CD23 expression in mantle cell lymphoma is associated with CD200 expression, leukemic non-nodal form, and a better prognosis

• Published in: Human pathology 2019-07, Vol.89, p.71-80
• Main Authors: Saksena, Annapurna, Yin, C. Cameron, Xu, Jie, Li, Jingyi, Zhou, Jiehao, Wang, Sa A., Lin, Pei, Tang, Guilin, Wang, Lifu, Wang, Michael, Miranda, Roberto N., Medeiros, L. Jeffrey, Li, Shaoying
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; Antigens, CD - biosynthesis; Biomarkers, Tumor - analysis; CD200; CD23; Cell cycle; Cloning; Female; Flow cytometry; Humans; Immunoglobulins; Immunophenotyping; Leukemia; Leukemic non-nodal mantle cell lymphoma; Lymphoma; Lymphoma, Mantle-Cell - metabolism; Lymphoma, Mantle-Cell - mortality; Lymphoma, Mantle-Cell - pathology; Male; Mantle cell lymphoma; Medical prognosis; Middle Aged; Prognosis; Progression-Free Survival; Receptors, IgE - biosynthesis; Retrospective Studies; SOX11; Studies
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2019.04.010

Mantle cell lymphoma (MCL) is usually CD23 negative, a feature helpful in distinguishing MCL from chronic lymphocytic leukemia/small lymphocytic lymphoma. However, a subset of MCL cases can be CD23+. Limited data are available regarding the clinicopathological features and prognosis of patients with CD23+ MCL. In this study, we reviewed 798 cases of MCL and identified 103 (13%) that were CD23+ by flow cytometry, all of which were positive for cyclin D1 and/or associated with CCND1/IGH. In all cases of CD23+ MCL, CD23 expression was dim partial or dim, unlike moderate to bright CD23 expression observed in chronic lymphocytic leukemia/small lymphocytic lymphoma. The clinicopathological features and outcome of patients with CD23+ MCL were compared with 240 patients with typical MCL negative for CD23. Patients with CD23+ MCL more often had an elevated leukocyte count (33% versus 18%, P = .009), bone marrow involvement (89% versus 78%, P = .02), stage 4 disease (87% versus 77%, P = .03), and a leukemic presentation (42% versus 11%, P = .0001). CD23+ MCL was also more often positive for CD200 (17% versus. 4.6%, P = .0005) and less commonly positive for SOX11 (55% versus. 74%, P = .027). All other clinicopathological features were similar. With similar treatment regimens and observation times, patients with CD23+ MCL had a significant better overall survival (P = .02) and progression-free survival (P = .029). In conclusion, CD23 expression was observed in 13% of MCL cases and is associated with a better prognosis in patients with MCL. CD23 is associated with leukocytosis, a leukemic presentation, bone marrow involvement, CD200 expression, and a lower frequency of SOX11 positivity. •CD23 expression in MCL is dim/partial, in contrast to moderate/strong in CLL/SLL.•CD23 expression is associated with better prognosis in patients with MCL.•CD23 expression in MCL correlates with a higher frequency of CD200 expression, a lower frequency of SOX11 expression, and a higher frequency of leukemic nonnodal presentation.•A small subset of CD23+ MCL has features similar to CLL (CD200+, SOX11−, leukemic).