Originally published as JCO Early Release 10.1200/JCO.2009.23.8188 on July 6 2009

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Smudge Cells, Serum Albumin, and Prognosis in B-Cell Chronic Lymphocytic Leukemia

Center for Cancer and Blood Disorders, Gundersen Lutheran Health System, La Crosse, WI

To the Editor:

The interesting study by Nowakowski et al¹ showed that the percentage of smudge cells on blood smear at diagnosis was an independent predictor of overall survival in their cohort of patients with B-cell chronic lymphocytic leukemia. However, they did not show data on whether this finding was or was not impacted if serum albumin level was included in their multivariate analysis. It is known for a long time that the addition of bovine serum albumin in the preparation of blood smear reduces the number of smudge cells and allows better appreciation of lymphocyte morphology. Moreover, previous studies have shown prognostic importance of serum albumin.^2,3 In theory, a higher level of serum albumin may result in a lower number of smudge cells. Therefore, the prognostic impact of the percentage of smudge cells may potentially be enhanced when it is adjusted for serum albumin level.

AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Nowakowski GS, Hoyer JD, Shanafelt TD, et al: Percentage of smudge cells on routine blood smear predicts survival in chronic lymphocytic leukemia. J Clin Oncol 27:1844–1849, 2009.[Abstract/Free Full Text]

2. Levis A, Ficara F, Marmont F, et al: Prognostic significance of serum albumin in chronic lymphocytic leukemia. Haematologica 76:113–119, 1991.[Medline]

3. Wierda WG, O'Brien S, Wang X, et al: Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Blood 109:4679–4685, 2007.[Abstract/Free Full Text]

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This article has been cited by other articles:

				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]

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