Journal of Hematopathology

, Volume 5, Issue 3, pp 123–130 | Cite as

Frequency of additional clonal populations detected by high sensitivity flow cytometry in patients with hairy cell leukemia

Original Article

Abstract

Samples from 115 patients with hairy cell leukemia (HCL) were analyzed by high sensitivity flow cytometry for evidence of an additional B cell or plasma cell clone. We found that 10.4% of HCL patients harbored an additional clonal population in either peripheral blood or bone marrow. Among the patients with additional clones, 58% had the second population present at the time of HCL diagnosis and 42% developed the second clone in a subsequent sample. Half of the clonal populations identified represented true disease entities rather than a monoclonal B lymphocytosis (MBL) or monoclonal gammopathy of undetermined significance (MGUS). The frequency of MBL and MGUS was similar to that reported in the general population, but the frequency of B cell-derived malignancies appears increased in the HCL cohort. Compared to patients without additional clones, the patients with second clones were older (median age 66 vs. 55 years old). Patients over age 60 were at higher risk for a second clone (18.2% vs. 5.6%, OR 3.7, P < 0.05). Among the patients with a second clone, 75% had second B cell clone, 42% had a plasma cell clone, and 17% had both. We have also identified a clear case of bi-clonal HCL; a finding not previously reported using contemporary diagnostic criteria. We conclude that second clonal expansions are relatively common in patients with HCL, in particular in older patients, and may represent clinically significant neoplasms.

