Nowakowski Grzegorz S, Hoyer James D, Shanafelt Tait D, Zent Clive S, Call Timothy G, Bone Nancy D, Laplant Betsy, Dewald Gordon W, Tschumper Renee C, Jelinek Diane F, Witzig Thomas E, Kay Neil E
Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
J Clin Oncol. 2009 Apr 10;27(11):1844-9. doi: 10.1200/JCO.2008.17.0795. Epub 2009 Mar 2.
Smudge cells are ruptured chronic lymphocytic leukemia (CLL) cells appearing on the blood smears of CLL patients. Our recent findings suggest that the number of smudge cells may have important biologic correlations rather than being only an artifact of slide preparation. In this study, we evaluated whether the smudge cell percentage on a blood smear predicted survival of CLL patients.
We calculated smudge cell percentages (ratio of smudged to intact cells plus smudged lymphocytes) on archived blood smears from a cohort of previously untreated patients with predominantly early-stage CLL enrolled onto a prospective observational study. The relationship between percentage of smudge cells, patient survival, and other prognostic factors was explored.
Between 1994 and 2002, 108 patients were enrolled onto the study and had archived blood smears available for review; 80% of patients had Rai stage 0 or I disease. The median smudge cell percentage was 28% (range, 1% to 75%). The percentage of smudge cells was lower in CD38(+) versus CD38(-) patients (P = .019) and in Zap70-positive versus Zap70-negative patients (P = .028). Smudge cell percentage as a continuous variable was associated with prolonged survival (P = .042). The 10-year survival rate was 50% for patients with 30% or less smudge cells compared with 80% for patients with more than 30% of smudge cells (P = .015). In multivariate analysis, the percentage of smudge cells was an independent predictor of overall survival.
Percentage of smudge cells on blood smear is readily available and an independent factor predicting overall survival in CLL.
涂抹细胞是慢性淋巴细胞白血病（CLL）患者血液涂片上出现的破裂细胞。我们最近的研究结果表明，涂抹细胞的数量可能具有重要的生物学关联，而不仅仅是玻片制备的假象。在本研究中，我们评估了血液涂片上的涂抹细胞百分比是否可预测CLL患者的生存期。
我们计算了来自一项前瞻性观察性研究中一组主要为早期CLL的未经治疗患者的存档血液涂片上的涂抹细胞百分比（涂抹细胞与完整细胞加涂抹淋巴细胞的比例）。探讨了涂抹细胞百分比、患者生存期及其他预后因素之间的关系。
1994年至2002年期间，108例患者纳入本研究并提供了可供复查的存档血液涂片；80%的患者为Rai 0期或I期疾病。涂抹细胞百分比中位数为28%（范围1%至75%）。CD38(+)患者的涂抹细胞百分比低于CD38(-)患者（P = .019），Zap70阳性患者低于Zap70阴性患者（P = .028）。涂抹细胞百分比作为连续变量与生存期延长相关（P = .042）。涂抹细胞≤30%的患者10年生存率为50%，而涂抹细胞>30%的患者为80%（P = .015）。多变量分析中，涂抹细胞百分比是总生存期的独立预测因素。
血液涂片上的涂抹细胞百分比易于获得，是预测CLL患者总生存期的独立因素。
