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【NEJM】单克隆性B淋巴细胞增多与慢性淋巴细胞性
Background A diagnosis of chronic lymphocytic leukemia (CLL) requires a count of over 5000 circulating CLL-phenotype cells per cubic millimeter. Asymptomatic persons with fewer CLL-phenotype cells have monoclonal B-cell lymphocytosis (MBL). The goal of this study was to investigate the relation between MBL and CLL.
Methods We investigated 1520 subjects who were 62 to 80 years of age with a normal blood count and 2228 subjects with lymphocytosis (>4000 lymphocytes per cubic millimeter) for the presence of MBL, using flow cytometry. Monoclonal B cells were further characterized by means of cytogenetic and molecular analyses. A representative cohort of 185 subjects with CLL-phenotype MBL and lymphocytosis were monitored for a median of 6.7 years (range, 0.2 to 11.8).
Results Monoclonal CLL-phenotype B cells were detected in 5.1% of subjects (78 of 1520) with a normal blood count and 13.9% (309 of 2228) with lymphocytosis. CLL-phenotype MBL had a frequency of 13q14 deletion and trisomy 12 similar to that of CLL and showed a skewed repertoire of the immunoglobulin heavy variable group (IGHV) genes. Among 185 subjects presenting with lymphocytosis, progressive lymphocytosis occurred in 51 (28%), progressive CLL developed in 28 (15%), and chemotherapy was required in 13 (7%). The absolute B-cell count was the only independent prognostic factor associated with progressive lymphocytosis. During follow-up over a median of 6.7 years, 34% of subjects (62 of 185) died, but only 4 of these deaths were due to CLL. Age above 68 years and hemoglobin level below 12.5 g per deciliter were the only independent prognostic factors for death.
Conclusions The CLL-phenotype cells found in the general population and in subjects with lymphocytosis have features in common with CLL cells. CLL requiring treatment develops in subjects with CLL-phenotype MBL and with lymphocytosis at the rate of 1.1% per year.
http://intl-content.nejm.org/cgi/content/abstract/359/6/575 我认领本文翻译任务，若48小时内未完成，请其他站友随意 Monoclonal B-Cell Lymphocytosis and Chronic Lymphocytic Leukemia
单克隆B淋巴细胞增多和慢性淋巴细胞性白血病
Background： A diagnosis of chronic lymphocytic leukemia (CLL) requires a count of over 5000 circulating CLL-phenotype cells per cubic millimeter. Asymptomatic persons with fewer CLL-phenotype cells have monoclonal B-cell lymphocytosis (MBL). The goal of this study was to investigate the relation between MBL and CLL.
背景 诊断慢性淋巴细胞性白血病（ Cll ）规定:外周循环中计数超过每立方米毫米5000个Cll-表型的细胞。无症状者且较少 Cll-表型细胞称为单克隆B淋巴细胞增多（MBL） 。这项研究的目标是调查单克隆B淋巴细胞增多和慢性淋巴细胞性白血病之间的关系。
Methods：We investigated 1520 subjects who were 62 to 80 years of age with a normal blood count and 2228 subjects with lymphocytosis (>4000 lymphocytes per cubic millimeter) for the presence of MBL, using flow cytometry. Monoclonal B cells were further characterized by means of cytogenetic and molecular analyses. A representative cohort of 185 subjects with CLL-phenotype MBL and lymphocytosis were monitored for a median of 6.7 years (range, 0.2 to 11.8).
方法：我们调查了1520个病人（62岁至80岁）有正常血细胞计数和2228个病人有淋巴细胞增多（> 4000个淋巴细胞每立方米毫米）并利用流式细胞仪明确为单克隆B淋巴细胞增多。单克隆B细胞再进一步通过细胞遗传学和分子分析来明确。185个有Cll -表型的单克隆B淋巴细胞增多或淋巴细胞增多的病人队列进行了监测，中位时间为6.7年（范围0.2至11.8年 ） 。
Results ：Monoclonal CLL-phenotype B cells were detected in 5.1% of subjects (78 of 1520) with a normal blood count and 13.9% (309 of 2228) with lymphocytosis. CLL-phenotype MBL had a frequency of 13q14 deletion and trisomy 12 similar to that of CLL and showed a skewed repertoire of the immunoglobulin heavy variable group (IGHV) genes. Among 185 subjects presenting with lymphocytosis, progressive lymphocytosis occurred in 51 (28%), progressive CLL developed in 28 (15%), and chemotherapy was required in 13 (7%). The absolute B-cell count was the only independent prognostic factor associated with progressive lymphocytosis. During follow-up over a median of 6.7 years, 34% of subjects (62 of 185) died, but only 4 of these deaths were due to CLL. Age above 68 years and hemoglobin level below 12.5 g per deciliter were the only independent prognostic factors for death.
结果：5.1％有正常外周血象的的被研究者中（1520人中的78人）有单克隆CLL-表型的B细胞，13.9％的淋巴细胞增多患者中（1520人中的309人）有单克隆CLL-表型的B细胞。CLL-表型的单克隆B淋巴细胞增多有高频率的13q14缺失和12三体综合征，同CLL相似并倾向于免疫球蛋白重变组（IGHV）的基因组成。在185个淋巴细胞增多的研究对象中，51个淋巴细胞增多有进展，占（28 ％） ，28个病人进展为CLL占（15％） ，13个病人需要化疗占（7％） 。淋巴细胞增多同预后独立相关的唯一因素：绝对的B细胞计数。在其后中位数为6.7年的观察时间段中， 34 ％的患者（62/185）死亡，但只有4人死于CLL 。年龄68岁以上和血红蛋白水平低于12.5克每分升是死亡的唯一独立预后因素。
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作者:admin@医学,生命科学 2011-03-12 05:14
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