Intensity of antigen expression reflects IGHV mutational status and Dohner-defined prognostic categories in chronic lymphocytic leukemia, monoclonal B-cell lymphocytosis, and small lymphocytic lymphoma.

We demonstrate the prognostic utility of antigen quantitation in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and monoclonal B-cell lymphocytosis (MBL). Median antibody-bound-per-cell (ABC) of CD20, CD22, CD25, CD19, and %CD38(+) was determined in CLL (185/208), SLL (8/208) and MBL (15/208) cases by flow cytometry, then compared to Dohner-classification, immunoglobulin status (mutated, IGHV-M; unmutated, IGHV-U), CLL-IPI risk and time to first treatment (TTFT). Trisomy 12 cases showed increased %CD38-expression (p = .0379). Higher %CD38 was observed in IGHV-U versus IGHV-M (p = .0003). CD20ABC was increased in IGHV-U versus IGHV-M (p = .006). Del13q cases demonstrated lower CD22ABC (p = .0198). Cases without cytogenetic abnormality exhibited higher CD19ABC (p = .0295) and CD22ABC (p = .0078). Del17p cases demonstrated lower CD25ABC (p = .0097). High and very-high CLL-IPI risk groups were associated with high CD38-expression (p = .02) and low CD25ABC (p = .0004). Shortened TTFT was associated with high CD38-expression (p < .0001). Interestingly, high CD25ABC trended toward shortened TTFT (p = .07). Quantitative antigen expression reflects CLL-IPI risk groups and Dohner-classification.

Quality of care and outcomes in patients with diabetes hospitalized with ischemic stroke: findings from Get With the Guidelines-Stroke.

BACKGROUND AND PURPOSE: Diabetes is a common comorbid disease in stroke patients and has a strong influence on stroke-related outcomes, including stroke recurrence. We sought to examine the quality of care and in-hospital outcomes in patients with diabetes in the Get With the Guidelines-Stroke (GWTG-Stroke) program. METHODS: Data were obtained from 415 926 ischemic stroke patients from 1070 United States hospitals that participated in GWTG-Stroke between 2003 and 2008. We analyzed the relationships between diabetes and quality of care, in-hospital mortality, and discharge home using multivariable logistic regression. RESULTS: There were 130 817 (31%) ischemic stroke patients with diabetes. Quality of care received by patients with and without diabetes was similar except for intravenous recombinant tissue plasminogen activator (rt-PA) and cholesterol treatment. Fifty-four percent of patients with diabetes who arrived within 2 hours of onset received rt-PA compared to 60.8% of patients without diabetes (adjusted odds ratio [aOR], 0.83; 95% CI, 0.79-0.88). Almost 80% of patients with diabetes were discharged on cholesterol treatment compared to 71% of patients without diabetes (aOR, 1.40; 95% CI, 1.37-1.44). Diabetes patients were less likely to be discharged home (aOR, 0.80; 95% CI, 0.78-0.81) and had a higher risk of in-hospital death (aOR, 1.12; 95% CI, 1.08-1.15). CONCLUSIONS: Quality of care among patients with and without diabetes was similar except for rt-PA and cholesterol treatment. Diabetes was associated with worse stroke-related outcomes. Greater quality-improvement efforts to increase the use of rt-PA and other secondary prevention treatments in patients with diabetes are warranted.