Neoplasma Vol.53, p.219-225, 2005
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Title: Prognostic relevance of the FAB morphological criteria in chronic lymphocytic leukemia: correlations with IgVH gene mutational status and other prognostic markers
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Author: J., SCHWARZ
; D., MIKULENKOVA
; M., CERMAKOVA
; V., POLANSKA
; K., MICHALOVA
; I., MARINOV
; V., CAMPR
; Š., RANSDORFOVA
; J., MARKOVA
; L., PAVLISTOVA
; J., BREZINOVA
; J., SAJDOVA
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Abstract: Morphological examination is the routine first step in the
diagnosis of hematological malignancies, including chronic
lymphocytic leukemia (CLL). Atypical cell morphology according to
the FAB criteria is known to herald disease progression.
Several years ago, it was proposed that FAB morphology at
diagnosis had a considerable prognostic impact. However,
this proposal has not been widely adopted in practice. Thus we
questioned the prognostic value of the morphological examination,
which was performed retrospectively in 88 patients out of our 110
institutional registry patients (70 males and 40 females,
median age 57 yrs) with CLL at diagnosis. We related the results
to the more modern prognostic markers.
Atypical FAB morphology was shown to correlate with IgVH gene
mutation status, trisomy of chromosome 12 and deletion
of 17p detected either by conventional G-banding or by
fluorescence in situ hybridization (FISH) analysis. The correlation
of FAB morphology with CD38 antigen expression or with the
histopathological pattern of bone marrow infiltration
was not significant. Overall survival (OS) data were available for
84 morphologically examined patients. The patients with
atypical morphology (64 patients) had a significantly shorter OS
(103 months) than the 20 patients presenting with typical
CLL morphology (237 months; p=0.03). Only the mutation status of
IgVH genes correlated more closely with OS (p=0.002).
Of note, there was no leukemia-related death within “unmutated”
cases who had typical FAB morphology (p=0.14), and
vice versa, the mutation status had a significant prognostic
impact within the morphologically atypical cases (p=0.01). Thus
FAB morphology and the mutation status may yield complementary
prognostic information. OS was affected both by the
presence of cytogenetic aberrations (p=0.03) – most adversely by
deletions of 17p and 11q, and by CD38 expression
(p=0.003).
We conclude that careful examination of peripheral blood smears
according to FAB is a simple, cheap and valuable tool
in the first-line assessment of prognosis of CLL patients and
should not be overlooked even in 3rd millenium when more
sophisticated
prognostic markers are at hand. This ought to be confirmed in
larger prospective studies with multivariate analysis
of data.
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Keywords: chronic lymphocytic leukemia, prognostic markers, morphology, FAB
classification, IgVH gene mutation status, cytogenetics
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Year: 2005, Volume: 53, Issue: |
Page From: 219, Page To: 225 |
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