CLL Support Association
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Prolymphocytes - Common or not?

At my appointment with the haematologist last week, my blood test results showed a reading for prollymp for the first time.

I was wondering if this is common?

I understand we are looking at trends. The lymphocytes continue to increase slowly and in small increments and everything else is ok, so I'm not too concerned there just the presence of these cells has my antenna working overtime.

Any similar experiences or info would be appreciated.

Cheers,

Lorraine

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Hi Lorraine,

I've heard of them and on investigation turned up this excellent answer from Dr Susan Leclair, who does a fantastic volunteer job of informing CLL patients that wish to understand more of how our blood can be impacted by CLL and what it means for us. This was Dr Leclair's answer back in September to a similar question:

"Re: Prolymphocytes

From: Susan LECLAIR Date: Mon, 28 Sep 2015 15:16:36 PDT

Lymphocytes grow up by altering the sequence of their DNA. For example genes might be strung as 1*---2#---3@--- when they are inactive but rearranged to look like 1*---2°---3^---. There are few to no visible changes. (spoil sports)

So we use lymphoblast to describe the earliest, most immature cell. This is followed by probably a several step sequence that is all lumped under the title "prolymphocyte" because "pro" means before and "cyte" refers to a cell that has some functionality. (not blast)

Finally comes lymphocyte. These can be further subdivided into resting or reactive or abnormal.

So - prolymphocytes are typically larger than lymphocytes.

They are typically a deeper blue (more active RNA)

They are typically less able to function correctly.

Can they grow up to be normal? yes

In the case of CLL cells, can they grow up to the CLL cells? yes

A leukemia with a lot of prolymphocytes usually has greater than 50% prolymphocytes. Anemia is present and can be profound. Thrombocytopenia is present and is also quite severe.

PCLL will often have t(11;14)(q13;q32) and/or cyclin D1 mutations as well as CD5 positivity and surface immunoglobulin positivity.

<snipped irrelevant content>

Do CLLers get prolymphocytes? Yes and as long as they are few in number, there is concern but no outright worry. (my emphasis - Neil) A lot of times stress in the marrow/lymph nodes will allow intermediate forms to be released into the peripheral blood stream and it would appear that you are one of the minority of CLLers to which this is happening.

Susan Leclair"

So in summary, these are baby lymphocytes that could be baby CLL cells. This might be a one-off for this blood test, but keep an eye on it and ask your specialist if this is anything to be concerned about if prolymphocytes continue to be reported in subsequent blood tests.

I can highly recommend any education video provided by Dr Leclair. You can find them on the PatientPower site or via a search on this site:

healthunlocked.com/search/s...

Neil

PS I've changed your title so others puzzled like you were can find your question and answers :)

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Fair play Neil, you are a mine of information. Peggy :-)

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ThanksNeil haven't found Susan's response but I will keep looking.

The specialist gave me a vague response at the consultation When I asked him about them!

Lorraine

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Hi Lorraine,

Sorry if I confused you, but I quoted Susan's response to another patient with a similar question to yours in italics above. The videos of Susan's further explanations about blood make-up are extras because she is so good at explaining what can be a complex problem in layman's terms. I've edited my reply above so my reference to the video extras comes last.

Neil (who didn't get much sleep last night and it shows)

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Hi Rex12, sometimes in my blood tests prolymphocytes can be seen that due to the low value (1% _2%) hematologist tells me it is normal, so do not worry as Neil explained .... 😀

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Do these show up in a regular CBC panel, or a more specialized test?

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Hi SeymourB,

I'm in Australia so the request may be different in other countries.

The pathology request says,

FBC

eLFT

This is the usual test.

I get a copy of the test results - cumulative full blood examination at the top of the page.

Other comments are:

Red cells normochromic and normocytic. Platelets appear normal.

An occasional Prolymphocyte is noted on the blood film.

The prolymph reading is 0.21 x and is under the Basos which is 0 as are the Monos.

Must only be reported if they are seen.

Comments in the past have mentioned smudge cells.

Just another aspect to this cancer I think!

Cheers

Lorraine

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Smudge cells are commonly reported in CLL patient blood test results. These are just fragile CLL cells, which are less robust than normal B-lymphocytes. I'm now wondering whether they smudge because they are worn out after being so active in the lymph node. According to the latest research as reported by Dr Sharman, CLL cells recharge in the blood stream before returning to a node.

healthunlocked.com/cllsuppo...

Neil

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