Monoclonal B-cell Lymphocytosis – a review of diagnostic criteria, biology, natural history, and clinical management

References

• Rawstron AC, Green MJ, Kuzmicki A, et al. Monoclonal B lymphocytes with the characteristics of “indolent” chronic lymphocytic leukemia are present in 3.5% of adults with normal blood counts. Blood 2002;100(2):635–639.
   PubMed Web of Science ®Google Scholar
• Marti GE, Rawstron AC, Ghia P, International Familial CLL Consortium, et al. Diagnostic criteria for monoclonal B-cell lymphocytosis. Br J Haematol. 2005;130(3):325–332.
   PubMed Web of Science ®Google Scholar
• Mulligan CS, Thomas ME, Mulligan SP. Monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia. N Engl J Med. 2008;359(19):2065–2066.
   PubMed Web of Science ®Google Scholar
• Hanson CA, Kurtin PJ, Dogan A. The proposed diagnostic criteria change for chronic lymphocytic leukemia: unintended consequences? Blood 2009;113(25):6495–6496.
   PubMed Web of Science ®Google Scholar
• Mulligan CS, Thomas ME, Mulligan SP. Lymphocytes, B lymphocytes, and clonal CLL cells: observations on the impact of the new diagnostic criteria in the 2008 guidelines for chronic lymphocytic leukemia (CLL). Blood 2009;113(25):6496.
   PubMed Web of Science ®Google Scholar
• Mulligan SP. Monoclonal B-lymphocytosis: reflections and definitions. Leuk Lymphoma. 2012;53(9):1647–1650.
   PubMed Web of Science ®Google Scholar
• Cheson BD, Bennett JM, Grever M, et al. National cancer institute-sponsored working group guidelines for chronic lymphocytic leukemia: revised guidelines for diagnosis and treatment. Blood 1996;87(12):4990–4997.
   PubMed Web of Science ®Google Scholar
• Swerdlow SC, Harris NL, Jaffe ES, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon, France: International Agency for Research on Cancer (IACR), 4th ed. 2017.
   Google Scholar
• Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood 2018;131(25):2745–2760.
   PubMed Web of Science ®Google Scholar
• Hallek M, Cheson BD, Catovsky D, International Workshop on Chronic Lymphocytic Leukemia, et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the international workshop on chronic lymphocytic leukemia updating the national cancer Institute-Working group 1996 guidelines. Blood 2008;111(12):5446–5456.
   PubMed Web of Science ®Google Scholar
• Ghia P, Prato G, Scielzo C, et al. Monoclonal CD5+ and CD5− B-lymphocyte expansions are frequent in the peripheral blood of the elderly. Blood 2004;103(6):2337–2342.
   PubMed Web of Science ®Google Scholar
• Mulligan CS, Thomas ME, Mulligan SP. Monoclonal B-lymphocytosis: demographics, nature and subclassification in 414 community patients. Leuk Lymphoma. 2011;52(12):2293–2298.
   PubMed Web of Science ®Google Scholar
• Nieto WG, Almeida J, Teodosio C, et al. Commentary: comparison of current flow cytometry methods for monoclonal B cell lymphocytosis detection. Cytometry B Clin Cytom. 2010;78(Suppl 1):S4–S9.
   PubMedGoogle Scholar
• Gentile M, Cutrona G, Fabris S, et al. Total body computed tomography scan in the initial work-up of Binet stage a chronic lymphocytic leukemia patients: results of the prospective, multicenter O-CLL1-GISL study. Am J Hematol. 2013;88(7):539–544.
   PubMed Web of Science ®Google Scholar
• Jaso JM, Yin CC, Wang SA, et al. Clinicopathologic features of CD5-positive nodal marginal zone lymphoma. Am J Clin Pathol. 2013;140(5):693–700.
   PubMed Web of Science ®Google Scholar
• Xochelli A, Kalpadakis C, Gardiner A, et al. Clonal B-cell lymphocytosis exhibiting immunophenotypic features consistent with a marginal-zone origin: is this a distinct entity? Blood 2014;123(8):1199–1206.
