Percentage of smudge cells determined on routine blood smears is a novel prognostic factor in chronic lymphocytic leukemia

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BlankPercentage of smudge cells determined on routine blood smears is a novel

prognostic factor in chronic lymphocytic leukemia.

P Johansson, L Eisele, L Klein-Hitpass, L Sellmann, U Duhrsen, J Durig, and H

Nuckel

Leuk Res, March 28, 2010; .

Department of Hematology, University Hospital, University of Duisburg-Essen,

Hufelandstr. 55, 45122 Essen, Germany.

Recently developed molecular prognostic tests in patients with early Binet stage

chronic lymphocytic leukemia (B-CLL) are costly and often require a high level

of technologic expertise. Recent data give evidence for the prognostic relevance

of the percentage of smudge cells in B-CLL. In our study we analysed the

prognostic potential of this novel marker in a cohort of 100 CLL patients. The

percentage of smudge cells ranged from 0% to 70% (median 21%). Patients with

</=20% smudge cells (according to ROC analysis) had a significantly shorter time

to first treatment and overall survival than patients with >20% smudge cells.

Multivariate regression analysis identified percentages of smudge cells,

stage according to Binet and CD38 expression as independent prognostic markers.

The percentage of smudge cells was significantly lower in CD38+, ZAP-70+ and

unmutated IgVH patients. Combined analysis of smudge cell percentages with CD38

expression provided complementary prognostic information identifying three

patient subgroups with good, intermediate and poor prognosis. Comparing gene

expression profiles in a subset of 12 patients we identified eight

differentially expressed genes in groups with high vs. low percentage of smudge

cells suggesting a role of these differentially expressed genes, especially for

Tribbles homolog 2 (Trib2), in the disease progression of high risk CLL

patients. In conclusion, our data confirm previous studies showing that the

simple and inexpensive microscopic detection of smudge cells on blood smears

prepared for routine diagnostic purposes is a novel independent factor

predicting overall survival in CLL.

PMID: 20353875

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