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Published on: October 19, 2014
Leukemic mantle cell lymphoma: clinical and pathologic spectrum of twenty-three cases
1Department of Hematopathology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. eschlett@mdanderson.org
Insights
Cytologic features in mantle cell lymphoma (MCL) with high lymphocyte counts predict patient prognosis. Small-cell morphology indicates better survival, while large/blastoid cells suggest a poorer outlook.
Area of Science:
- Hematology
- Oncology
- Genetics
Background:
- Mantle cell lymphoma (MCL) can present with significant leukemic involvement.
- Patients with marked leukemic involvement often have high absolute lymphocyte counts (>10 x 10(9)/L).
Purpose of the Study:
- To investigate the prognostic significance of cytologic features in MCL with leukemic involvement.
- To identify common genetic abnormalities and their correlation with clinical features in these cases.
Main Methods:
- Retrospective analysis of 23 MCL patients with marked leukemic involvement.
- Morphologic classification based on the percentage of large or blastoid cells (cutoff at 20%).
- Karyotypic analysis and p53 expression assessment.
Main Results:
- MCL cases were divided into small-cell (<20% large/blastoid) and large/blastoid (>=20%) morphologic groups.
- Patients with small-cell morphology demonstrated significantly longer survival than those with large/blastoid features (P=.003).
- Chromosome 17 abnormalities were frequent (56.5%), correlating with p53 overexpression but not morphology.
Conclusions:
- Cytologic features are a significant predictor of prognosis in leukemic MCL.
- Chromosome 17 abnormalities are common in leukemic MCL and associated with p53 expression, potentially influencing pathogenesis.
Abstract:
Twenty-three patients with marked leukemic involvement by mantle cell lymphoma (MCL) are described. Each patient had an absolute lymphocyte count more than 10 x 10(9)/L. The diagnosis of MCL was supported by compatible immunophenotypic findings and the t(11;14)(q13;q32) in all cases. Morphologically, these cases exhibited a spectrum of findings that we divided into two groups using a cutoff of 20% large or blastoid cells (log rank test, P =.004). Patients with small-cell (<20%) morphologic features survived longer than patients with large/blastoid (> or =20%) morphologic features, (P =.003, log rank test). The most common additional karyotypic abnormality identified in this study involved chromosome 17, in 13 of 23 (56.5%) cases, which correlated with p53 overexpression but not with cytologic features. We conclude that cytologic features of MCL predict the prognosis of patients with marked leukemic involvement. Chromosome 17 abnormalities are common in leukemic MCL, may be involved in pathogenesis, and are associated with p53 expression.
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