   PubMed Web of Science ®Google Scholar
• Boddicker NJ, Achenbach SJ, Parikh SA, et al. Associations of history of vaccination and hospitalization due to infection with risk of monoclonal B-cell lymphocytosis. Leukemia 2022;36(5):1404–1404.
   PubMed Web of Science ®Google Scholar
• Shim YK, Rachel JM, Ghia P, et al. Monoclonal B-cell lymphocytosis in healthy blood donors: an unexpectedly common finding. Blood 2014;123(9):1319–1326.
   PubMed Web of Science ®Google Scholar
• National Institutes of Health. Chronic lymphocytic leukemia – cancer stat facts. Bethesda, Maryland, USA: National Institutes of Health. Available from: https://seer.cancer.gov/statfacts/html/clyl.html.
   Google Scholar
• Kolijn PM, Hosnijeh FS, Späth F, et al. High-risk subtypes of chronic lymphocytic leukemia are detectable as early as 16 years prior to diagnosis. Blood 2022;139(10):1557–1563.
   PubMed Web of Science ®Google Scholar
• Nieto WG, Almeida J, Romero A, Primary Health Care Group of Salamanca for the Study of MBL, et al. Increased frequency (12%) of circulating chronic lymphocytic leukemia-like B-cell clones in healthy subjects using a highly sensitive multicolor flow cytometry approach. Blood 2009;114(1):33–37.
   PubMed Web of Science ®Google Scholar
• Scarfò L, Dagklis A, Scielzo C, et al. CLL-like monoclonal B-cell lymphocytosis: are we all bound to have it? Semin Cancer Biol. 2010;20(6):384–390.
   PubMed Web of Science ®Google Scholar
• Dagklis A, Fazi C, Sala C, et al. The immunoglobulin gene repertoire of low-count chronic lymphocytic leukemia (CLL)-like monoclonal B lymphocytosis is different from CLL: diagnostic implications for clinical monitoring. Blood 2009;114(1):26–32.
   PubMed Web of Science ®Google Scholar
• Soosapilla A, Pepperell D, Best G, et al. Monoclonal B-lymphocytosis in patients aged over 90 years is common but not inevitable, and has a prevalence comparable to that in individuals aged 65–90 years. Leuk Lymphoma. 2015;56(7):2182–2184.
   PubMed Web of Science ®Google Scholar
• Rawstron AC, Bennett FL, O’Connor SJM, et al. Monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia. N Engl J Med. 2008;359(6):575–583.
   PubMed Web of Science ®Google Scholar
• Slager SL, Parikh SA, Achenbach SJ, et al. Prevalence and overall survival of low count monoclonal B-cell lymphocytosis (LC-MBL): a screening study of 8,297 individuals from the Mayo Clinic Biobank. Blood 2021;138(Suppl 1):2632–2632.
   PubMedGoogle Scholar
• Rawstron AC, Ssemaganda A, de Tute R, et al. Monoclonal B-cell lymphocytosis in a hospital-based UK population and a rural Ugandan population: a cross-sectional study. Lancet Haematol. 2017;4(7):e334–e340.
   PubMed Web of Science ®Google Scholar
• Yağcı M, Yegin ZA, Yenicesu İ, et al. Monoclonal B-cell lymphocytosis in blood donors in Turkey. Hematology 2018;23(1):25–29.
   PubMed Web of Science ®Google Scholar
• Aljurf M, Rawas F, Alnounou R, et al. Prevalence and relative proportions of CLL and non-CLL monoclonal B-cell lymphocytosis phenotypes in the Middle Eastern population. Hematol Oncol Stem Cell Ther. 2017;10(1):42–43.
   PubMedGoogle Scholar
• Yuille MR, Matutes E, Marossy A, et al. Familial chronic lymphocytic leukaemia: a survey and review of published studies. Br J Haematol. 2000;109(4):794–799.
   PubMed Web of Science ®Google Scholar
• Rawstron AC, Yuille MR, Fuller J, et al. Inherited predisposition to CLL is detectable as subclinical monoclonal B-lymphocyte expansion. Blood 2002;100(7):2289–2290.
