Aim: Multiple B-cell clones in peripheral blood at diagnostic flow cytometry.
Method: Patients with two/more clones were recorded manually.
Results: Total 30 B-LPD cases with 2 or more B-cell clones from 2000-2014. M:F of 1.9:1. The median age,68.8 years. FBC parameters showed Hb 81-158 g/dl, WCC 1.4-51.2, lymphocyte count 0.5-39.6, and platelet count 36-476. Immunoglobulin levels measured in 15 patients -IgG 3.3-14.01, IgA 0.58-29.83, IgM 0.07-39.92.
Of 30 patients with dual clones, 26 had CLL-type (CLL, MBL or SLL) clone as one of two clones. Next was CD5-negative, B-cell lymphoma (20 patients), 2 with morphology consistent with splenic lymphoma ,1 CD10-positive consistent with follicular lymphoma. There were 4 Hairy Cell Leukaemia (HCL), 3 Mantle Cell Leukaemia (MCL), and 1 myeloma.
Commonest combinations were CLL with NHL(19), while dual CLL clones seen in 4 patients, all had both a kappa and a lambda clone. One had 3 clones with NHL-k, NHL-l, CLL clone. 4/30 patients with an HCL clone appears higher than expected from the incidence of HCL, paired with CLL(2), MCL(1) ,Myeloma(1).
Conclusion: 2 or more clones are not a rare event in the flowcytometry laboratory. Most common combination is CLL and NHL clone. HCL clones seen in combination possibly more common than might be expected.