Florensa L, Navarro JT, Pérez Vila ME, Domingo A, De la Banda E, Rozman M, Camós M, Millá F, Perea G, Alonso E, Ayats R, Aventín A, Cabezudo E, Espinet B, Merino A, Romero P, Sánchez C, Tuset E, Solé F, Feliu E, Fernández C, Gallart M, Vallespí T, Woessner S. [Persistent polyclonal B-cell lymphocytosis: study of 35 cases].
Med Clin (Barc) 2011;
136:565-73. [PMID:
21396665 DOI:
10.1016/j.medcli.2010.09.048]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/02/2010] [Accepted: 09/02/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES
Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare entity, presenting especially in adult smoker women. It is characterized by an increase of serum IgM, DR7-HLA haplotype, cytogenetic abnormalities and multiple IgH/BCL-2 rearrangements. To date, it has not been elucidated whether this is a benign or premalignant disorder. We analyzed the PPBL characteristics with especial attention to its evolution.
PATIENTS AND METHODS
Thirty-five PPBL patients from 5 hospitals in Catalonia were retrospectively analyzed. A simultaneous morphologic review of the blood smears was performed by members of the GCCH in a 16 multiple-observer optic microscope. Clinical and biological data were also analyzed.
RESULTS
PPBL presents in the majority of cases with persistent polyclonal B-cell lymphocytosis and affects primarily smoker women. The morphologic hallmark, in absence of viral infections, is the presence of activated lymphocytes with bilobulated and/or cleaved nuclei, and nuclear pockets in the ultrastructural study. Increased serum IgM, HLA-DR7 haplotype, chromosomal abnormalities such as i(3)(q10) and multiple IgH/BCL-2 rearrangements were detected. Thirty-four out of 35 patients are alive after a median follow up of 70.7 months. One patient died because of lung adenocarcinoma and another developed a follicular lymphoma without relation to PPBL.
CONCLUSIONS
PPBL has an asymptomatic and stable evolution, although it frequently presents genetic abnormalities. It remains unknown whether it is a premalignant entity, similar to monoclonal gammopathies of unknown significance. Hence, accurate cytologic diagnosis and follow-up are essential.
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