   PubMed Web of Science ®Google Scholar
• Marti GE, Carter P, Abbasi F, et al. B-cell monoclonal lymphocytosis and B-cell abnormalities in the setting of familial B-cell chronic lymphocytic leukemia. Cytometry B Clin Cytom. 2003;52B(1):1–12.
   Web of Science ®Google Scholar
• de Tute R, Yuille M, Catovsky D, et al. Monoclonal B-cell lymphocytosis (MBL) in CLL families: substantial increase in relative risk for young adults. Leukemia 2006;20(4):728–729.
   PubMed Web of Science ®Google Scholar
• Matos DM, Ismael SJ, Scrideli CA, et al. Monoclonal B-cell lymphocytosis in first-degree relatives of patients with sporadic (non-familial) chronic lymphocytic leukaemia. Br J Haematol. 2009;147(3):339–346.
   PubMed Web of Science ®Google Scholar
• Kleinstern G, Weinberg JB, Parikh SA, et al. Polygenic risk score and risk of monoclonal B-cell lymphocytosis in caucasians and risk of chronic lymphocytic leukemia (CLL) in African Americans. Leukemia 2022;36(1):119–125.
   PubMed Web of Science ®Google Scholar
• Yang S, Varghese AM, Sood N, et al. Ethnic and geographic diversity of chronic lymphocytic leukaemia. Leukemia 2021;35(2):433–439.
   PubMed Web of Science ®Google Scholar
• Edlefsen KL, Cherian S, De Roos AJ, et al. Detection of non-CLL-like monoclonal B cell lymphocytosis increases dramatically in the very elderly, while detection of CLL-like populations varies by race: findings in a multiethnic population-based cohort of elderly women. Ann Hematol. 2016;95(10):1695–1704.
   PubMed Web of Science ®Google Scholar
• Yang SM, Li JY, Gale RP, et al. The mystery of chronic lymphocytic leukemia (CLL): why is it absent in Asians and what does this tell us about etiology, pathogenesis and biology? Blood Rev. 2015;29(3):205–213.
   PubMed Web of Science ®Google Scholar
• Gale RP, Cozen W, Goodman MT, et al. Decreased chronic lymphocytic leukemia incidence in Asians in Los Angeles county. Leuk Res. 2000;24(8):665–669.
   PubMed Web of Science ®Google Scholar
• Pan JW, Cook LS, Schwartz SM, et al. Incidence of leukemia in Asian migrants to the United States and their descendants. Cancer Causes Control. 2002;13(9):791–795. [Mismatch
   PubMed Web of Science ®Google Scholar
• Mak V, Ip D, Mang O, et al. Preservation of lower incidence of chronic lymphocytic leukemia in Chinese residents in British Columbia: a 26-year survey from 1983 to 2008. Leuk Lymphoma. 2014;55(4):824–827.
   PubMed Web of Science ®Google Scholar
• Landgren O, Albitar M, Ma W, et al. B-cell clones as early markers for chronic lymphocytic leukemia. N Engl J Med. 2009;360(7):659–667.
   PubMed Web of Science ®Google Scholar
• Xu J, Li J, Wei Z, et al. Screening for monoclonal B-lymphocyte expansion in a hospital-based Chinese population with lymphocytosis: an observational cohort study. BMJ Open 2020;10(9):e036006.
   PubMed Web of Science ®Google Scholar
• Albitar M, Rawas F, Nounou R, et al. Dominance of non-CLL phenotype of monoclonal B-cell lymphocytosis (MBL) in the Middle east and an overall MBL prevalence comparable to Western countries. Blood 2011;118(21):4586–4586.
   Google Scholar
• Anderson LA, Landgren O, Engels EA. Common community acquired infections and subsequent risk of chronic lymphocytic leukaemia. Br J Haematol. 2009;147(4):444–449.
   PubMed Web of Science ®Google Scholar
• Casabonne D, Almeida J, Nieto WG, Primary Health Care Group of Salamanca for the Study of MBL, et al. Common infectious agents and monoclonal B-cell lymphocytosis: a cross-sectional epidemiological study among healthy adults. PLoS One 2012;7(12):e52808.
