TO THE EDITOR:

Chronic lymphocytic leukemia (CLL) is characterized by a clonal expansion of mature CD19+CD5+ B cells, which are highly dependent on microenvironmental cues for their survival.1 This common adult leukemia is preceded by a precursor phase termed monoclonal B-cell lymphocytosis (MBL),2,3 which has been characterized as indistinguishable from CLL at the genetic, transcriptomic, and epigenomic level.4-6 However, how leukemia cells coevolve with immune cells in their circulating microenvironment during the onset of MBL and upon progression to CLL remains incompletely characterized.7 

Recently, single-cell transcriptome sequencing (scRNA-seq) approaches have transformed our ability to gain a comprehensive evaluation of the spectrum of immune cells within the tumor microenvironment and of their potential cross talk with cancer cells.8-14 In our study, we applied scRNA-seq to broadly characterize circulating immune cells coexisting with leukemic...

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