Nowakowski Grzegorz S, Hoyer James D, Shanafelt Tait D, Geyer Susan M, LaPlant Betsy R, Call Timothy G, Jelinek Diane F, Zent Clive S, Kay Neil E
Division of Hematology, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clin Proc. 2007 Apr;82(4):449-53. doi: 10.4065/82.4.449.
Recently developed prognostic tests in early Rai and Binet stage chronic lymphocytic leukemia (CLL) require considerable technologic expertise and are not available worldwide. Smudge cells are CLL cells ruptured during smear preparation. We hypothesized that smudge cell formation is inversely correlated with expression of vimentin, a cytoskeletal protein and prognostic marker, and that the percentage of smudge cells would predict prognosis in CLL. We reviewed the blood smears of 75 patients with previously untreated early and intermediate-stage CLL (Rai stage 0-II) who were seen at the Mayo Clinic in Rochester, Minn, between September 1989 and December 2000. A total of 200 lymphocytes and smudge cells were counted on each slide and the results expressed as a percentage of the total lymphocytes (intact and smudged). The median percentage of smudge cells was 27% (range, 4%-72%). The percentage of smudge cells inversely correlated with vimentin expression (r=-0.57; P=.007). The median percentage of smudge cells was higher in patients with the mutated immunoglobulin heavy chain gene than in those with the unmutated immunoglobulin heavy chain gene (31% vs 13%; P=.02). Patients with less than 30% smudge cells had a median time from diagnosis to initial treatment of 72.7 months, whereas the median time from diagnosis to initial treatment in patients with 30% or more smudge cells was not reached (P=.001). The percentage of smudge cells as a continuous variable correlated with overall survival (P=.04). The estimation of smudge cells on a blood smear could be a universally available prognostic test in early-stage CLL.
近期开发的用于早期Rai和Binet分期慢性淋巴细胞白血病（CLL）的预后检测需要相当的技术专长，且并非在全球范围内都可获得。涂抹细胞是在涂片制备过程中破裂的CLL细胞。我们假设涂抹细胞的形成与波形蛋白（一种细胞骨架蛋白和预后标志物）的表达呈负相关，并且涂抹细胞的百分比可预测CLL的预后。我们回顾了1989年9月至2000年12月期间在明尼苏达州罗切斯特市梅奥诊所就诊的75例未经治疗的早期和中期CLL患者（Rai分期0 - II期）的血涂片。每张玻片上共计数200个淋巴细胞和涂抹细胞，并将结果表示为总淋巴细胞（完整和涂抹的）的百分比。涂抹细胞的中位数百分比为27%（范围为4% - 72%）。涂抹细胞的百分比与波形蛋白表达呈负相关（r = -0.57；P = 0.007）。免疫球蛋白重链基因突变的患者涂抹细胞的中位数百分比高于免疫球蛋白重链基因未突变的患者（31%对13%；P = 0.02）。涂抹细胞少于30%的患者从诊断到初始治疗的中位时间为72.7个月，而涂抹细胞为30%或更多的患者从诊断到初始治疗的中位时间未达到（P = 0.001）。涂抹细胞百分比作为连续变量与总生存期相关（P = 0.04）。血涂片上涂抹细胞的评估可能是早期CLL普遍可用的预后检测方法。
