Is there an epidemic of chronic lymphocytic leukaemia (CLL) in China?

Yang, Shenmiao; Gale, Robert Peter; Shi, Hongxia; Liu, Yanrong; Lai, Yue‐Yun; Huang, Xiao‐Jun

doi:10.1016/j.leukres.2018.08.011

Cited by 13 publications

(17 citation statements)

References 20 publications

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“…Chronic lymphocytic leukemia (CLL) is a common clonal neoplasm of small, mature B lymphocytes among adults in Western countries; however, it is relatively rare in Asians (1). Recently, there has been an increasing frequency of new CLL cases in China with the development of the Chinese economy and the improvement of testing methods (2). Cytogenetic analyses, including fluorescence in situ hybridization (FISH) and chromosome banding analysis (CBA), play an important role in the prognostic evaluation of CLL.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Chronic Lymphocytic Leukemia With a Rare Translocation t(14;19)(q32;q13) Involving IGH/BCL3 Rearrangements: Report of Three Chinese Cases and Literature Review

Xing

Zhang

et al. 2020

Front. Oncol.

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BackgroundA translocation t(14;19)(q32;q13) leading to a fusion of IGH and BCL3 which is a rare cytogenetic abnormality in CLL patients, has a more aggressive clinical course with a shorter time to first treatment (TTT) and worse overall survival (OS). To date, there is no literature reporting the identification of the t(14;19) in Chinese CLL patients and the reviewing the characteristic of all patients with this abnormality reported previously in the literature.Patients and MethodsWe first demonstrate three cases of t(14;19) translocation among the 200 CLL patients from 2017 to 2019 in our hospital. We investigated several aspects such as clinicopathologic features, cytogenetic analysis, IGHV mutations, next-generation sequencing technology (NGS), and histopathological characteristics in order to clearly define the features of this entity in Chinese patients and compare them with patients reported previously in western countries.ResultsThe clinical and pathological features of our three cases resemble those of earlier reports. All patients had atypical morphologic features and atypical immunophenotypes with low CLL scores detected by flow cytometry. All cases were unmutated in the IGHV mutations. Two cases showed complex karyotype and one case demonstrate missense mutations of TP53 and FBXW7.ConclusionIn conclusion, this is the first report on IGH/BCL3-positive B-CLLs in Chinese people, which provided a comprehensive analysis of clinical and pathological characteristics. In addition to some similar clinical and laboratory features reported in the previous literature, we first found that CLL with t(14;19) has a higher possibility of being accompanied with high complex karyotype (high-CK), which is now regarded as a novel negative prognostic marker. Early identification of this abnormality in CLL patients is so important that patients can benefit from the more aggressive treatments at the onset of the disease.

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Section: Introductionmentioning

confidence: 99%

Case Report: Chronic Lymphocytic Leukemia With a Rare Translocation t(14;19)(q32;q13) Involving IGH/BCL3 Rearrangements: Report of Three Chinese Cases and Literature Review

Xing

Zhang

et al. 2020

Front. Oncol.

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“…Another recent retrospective study conducted in China showed that CLL accounted for 55.9% of all 653 cases of B-LPD (median age: 61 years, IQR: 54–70 years), which was treated at a single haematological centre. 12 Similarly, Yang et al 6 reported an increased frequency of CLL at their centre in Beijing, China. These data seem to overthrow the view that CLL is much less common in Asians compared with persons of European descent.…”

Section: Discussionmentioning

confidence: 94%

“… 3 CLL is a relatively rare haematological malignancy in China, with an annual incidence of only 0.05/100 000 according to a previous population-based study. 4 5 However, an increase in the frequency of CLL was recently observed in several large medical centres in China, 6 indicating that the actual incidence of CLL in China may have been underestimated due to high misdiagnosis rates as well as high diagnostic delay.…”

