Originally published as JCO Early Release 10.1200/JCO.2008.21.2704 on July 20 2009

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Brief Report: Natural History of Individuals With Clinically Recognized Monoclonal B-Cell Lymphocytosis Compared With Patients With Rai 0 Chronic Lymphocytic Leukemia

From the Mayo Clinic, Rochester, MN; and The Ohio State University, Columbus, OH.

Corresponding author: Tait D. Shanafelt, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: shanafelt.tait{at}mayo.edu.

Purpose The diagnosis of monoclonal B-cell lymphocytosis (MBL) is used to characterize patients with a circulating population of clonal B cells, a total B-cell count of less than 5 x 10⁹/L, and no other features of a B-cell lymphoproliferative disorder including lymphadenopathy/organomegaly. The natural history of clinically identified MBL is unclear. The goal of this study was to explore the outcome of patients with MBL relative to that of individuals with Rai stage 0 chronic lymphocytic leukemia (CLL).

Patients and Methods We used hematopathology records to identify a cohort of 631 patients with newly diagnosed MBL or Rai stage 0 CLL. Within this cohort, 302 patients had MBL (B-cell counts of 0.02 to 4.99 x 10⁹/L); 94 patients had Rai stage 0 CLL with an absolute lymphocyte count (ALC) 10 x 10⁹/L; and 219 patients had Rai stage 0 CLL with an ALC more than 10 x 10⁹/L. Data on clinical outcome were abstracted from medical records.

Results The percentage of MBL patients free of treatment at 1, 2, and 5 years was 99%, 98%, and 93%, respectively. B-cell count as a continuous variable (hazard ratio [HR] = 2.9, P = .04) and CD38 status (HR = 10.8, P = .006) predicted time to treatment (TTT) among MBL patients. The likelihood of treatment for MBL patients was lower (HR = 0.32, P = .04) than that of both Rai stage 0 CLL patients with an ALC less than 10 x 10⁹/L (n = 94) and Rai stage 0 CLL patients with an ALC more than 10 x 10⁹/L (n = 219; P = .0003).

Conclusion Individuals with MBL identified in clinical practice have a low risk for progression at 5 years. Because B-cell count seems to relate to TTT as a continuous variable, additional studies are needed to determine what B-cell count should be used to distinguish between MBL and CLL.

Supported by National Cancer Institute Grant No. CA 113408, Gabrielle's Angel Research Foundation, and the Mayo Clinic Cancer Center.

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

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