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Prepublished online as a Blood First Edition Paper on April 3, 2003; DOI 10.1182/blood-2002-12-3639.
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Blood, 1 August 2003, Vol. 102, No. 3, pp. 1035-1041
NEOPLASIA
Chronic lymphocytic leukemia patients with highly stable and indolent disease show distinctive phenotypic and genotypic features
Anna Guarini,
Gianluca Gaidano,
Francesca Romana Mauro,
Daniela Capello,
Francesca Mancini,
Maria Stefania De Propris,
Marco Mancini,
Enrica Orsini,
Massimo Gentile,
Massimo Breccia,
Antonio Cuneo,
Gianluigi Castoldi, and
Robert Foa
From the Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Roma, Italy; Unità Didattico Assistentiale (UDA) Ematologia, Dipartimento di Scienze Mediche & Interdisciplinary Research Center on Autoimmune Diseases (IRCAD), Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy; and Dipartimento di Scienze Biomediche e Terapie Avanzate, Università degli Studi, Ferrara, Italy
Different biologic features have been associated with a more or less aggressive clinical course in chronic lymphocytic leukemia (CLL). In the present study, 20 patients with highly stable CLL observed at a single institution over a period of 10 to 23 years and who never required treatment were extensively characterized. The aim was to identify a distinct and reproducible biologic profile associated with disease stability that may be used to recognize at presentation CLL patients who are likely to have a very benign clinical course and for whom treatment is not indicated. The results obtained indicate that numerous parameters are closely associated with disease stability: a typical CLL morphology and immunophenotype, the lack of expression of the CD38 antigen, the mutated immunoglobulin (Ig) heavy (H) chain variable (V) pattern, the absence of p53 mutations, a CD4/CD8 ratio more than 1, the lack of 17p and 11q deletions and of complex karyotypic aberrations, and the occurrence of the 13q14 deletion. No case displayed the VH3-21 gene, linked in mutated CLL with a poor outcome. In addition, the VH1-69 gene associated with unmutated CLL cases was never detected. These biologic features were coupled with an indolent clinical course characterized by an unmodified clinical stage over time, and by lack of autoimmune phenomena and of major infections requiring parental antibiotics. At a time when aggressive therapeutic strategies are always more frequently used in the management of CLL, the distinctive features of patients with long-lived stable disease should be prospectively identified at presentation.

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