Novel Prognostic Factors 31 Immunophenotype Characteristics

Immunophenotypic analysis of chronic lymphoproliferative disorders allows an accurate classification of such disorders. Matutes et al. (74) analyzed circulating cells from 666 cases, including CLL, PLL, hairy cell leukemia, and others. On the basis of the most common marker profile in CLL [CD5+, CD23+, FMC7-, and weak expression (+/-) of surface immunoglobulin (SIg) and CD22], a scoring system was devised. Considering each marker individually, no single one distinguished CLL from other diseases, although the most reliable were SmIg intensity and FMC7 (74). Moreover, Moreau et al. (75) found that the replacement of CD22 by CD79b (SN8) in the original scoring system increased its potential to discriminate between CLL and other B-cell lymphoproliferative diseases. Geisler et al. (76) examined 540 cases of CLL using immu-nofluorescence flow cytometry with a panel of surface membrane markers, including IgM and IgD, the monoclonal antibodies anti-CD3, -5, -20, -21, -22, and -23, as well as anti-FMC7. In a multivariate analysis, and independently of clinical variables, CD23 and IgM intensity proved to be useful prognostic markers in the management of CD5+, B-cell CLL (76).

Other studies attempting to correlate immunophenotype with prognosis have been inconclusive (77,78). In a series of patients with B-cell CLL fulfilling strict immunological criteria, a high CD20 expression significantly correlated with atypical morphology and worse prognosis (79). Thus, quantitative immunophenotyping makes it possible to analyze the biological heterogeneity of disease better, although it is difficult to transfer these results into prognosis (79). Non-B-lineage antigens have been analyzed in several studies, with inconclusive results (80).

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