   PubMed Web of Science ®Google Scholar
• Criado I, Muñoz-Criado S, Rodríguez-Caballero A, Primary Health Care Group of Salamanca for the Study of MBL, et al. Host virus and pneumococcus-specific immune responses in high-count monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia: implications for disease progression. Haematologica 2017;102(7):1238–1246.
   PubMed Web of Science ®Google Scholar
• Rawstron AC, Shanafelt T, Lanasa MC, et al. Different biology and clinical outcome according to the absolute numbers of clonal B-cells in monoclonal B-cell lymphocytosis (MBL). Cytometry 2010;78B(S1):S19–S23.
   Google Scholar
• Vardi A, Agathangelidis A, Sutton L-A, et al. IgG-switched CLL has a distinct immunogenetic signature from the common MD variant: ontogenetic implications. Clin Cancer Res. 2014;20(2):323–330.
   PubMed Web of Science ®Google Scholar
• Agathangelidis A, Galigalidou C, Scarfò L, et al. Infrequent “chronic lymphocytic leukemia-specific” immunoglobulin stereotypes in aged individuals with or without low-count monoclonal B-cell lymphocytosis. Haematologica 2021;106(4):1178–1181.
   PubMed Web of Science ®Google Scholar
• Criado I, Rodríguez-Caballero A, Gutiérrez ML, Primary Health Care Group of Salamanca for the Study of MBL, et al. Low-count monoclonal B-cell lymphocytosis persists after seven years of follow up and is associated with a poorer outcome. Haematologica 2018;103(7):1198–1208.
   PubMed Web of Science ®Google Scholar
• Fazi C, Scarfò L, Pecciarini L, et al. General population low-count CLL-like MBL persists over time without clinical progression, although carrying the same cytogenetic abnormalities of CLL. Blood 2011;118(25):6618–6625.
   PubMed Web of Science ®Google Scholar
• Slager SL, Lanasa MC, Marti GE, et al. Natural history of monoclonal B-cell lymphocytosis among relatives in CLL families. Blood 2021;137(15):2046–2056.
   PubMed Web of Science ®Google Scholar
• Shanafelt TD, Kay NE, Parikh SA, et al. Risk of serious infection among individuals with and without low count monoclonal B-cell lymphocytosis (MBL). Leukemia 2021;35(1):239–244.
   PubMed Web of Science ®Google Scholar
• Vardi A, Dagklis A, Scarfò L, et al. Immunogenetics shows that not all MBL are equal: the larger the clone, the more similar to CLL. Blood 2013;121(22):4521–4528.
   PubMed Web of Science ®Google Scholar
• Kern W, Bacher U, Haferlach C, et al. Monoclonal B-cell lymphocytosis is closely related to chronic lymphocytic leukaemia and may be better classified as early-stage CLL. Br J Haematol. 2012;157(1):86–96.
   PubMed Web of Science ®Google Scholar
• Shanafelt TD, Kay NE, Rabe KG, et al. Brief report: natural history of individuals with clinically recognized monoclonal B-cell lymphocytosis compared with patients with Rai 0 chronic lymphocytic leukemia. J Clin Oncol. 2009;27(24):3959–3963.
   PubMed Web of Science ®Google Scholar
• Shanafelt TD, Kay NE, Rabe KG, et al. Survival of patients with clinically identified monoclonal B-cell lymphocytosis (MBL) relative to the age- and sex-matched general population. Leukemia 2012;26(2):373–376.
   PubMed Web of Science ®Google Scholar
• Nieto WG, Teodosio C, López A, Primary Health Care Group of Salamanca for the Study of MBL, et al. Non-CLL-like monoclonal B-cell lymphocytosis in the general population: prevalence and phenotypic/genetic characteristics. Cytometry 2010;78B(S1):S24–S34.
