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Published on: October 19, 2014
Chronic lymphocytic leukemia with two cellular populations: a biphenotypic or biclonal disease
J González-Campos1, E Ríos-Herranz, J M De Blas-Orlando
1Department of Hematology and Hemotherapy, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
Insights
This case study reports chronic lymphocytic leukemia (CLL) in a 50-year-old man, revealing two distinct leukemic cell populations. Gene rearrangement studies confirmed the presence of at least two monoclonal cell populations.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Chronic lymphocytic leukemia (CLL) is a heterogeneous lymphoproliferative disorder.
- Diagnosis typically relies on immunophenotyping and molecular analyses.
- Rare cases may present with complex cellular or genetic profiles.
Observation:
- A 50-year-old male presented with persistent absolute lymphocytosis and numerous small lymphocytes on peripheral blood smear.
- Bone marrow examination revealed 85% lymphocytes with a mixed nodular-interstitial infiltration pattern.
- Immunophenotypic analysis identified two distinct leukemic B-cell populations with differing CD18, CD22, and FMC7 expression, but shared CD5, CD19, CD20, CD23, and lambda light chain restriction.
Findings:
- Gene rearrangement studies, specifically immunoglobulin heavy chain (IgH) gene analysis, detected multiple rearranged bands.
- The detection of three rearranged bands in the Jh blot indicated the presence of at least two independent B-cell clones.
- These molecular findings correlated with the distinct immunophenotypic profiles of the two observed leukemic cell populations.
Implications:
- This case highlights the potential for clonal heterogeneity in chronic lymphocytic leukemia.
- The presence of multiple monoclonal populations may have implications for understanding CLL pathogenesis and treatment response.
- Further research is warranted to explore the clinical significance and biological basis of dual-clone CLL.
Abstract:
A case of CLL with two different cellular populations is reported. A 50-year-old man was evaluated for persistent absolute lymphocytosis. A peripheral blood smear revealed numerous small lymphocytes (83% of white blood cells counted). Frequent Grumpecht shadows were present, too. On bone marrow aspirate smears lymphocytes comprised 85% of the total cells counted, and the bone marrow biopsy showed a mixed nodular-interstitial infiltration pattern. The immunophenotypic study showed two different leukemic populations. The first one (comprising 79% leukemic cells) was CD5+, CD19+, CD10-, CD20+, CD18-, CD22-, CD23+ +, lambda dim, and FMC7-. The second population (comprising 21% leukemic cells) was CD5+, CD19+, CD10-, CD20+, CD18+, CD22+, CD23+, lambda+ +, and FMC7+. Gene rearrangement studies detected the germline and one rearranged band in Jk blot with each restriction endonuclease. In the Jh blot the germline and two rearranged bands were detected with EcoRI and BamHI and three rearranged bands with HindIII. The JBI/JBII blot detected only the germline band. The detection of three rearranged bands was interpreted as evidence of the presence of at least two monoclonal populations of cells with the same light chain restriction.
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