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Chronic lymphocytic leukemia

Risk of serious infection among individuals with and without low count monoclonal B-cell lymphocytosis (MBL)

Leukemia volume 35, pages 239–244 (2021)Cite this article

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Monoclonal B-cell lymphocytosis (MBL), the precursor state to chronic lymphocytic leukemia (CLL), is one of the most common premalignant conditions in humans [1, 2]. MBL is subdivided into low count (LC) MBL and high count (HC) MBL depending on whether the absolute B-cell count is above or below 0.5 × 109/L [3]. Although all individuals who develop CLL appear to pass through MBL [4], only a minority of individuals with MBL progress to develop CLL. The overwhelming majority (i.e., >98%) of individuals with MBL have LC MBL and never come to clinical attention [3, 5]. The clinical consequences of LC MBL are largely unknown. Although longitudinal studies indicate that the clonal B-cell population persists and expands over time in the majority of individuals with LC MBL [5, 6], progression to CLL is rare and believed to occur in ~1 in 500 LC MBL patients. Currently, it is unknown whether LC MBL has other clinical implications. Evidence suggests that some of the immune deficits observed in HC MBL are present in LC MBL, albeit to a lesser degree [5, 6].

Herein, we screened for MBL using highly sensitive flow cytometry in asymptomatic adults participating in the Mayo Clinic Biobank to evaluate the prevalence of MBL and its relationship to infectious complications and overall survival. The Mayo Clinic Biobank is a large scale bio-repository of adult patients assembled to study a wide array of health-related research studies [7]. With consent of participants and the approval of the Mayo Clinic IRB, we screened participating individuals from Olmsted County (the county in which Mayo Clinic is located), Minnesota, who were 40 years of age or older, no prior history of hematologic malignancy, and who had stored PBMC (samples from 7/14/2009 to 3/4/2016). Data on hospitalization with infection was abstracted from clinical records as previously published [4]. All hospitalizations occurring after the date of enrollment in the Biobank were ascertained through the earliest date of death, migration from Olmsted County, or 12/31/2017. Infections associated with hospitalization were considered “serious or life-threatening infections.”

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Fig. 1: Clinical outcomes of individuals with monoclonal B-cell lymphocytosis (MBL) compared to those without MBL.

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Acknowledgements

This work was funded by grants from the NIH: RO1 AG58266 and RO1 CA 193541.

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Authors and Affiliations

  1. Stanford University, Palo Alto, CA, United States

    Tait D. Shanafelt

  2. Mayo Clinic, Rochester, MN, United States

    Neil E. Kay, Sameer A. Parikh, Sara J. Achenbach, Connie E. Lesnick, Curtis A. Hanson, Geffen Kleinstern, Janet E. Olson, Aaron D. Norman, Kari G. Rabe, Susan M. Schwager, Timothy G. Call & Susan L. Slager

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  1. Tait D. Shanafelt
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Contributions

Concept and study design was performed by TDS, NEK, SAP, and SLS. Acquisition of data was performed by TDS, NEK, CEL, CAH, JEO, ADN, SMS, and SLS. Analysis of data was performed by SJA, KGR, and SLS. Interpretation of data was performed by TDS, NEK, SAP, SJA, CEL, CAH, GK, JEO, AND, KGR, SMS, TGC, and SLS. Manuscript was drafted by TDS, NEK, and SLS. Reviewed/revised manuscript was completed by all authors.

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Correspondence to Tait D. Shanafelt.

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Shanafelt, T.D., Kay, N.E., Parikh, S.A. et al. Risk of serious infection among individuals with and without low count monoclonal B-cell lymphocytosis (MBL). Leukemia 35, 239–244 (2021). https://doi.org/10.1038/s41375-020-0799-8

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