International Journal of Laboratory Hematology The Official journal of the International Society for Laboratory Hematology
ORIGINAL ARTICLE
INTERNAT IONAL JOURNAL OF LABORATO RY HEMATO LOGY
Morphologic identification of atypical chronic lymphocytic leukemia by digital microscopy S. MARIONNEAUX* , † , P. MASLAK*, E. M. KEOHANE †
*Memorial Sloan Kettering Cancer Center, New York, NY, USA † Rutgers-School of Health Related Professions, Newark, NJ, USA Correspondence: Steven Marionneaux, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room S632, New York, NY 10065, USA. Tel.: 212-639-7060; Fax: 646-422-2313; E-mail: [email protected] doi:10.1111/ijlh.12167
Received 21 June 2013; accepted for publication 15 October 2013 Keywords Atypical chronic lymphocytic leukemia, chronic lymphocytic leukemia (CLL), morphology, digital imaging
S U M M A RY Introduction: Atypical chronic lymphocytic leukemia (aCLL) is a morphologic variant found in approximately 25% of patients with chronic lymphocytic leukemia (CLL). Although aCLL has a more aggressive course compared to typical CLL (tCLL), it is not usually reported. This retrospective study used digital microscopy to morphologically classify CLL patients as aCLL or tCLL, and determined the prevalence of prognostic markers in each group. Methods: CellaVision AB (Lund, Sweden) was used to evaluate lymphocyte morphology on archived blood films of 97 CLL patients, and results of their prognostic marker analysis at diagnosis were obtained. The unpaired t-test, Chi-square, or Fisher’s Exact test were used for statistical analysis. Results: 27% of CLL cases were morphologically classified as aCLL. The aCLL group had a higher prevalence of trisomy 12, unmutated IgVH, and CD38 expression (markers associated with poor prognosis), and a lower prevalence of 13q14 deletions compared to tCLL; this was statistically significant. Conclusion: Using digital imaging to identify aCLL is feasible, economical, and may provide clinically relevant prognostic information at diagnosis and during periodic monitoring. Further study of a larger number of patients is needed to assess the clinical utility of reporting aCLL morphology.
INTRODUCTION Chronic lymphocytic leukemia (CLL) is a clonal disease of mature, antigen-stimulated, functionally incompetent B lymphocytes. CLL represents 30% of all leukemia diagnosed in western countries [1]. The disease is seen most often in the elderly and the incidence increases with age. CLL can be morphologically classified as typical (tCLL) or atypical (aCLL). In tCLL (approximately 80% of cases), [2] over 90% of © 2013 John Wiley & Sons Ltd, Int. Jnl. Lab. Hem.
the circulating lymphocytes are small-to-medium sized with relatively normal morphology, except for a characteristically clumped, chunky chromatin pattern. Prolymphocytes, if present, represent 10% and 20%) Trisomy 12, del 6q, 17p, 11q, or unmutated IgVH
5/71 (7) 17/66 (26)
15/26 (58) 18/24 (75)
29.8 17.96
ORIGINAL ARTICLE
INTERNAT IONAL JOURNAL OF LABORATO RY HEMATO LOGY
Morphologic identification of atypical chronic lymphocytic leukemia by digital microscopy S. MARIONNEAUX* , † , P. MASLAK*, E. M. KEOHANE †
*Memorial Sloan Kettering Cancer Center, New York, NY, USA † Rutgers-School of Health Related Professions, Newark, NJ, USA Correspondence: Steven Marionneaux, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room S632, New York, NY 10065, USA. Tel.: 212-639-7060; Fax: 646-422-2313; E-mail: [email protected] doi:10.1111/ijlh.12167
Received 21 June 2013; accepted for publication 15 October 2013 Keywords Atypical chronic lymphocytic leukemia, chronic lymphocytic leukemia (CLL), morphology, digital imaging
S U M M A RY Introduction: Atypical chronic lymphocytic leukemia (aCLL) is a morphologic variant found in approximately 25% of patients with chronic lymphocytic leukemia (CLL). Although aCLL has a more aggressive course compared to typical CLL (tCLL), it is not usually reported. This retrospective study used digital microscopy to morphologically classify CLL patients as aCLL or tCLL, and determined the prevalence of prognostic markers in each group. Methods: CellaVision AB (Lund, Sweden) was used to evaluate lymphocyte morphology on archived blood films of 97 CLL patients, and results of their prognostic marker analysis at diagnosis were obtained. The unpaired t-test, Chi-square, or Fisher’s Exact test were used for statistical analysis. Results: 27% of CLL cases were morphologically classified as aCLL. The aCLL group had a higher prevalence of trisomy 12, unmutated IgVH, and CD38 expression (markers associated with poor prognosis), and a lower prevalence of 13q14 deletions compared to tCLL; this was statistically significant. Conclusion: Using digital imaging to identify aCLL is feasible, economical, and may provide clinically relevant prognostic information at diagnosis and during periodic monitoring. Further study of a larger number of patients is needed to assess the clinical utility of reporting aCLL morphology.
INTRODUCTION Chronic lymphocytic leukemia (CLL) is a clonal disease of mature, antigen-stimulated, functionally incompetent B lymphocytes. CLL represents 30% of all leukemia diagnosed in western countries [1]. The disease is seen most often in the elderly and the incidence increases with age. CLL can be morphologically classified as typical (tCLL) or atypical (aCLL). In tCLL (approximately 80% of cases), [2] over 90% of © 2013 John Wiley & Sons Ltd, Int. Jnl. Lab. Hem.
the circulating lymphocytes are small-to-medium sized with relatively normal morphology, except for a characteristically clumped, chunky chromatin pattern. Prolymphocytes, if present, represent 10% and 20%) Trisomy 12, del 6q, 17p, 11q, or unmutated IgVH
5/71 (7) 17/66 (26)
15/26 (58) 18/24 (75)
29.8 17.96