   Google Scholar
• Galigalidou C, Zaragoza-Infante L, Iatrou A, et al. Understanding monoclonal B cell lymphocytosis: an interplay of genetic and microenvironmental factors. Front Oncol. 2021;11:769612.
   PubMed Web of Science ®Google Scholar
• Rossi D, Sozzi E, Puma A, et al. The prognosis of clinical monoclonal B cell lymphocytosis differs from prognosis of Rai 0 chronic lymphocytic leukaemia and is recapitulated by biological risk factors. Br J Haematol. 2009;146(1):64–75.
   PubMed Web of Science ®Google Scholar
• Molica S, Mauro FR, Giannarelli D, et al. Differentiating chronic lymphocytic leukemia from monoclonal b-lymphocytosis according to clinical outcome: on behalf of the GIMEMA chronic lymphoproliferative diseases working group. Haematologica 2011;96(2):277–283.
   PubMed Web of Science ®Google Scholar
• Shanafelt TD, Kay NE, Jenkins G, et al. B-cell count and survival: differentiating chronic lymphocytic leukemia from monoclonal B-cell lymphocytosis based on clinical outcome. Blood 2009;113(18):4188–4196.
   PubMed Web of Science ®Google Scholar
• Henriques A, Rodríguez-Caballero A, Nieto WG, et al. Combined patterns of IGHV repertoire and cytogenetic/molecular alterations in monoclonal B lymphocytosis versus chronic lymphocytic leukemia. PLoS One 2013;8(7):e67751.
   PubMed Web of Science ®Google Scholar
• Kostopoulos IV, Paterakis G, Pavlidis D, et al. Clonal evolution is a prognostic factor for the clinical progression of monoclonal B-cell lymphocytosis. Blood Cancer J. 2017;7(8):e597.
   PubMedGoogle Scholar
• Morabito F, Mosca L, Cutrona G, et al. Clinical monoclonal B lymphocytosis versus Rai 0 chronic lymphocytic leukemia: a comparison of cellular, cytogenetic, molecular, and clinical features. Clin Cancer Res. 2013;19(21):5890–5900.
   PubMed Web of Science ®Google Scholar
• Parikh SA, Rabe KG, Kay NE, et al. The CLL international prognostic index predicts outcomes in monoclonal B-cell lymphocytosis and Rai 0 CLL. Blood 2021;138(2):149–159.
   PubMed Web of Science ®Google Scholar
• Kleinstern G, O’Brien DR, Li X, et al. Tumor mutational load predicts time to first treatment in chronic lymphocytic leukemia (CLL) and monoclonal B-cell lymphocytosis beyond the CLL international prognostic index. Am J Hematol. 2020;95(8):906–917.
   PubMed Web of Science ®Google Scholar
• Shen Y, Freeman JA, Holland J, et al. COVID-19 vaccine failure in chronic lymphocytic leukaemia and monoclonal B-lymphocytosis; humoural and cellular immunity. Br J Haematol. 2022;197(1):41–51.
   PubMed Web of Science ®Google Scholar
• Sun C. COVID-19 vaccine response in chronic lymphocytic leukaemia is more than just seroconversion. Br J Haematol. 2022;197(1):11–12.
   PubMed Web of Science ®Google Scholar
• Moreira J, Rabe KG, Cerhan JR, et al. Infectious complications among individuals with clinical monoclonal B-cell lymphocytosis (MBL): a cohort study of newly diagnosed cases compared to controls. Leukemia 2013;27(1):136–141.
   PubMed Web of Science ®Google Scholar
• Andersen MA, Rostgaard K, Niemann CU, et al. Antimicrobial use before chronic lymphocytic leukemia: a retrospective cohort study. Leukemia 2021;35(3):747–751.
   PubMed Web of Science ®Google Scholar
• Criado I, Blanco E, Rodríguez-Caballero A, EuroFlow PID Group and The Primary Health Care Group of Salamanca for the Study of MBL, et al. Residual normal B-cell profiles in monoclonal B-cell lymphocytosis versus chronic lymphocytic leukemia. Leukemia 2018;32(12):2701–2705.
