1
|
Tang C, Shen Y, Soosapilla A, Mulligan SP. Monoclonal B-cell Lymphocytosis - a review of diagnostic criteria, biology, natural history, and clinical management. Leuk Lymphoma 2022; 63:2795-2806. [PMID: 35767361 DOI: 10.1080/10428194.2022.2092857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since first described almost two decades ago, there has been significant evolution in our definition and understanding of the biology and implications of monoclonal B-cell lymphocytosis (MBL). This review provides an overview of the definition, classification, biology, and natural history of MBL, mainly focused on the dominant CLL-like phenotype form of MBL. The increasingly recognized implications of MBL with respect to immune dysfunction are discussed, particularly in view of the COVID-19 pandemic, along with management recommendations for MBL in the clinic.
Collapse
Affiliation(s)
- Catherine Tang
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia.,Department of Haematology, Gosford Hospital, Gosford, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Yandong Shen
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Kolling Institute, University of Sydney, St Leonards, Sydney, Australia
| | - Asha Soosapilla
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia
| | - Stephen P Mulligan
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia.,Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Kolling Institute, University of Sydney, St Leonards, Sydney, Australia
| |
Collapse
|
2
|
Shen Y, Freeman JA, Holland J, Solterbeck A, Naidu K, Soosapilla A, Downe P, Tang C, Kerridge I, Wallman L, Van Bilsen N, Milogiannakis V, Akerman A, Martins Costa Gomes G, Sandgren K, Cunningham AL, Turville S, Mulligan SP. COVID‐19 Vaccine Failure in Chronic Lymphocytic Leukaemia and Monoclonal B‐Lymphocytosis; Humoral and Cellular Immunity. Br J Haematol 2021; 197:41-51. [DOI: 10.1111/bjh.18014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yandong Shen
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
- Kolling Institute Royal North Shore Hospital St Leonards NSW Australia
| | - Jane A. Freeman
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
- Northern Haematology and Oncology Group Sydney Adventist Hospital Wahroonga NSW Australia
| | - Juliette Holland
- Department of Microbiology Laverty Pathology, Macquarie Park NSW Australia
| | - Ann Solterbeck
- Statistical Revelations Pty Ltd 41 The Parade, Ocean Grove VIC Australia
| | - Kartik Naidu
- Department of Microbiology Laverty Pathology, Macquarie Park NSW Australia
| | - Asha Soosapilla
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Paul Downe
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Catherine Tang
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Ian Kerridge
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
| | - Lucinda Wallman
- Department of Immunology Laverty Pathology, Macquarie Park NSW Australia
| | - Nenna Van Bilsen
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | | | - Anouschka Akerman
- Kirby Institute University of New South Wales Kensington NSW Australia
| | | | - Kerrie Sandgren
- Centre for Virology Research Westmead Institute Sydney Infectious Diseases University of Sydney NSW Australia
| | - Anthony L Cunningham
- Centre for Virology Research Westmead Institute Sydney Infectious Diseases University of Sydney NSW Australia
| | - Stuart Turville
- Kirby Institute University of New South Wales Kensington NSW Australia
| | - Stephen P. Mulligan
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
- Kolling Institute Royal North Shore Hospital St Leonards NSW Australia
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| |
Collapse
|
3
|
Maitre E, Troussard X. Monoclonal B-cell lymphocytosis. Best Pract Res Clin Haematol 2019; 32:229-238. [PMID: 31585623 DOI: 10.1016/j.beha.2019.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022]
Abstract
Flow cytometry diagnostic practices can detect very low levels of clonal B cells in the peripheral blood. In the absence of clinical symptoms, cytopenia or organomegaly, the small clones may correspond to monoclonal B-cell leukemia (MBL) diagnosis. Most MBLs harbor a chronic lymphocytic leukemia (CLL) phenotype (e.g., CD5+, CD23+) and are referred to as CLL-type MBL. The two other types are atypical CLL-type MBL and non-CLL-type MBL. In addition to the phenotypical classification, the clonal B count is a major issue because of the impact on the prognosis and the risk of progression in CLL. It allows for the discrimination of two distinct types: high-count (HC) MBL and low-count (LC)-MBL based on a cutoff value of 0.5 × 109/L clonal B cells. LC MBL appears to be very stable over time and is probably related to immunosenescence. Conversely, HC MBL could be a premalignant state before the occurrence of CLL.
