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New insights into smudge cell percentage in chronic lymphocytic Leukemia: A novel prognostic indicator of disease burden

Amal Abd El Hamid Mohamed
Nesma Ahmed Safwat


Background: Percentage of smudge cells in CLL patients has recently been reported as a novel prognostic factor.

Objectives: To investigate the impact of smudge cells percentage on the clinicolaboratory data of CLL patients and to evaluate the relationship between it and other prognostic factors in CLL.

Methods: Ninety adults with CLL were enrolled. Smudge cells percentage was calculated by microscopic evaluation of blood smears. Testing of CD38 expression was done by immunophenotyping and detection of ATM, P53 deletions and trisomy 12 were performed using fluorescent in situ hybridization (FISH)

Results: Lower smear cells percentage (<30%) was significantly correlated with age, lymphadenopathy, organomegaly and advanced staging. It was also associated with high TLC, low hemoglobin and platelets count and high absolute and atypical lymphocytic count. Correlation studies with other prognostic factors revealed an association between low smear cells percentage and CD38 expression, short LDT, P53 and ATM deletions. Logistic regression analysis was also done to provide complementary prognostic information identifying the significant independent factors that predict low smear cell percentage.

Conclusion: low percentage of smudge cells (<30%) could be considered as an adverse prognostic predictor being associated with high risk markers in CLL.

Keywords: Smudge cells, CLL