Monoclonal B-cell lymphocytosis (MBL)is detectable in > 3% of the general population. Recent data are compatible, at least in a proportion of cases, with MBL being a progenitor lesion for chronic lymphocytic leukemia (CLL) and a surrogate for inherited predisposition.
IntroductionThe strong familial risk of chronic lymphocytic leukemia (CLL) provides evidence for inherited susceptibility to the disease. 1 Diagnosis of CLL is based on a B-cell count of more than or equal to 5 ϫ 10 9 /L and the presence of CD19, CD5, and CD23, weak expression of CD20, CD79b, and immunoglobulin receptor on B-cells. 2 Persons with peripheral CLL-phenotype monoclonal B cells less than 5 ϫ 10 9 /L but no clinical features of CLL are classified as having monoclonal B-cell lymphocytosis (MBL). 3 Approximately 10% to 15% of persons with a lymphocytosis have MBL, and 1% to 5% per year require treatment for progressive disease. 4,5 Very low levels of CLL-phenotype cells (Ͻ 0.01 ϫ 10 9 /L) are detected in more than 5% of adults. 6 A genome-wide association study 7,8 has identified single nucleotide polymorphisms (SNPs) mapping to 2q13(rs17483466), 2q37.1(rs13397985, SP140), 2q37.3(rs757978, FARP2), 6p25.3(rs872071, IRF4), 8q24.21(rs2456449), 11q24.1(rs735665), 15q21.3(rs7169431), 15q23(rs7176508), 16q24.1(rs305061), and 19q13.32(rs11083846, PRKD2), conferring a modest but significant increase in CLL risk. 7 Recent studies are compatible with MBL being a surrogate marker for inherited genetic susceptibility to CLL. 9 To explore whether the 10 SNPs influence CLL risk through predisposition to MBL, we analyzed 3 independent case-control series totaling 419 MBL cases and 1753 controls.
MethodsThe first 2 series were ascertained through laboratory investigations for an asymptomatic lymphocytosis. The series ascertained by the Hematological Malignancy Diagnostic Service (HMDS) was composed of 264 MBL cases (139 male; mean age, 71 years; SD, 11 years; mean lymphocyte count, 5.9 ϫ 10 9 /L; SD, 2 ϫ 10 9 /L; mean B-cell count, 3.0 ϫ 10 9 /L; SD, 1 ϫ 10 9 /L), who were all United Kingdom residents. Blood samples from 891 healthy persons (340 male; mean age, 59 years; SD, 11 years) collected through the National Study of Colorectal Cancer Genetics 10 and Genetic Lung Cancer Predisposition Study 11 studies served as controls. These persons were all United Kingdom residents and had self-reported European ancestry. Collection of samples and clinical information was undertaken with informed consent in accordance with the Declaration of Helsinki and with ethical review board approval from the Institute of Cancer Research. The second series were ascertained through the Amedeo Avogadro University of Eastern Piedmont (AAUEP) and consisted of 78 Italian MBL cases from Novara (42 male; mean age, 68 years; SD, 10 years; mean lymphocyte count, 4.7 ϫ 10 9 /L; SD, 2 ϫ 10 9 /L; mean B-cell count, 2.7 ϫ 10 9 /L; SD, 1.1 ϫ 10 9 /L). 4 Blood samples from 170 healthy persons (95 male; mean age, 68 years; SD, 10 years) from the same geographic area with normal hematology...