Collapse
Affiliation(s)
- Elsa Maitre
- Laboratoire d'hématologie biologique, CHU de Caen Normandie, Caen, 14033, CEDEX 9, France.
| | - Xavier Troussard
- Laboratoire d'hématologie biologique, CHU de Caen Normandie, Caen, 14033, CEDEX 9, France.
| |
Collapse
|
4
|
Yağcı M, Yegin ZA, Yenicesu İ, Suyanı E, Ulu BU, İnci K, Çetin Z, Yılmaz Z, Kurşunoğlu N, Özkurt ZN. Monoclonal B-cell lymphocytosis in blood donors in Turkey. ACTA ACUST UNITED AC 2017; 23:25-29. [PMID: 28583051 DOI: 10.1080/10245332.2017.1335969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Monoclonal B-cell lymphocytosis (MBL) is a precursor state of chronic lymphocytic leukemia (CLL) with peripheral lymphocytosis below 5 × 109/l. The diagnostic criteria exclude the presence of lymphadenopathy, organomegaly, infections, autoimmune diseases or any sign of a lymphoproliferative disorder. This prospective study was designed in order to evaluate the frequency of MBL in blood donors in Turkey. METHODS The diagnosis of MBL was identified by flow cytometry method based on the International Familial CLL Consortium Report. A total of 999 volunteers [median age 34 (18-78) years; male/female: 705/294] were included in the study. RESULTS Monoclonal B-cell lymphocytosis was demonstrated in 18 cases (1.8%). A total of 16 cases (1.6%) was evaluated as CLL-like MBL, while 2 (0.2%) had a non-CLL-like phenotype. The subjects were divided into three groups according to age, as <40 years, 40-60 years and >60 years. The prevalence of MBL was 1.1% below 40 years, 0.6% between 40 and 60 years and 0.1% in cases over 60 years, without statistical significance (p > 0.05). DISCUSSION The sensitivity of the flow cytometry method is essential and may be responsible for the variations in the prevalence of MBL in different populations which can also be attributed to study design, higher detection rates in the elderly and families with genetic predisposition to CLL. CONCLUSION Large population-based studies and standardized laboratory methods are needed to determine the potential risk factors of progression to CLL, including molecular markers and genetic profile.
Collapse
Affiliation(s)
- Münci Yağcı
- a Faculty of Medicine, Department of Hematology , Gazi University , Ankara , Turkey
| | - Zeynep Arzu Yegin
- a Faculty of Medicine, Department of Hematology , Gazi University , Ankara , Turkey
| | - İdil Yenicesu
- b Faculty of Medicine, Department of Pediatric Hematology and Blood Bank , Gazi University , Ankara , Turkey
| | - Elif Suyanı
- a Faculty of Medicine, Department of Hematology , Gazi University , Ankara , Turkey
| | - Bahar Uncu Ulu
- c Faculty of Medicine, Department of Internal Medicine , Gazi University , Ankara , Turkey
| | - Kamil İnci
- c Faculty of Medicine, Department of Internal Medicine , Gazi University , Ankara , Turkey
| | - Zeynep Çetin
- c Faculty of Medicine, Department of Internal Medicine , Gazi University , Ankara , Turkey
| | - Zeynep Yılmaz
- a Faculty of Medicine, Department of Hematology , Gazi University , Ankara , Turkey
| | - Nevruz Kurşunoğlu
- a Faculty of Medicine, Department of Hematology , Gazi University , Ankara , Turkey
| | - Zübeyde Nur Özkurt
- a Faculty of Medicine, Department of Hematology , Gazi University , Ankara , Turkey
| |
Collapse
|
5
|
Furtado FM, Scheucher PS, Santana BA, Zanette DL, Calado RDT, Rego EM, Matos DM, Falcão RP. Comparison of microRNA expression in high-count monoclonal B-cell lymphocytosis and Binet A chronic lymphocytic leukemia. Rev Bras Hematol Hemoter 2017; 39:237-243. [PMID: 28830603 PMCID: PMC5568587 DOI: 10.1016/j.bjhh.2017.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/24/2017] [Accepted: 03/24/2017] [Indexed: 11/05/2022] Open
Abstract
Background Evidence suggests that monoclonal B-cell lymphocytosis precedes all chronic lymphocytic leukemia cases, although the molecular mechanisms responsible for disease progression are not understood. Aberrant miRNA expression may contribute to the pathogenesis of chronic lymphocytic leukemia. The objective of this study was to compare miRNA expression profiles of patients with Binet A chronic lymphocytic leukemia with those of subjects with high-count monoclonal B-cell lymphocytosis and healthy volunteers (controls). Methods Twenty-one chronic lymphocytic leukemia patients, 12 subjects with monoclonal B-cell lymphocytosis and ten healthy volunteers were enrolled in this study. Flow cytometry CD19+CD5+-based cell sorting was performed for the chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis groups and CD19+ cells were sorted to analyze the control group. The expressions of miRNAs (miR-15a, miR-16-1, miR-29b, miR-34a, miR-181a, miR-181b and miR-155) were determined by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Results Significant differences between the expressions in the chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis groups were restricted to the expression of miR-155, which was higher in the former group. A comparison between healthy controls and monoclonal B-cell lymphocytosis/chronic lymphocytic leukemia patients revealed higher miR-155 and miR-34a levels and lower miR-15a, miR-16-1, miR-181a and miR-181b in the latter group. Conclusions Our results show a progressive increase of miR-155 expression from controls to monoclonal B-cell lymphocytosis to chronic lymphocytic leukemia. The role of miR-155 in the development of overt chronic lymphocytic leukemia in individuals with monoclonal B-cell lymphocytosis must be further analyzed.
