Saturday, May 07, 2011

Can we pick the MBLs that won't progress?

Does everybody with a monoclonal B cell lymphocytosis or stage 0 CLL need to be followed up? CLL has got commoner over the years because we have got cleverer at diagnosing it. It is now clear that 3.5% of the population over 40 has a population of CLL-like cells in their blood. Does it matter?

It must be clear that since the incidence of CLL is only about 4 per 100,000, that it does not matter a jot for most people. There are a lot of people out there being worried unnecessary. To allay these fears a new condition, monoclonal B cell lymphocytosis, has been invented and it is separated from stage 0 CLL by counting the B-cells in the blood. There must be 5000 per cubic millimeter for it to be CLL. But this is an arbitrary figure and to give it some evidence base there have been two studies. One from the Mayo Clinic suggested that a more appropriate figure might be 11,000 per cu mm and now a new study from Italy has been published in Haematologica.

They looked at 1158 patients with newly diagnosed Binet stage A CLL.The levels of 11,500 for absolute lymphocyte count and 10,000 for B cell count were the best discriminators between those who would never require treatment and those who would. Those with a B cell count of less than 10,000 would progress at a rate of 2.3% per year to eventually requiring treatment, while those with more than 10,000 would progress at a rate of 5.2% per year.

I am not sure that this is much help since it appears from their graph that even after 20 years 78% of those with a B cell count of <10,000 will never be treated and even at greater than 11,000 50% will remain untreated at 20 years.

The recommendation still means that everybody with a lymphocytosis should have flow cytometry in order to count the B cells.

I know that in the UK it is common practice for mild lymphocytoses to be ignored as having no clinical significance, but I wonder whether there is a more certain way of looking at this, perhaps using CD38.


Anonymous said...

my problem with studies that compare WBCs or ALCs at dx, is that those with higher counts may have just been had the CLL longer.

john liston

Abe said...

Hello Terry
I wrote in my previous message that I am "remarkably stable and healthy". That does not mean I belong to the "elite' club of people who will not need treatment for a long time, if ever (your MBLs article). My numbers are in the danger zones but have been stable for the last 2 years or so. Also I have/had many, many physical problems but I have been able through hard work,a diet and a lot of help from my wife (of 45 years)to shake most of them. They seem, by the way, mostly caused by the inability of my body to deal with certain substances (like salicylic acid)and inflammations, of course. I consider myself to be a lucky man that I am this stable and healthy after 11 years.

I was familiar with some of your work and accidentally found your blog while researching the possible benefits of flu shots. I was dismayed to read about your poor health (and retirement). Hope you are doing better now and we wish you all the best. Regards, Abe

Bill said...


Would it possible for you to say what your counts are at present?

Anonymous said...

What about SLL where the blood counts stay low (sometimes just under 5k) and the disease shows up in the nodes?

Terry Hamblin said...

Then the size of nodes determines both the diagnosis and the treatment. Some cases can be treated by radiotherapy.