Survey studies consistently show that 7–30% of older subjects with normal serum Cbl values have elevated levels of the Cbl-dependent metabolites, MMA and HCys, even when renal function is normal. Although this finding may reflect insensitivity of the measurement of total serum Cbl to early Cbl depletion, the possibility of Cbl “resistance” with “functional” Cbl deficiency should also be considered. I recently reported that Cbl, MMA and HCys levels are not predictive of clinical responses to Cbl therapy (
Blood
2005
;105
, 2005
Corresponding author
2005, The American Society of Hematology
2005
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