Clinico-prognostic implications of simultaneous increased serum levels of soluble CD23 and beta(2)-microglobulin in B-cell chronic lymphocytic leukemia

Soluble CD23 (sCD23) and beta-2 microglobulin (beta(2)-m) are reliable prog nostic parameters in B-cell chronic lymphocytic leukemia (CLL); however, th eir merit over well-established clinical variables such as clinical stages, bone marrow (BM) histology and lymphocyte doubling time (LDT) remains to b e defined. Furthermore, information dealing with the impact on overall surv ival of the simultaneous increase of either beta(2)-m or sCD23 are lacking. In this prospective study based on 106 B-cell CLL patients, we propose a c ombination of beta(2)-m and sCD23 as a strong prognostic system whose stati stical significance was mainly due to an excess of deaths in the subgroup d isplaying increased serum levels of either beta(2)-m or sCD23. Multivariate survival analysis confirmed the important dominant role of such a finding, thus excluding features with a high degree of codependence (i.e. clinical stages, LDT) and including variables with low association (i.e. BM histolog y) in the final regression model. The presence of increased serum levels of beta(2)-m/sCD23 and diffuse BM histology signified high-risk disease, wher eas the absence of any adverse variable was associated with prolonged survi val; in between there was a subgroup with only 1 characteristic which displ ayed an intermediate pattern of survival. Finally, on the basis combined in creased serum levels of beta(2)-m and sCD23, a better stratification of low - and intermediate-risk patients could be obtained, thus allowing the formu lation of a clinico-biological staging for CLL.