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While we were at ASH 2016, Dr. Neil Kay and I discussed what we know about precursors to chronic lymphocytic leuekmia (CLL).
When we look very carefully at all individuals over 50, we find that 4-5% have a clonal population of lymphocytes that are identical to those found in CLL. This is called MBL the abbreviations for monoclonal B cell lymphocytosis.
While MBL is mostly an area of active research, it does have important clinical implications and population health consequences.
Take Away Points
- Patients who eventually develop CLL have had a small numbers of the cancer cells in their circulating blood, often long before they are officially diagnosed by a rising absolute lymphocyte count that tops 5,000.
- These clonal populations are found by flow cytometry (flow), a way to “fingerprint” the surface of the cells. The usual complete blood count or CBC would be completely normal.
- Low count MBL is where the median count of such monoclonal cancer cells found in the blood is only MBL 1 and is mostly of interest to researchers.
- High count MBL has a clonal population of 1500 and should be followed.
- 1% of high count MBL progress to chronic lymphocytic leukemia yearly.
- Patient with high count MBL have a higher risks of other cancers and infections.
- These patients should be encouraged to have appropriate cancer screening and take adequate Vitamin D.
Here is a link to an article on this topic.
Here is my interview with Dr. Kay who also explains the interesting back-story on just how MBL was first identified.
While this may be more of scientific than clinical import as of today, knowing the origin of our cancer and its genetic evolution over time is how we can discover more effective future treatments.
Brian Koffman, MD 6/13/17