Originally published as JCO Early Release 10.1200/JCO.2008.17.0795 on March 2 2009

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Percentage of Smudge Cells on Routine Blood Smear Predicts Survival in Chronic Lymphocytic Leukemia

From the Department of Internal Medicine, Division of Hematology; Department of Laboratory Medicine and Pathology, Division of Hematopathology and Division of Cytogenetics; Health Sciences Research, Division of Biostatistics; and Department of Immunology, Mayo Clinic, Rochester, MN.

Corresponding author: Grzegorz S. Nowakowski, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: Nowakowski.Grzegorz{at}mayo.edu.

Purpose 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.

Patients and Methods 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.

Results 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.

Conclusion Percentage of smudge cells on blood smear is readily available and an independent factor predicting overall survival in CLL.

Supported in part by Grant No. CA95241 from the National Cancer Institute, National Institutes of Health, and philanthropic support from the Donner Family Foundation.

Presented in part at the 12th Annual International Workshop for Chronic Lymphocytic Leukemia, September 14-16, 2007, London, United Kingdom.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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Related Correspondence

• Smudge Cells, Serum Albumin, and Prognosis in B-Cell Chronic Lymphocytic Leukemia
  Ronald S. Go
  JCO 2009 27: 44 [Full Text]

This article has been cited by other articles:

				R. S. Go Smudge Cells, Serum Albumin, and Prognosis in B-Cell Chronic Lymphocytic Leukemia J. Clin. Oncol., August 1, 2009; 27(22): e44 - e44. [Full Text] [PDF]

				G. S. Nowakowski, T. D. Shanafelt, S. Schwager, and N. E. Kay Reply to R.S. Go J. Clin. Oncol., August 1, 2009; 27(22): e45 - e45. [Full Text] [PDF]