Collapse
|
6
|
Furtado FM, Scheucher PS, Santana BA, Scatena NF, Calado RT, Rego EM, Matos DM, Falcão RP. Telomere length analysis in monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia Binet A. ACTA ACUST UNITED AC 2017; 50:e6019. [PMID: 28423121 PMCID: PMC5441285 DOI: 10.1590/1414-431x20176019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/22/2017] [Indexed: 11/22/2022]
Abstract
Monoclonal B-cell lymphocytosis (MBL) is an asymptomatic clinical entity characterized by the proliferation of monoclonal B cells not meeting the diagnosis criteria for chronic lymphocytic leukemia (CLL). MBL may precede the development of CLL, but the molecular mechanisms responsible for disease progression and evolution are not completely known. Telomeres are usually short in CLL and their attrition may contribute to disease evolution. Here, we determined the telomere lengths of CD5+CD19+ cells in MBL, CLL, and healthy volunteers. Twenty-one CLL patients, 11 subjects with high-count MBL, and 6 with low-count MBL were enrolled. Two hundred and sixty-one healthy volunteers aged 0 to 88 years were studied as controls. After diagnosis confirmation, a flow cytometry CD19+CD5+-based cell sorting was performed for the study groups. Telomere length was determined by qPCR. Telomere length was similar in the 3 study groups but shorter in these groups compared to normal age-matched subjects that had been enrolled in a previous study from our group. These findings suggest that telomere shortening is an early event in CLL leukemogenesis.
Collapse
Affiliation(s)
- F M Furtado
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P S Scheucher
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - B A Santana
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - N F Scatena
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R T Calado
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E M Rego
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D M Matos
- Hospital Universitário Walter Cantidio, Faculdade de Medicina de Fortaleza, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - R P Falcão
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| |
Collapse
|
7
|
Detection of non-CLL-like monoclonal B cell lymphocytosis increases dramatically in the very elderly, while detection of CLL-like populations varies by race: findings in a multiethnic population-based cohort of elderly women. Ann Hematol 2016; 95:1695-704. [DOI: 10.1007/s00277-016-2760-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
|
8
|
Soosapilla A, Pepperell D, Best G, Brizzi C, Mulligan CS, van Bilsen N, Mulligan SP. Monoclonal B-lymphocytosis in patients aged over 90 years is common but not inevitable, and has a prevalence comparable to that in individuals aged 65–90 years. Leuk Lymphoma 2015; 56:2182-4. [DOI: 10.3109/10428194.2014.976822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
9
|
Hamad N, Kliman D, Best OG, Caramins M, Hertzberg M, Lindeman R, Porter R, Mulligan SP. Chronic lymphocytic leukaemia, monoclonal B-lymphocytosis and pregnancy: five cases, a literature review and discussion of management. Br J Haematol 2014; 168:350-60. [PMID: 25256787 DOI: 10.1111/bjh.13134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) occurs rarely with pregnancy and monoclonal B-Lymphocytosis (MBL) has not previously been described in this setting. CLL is predominantly a disease of the elderly and affects men twice as often as women and hence only an estimated 2% of patients are females of childbearing age. We identified only five reported cases of CLL in pregnancy in the literature. We describe two additional cases, plus three other women with CLL dealing with pregnancy-related decisions. We review the literature and discuss proposals for management and issues that arise in this relatively uncommon occurrence. In contrast to many other haematological malignancies where longer remissions are typically associated with a lower risk of relapse, most patients with CLL who require treatment will ultimately relapse with current therapy. This complex setting requires careful consideration and well informed patients to assist with decisions related to pregnancy.
Collapse
Affiliation(s)
- Nada Hamad
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; Kolling Institute, University of Sydney, St Leonards, Sydney, NSW, Australia; Chronic Lymphocytic Leukaemia Australian Research Consortium (CLLARC), Sydney, NSW, Australia
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Monoclonal B cell Lymphocytosis (MBL) or similar terms have been used for decades to describe the presence of light-chain restricted B lymphocytes with uncertain clinical significance, usually having a phenotype consistent with chronic lymphocytic leukemia (CLL). As diagnostic technology improved, ever smaller monoclonal B cell populations were identifiable in the population, and approximately half of people over 90 years old have a minimal (<1 cell/μL) circulating CLL-like B cell population. These minimal CLL-like B cell populations share some molecular characteristics with CLL, but have no clinical significance. In contrast, CLL-like MBL cases detected through hospital investigations are biologically indistinguishable from early stage CLL, but the neoplastic B cell levels are usually stable over time and the risk of progressive disease requiring treatment is much lower than for early stage CLL. However, there is usually partial or complete depletion of normal B cells, with an increased relative risk of severe infection, comparable to early stage CLL, which may impair overall survival.
Collapse
|
11
|
|
12
|
van Krieken JH. New developments in the pathology of malignant lymphoma. A review of the literature published from February 2011 to August 2011. J Hematop 2011. [DOI: 10.1007/s12308-011-0112-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|