   PubMed Web of Science ®Google Scholar
• Tsai HT, Caporaso NE, Kyle RA, et al. Evidence of serum immunoglobulin abnormalities up to 9.8 years before diagnosis of chronic lymphocytic leukemia: a prospective study. Blood 2009;114(24):4928–4932.
   PubMed Web of Science ®Google Scholar
• Glancy EJ, Siles RI. Monoclonal B cell lymphocytosis and hypogammaglobulinaemia. Br J Haematol. 2016;173(2):316–317.
   PubMed Web of Science ®Google Scholar
• Blanco G, Vardi A, Puiggros A, et al. Restricted T cell receptor repertoire in CLL-like monoclonal B cell lymphocytosis and early stage CLL. Oncoimmunology 2018;7(6):e1432328.
   PubMed Web of Science ®Google Scholar
• D’Arena G, Rossi G, Minervini MM, et al. Circulating regulatory T cells in clinical monoclonal B-cell lymphocytosis. Int J Immunopathol Pharmacol. 2011;24(4):915–923.
   PubMed Web of Science ®Google Scholar
• Parikh SA, Ramsay AG, Boysen J, et al. Longitudinal evaluation of T-cells in clinical monoclonal B-cell lymphocytosis (MBL). Haematologica 2016;101(S1):223.
   Google Scholar
• Whitaker JA, Shanafelt TD, Poland GA, et al. Room for improvement: immunizations for patients with monoclonal B-cell lymphocytosis or chronic lymphocytic leukemia. Clin Adv Hematol Oncol. 2014;12(7):440–450.
   PubMedGoogle Scholar
• Whitaker JA, Parikh SA, Shanafelt TD, et al. The humoral immune response to high-dose influenza vaccine in persons with monoclonal B-cell lymphocytosis (MBL) and chronic lymphocytic leukemia (CLL). Vaccine 2021;39(7):1122–1130.
   PubMed Web of Science ®Google Scholar
• Muchtar E, Koehler AB, Johnson MJ, et al. Humoral and cellular immune responses to recombinant herpes zoster vaccine in patients with chronic lymphocytic leukemia and monoclonal B cell lymphocytosis. Am J Hematol. 2021, 97:90–98.
   Web of Science ®Google Scholar
• Herishanu Y, Avivi I, Aharon A, et al. Efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia. Blood 2021;137(23):3165–3173.
   PubMed Web of Science ®Google Scholar
• Roeker LE, Knorr DA, Thompson MC, et al. COVID-19 vaccine efficacy in patients with chronic lymphocytic leukemia. Leukemia 2021;35(9):2703–2705.
   PubMed Web of Science ®Google Scholar
• Tsimberidou AM, Wen S, McLaughlin P, et al. Other malignancies in chronic lymphocytic leukemia/small lymphocytic lymphoma. J Clin Oncol. 2009;27(6):904–910.
   PubMed Web of Science ®Google Scholar
• da Cunha-Bang C, Rostgaard K, Andersen MA, et al. Risk of new malignancies among patients with CLL treated with chemotherapy: results of a Danish population-based study. Br J Haematol. 2021;193(2):339–345.
   PubMed Web of Science ®Google Scholar
• Ishdorj G, Beiggi S, Nugent Z, et al. Risk factors for skin cancer and solid tumors in newly diagnosed patients with chronic lymphocytic leukemia and the impact of skin surveillance on survival. Leuk Lymphoma. 2019;60(13):3204–3213.
   PubMed Web of Science ®Google Scholar
• Solomon BM, Chaffee KG, Moreira J, et al. Risk of non-hematologic cancer in individuals with high-count monoclonal B-cell lymphocytosis. Leukemia 2016;30(2):331–336.
   PubMed Web of Science ®Google Scholar
• Shen Y, Coyle L, Kerridge I, et al. Second primary malignancies in chronic lymphocytic leukaemia: skin, solid organ, haematological and Richter’s syndrome. eJHaem. 2022;3(1):129–138.
   PubMedGoogle Scholar
• Akhtar OS, Groman A, Singh A, et al. Frequency and timing of other primary cancers in patients with chronic lymphocytic leukemia (CLL): a 17-year longitudinal study. Leuk Lymphoma. 2022;63(5):1127–1110.
