A 72-year-old man presents with fatigue. CBC shows WBC 85,000/µL with 78% small mature-appearing lymphocytes, Hb 10.2 g/dL, platelets 98,000/µL. Peripheral smear shows smudge cells. Flow cytometry: CD5+, CD19+, CD20 (dim)+, CD23+, FMC7−, CD79b (dim)+, surface Ig (dim)+. What is the CLL/SLL score for this patient, and what prognosis does the score imply?
- A Score 3: borderline, cannot diagnose CLL without FISH studies
- B Score 1–2: unlikely CLL, suggests mantle cell lymphoma
- C Score 4–5: consistent with CLL, good prognosis with typical response to therapy ✓
- D Score 6: diagnostic of prolymphocytic leukemia
Correct answer: C. Score 4–5: consistent with CLL, good prognosis with typical response to therapy
Explanation
The Matutes CLL scoring system assigns 1 point each for: CD5+, CD23+, weak surface Ig, weak/negative CD79b, and weak/negative FMC7. This patient scores 5/5 (CD5+, CD23+, FMC7−, CD79b dim, surface Ig dim), which is highly characteristic of CLL (score 4–5 = CLL). A score of 3 is borderline (consider MCL or other disorders), and score 1–2 favours other B-cell lymphoproliferative disorders. This patient's score of 5 is consistent with typical CLL, though FISH for del(17p), del(11q), trisomy 12, and IGHV mutational status determine prognosis more precisely.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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