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Leukaemias of Mature B- and T/NK-Cells
Published in Tariq I. Mughal, Precision Haematological Cancer Medicine, 2018
CLL predominantly affects older people and is more prevalent in males. The median age of onset is 70 years, and the incidence increases steadily with age, reaching 40 per 100,000 of adults in the eighth decade. In 2016, there were over 19,000 new cases diagnosed in the United States (US), and about 5000 CLL–related deaths. The prevalence of CLL is increasing largely due to extended life expectancies, rather than better therapies. Based on the increasing number of asymptomatic individuals who are noted to have a monoclonal B-cell lymphocytosis (MBL), which I discuss below, it is likely that the true incidence of CLL is considerably higher. It appears to be less common in certain geographical locations, such as India and China, but this requires additional studies since reliable epidemiological information on haematological malignancies in many parts of the world is sparse.
Bone Marrow
Published in Wojciech Gorczyca, Atlas of Differential Diagnosis in Neoplastic Hematopathology, 2014
Lymphoid cells are normally present in the BM and account for approximately 10%–20% of marrow cells in adults. The number of lymphocytes generally rises with age and/or the degree of chronic immune stimulation. The presence of moderate to marked lymphocytosis of small lymphocytes is suggestive of a low-grade lymphoproliferative disorder, such as B-cell chronic lymphocytic leukemia (B-CLL; Figure 2.5A). Most of the lymphocytes of B-CLL have a scanty cytoplasm, round (or rarely irregular) nuclei, and a condensed, dark chromatin. Prolymphocytes are larger than small lymphocytes of B-CLL and have prominent nucleoli (Figure 2.5B). Lymphoplasmacytic lymphoma (LPL) is characterized by small lymphocytes, lymphocytes with more abundant cytoplasm (plasmacytoid lymphocytes), and plasma cells (Figure 2.5C). Mantle cell lymphoma (MCL; Figure 2.5D) and follicular lymphoma (FL) display irregular, often indented (cleaved) nuclei. Lymphoid cells of Burkitt lymphoma (BL; Figure 2.5E) are of medium size and have a scanty, vacuolated cytoplasm; blastoid nuclei with finely dispersed chromatin; and prominent nucleoli. Large cell lymphomas, such as diffuse large B-cell lymphoma (DLBCL; Figure 2.5F), have large, often irregular nuclei; an abundant cytoplasm; and one to several nucleoli. The nuclear and cytoplasmic characteristics vary, depending on the type of large cell lymphoma. High-grade lymphomas may display cytologic features similar to BL. Because of the reticulin fibrosis that often accompanies the neoplastic lymphoid infiltrate in the BM and/or the tendency of some lymphomas (especially FL) for a paratrabecular distribution, the BM aspirate smear may not show lymphocytosis or atypical lymphoid cells, despite histologically proved involvement. The BM is often involved also in patients with monoclonal B-cell lymphocytosis [3], benign condition defined by <5 × 109/L monoclonal B cells in the blood.
Monoclonal B-cell lymphocytosis in blood donors in Turkey
Published in Hematology, 2018
Münci Yağcı, Zeynep Arzu Yegin, İdil Yenicesu, Elif Suyanı, Bahar Uncu Ulu, Kamil İnci, Zeynep Çetin, Zeynep Yılmaz, Nevruz Kurşunoğlu, Zübeyde Nur Özkurt
Monoclonal B-cell lymphocytosis was demonstrated in 18 cases (1.8%). A total of 16 cases (1.6%) were evaluated as CLL-like MBL, while 2 (0.2%) had a non-CLL-like phenotype. Median leukocyte count was 7.5(3.16–21.22)×109/l. Median absolute lymphocyte count was found to be 2.2(0.88–6.5)×109/l, median lymphocyte percentage was 29.4% (9.6–63.5). Median absolute lymphocyte count in MBL cases was 2(1.2–2.7)×109/l and 2.2(0.88–6.5)×109/l in normal subjects (p > 0.05). Prevalence of MBL was not statistically different between male and female subjects (p> 0.05). Patient characteristics are summarized in Table 1.
A case of immunotactoid glomerulopathy in a patient with monoclonal gammopathy of renal significance
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Victoria Campdesuner, Yeshanew Teklie, Natalia Lattanzio, Christian Lorenzo, Stephen Bell, Yorlenis Rodriguez, Ashok Sastry
Subsequently, the patient was referred to hematology/oncology and underwent a bone marrow biopsy, which showed normocellular bone marrow with trilineage hematopoiesis and approximately 15% plasma cell involvement. Microscopic examination via light microscopy revealed patchy moderate interstitial fibrosis (Figure 1) with tubular atrophy (Figure 2). Immunofluorescence revealed amorphous deposits within the glomeruli that stained positive for IgG (Figure 3) and lambda light chain (Figure 4). Congo red stain was negative for amyloid. Electron microscopy showed occlusion of capillary loops by large electron-dense microtubule deposits arranged in parallel arrays (Figure 5). Flow cytometry revealed a lambda restricted monoclonal population of plasma cells and 2.4% monoclonal kappa restricted B cells. Fluorescence in situ hybridization (FISH) study for myeloma was normal. Clonal B cells identified via flow cytometry were determined to most likely represent monoclonal B cell lymphocytosis. Repeat serum electrophoresis and serum immunofixation showed an IgG lambda monoclonal protein with a Monoclonal protein spike (M-spike) measuring 0.59 g/dL. Skeletal survey was unremarkable. Given worsening renal function with an estimated glomerular filtration rate (GFR) of <40 and a serum creatinine >3 mg/dL, as well as plasma cell involvement in the bone marrow, treatment was initiated with bortezomib, dexamethasone, and lenalidomide. Herpesvirus prophylaxis was initiated with acyclovir. Treatment was complicated by thrombocytopenia, requiring postponed treatment. One month following initiation of treatment, creatinine had improved to 1.8 mg/dL. Follow-up evaluation of M-spike showed a downtrend with a value of 0.29 g/dL.
Minimal residual disease in chronic lymphocytic leukemia: A consensus paper that presents the clinical impact of the presently available laboratory approaches
Published in Critical Reviews in Clinical Laboratory Sciences, 2018
Ciprian Tomuleasa, Cristina Selicean, Sonia Cismas, Anca Jurj, Mirela Marian, Delia Dima, Sergiu Pasca, Bobe Petrushev, Vlad Moisoiu, Wilhelm-Thomas Micu, Anna Vischer, Kanza Arifeen, Sonia Selicean, Mihnea Zdrenghea, Horia Bumbea, Alina Tanase, Ravnit Grewal, Laura Pop, Carmen Aanei, Ioana Berindan-Neagoe
A condition known to precede the development of CLL is monoclonal B-cell lymphocytosis [18,19]. Monoclonal B-cell lymphocytosis is rather frequent in individuals over 60 years of age and in families that show a hereditary model for CLL [20–23]. Current National Comprehensive Cancer Network (NCCN) guidelines recommend classification from the point of view of prognosis in three groups: low, intermediate, and high risk [24].