Refining the Limits of Borderline Lymphoproliferative Disorders

Abstract

BackgroundThe concept of borderline lymphoproliferative disorder (LPD) has not been clearly defined.MethodsThis study aimed to classify patients with leukemic LPD (n = 597, excluding hairy cell leukemia, mantle cell lymphomas, and CD10‐positive LPDs) into CLL or non‐CLL applying three diagnostic strategies (the D'Arena and CLLflow scores and CD43 expression) and to better characterize unclassified patients.ResultsPatients with concurring CLL‐like (n = 441) or non‐CLL like (n = 99) results with the three diagnostic strategies were determined to have CLL and non‐CLL, respectively. Patients with discordant results (n = 57) were analyzed taking into consideration each individual cytometric marker and cytogenetic data: 41 were classified (11 CLL, 30 non‐CLL) and 16 (2.7% of the entire series) could not and were considered borderline LPD. Excluding borderline LPD, the CLLflow score had the highest accuracy of the three strategies. With the addition of CD43 no patient was misclassified. With the aid of hierarchical clustering, 12 of the 16 borderline patients seemed to fall into two well‐defined antigenic groups. None of the diagnostic strategies could reliably pick out borderline LPD.ConclusionThe combination of the CLLflow score and CD43 generally has a high diagnostic accuracy for leukemic LPD but it is not reliable to identify or diagnose borderline LPD. This latter group needs further study to determine its underlying biology. © 2018 International Clinical Cytometry Society

Positive predictive value of CD200 positivity in the differential diagnosis of chronic lymphocytic leukemia

“…Forty‐three articles and meeting abstracts (Alapat et al, ; Arlindo, Marcondes, Fernandes, & Faulhaber, ; Aytan et al, ; Brunetti et al, ; Challagundla, Medeiros, Kanagal‐Shamanna, Miranda, & Jorgensen, ; D'Arena et al, ; Debord et al, ; Dorfman & Shahsafaei, ; El Desoukey, Afify, Amin, & Mohammed, ; El Din Fouad, Ibrahim, Abdel Aziz, & Ibrahim, ; Espinet et al, ; Falay et al, ; Fan et al, ; Fanoni et al, ; Favre et al, ; Hu et al, ; Köhnke et al, ; Lesesve et al, ; Mason, Pozdnyakova, Li, Dudley, & Dorfman, ; Miao et al, ; Miguet et al, ; Mongeau‐Marceau et al, ; Montesdeoca et al, ; Mora et al, ; Palumbo et al, ; Pillai et al, ; Poongodi, Varma, Naseem, Parveen, & Varma, ; Rahman et al, ; Rahman, Kumar, Gupta, Singh, & Nityanand, ; Rawstron et al, ; Rawstron et al, ; Rawstron et al, ; Sallam, Elsalakawy, El‐Sewefy, & Khattab, ; Sandes et al, ; Sorigue, Franch‐Sarto, Sarrate, & Junca, ; Sorigue, Juncà, et al, ; Sorigue, Junca, & Granada, ; Sorigue, Raya, et al, ; Spacek et al, ; Starostka et al, ; Ting et al, ; van Dongen et al, ; Ye et al, ) were read in full, of which 16 were excluded (Figure S1). Therefore, 27 studies (5,764 patients) were included.…”

“…m, n, and o cannot be determined from the systematic review, as explained in the material and methods section. Based on published studies the prevalence of CLL among leukemic LPD is around 75% (Köhnke et al, ; Sorigue, Raya, et al, ). Knowing that m = 0.75 then n + o = 0.25 and =0.25 − n .…”

“…Those that did not report on (or no data could be extracted in reference to) the diagnostic value of CD200 for any of the histological subtypes were then excluded. Pertinent data from one study was unpublished but was provided by the authors (Sorigue, Raya, et al, ).…”

“…They are an essential parameter in clinical and laboratory practice, as they are relevant in the need for further testing to confirm or rule out a diagnosis. As CLL is the most common leukemic lymphoproliferative disorder (LPD) and the sensitivity of CD200 for CLL is high (Sorigue et al, ), the negative predictive value is also high. Conversely, the positive predictive value (PPV) depends on the prevalence of each of the alternatives, which is not well defined, as well as the CD200 positivity rate in each of them, which is similarly ill‐defined.…”

Issue Highlights – September 2020

“…Although CLL is usually easily diagnosed by its flow cytometric profile based on its expression of CD19, CD5, CD23, and under expression/loss of other B cell antigens, a few patients with leukemic lymphoproliferative disorders (LPD) show a combination of findings that are hard to classify. The CLLflow score alone or in combination with CD43 has been used to accurately distinguish between CLL and non‐CLL LPD (13,14). Among the additional markers proposed to complement the CLLflow score only CD200 has proven useful (15,16).…”