Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study
Objectives Screening of monoclonal B-cell lymphocytosis (MBL) has improved the early detection of B-cell lymphoproliferative disorders (B-LPDs). This study was designed to find the most cost-effective way to screen for asymptomatic B-LPD.Design Observational study.Setting A lymphocytosis screening p...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-09-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e036006.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841553634075082752 |
|---|---|
| author | Yue Wang Jing Li Peng Liu Jiadai Xu Zheng Wei |
| author_facet | Yue Wang Jing Li Peng Liu Jiadai Xu Zheng Wei |
| author_sort | Yue Wang |
| collection | DOAJ |
| description | Objectives Screening of monoclonal B-cell lymphocytosis (MBL) has improved the early detection of B-cell lymphoproliferative disorders (B-LPDs). This study was designed to find the most cost-effective way to screen for asymptomatic B-LPD.Design Observational study.Setting A lymphocytosis screening project was conducted at a large-scale hospital among the Chinese population.Participants For 10 consecutive working days in 2018, 22 809 adult patients who received a complete blood count (CBC) were reviewed. These patients were selected from the outpatient, inpatient and health examination departments of a National Medical Centre in China.Results A total of 254 patients (1.1%, 254/22 809) were found to have lymphocytosis (absolute lymphocyte count (ALC) >3.5×109/L). Among them, a population of circulating monoclonal B-lymphocytes were detected in 14 patients, with 4 having chronic lymphocytic leukaemia (CLL) and 10 having MBL, indicating an overall prevalence of 5.5% for B-LPD (3.9% for MBL). The prevalence of CLL among the elderly patients with lymphocytosis (≥60 years) was determined to be 4.3% (4/92). In the patients over 60 years of age, the prevalence of MBL was found to be 8.7%. CD5 (−) non-CLL-like MBL was observed to be the most common subtype (8, 80%), followed by CLL-like phenotype (1, 10.0%) and atypical CLL phenotype (1, 10.0%). The receiver operating characteristic curve analysis for the CBC results revealed that the ALC of 4.7×109/L may serve as the optimal and cost-effective cut-off for screening for early-stage asymptomatic B-LPD.Conclusion In Chinese patients with lymphocytosis, there was a relatively high proportion of patients with CLL among individuals over 60 years of age. MBL is an age-related disorder. Non-CLL-like MBL was the most common MBL subtype, almost all of whom displayed a pattern of ‘marginal zone lymphoma (MZL)-like’ MBL. Lymphocytosis screening among the elderly would be effective in the detection of B-LPD and MBL. |
| format | Article |
| id | doaj-art-a7550953f9604051bd19be1071819a02 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-a7550953f9604051bd19be1071819a022025-01-09T06:50:09ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2019-036006Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort studyYue Wang0Jing Li1Peng Liu2Jiadai Xu3Zheng Wei43 Department of Thyroid and Breast Surgery, Peking University First Hospital, Beijing, ChinaNational Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China7 Faculté de Médecine, Université Paris-Saclay, Kremlin-Bicêtre, FranceHematology, Zhongshan Hospital, Fudan University, Shanghai, ChinaHematology, Zhongshan Hospital, Fudan University, Shanghai, ChinaObjectives Screening of monoclonal B-cell lymphocytosis (MBL) has improved the early detection of B-cell lymphoproliferative disorders (B-LPDs). This study was designed to find the most cost-effective way to screen for asymptomatic B-LPD.Design Observational study.Setting A lymphocytosis screening project was conducted at a large-scale hospital among the Chinese population.Participants For 10 consecutive working days in 2018, 22 809 adult patients who received a complete blood count (CBC) were reviewed. These patients were selected from the outpatient, inpatient and health examination departments of a National Medical Centre in China.Results A total of 254 patients (1.1%, 254/22 809) were found to have lymphocytosis (absolute lymphocyte count (ALC) >3.5×109/L). Among them, a population of circulating monoclonal B-lymphocytes were detected in 14 patients, with 4 having chronic lymphocytic leukaemia (CLL) and 10 having MBL, indicating an overall prevalence of 5.5% for B-LPD (3.9% for MBL). The prevalence of CLL among the elderly patients with lymphocytosis (≥60 years) was determined to be 4.3% (4/92). In the patients over 60 years of age, the prevalence of MBL was found to be 8.7%. CD5 (−) non-CLL-like MBL was observed to be the most common subtype (8, 80%), followed by CLL-like phenotype (1, 10.0%) and atypical CLL phenotype (1, 10.0%). The receiver operating characteristic curve analysis for the CBC results revealed that the ALC of 4.7×109/L may serve as the optimal and cost-effective cut-off for screening for early-stage asymptomatic B-LPD.Conclusion In Chinese patients with lymphocytosis, there was a relatively high proportion of patients with CLL among individuals over 60 years of age. MBL is an age-related disorder. Non-CLL-like MBL was the most common MBL subtype, almost all of whom displayed a pattern of ‘marginal zone lymphoma (MZL)-like’ MBL. Lymphocytosis screening among the elderly would be effective in the detection of B-LPD and MBL.https://bmjopen.bmj.com/content/10/9/e036006.full |
| spellingShingle | Yue Wang Jing Li Peng Liu Jiadai Xu Zheng Wei Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study BMJ Open |
| title | Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study |
| title_full | Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study |
| title_fullStr | Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study |
| title_full_unstemmed | Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study |
| title_short | Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study |
| title_sort | screening for monoclonal b lymphocyte expansion in a hospital based chinese population with lymphocytosis an observational cohort study |
| url | https://bmjopen.bmj.com/content/10/9/e036006.full |
| work_keys_str_mv | AT yuewang screeningformonoclonalblymphocyteexpansioninahospitalbasedchinesepopulationwithlymphocytosisanobservationalcohortstudy AT jingli screeningformonoclonalblymphocyteexpansioninahospitalbasedchinesepopulationwithlymphocytosisanobservationalcohortstudy AT pengliu screeningformonoclonalblymphocyteexpansioninahospitalbasedchinesepopulationwithlymphocytosisanobservationalcohortstudy AT jiadaixu screeningformonoclonalblymphocyteexpansioninahospitalbasedchinesepopulationwithlymphocytosisanobservationalcohortstudy AT zhengwei screeningformonoclonalblymphocyteexpansioninahospitalbasedchinesepopulationwithlymphocytosisanobservationalcohortstudy |