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Blood, 1 March 2008, Vol. 111, No. 5, pp. 2790-2796.
Prepublished online as a Blood First Edition Paper on December 26, 2007; DOI 10.1182/blood-2007-10-110460.


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NEOPLASIA

Increased proteasomal degradation of Bax is a common feature of poor prognosis chronic lymphocytic leukemia

Samir G. Agrawal1,3, Feng-Ting Liu1, Catherine Wiseman2, Sima Shirali4, Hongxiang Liu4, Debra Lillington5, Ming-Qing Du4, Denise Syndercombe-Court1, Adrian C. Newland1,2, John G. Gribben3,6, and Li Jia1

1 Centre for Haematology, Institute of Cell and Molecular Science; Departments of2 Haematology and 3 Haemato-Oncology, Queen Mary University of London and Barts and the London National Health Service (NHS) Trust, London; 4 Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; 5 Department of Cytogenetics and 6 Institute of Cancer, Cancer Research United Kingdom (CRUK), Queen Mary University of London and Barts and the London NHS Trust, London, United Kingdom

Many biologic markers are associated with poor prognosis in chronic lymphocytic leukemia (CLL), but their mechanistic role remains unclear. Bax is an essential proapoptotic protein and decreased levels in malignant cells lead to resistance to apoptosis. Using a Bax degradation activity (BDA) assay, CLL cells were found to show variable Bax instability. However, BDA did not correlate with Bax protein levels: BDA positive and negative cases had high and low baseline Bax levels. BDA positive cases showed a marked accumulation of poor prognostic markers—unmutated immunoglobulin heavy chain variable genes, ZAP-70/CD38 positivity, 11q22/17p13 deletion, and short lymphocyte doubling time. Patients with BDA positive cells had a shorter median overall survival (OS; 126 months vs not reached, P = .011) and time to first treatment (16 vs 156 months, P = .029) than BDA negative cases. Dual BDA and ZAP-70 positivity had a median OS of 84 months (P = .012). The BDA assay measures the intrinsic ubiquitin/proteasome activity of CLL cells and dynamic changes in Bax protein levels over time. Mechanistically, Bax instability may represent a final common pathway for disparate prognostic markers, as well as being itself an indicator of poor prognosis.


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