M. L. Sanchez, M. Jara-Acevedo, A. Rasillo, M. Gonzalez, et al. Increased frequency (12%) of circulating chronic lymphocytic leukemia-like B-cell clones in healthy subjects using a highly sensitive multicolor flow cytometry approach Blood, July 2, 2009; 114(1): 33 - 37. [Abstract] [Full Text] [PDF] C. A. Hanson, P. J. Kurtin, and A. Dogan The proposed diagnostic criteria change for chronic lymphocytic leukemia: unintended consequences? Blood, June 18, 2009; 113(25): 6495 - 6496. [Full Text] [PDF] G. E. Marti The changing definition of CLL Blood, April 30, 2009; 113(18): 4130 - 4131. [Full Text] [PDF]

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