Section: Introductionmentioning

confidence: 99%

Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study

Wei

et al. 2020

BMJ Open

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ObjectivesScreening of monoclonal B-cell lymphocytosis (MBL) has improved the early detection of B-cell lymphoproliferative disorders (B-LPDs). This study was designed to find the most cost-effective way to screen for asymptomatic B-LPD.DesignObservational study.SettingA lymphocytosis screening project was conducted at a large-scale hospital among the Chinese population.ParticipantsFor 10 consecutive working days in 2018, 22 809 adult patients who received a complete blood count (CBC) were reviewed. These patients were selected from the outpatient, inpatient and health examination departments of a National Medical Centre in China.ResultsA total of 254 patients (1.1%, 254/22 809) were found to have lymphocytosis (absolute lymphocyte count (ALC) >3.5×109/L). Among them, a population of circulating monoclonal B-lymphocytes were detected in 14 patients, with 4 having chronic lymphocytic leukaemia (CLL) and 10 having MBL, indicating an overall prevalence of 5.5% for B-LPD (3.9% for MBL). The prevalence of CLL among the elderly patients with lymphocytosis (≥60 years) was determined to be 4.3% (4/92). In the patients over 60 years of age, the prevalence of MBL was found to be 8.7%. CD5 (−) non-CLL-like MBL was observed to be the most common subtype (8, 80%), followed by CLL-like phenotype (1, 10.0%) and atypical CLL phenotype (1, 10.0%). The receiver operating characteristic curve analysis for the CBC results revealed that the ALC of 4.7×109/L may serve as the optimal and cost-effective cut-off for screening for early-stage asymptomatic B-LPD.ConclusionIn Chinese patients with lymphocytosis, there was a relatively high proportion of patients with CLL among individuals over 60 years of age. MBL is an age-related disorder. Non-CLL-like MBL was the most common MBL subtype, almost all of whom displayed a pattern of ‘marginal zone lymphoma (MZL)-like’ MBL. Lymphocytosis screening among the elderly would be effective in the detection of B-LPD and MBL.

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“…CLL, as one of the most common lymphomas, is estimated to affect an increasing number of the Chinese population [4]. Since the incidence rate of CLL rises with age, and aging is becoming an increasingly significant problem in China, the morbidity and mortality of CLL are expected to rise rapidly in the next few decades [5]. Hence, even though the prevalence of CLL is not "high" for now, it still deserves attention and research from academia.…”

Section: Introductionmentioning

confidence: 99%

“…The new scale provides an advanced assessment of the HRQoL, including both the physical and mental dimensions of patients living with CLL. In China, although the population of patients affected by CLL has expanded in recent years [5], studies on the impact of CLL on patient's HRQoL are still nascent. It is important to provide a valid, reliable, and responsive measure to evaluate the impact of CLL and associated interventions on the HRQoL changes.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Chinese EORTC chronic lymphocytic leukaemia module – application of classical test theory and item response theory

Dong

Jin

Oerlemans

et al. 2020

Health Qual Life Outcomes

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Purpose: The association of chronic lymphocytic leukemia (CLL) with health-related quality of life (HRQoL) is rarely studied globally. This study evaluated the psychometric properties of the EORTC-Chronic Lymphocytic Leukaemia (CLL17 [phase III]) module, a newly developed assessment on CLL patients' HRQoL, among Chinese CLL patients. Methods: The Chinese CLL17, comprised of three subscales (symptom burden [SB], physical condition [PC] and worries/fears [WF]), was provided by the developer team through EORTC. A cross-sectional online survey was conducted to collect data. The classical traditional theory (CTT) and the item response theory (IRT) were used to evaluate the psychometric properties of CLL17. Internal consistency reliability was determined by the Cronbach's alpha and item-total correlation. Dimensionality was verified through confirmatory factor analysis (CFA). Convergent validity was also assessed. The generalized partial credit model was used for the IRT. The difficulty, discrimination, item fit, and differential item functioning (DIF) were calculated to assess the instrument's psychometric properties. Results: In all, 318 patients, aged between 26 and 82 years, completed the questionnaire. A good level of internal reliability was achieved (Cronbach's alpha = 0.92). The item-total correlation coefficient ranged from 0.46 to 0.72. There was a mid-to-high correlation between CLL17 and domains of EQ-5D and QLQ-C30. The IRT model showed a satisfactory homogeneity, item fit and good discrimination of items, except for item 4, 6 and 16 (< 1.0). low information provided by item 16 and 17. SB and PC provided more information with theta > 0, whereas WF provided more information with theta < 0. Item 17 perform inconsistently for respondents from different age groups (DIF). Conclusion: The EORTC-CLL17 Chinese version shows acceptable reliability and validity, making it a valuable instrument to evaluate the impact on the HRQoL of Chinese CLL patients.

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Is there an epidemic of chronic lymphocytic leukaemia (CLL) in China?

Cited by 13 publications

References 20 publications

Case Report: Chronic Lymphocytic Leukemia With a Rare Translocation t(14;19)(q32;q13) Involving IGH/BCL3 Rearrangements: Report of Three Chinese Cases and Literature Review

Case Report: Chronic Lymphocytic Leukemia With a Rare Translocation t(14;19)(q32;q13) Involving IGH/BCL3 Rearrangements: Report of Three Chinese Cases and Literature Review

Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study

Validation of the Chinese EORTC chronic lymphocytic leukaemia module – application of classical test theory and item response theory

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