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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.
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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
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Giudice ID, Foà R. Response to Comment by Amato T. et al.. Haematologica 2019; 104:e541. [PMID: 31666346 DOI: 10.3324/haematol.2019.224303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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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.
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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.
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Alfano G, Fontana F, Colaci E, Franceschini E, Ligabue G, Messerotti A, Bettelli F, Grottola A, Gennari W, Potenza L, Guaraldi G, Mussini C, Luppi M, Cappelli G. Immunophenotypic profile and clinical outcome of monoclonal B-cell lymphocytosis in kidney transplantation. Clin Transplant 2018; 32:e13338. [PMID: 30074641 DOI: 10.1111/ctr.13338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 04/09/2018] [Accepted: 06/23/2018] [Indexed: 12/17/2022]
Abstract
Monoclonal B-cell lymphocytosis (MBL) is a lymphoproliferative disorder characterized by clonal expansion of a B-cell population in peripheral blood of otherwise healthy subjects. MBL is divided into CLL (chronic lymphocytic leukemia)-like, atypical CLL-like and non-CLL MBL. The aim of this study was to evaluate immunophenotypic characteristics and clinical outcomes of MBL in kidney transplant (KT) recipients. We retrospectively evaluated 593 kidney transplant (KT) recipients in follow-up at our center. Among them, 157 patients underwent peripheral blood flow cytometry for different clinical indications. A 6-color panel flow cytometry was used to diagnose MBL. This condition was detected in 5 of 157 KT recipients. Immunophenotypic characterization of MBL showed four cases of non-CLL MBL and one case of CLL-like MBL. At presentation, median age was 65 years (range 61-73). After a median follow-up of 3.1 years (95%CI; 1.1-5) from diagnosis, patients did not progress either to CLL or to lymphoma. The disorder did not increase the risk of malignancy, severe infections, graft loss and mortality among our KT recipients. Surprisingly, all cases were also affected by concomitant monoclonal gammopathy of undetermined significance, which did not progress to multiple myeloma during follow-up. In conclusion, our data suggest that MBL is an age-related disorder, with non-CLL MBL being the most common subtype among KT recipients.
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Affiliation(s)
- Gaetano Alfano
- Section of Nephrology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Francesco Fontana
- Section of Nephrology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Elisabetta Colaci
- Section of Hematology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Giulia Ligabue
- Section of Nephrology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Andrea Messerotti
- Section of Hematology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Francesca Bettelli
- Section of Hematology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Antonella Grottola
- Microbiology and Virology Unit, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - William Gennari
- Microbiology and Virology Unit, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Leonardo Potenza
- Section of Hematology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Giovanni Guaraldi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Mario Luppi
- Section of Hematology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
| | - Gianni Cappelli
- Section of Nephrology, Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero - Universitaria Policlinico, Modena, Italy
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