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Blood, 15 May 2008, Vol. 111, No. 10, pp. 5101-5108.
Prepublished online as a Blood First Edition Paper on March 7, 2008; DOI 10.1182/blood-2007-12-130229.


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NEOPLASIA

Use of IGHV3–21 in chronic lymphocytic leukemia is associated with high-risk disease and reflects antigen-driven, post–germinal center leukemogenic selection

Emanuela M. Ghia1,2, Sonia Jain1,3, George F. Widhopf, II1,2, Laura Z. Rassenti1,2, Michael J. Keating1,4, William G. Wierda1,4, John G. Gribben1,5, Jennifer R. Brown1,6, Kanti R. Rai1,7, John C. Byrd1,8, Neil E. Kay1,9, Andrew W. Greaves1,2, and Thomas J. Kipps1,2

1 Chronic Lymphocytic Leukemia Research Consortium, La Jolla, CA; 2 Moores Cancer Center, Division of Hematology/Oncology and 3 Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla; 4 Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston; 5 Barts and the London School of Medicine, London, United Kingdom; 6 Dana-Farber Cancer Institute, Boston, MA; 7 Long Island Jewish Medical Center, New Hyde Park, NY; 8 The Ohio State University, Columbus; and 9 Mayo Clinic, Rochester, MN

We examined the chronic lymphocytic leukemia (CLL) cells of 2457 patients evaluated by the CLL Research Consortium (CRC) and found that 63 (2.6%) expressed immunoglobulin (Ig) encoded by the Ig heavy-chain-variable-region gene (IGHV), IGHV3-21. We identified the amino acid sequence DANGMDV (motif-1) or DPSFYSSSWTLFDY (motif-2) in the Ig heavy-chain (IgH) third complementarity-determining region (HCDR3) of IgH, respectively, used by 25 or 3 cases. The IgH with HCDR3 motif-1 or motif-2, respectively, was paired with Ig light chains (IgL) encoded by IGLV3-21 or IGKV3-20, suggesting that these Ig had been selected for binding to conventional antigen(s). Cases that had HCDR3 motif-1 had a median time from diagnosis to initial therapy comparable with that of cases without a defined HCDR3 motif, as did cases that used mutated IGHV3-21 (n = 27) versus unmutated IGHV3-21 (n = 30). Of 7 examined cases that used Ig encoded by IGHV3-21/IGLV3-21, we found that 5 had a functionally rearranged IGKV allele that apparently had incurred antigendriven somatic mutations and subsequent rearrangement with KDE. This study reveals that CLL cells expressing IGHV3-21/IGLV3-21 most likely were derived from B cells that had experienced somatic mutation and germinal-center maturation in an apparent antigen-driven immune response before undergoing Ig-receptor editing and after germinal-center leukemogenic selection.


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