Keywords

Hairy cell leukemia Flow cytometry B cell lymphoma Plasma cell neoplasm 

References

  1. 1.
    Swerdlow S, Harris NL et al (eds.) World Health Organization Classification of Tumors: WHO classification of tumors of haematopoietic and lymphoid tissues, 4th edition., IARC Press.Google Scholar
  2. 2.
    Goodman GR, Bethel KJ, Saven A (2003) Hairy cell leukemia: an update. Curr Opin Hematol 10:258–266PubMedCrossRefGoogle Scholar
  3. 3.
    Del Giudice I, Matutes E, Morilla R et al (2004) The diagnostic value of CD123 in B-cell disorders with hairy or villous lymphocytes. Haematologica 89:303–308PubMedGoogle Scholar
  4. 4.
    Forconi F, Sahota SS, Raspadori D et al (2004) Hairy cell leukemia: at the crossroad of somatic mutation and isotype switch. Blood 104:3312–3317PubMedCrossRefGoogle Scholar
  5. 5.
    Chen YH, Tallman MS, Goolsby C et al (2006) Immunophenotypic variations in hairy cell leukemia. Am J Clin Pathol 125:251–259PubMedGoogle Scholar
  6. 6.
    Jasionowski TM, Hartung L, Greenwood JH et al (2003) Analysis of CD10+ hairy cell leukemia. Am J Clin Pathol 120:228–235PubMedCrossRefGoogle Scholar
  7. 7.
    Dasanu CA, Alexandrescu DT (2010) Risk of additional cancers in untreated and treated hairy cell leukemia patients. Expert Opin Pharmacother 11:41–50PubMedCrossRefGoogle Scholar
  8. 8.
    Hisada M, Chen BE, Jaffe ES et al (2007) Second cancer incidence and cause-specific mortality among 3104 patients with hairy cell leukemia: a population-based study. J Natl Cancer Inst 99:215–222PubMedCrossRefGoogle Scholar
  9. 9.
    Paltiel O, Adler B, Barchana M et al (2006) A population-based study of hairy cell leukemia in Israel. Eur J Haematol 77:372–377PubMedCrossRefGoogle Scholar
  10. 10.
    Federico M, Zinzani PL, Frassoldati A et al (2002) Risk of second cancer in patients with hairy cell leukemia: long-term follow-up. J Clin Oncol 20:638–646PubMedCrossRefGoogle Scholar
  11. 11.
    Au WY, Klasa RJ, Gallagher R et al (1998) Second malignancies in patients with hairy cell leukemia in british columbia: a 20-year experience. Blood 92:1160–1164PubMedGoogle Scholar
  12. 12.
    Kurzrock R, Strom SS, Estey E et al (1997) Second cancer risk in hairy cell leukemia: analysis of 350 patients. J Clin Oncol 15:1803–1810PubMedGoogle Scholar
  13. 13.
    Sokol L, Agosti SJ (2004) Simultaneous manifestation of chronic lymphocytic leukemia (CLL) and hairy cell leukemia (HCL). Am J Hematol 75:107–109PubMedCrossRefGoogle Scholar
  14. 14.
    Gine E, Bosch F, Villamor N et al (2002) Simultaneous diagnosis of hairy cell leukemia and chronic lymphocytic leukemia/small lymphocytic lymphoma: a frequent association? Leukemia 16:1454–1459PubMedCrossRefGoogle Scholar
  15. 15.
    Saif MW, Greenberg BR (2001) Multiple myeloma and hairy cell leukemia: a rare association or coincidence? Leuk Lymphoma 42:1043–1048PubMedCrossRefGoogle Scholar
  16. 16.
    Resegotti L, Pistone M, Testa D et al (1985) Simultaneous occurrence of hairy cell leukemia and Hodgkin’s disease in the same patient. Haematologica 70:185PubMedGoogle Scholar
  17. 17.
    Sanchez ML, Almeida J, Gonzalez D et al (2003) Incidence and clinicobiologic characteristics of leukemic B-cell chronic lymphoproliferative disorders with more than one B-cell clone. Blood 102:2994–3002PubMedCrossRefGoogle Scholar
  18. 18.
    Raghavachar A, Bartram CR, Porzsolt F (1986) Eradication by alpha-interferon of one clone in biclonal hairy cell leukaemia. Lancet 2:516PubMedCrossRefGoogle Scholar
  19. 19.
    Evans PA, Pott C, Groenen PJ et al (2007) Significantly improved PCR-based clonality testing in B-cell malignancies by use of multiple immunoglobulin gene targets. Report of the BIOMED-2 Concerted Action BHM4-CT98-3936. Leukemia 21:207–214PubMedCrossRefGoogle Scholar
  20. 20.
    Staines A, Cartwright RA (1993) Hairy cell leukaemia: descriptive epidemiology and a case–control study. Br J Haematol 85:714–717PubMedCrossRefGoogle Scholar
  21. 21.
    Kristinsson SY, Vidarsson B, Agnarsson BA et al (2002) Epidemiology of hairy cell leukemia in Iceland. Hematol J 3:145–147PubMedCrossRefGoogle Scholar
  22. 22.
    Nieto WG, Teodosio C, Lopez A et al (2010) Non-CLL-like monoclonal B-cell lymphocytosis in the general population: prevalence and phenotypic/genetic characteristics. Cytometry B Clin Cytom 78(Suppl 1):S24–S34PubMedGoogle Scholar
  23. 23.
    Shim YK, Middleton DC, Caporaso NE et al (2010) Prevalence of monoclonal B-cell lymphocytosis: a systematic review. Cytometry B Clin Cytom 78(Suppl 1):S10–S18PubMedGoogle Scholar
  24. 24.
    Nieto WG, Almeida J, Romero A et al (2009) Increased frequency (12%) of circulating chronic lymphocytic leukemia-like B-cell clones in healthy subjects using a highly sensitive multicolor flow cytometry approach. Blood 114:33–37PubMedCrossRefGoogle Scholar
  25. 25.
    Rawstron AC, Green MJ, Kuzmicki A et al (2002) Monoclonal B lymphocytes with the characteristics of “indolent” chronic lymphocytic leukemia are present in 3.5% of adults with normal blood counts. Blood 100:635–639PubMedCrossRefGoogle Scholar
  26. 26.
    Kyle RA, Therneau TM, Rajkumar SV et al (2006) Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med 354:1362–1369PubMedCrossRefGoogle Scholar
  27. 27.
    Kikushige Y, Ishikawa F, Miyamoto T et al (2011) Self-renewing hematopoietic stem cell is the primary target in pathogenesis of human chronic lymphocytic leukemia. Cancer Cell 20:246–259PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of Laboratory MedicineUniversity of WashingtonSeattleUSA
  3. 3.Seattle Cancer Care Alliance Mail Stop G7-800SeattleUSA

Personalised recommendations