   PubMed Web of Science ®Google Scholar
• Kate H, Gerardo F, Emili M, et al. Chronic lymphocytic leukemia and autoimmunity: a systematic review. Haematologica 2011;96(5):752–761.
   PubMed Web of Science ®Google Scholar
• Ghia P, Scielzo C, Frenquelli M, et al. From normal to clonal B cells: chronic lymphocytic leukemia (CLL) at the crossroad between neoplasia and autoimmunity. Autoimmun Rev. 2007;7(2):127–131.
   PubMed Web of Science ®Google Scholar
• Cines DB, Bussel JB, Liebman HA, et al. The ITP syndrome: pathogenic and clinical diversity. Blood 2009;113(26):6511–6521.
   PubMed Web of Science ®Google Scholar
• Mittal S, Blaylock MG, Culligan DJ, et al. A high rate of CLL phenotype lymphocytes in autoimmune hemolytic anemia and immune thrombocytopenic purpura. Haematologica 2008;93(1):151–152.
   PubMed Web of Science ®Google Scholar
• Hjalgrim H, Rostgaard K, Vasan SK, et al. No evidence of transmission of chronic lymphocytic leukemia through blood transfusion. Blood 2015;126(17):2059–2061.
   PubMed Web of Science ®Google Scholar
• Perz JB, Ritgen M, Moos M, et al. Occurrence of donor-derived CLL 8 years after sibling donor SCT for CML. Bone Marrow Transplant. 2008;42(10):687–688.
   PubMed Web of Science ®Google Scholar
• Hardy NM, Grady C, Pentz R, et al. Bioethical considerations of monoclonal B-cell lymphocytosis: donor transfer after haematopoietic stem cell transplantation. Br J Haematol. 2007;139(5):824–831.
   PubMed Web of Science ®Google Scholar
• Ferrand C, Garnache-Ottou F, Collonge-Rame MA, et al. Systematic donor blood qualification by flow cytometry would have been able to avoid CLL-type MBL transmission after unrelated hematopoietic stem cell transplantation. Eur J Haematol. 2012;88(3):269–272.
   PubMed Web of Science ®Google Scholar
• Kharfan-Dabaja MA, Kumar A, Hamadani M, et al. Clinical practice recommendations for use of allogeneic hematopoietic cell transplantation in chronic lymphocytic leukemia on behalf of the guidelines committee of the American society for blood and marrow transplantation. Biol Blood Marrow Transplant. 2016;22(12):2117–2125.
   PubMed Web of Science ®Google Scholar
• Hamad N, Kliman D, Best OG, et al. Chronic lymphocytic leukaemia, monoclonal B-lymphocytosis and pregnancy: five cases, a literature review and discussion of management. Br J Haematol. 2015;168(3):350–360.
   PubMed Web of Science ®Google Scholar
• Kühnert M, Strohmeier R, Stegmüller M, et al. Changes in lymphocyte subsets during normal pregnancy. Eur J Obstet Gynecol Reprod Biol. 1998;76(2):147–151.
   PubMed Web of Science ®Google Scholar
• Luppi P, Haluszczak C, Trucco M, et al. Normal pregnancy is associated with peripheral leukocyte activation. Am J Reprod Immunol. 2002;47(2):72–81.
   PubMed Web of Science ®Google Scholar
• Molica S, Mauro FR, Molica M, et al. Monoclonal B-cell lymphocytosis: a reappraisal of its clinical implications. Leuk Lymphoma. 2012;53(9):1660–1665.
   PubMed Web of Science ®Google Scholar
• Mowery YM, Lanasa MC. Clinical aspects of monoclonal B-cell lymphocytosis. Cancer Control. 2012;19(1):8–17.
   PubMed Web of Science ®Google Scholar
• Johnstone P, Hibbs S, Butler T, et al. When should haematologists see patients with asymptomatic lymphocytosis? Br J Haematol. 2020;189:73.
   Web of Science ®Google Scholar