Immunophenotyping for the Assessment of Asymptomatic Lymphocytosis: A Retrospective Analysis and National Survey.

IF 2.3 3区 医学 Q2 HEMATOLOGY
Tanya Freeman, Peter Johnstone, Stephen P Hibbs, Esubalew Assefa, Shamzah Araf, Timothy Farren, Tom Butler
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引用次数: 0

Abstract

Asymptomatic lymphocytosis poses a common challenge in haematology. Immunophenotyping can establish whether a clonal population is present, but it is expensive and the benefit of diagnosing asymptomatic patients is unproven. This study aimed to establish data to guide the use of immunophenotyping. We analysed the proportion of lymphocytosis in full blood count (FBC) samples across a five-year period within a large UK National Health Service (NHS) trust. Persistent lymphocytosis was present in 0.18% (437/242678) of repeat community samples. Of samples sent for immunophenotyping, 743/784 (95%) with a lymphocyte count > 10 × 109/L had a clonal population, compared to 223/1696 (14%) with a lymphocyte count < 5 × 109/L. We followed up a longitudinal cohort of asymptomatic patients with clonal lymphocytosis to determine how many required treatment. The minority (11/46) of patients needed treatment within 9 years of follow-up. Of patients needing treatment, 10/11 (91%) had a presenting lymphocyte count > 10 × 109/L. In all cases, treatment was initiated when the patient became symptomatic. We propose a lymphocyte count threshold of > 10 × 109/L for referral and immunophenotyping in patients with asymptomatic lymphocytosis. This approach aims to balance safety and cost-effectiveness and reflects uncertainty in the value of diagnosis for asymptomatic patients.

用于评估无症状淋巴细胞增多症的免疫分型:回顾性分析和全国调查
无症状淋巴细胞增多症是血液学中常见的难题。免疫分型可确定是否存在克隆群体,但其费用昂贵,而且诊断无症状患者的益处尚未得到证实。本研究旨在建立数据,为免疫分型的使用提供指导。我们分析了英国一家大型国民健康服务(NHS)托管机构五年内全血计数(FBC)样本中淋巴细胞增多的比例。在社区重复样本中,0.18%(437/242678)的样本存在持续性淋巴细胞增多。在送去进行免疫分型的样本中,淋巴细胞计数大于 10 × 109/L 的样本有 743/784 例(95%)出现了克隆群体,而淋巴细胞计数为 9/L 的样本有 223/1696 例(14%)出现了克隆群体。我们对无症状的克隆性淋巴细胞增多症患者进行了纵向队列随访,以确定有多少患者需要治疗。少数患者(11/46)需要在 9 年随访期内接受治疗。在需要治疗的患者中,10/11(91%)的淋巴细胞计数大于 10 × 109/L。在所有病例中,治疗都是在患者出现症状时开始的。我们建议将无症状淋巴细胞增多症患者转诊并进行免疫分型的淋巴细胞计数阈值定为 > 10 × 109/L。这种方法旨在平衡安全性和成本效益,并反映出无症状患者诊断价值的不确定性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
168
审稿时长
4-8 weeks
期刊介绍: European Journal of Haematology is an international journal for communication of basic and clinical research in haematology. The journal welcomes manuscripts on molecular, cellular and clinical research on diseases of the blood, vascular and lymphatic tissue, and on basic molecular and cellular research related to normal development and function of the blood, vascular and lymphatic tissue. The journal also welcomes reviews on clinical haematology and basic research, case reports, and clinical pictures.
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