The proposed diagnostic criteria change for chronic lymphocytic leukemia: unintended consequences?

B-cell count and survival: differentiating chronic lymphocytic leukemia from monoclonal B-cell lymphocytosis based on clinical outcome

“…40 First, the optimal way to measure B-cell count for such analysis has not been defined. 40 Second, such a shift could necessitate repeated flow cytometric analysis (and attendant cost) to monitor the B-cell count among people with a documented clonal lymphocyte population but whose initial count is below the diagnostic threshold.…”

“…40 First, the optimal way to measure B-cell count for such analysis has not been defined. 40 Second, such a shift could necessitate repeated flow cytometric analysis (and attendant cost) to monitor the B-cell count among people with a documented clonal lymphocyte population but whose initial count is below the diagnostic threshold. The relationship between B-cell count and ALC illustrated in Figure 1 suggests that a practical and fiscally responsible approach would be to simply monitor the ALC among people with a B-cell count below the diagnostic threshold and to reclassify them as having CLL when the ALC indicates their B-cell count has likely crossed the threshold.…”

Monoclonal B lymphocytosis versus chronic lymphocytic leukemia: Factors affecting implementation of an absolute threshold

“…There is limited literature comparing SP and DP methods for enumerating CLL‐like B cells. The study of Mekouar et al (19) reported a tendency toward slightly lower absolute counts using an SP bead method and in contrast Hanson et al (5) illustrated slightly higher results for an SP method for many of the cases illustrated in their letter to the editor. However, neither of these previous reports includes detailed information about the methods employed.…”

“…Regardless of the threshold applied, introduction of the term MBL has led to increased emphasis on enumeration of cells with a CLL‐like phenotype. However, one potential shortcoming of the proposed diagnostic criteria is lack of standardization (4, 5). A recent review of flow cytometric methods used to detect CLL‐like B cells at centers actively studying MBL highlighted this lack of standardization, with sites differing in specimen preparation, antibodies and flow cytometry instrument used, number of events collected, and analysis strategy (4).…”

A matter of debate in chronic lymphocytic leukemia

“…According to IWCLL guidelines, CLL should be treated in case of disease activity: AHIA and/or ITP poorly responsive to corticosteroids or other standard therapy [31,32] are considered the indicators of disease activity.…”