Blood Res 2018; 53(3): 218-222  https://doi.org/10.5045/br.2018.53.3.218
Smudge cell percentage as a surrogate marker for ZAP-70 expression in patients with chronic lymphocytic leukemia
Waiel Al-Kahiry1, Hadeel Said Tawfik2, Homam Sharshira3, Amal Ghanem3, Maha El-Gammal3, Irene Lewis Mikhael3
1Department of Hematology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen, 2Department of Medical Laboratory Technology, Pharos University in Alexandria, 3Department of Hematology, Medical Research Institute, University of Alexandria, Alexandria, Egypt
Correspondence to: Waiel Al-Kahiry, M.D. Department of Hematology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Khor Makser, Yemen E-mail: kahiry13@gmail.com
Received: January 15, 2018; Revised: March 8, 2018; Accepted: May 10, 2018; Published online: September 30, 2018.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
This study aimed to evaluate the prognostic value of smudge cell percentage as a surrogate marker for zeta-chain-associated protein kinase 70 (ZAP-70) expression in chronic lymphocytic leukemia (CLL) patients.
Methods
Sixty three newly diagnosed CLL patients were investigated at the Hematology Department of the Medical Research Institute of Alexandria University with complete blood count, lactate dehydrogenase, β2 microglobulin levels, ZAP-70 expression, and estimation of the percentage of smudge cells.
Results
The percentage of smudge cells ranged from 2 to 58% with a mean of 24.03±13.98%. Higher percentages of smudge cells (>30%) were statistically significantly associated with markers of better prognosis (negative ZAP-70, early-stage disease according to the Binet and Rai staging systems, as well as low and intermediate risk CLL prognostic index). The percentage of smudge cells showed significantly negative correlation with the ZAP-70 expression and higher area under the curve for prediction of ZAP-70 positivity with better survival for 36 months in patients with >30% smudge cells.
Conclusion
The percentage of smudge cells at presentation of newly diagnosed CLL patients could be used as a surrogate marker for ZAP-70 expression and an additional prognostic marker for disease progression.
Keywords: Smudge cells, CLL, ZAP-70, Surrogate, Prognostic, Survival


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