Expanded and highly active proliferation centers identify a histological subtype of chronic lymphocytic leukemia ("accelerated" chronic lymphocytic leukemia) with aggressive clinical behavior (Retracted Article. See vol 95, pg 1620, 2010)
Expanded and highly active proliferation centers identify a histological subtype of chronic lymphocytic leukemia ("accelerated" chronic lymphocytic leukemia) with aggressive clinical behavior (Retracted Article. See vol 95, pg 1620, 2010)
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DOI：
10.3324/haematol.2010.022277
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发表时间：
2010-09-01
期刊：
影响因子：
--
通讯作者：
Montserrat, Emili
中科院分区：
文献类型：
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作者：
Gine, Eva;Martinez, Antoni;Montserrat, Emili
背景“加速”慢性淋巴细胞白血病的概念经常被病理学家和临床医生使用。然而，定义这种形式的慢性淋巴细胞白血病的组织学标准及其临床相关性和预后影响都尚未在大量患者中得到正式定义。 设计和方法对 100 名慢性淋巴细胞白血病患者的组织活检进行分析，了解增殖中心的大小及其增殖率（通过有丝分裂计数和 Ki-67 免疫染色评估）。组织学模式与主要临床生物学特征和结果相关。 结果 怀疑疾病转化是进行组织活检的主要原因，组织活检的中位时间为慢性淋巴细胞白血病诊断后 14 个月（范围为 0 至 204 个月）。活检显示22例组织学转变为弥漫性大B细胞淋巴瘤。在其余 78 名患者中，存在扩大的增殖中心（比 20 倍视野更宽）和高增殖率（>2.4 个有丝分裂/增殖中心或 Ki-67 >40%/增殖中心）预示着不良结果，并被选择来定义高度增殖组。因此，23名具有扩大的增殖中心或高增殖率的患者被认为患有“加速”慢性淋巴细胞白血病。这些患者表现出特殊的特征，包括比“非加速”病例更高的血清乳酸脱氢酶水平和更常见的 ZAP-70 升高。 “非加速型”慢性淋巴细胞白血病、“加速型”慢性淋巴细胞白血病和转化为弥漫性大 B 细胞白血病患者的活检中位生存期分别为 76、34 和 4.3 个月（P
Background The concept of "accelerated" chronic lymphocytic leukemia is frequently used by both pathologists and clinicians. However, neither histological criteria to define this form of chronic lymphocytic leukemia nor its clinical correlates and prognostic impact have been formally defined in large series of patients.Design and Methods Tissue biopsies from 100 patients with chronic lymphocytic leukemia were analyzed for the size of proliferation centers and their proliferation rate as assessed by mitosis count and Ki-67 immunostaining. Histological patterns were correlated with main clinico-biological features and outcome.Results A suspicion of disease transformation was the main reason for carrying out tissue biopsy, which was performed at a median time of 14 months (range, 0 to 204 months) after the diagnosis of chronic lymphocytic leukemia. The biopsy showed histological transformation to diffuse large B-cell lymphoma in 22 cases. In the remaining 78 patients, the presence of expanded proliferation centers (broader than a 20x field) and high proliferation rate (either >2.4 mitoses/proliferation center or Ki-67 >40%/proliferation center) predicted a poor outcome and were selected to define a highly proliferative group. Thus, 23 patients with either expanded proliferation centers or high proliferation rate were considered as having "accelerated" chronic lymphocytic leukemia. These patients displayed particular features, including higher serum lactate dehydrogenase levels and more frequently elevated ZAP-70 than "non-accelerated" cases. The median survival from biopsy of patients with "non-accelerated" chronic lymphocytic leukemia, "accelerated" chronic lymphocytic leukemia and transformation to diffuse large B-cell leukemia was 76, 34, and 4.3 months, respectively (P