Overall survival (OS) based on the percentage of smudge cells on blood smear. (A) Kaplan-Meier estimates of OS based on the percentage of smudge cells in the entire cohort. The 10-year survival rate was 50% v 80% for patients with smudge cell percentage ≤ 30% v more than 30%, respectively (P = .015). (B) Kaplan-Meier estimates of OS based on the percentage of smudge cells in patients with Rai stage 0 and I disease only. The 10-year survival rate was 61% v 84% for patients with smudge cell percentage ≤ 30% v more than 30%, respectively (P = .033). (C) Kaplan-Meier estimates of OS based on smudge cell percentage and CD38 expression. The 10-year survival of patients with CD38+ disease and less than 30% smudge cells was only 13% compared with 58%, 72%, and 85% for patients with CD38+ disease and ≥ 30% smudge cells, CD38– disease and less than 30% smudge cells, and CD38– disease and ≥ 30% smudge cells, respectively (P < .001).