Jahic Azra, Iljazovic Ermina, Arnautovic-Custovic Aida, Halilbasic Alma, Simendic Vlastimir, Zabic Aida
Department of Hematology, Clinic for Oncology, Hematology and Radiotherapy, University Clinical Center Tuzla, 75000 Tzla, Tlrnovac b.b., Bosnia and Herzegovina.
Med Arh. 2011;65(3):132-6. doi: 10.5455/medarh.2011.65.132-136.
The clinical course and outcome of B-CLL is various and so far unpredictible. Defining prognostic parameters potentiating division of patients in groups with favorable and unfavorable prognosis which could help the benefit assessment of early treatment, improve treatment effects, and potentiate treatment modification for each patient.
To analyze the bone-marrow (BM) pattern and immunophenotypic score at diagnosis of B-CLL and determine the correlation of BM pattern with the clinical stage of disease and immunophenotypic score.
A sample of 40 untreated patients with B-CLL was divided into two groups: group with clinical stage Binet A and group with clinical stages Binet B and Binet C. BM patterns were observed as a diffuse, interstitial, nodular and mixed. BM immunophenotyping included CD5, CD23, CD22, and CD20 as an indirect indicator of FMC7.
The overall sample mean age was 62.88 years +/- 11.10, without significant difference in the age of two compared groups (63.15 +/- 10.53 years vs. 62.60 +/- 11.50 years) (t = 0.16, df= 38, p = 0.88). Proportion of men was significantly higher in stages Binet B and C (12/20) compared to stage Binet A (5/20) (Z=2.24, p=0.025). The percentage of women was higher than men in Binet A stage (75% vs. 25%). The BM patterns in Binet A stage were observed as follows: mixed 50% (10/20), interstitial 30% (6/20), nodular 15% (3/20) and diffuse 5% (1/20). The BM patterns in Binet B and C stages were observed as follows: diffuse 50% (10/20), mixed 40% (8/20), interstitial 5% (1/20) and nodular 5% (1/20). Clinical stage and the BM patterns were significantly associated (c2=8.02, p=0,005). The chance for non-diffuse patterns was 19 times higher in stage Binet A compared to stages Binet B and C, respectively, analyzing 95% CI at least 2 times higher (95% CI: 2.02-866.6). Immunophenotypic score in total sample was observed as follows: score 4: 5% (2/40), score 3: 72.5% (29/40), score 2: 20% (8/40) and score 1: 2,5% (1/40). Immunophenotypic score 3 and > 3 had 77.5% of patients (31/40), but there was no significant association between the immunophenotypic score and the BM patterns (c2=0.76, p=0.38).
Diffuse BM pattern was significantly associated with the clinical stages Binet B and C, compared to non-diffuse BM patterns which were significantly associated with the clinical stage Binet A. Diffuse BM pattern represent the parameter of progressive disease compared to the non-diffuse BM patterns which are more often represented in stable disease. Immunophenotypic score improves diagnostic accuracy of B-CLL, but should not be used as a prognostic parameter of B -CLL.
B细胞慢性淋巴细胞白血病（B-CLL）的临床病程和预后各不相同，迄今为止难以预测。确定预后参数有助于将患者分为预后良好和不良的组，这有助于评估早期治疗的获益、提高治疗效果并为每位患者优化治疗方案。
分析B-CLL诊断时的骨髓（BM）模式和免疫表型评分，并确定BM模式与疾病临床分期和免疫表型评分之间的相关性。
将40例未经治疗的B-CLL患者样本分为两组：Binet A临床分期组和Binet B及Binet C临床分期组。观察到的BM模式有弥漫性、间质型、结节型和混合型。BM免疫表型分析包括CD5、CD23、CD22以及作为FMC7间接指标的CD20。
样本总体平均年龄为62.88岁±11.10岁，两组年龄无显著差异（63.15±10.53岁 vs. 62.60±11.50岁）（t = 0.16，自由度 = 38，p = 0.88）。与Binet A期（5/20）相比，Binet B和C期男性比例显著更高（12/20）（Z = 2.24，p = 0.025）。Binet A期女性百分比高于男性（75%对25%）。观察到Binet A期的BM模式如下：混合型50%（10/20），间质型30%（6/20），结节型15%（3/20），弥漫型5%（1/20）。Binet B和C期的BM模式如下：弥漫型50%（10/20），混合型40%（8/20），间质型5%（1/20），结节型5%（1/20）。临床分期与BM模式显著相关（c2 = 8.02，p = 0.005）。与Binet B和C期相比，Binet A期出现非弥漫性模式的几率分别高19倍，分析95%置信区间至少高2倍（95%置信区间：2.02 - 866.6）。观察到总样本的免疫表型评分如下：4分：5%（2/40），3分：72.5%（29/40），2分：20%（8/40），1分：2.5%（1/40）。免疫表型评分为3分及>3分的患者占77.5%（31/40），但免疫表型评分与BM模式之间无显著关联（c2 = 0.76，p = 0.38）。
与非弥漫性BM模式（与Binet A临床分期显著相关）相比，弥漫性BM模式与Binet B和C临床分期显著相关。与更常见于稳定疾病的非弥漫性BM模式相比，弥漫性BM模式代表疾病进展的参数。免疫表型评分提高了B-CLL的诊断准确性，但不应作为B-CLL的预后参数。
