Köhnke Thomas, Wittmann Veronika K, Bücklein Veit L, Lichtenegger Felix, Pasalic Zlatana, Hiddemann Wolfgang, Spiekermann Karsten, Subklewe Marion
Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany.
Br J Haematol. 2017 Nov;179(3):480-487. doi: 10.1111/bjh.14901. Epub 2017 Aug 18.
The modified Matutes score has been the basis for the diagnosis of chronic lymphocytic leukaemia (CLL) by flow cytometry for the past 15 years. To increase the specificity of the current score we systematically evaluated the diagnostic value of established as well as novel markers, such as CD200, in a large cohort of patients with untreated B-cell malignancies (n = 370). Double positivity for CD5 and CD23 was of very high value to differentiate between CLL and non-CLL cases. In addition, lack of FMC7 expression as well as CD79b expression intensity showed high sensitivity (90·4% and 92·3%) with acceptable specificity (74·4% and 76·9%). For surface IgM, low or absent expression displayed poor specificity in distinguishing CLL from non-CLL cases (51,3%; sensitivity 83,7%). Finally, CD200 positivity showed high sensitivity and specificity. Therefore, CD5/CD23, FMC7, CD79b and CD200 were included in our new CLLflow score, which retained high sensitivity (97·1% vs. 98·6% for the Matutes score, P = 0·38), but showed markedly increased specificity (87·2% vs. 53·8%, P < 0·001). These results were confirmed in our validation cohort (sensitivity 97·0% vs. 100%, P = not applicable; specificity 86·4% vs. 59·1%, P = 0·03). Our data support the use of our new CLLflow score for the diagnosis of CLL with significantly higher specificity.
在过去15年里，改良的马图特斯（Matutes）评分一直是通过流式细胞术诊断慢性淋巴细胞白血病（CLL）的基础。为提高当前评分的特异性，我们在一大群未经治疗的B细胞恶性肿瘤患者（n = 370）中系统评估了既定标志物以及新型标志物（如CD200）的诊断价值。CD5和CD23双阳性对于区分CLL和非CLL病例具有很高的价值。此外，FMC7表达缺失以及CD79b表达强度显示出高敏感性（分别为90.4%和92.3%），特异性也可接受（分别为74.4%和76.9%）。对于表面IgM，低表达或无表达在区分CLL和非CLL病例时特异性较差（51.3%；敏感性83.7%）。最后，CD200阳性显示出高敏感性和特异性。因此，CD5/CD23、FMC7、CD79b和CD200被纳入我们新的CLLflow评分中，该评分保留了高敏感性（马图特斯评分为98.6%，新评分为97.1%，P = 0.38），但特异性显著提高（分别为87.2%和53.8%，P < 0.001）。这些结果在我们的验证队列中得到了证实（敏感性分别为100%和97.0%，P = 不适用；特异性分别为59.1%和86.4%，P = 0.03）。我们的数据支持使用我们新的CLLflow评分来诊断CLL，其特异性显著更高。
