Prognostic importance of flow cytometric immunophenotyping of 540 consecutive patients with B-cell chronic lymphocytic leukemia

Abstract

Blood mononuclear cells from 540 newly diagnosed, unselected patients with B-cell chronic lymphocytic leukemia (CLL) were examined by immunofluorescence flow cytometry for a panel of surface membrane markers, including IgM and IgD, the monoclonal antibodies anti-CD3, -5, -20, -21, -22, -FMC7, and, for the final 125 patients, anti-CD23. There were 503 CD5+ and 37 CD5- cases. In the CD5+ cases, the cells typically expressed IgM, IgD, CD20, CD21, CD22, and CD23. In univariate analysis, age, clinical stage, IgM-fluorescence intensity, CD23, and FMC7 had significant prognostic importance, with high IgM-fluorescence intensity, high FMC7, and low CD23 expression being associated with a short survival. There was no significant difference in survival between 351 cases expressing IgMD and 55 cases expressing IgM without IgD, or between kappa and lambda light chain monoclonal cases. CD20, CD21, and CD22 had no prognostic importance. In Cox multiple regression analyses, age, CD23, IgM-fluorescence intensity, and clinical stage (International Workshop System) had independent prognostic importance. Thus, besides clinical variables, CD23 and IgM intensity might be useful prognostic markers in the management of CD5+, B-cell CLL. The survival of CD5- patients was on the borderline of being significantly shorter than that of CD5+ patients. The majority of the CD5- cases were FMC7+, CD23-, had strong IgM fluorescence, and had splenomegaly.

CD200 is a useful marker in the diagnosis of chronic lymphocytic leukemia

“…The diagnosis of CLL is sustained by the presence of more than 5,000 monoclonal B-cells per microliter with a distinctive immunophenotype (i.e., SmIg weak , CD5 + CD19 + , CD20 weak , and CD23 + ) population (5)(6)(7). Based on the antigenic profile, Matutes et al designed an immunologic score system (Matutes score, MS) to ensure the diagnosis of CLL (8).…”

Danish CLL2‐Study revisited: FISH on a cohort with a 20‐yr follow‐up confirms the validity of the hierarchical model of genomic aberrations in chronic lymphocytic leukaemia

“…The median survival of our cohort of only 4.8 yr from the time of diagnosis, is shorter than that of more recently reported CLL cohorts (7), with a median survival of about 10 yr and a much higher proportion of the patients in stage A (>80%), probably reflecting both earlier diagnosis and more effective treatment including purine analogues. Our immunophenotypic criteria for inclusion did not rule out the inclusion some cases of leukaemic non-Hodgin's lymphoma (NHL) including mantle cell lymphoma (6). The identical results of all analyses of all patients as well as the subsets fllowing removal of patients including the two cases with t (11,14), however, indicate that our findings are valid for bona fide CLL.…”

“…Also patients in stages B and C were randomised to primary treatment with either cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) or chlorambucil + prednisolone. The diagnosis of CLL was based on central pathology review and an immune phenotype of monoclonal B-cell leukaemia (6).…”

Expression of mdr1 and mrp in the normal B‐cell homologue of B‐cell chronic lymphocytic leukaemia

“…CLL cells have also been shown to over-express mRNA coding for mrp (Beck et al, 1994;Burger et al, 1994). B-CLL is typically a clonal proliferation of CD19 and CD20 expressing B cells which weakly, but characteristically, express the T-cell marker CD5 (Martin et al, 1980;Boumsell et al, 1980;Kamoun et al, 1981;Geisler et al, 1991;Bennett et al, 1989). B-CLL cells usually have weak surface membrane immunoglobulin staining with m heavy chain and monoclonal light chain (Ternyck et al, 1974).…”

“…These cells also contain cytoplasmic m immunoglobulin and express Fc, Ia and mouse red cell receptors. Additionally, B-CLL cells may also express CD21, CD22 and CD23 (Geisler et al, 1991). The precise phenotype depends upon the definition of CLL; however, the World Health Organization (W.H.O.)…”