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Blood, 15 August 2002, Vol. 100, No. 4, pp. 1410-1416

NEOPLASIA

VH mutation status, CD38 expression level, genomic aberrations, and survival in chronic lymphocytic leukemia

Alexander Kröber, Till Seiler, Axel Benner, Lars Bullinger, Elsbeth Brückle, Peter Lichter, Hartmut Döhner, and Stephan Stilgenbauer

From Abteilung Innere Medizin III, University of Ulm, Germany; Zentrale Einheit Biostatistik and Abteilung Organisation komplexer Genome, Deutsches Krebsforschungszentrum, Heidelberg, Germany.

In chronic lymphocytic leukemia (CLL), biologic risk factors such as immunoglobulin variable heavy chain gene (VH) mutation status, CD38 expression level, and genomic aberrations have recently been identified, but the relative prognostic impact of the individual parameters is unknown. In the current study, we analyzed VH mutation status by polymerase chain reaction and sequencing (n = 300), genomic aberrations by fluorescence in situ hybridization (+3q, 6q-, +8q, 11q-, +12q, 13q-, t(14q), 17p-) (n = 300), and CD38 expression by triple-color FACS (CD5, CD19, CD38) (n = 157) in a unicentric CLL cohort. The prognostic influence of VH mutation rate and CD38 expression level was tested by maximally selected log-rank statistics. A corrected P value (Pcor) for a cutoff level allowing the best separation of 2 subgroups with different survival probabilities was identified at 97% VH homology (95% confidence interval [CI], 96%-98% homology, Pcor <.001) and at 7% CD38 expression (95% CI, 20%-71% expression, Pcor = .02). In univariate analyses, unmutated VH genes and high CD38 expression levels predicted for shorter survival times. The overall incidence of genomic aberrations was similar in the VH unmutated and VH mutated subgroups. High-risk genomic aberrations such as 17p- and 11q- occurred almost exclusively in the VH unmutated subgroup, whereas favorable aberrations such as 13q- and 13q- as single abnormalities were overrepresented in the VH mutated subgroup. In multivariate analysis, unmutated VH, 17p deletion, 11q deletion, age, WBC, and LDH were identified as independent prognostic factors, indicating a complementary role of VH mutation status and genomic aberrations to predict outcome in CLL.

© 2002 by The American Society of Hematology.
 

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BloodHome page
C. Mayr, M. R. Speicher, D. M. Kofler, R. Buhmann, J. Strehl, R. Busch, M. Hallek, and C.-M. Wendtner
Chromosomal translocations are associated with poor prognosis in chronic lymphocytic leukemia
Blood, January 15, 2006; 107(2): 742 - 751.
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ASH Education BookHome page
N. Chiorazzi and M. Ferrarini
Evolving View of the In-Vivo Kinetics of Chronic Lymphocytic Leukemia B Cells
Hematology, January 1, 2006; 2006(1): 273 - 278.
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ASH Education BookHome page
E. Montserrat
New Prognostic Markers in CLL
Hematology, January 1, 2006; 2006(1): 279 - 284.
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The OncologistHome page
B. L. Abbott
Chronic Lymphocytic Leukemia: Recent Advances in Diagnosis and Treatment
Oncologist, January 1, 2006; 11(1): 21 - 30.
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J. Mol. Diagn.Home page
R. Marasca, R. Maffei, M. Morselli, P. Zucchini, I. Castelli, S. Martinelli, M. Fontana, S. Ravanetti, M. Curotti, G. Leonardi, et al.
Immunoglobulin Mutational Status Detected through Single-Round Amplification of Partial VH Region Represents a Good Prognostic Marker for Clinical Outcome in Chronic Lymphocytic Leukemia
J. Mol. Diagn., November 1, 2005; 7(5): 566 - 574.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
D. Caballero, J. A. Garcia-Marco, R. Martino, V. Mateos, J. M. Ribera, J. Sarra, A. Leon, G. Sanz, J. de la Serna, R. Cabrera, et al.
Allogeneic Transplant with Reduced Intensity Conditioning Regimens may Overcome the Poor Prognosis of B-Cell Chronic Lymphocytic Leukemia with Unmutated Immunoglobulin Variable Heavy-Chain Gene and Chromosomal Abnormalities (11q- and 17p-)
Clin. Cancer Res., November 1, 2005; 11(21): 7757 - 7763.
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Cancer Res.Home page
D. J. Allsup, A. S. Kamiguti, K. Lin, P. D. Sherrington, Z. Matrai, J. R. Slupsky, J. C. Cawley, and M. Zuzel
B-Cell Receptor Translocation to Lipid Rafts and Associated Signaling Differ between Prognostically Important Subgroups of Chronic Lymphocytic Leukemia
Cancer Res., August 15, 2005; 65(16): 7328 - 7337.
[Abstract] [Full Text] [PDF]


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BloodHome page
P. Oppezzo, Y. Vasconcelos, C. Settegrana, D. Jeannel, F. Vuillier, M. Legarff-Tavernier, E. Y. Kimura, S. Bechet, G. Dumas, M. Brissard, et al.
The LPL/ADAM29 expression ratio is a novel prognosis indicator in chronic lymphocytic leukemia
Blood, July 15, 2005; 106(2): 650 - 657.
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BloodHome page
S. Falt, M. Merup, G. Tobin, U. Thunberg, G. Gahrton, R. Rosenquist, and A. Wennborg
Distinctive gene expression pattern in VH3-21 utilizing B-cell chronic lymphocytic leukemia
Blood, July 15, 2005; 106(2): 681 - 689.
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BloodHome page
P. Grabowski, M. Hultdin, K. Karlsson, G. Tobin, A. Aleskog, U. Thunberg, A. Laurell, C. Sundstrom, R. Rosenquist, and G. Roos
Telomere length as a prognostic parameter in chronic lymphocytic leukemia with special reference to VH gene mutation status
Blood, June 15, 2005; 105(12): 4807 - 4812.
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JCOHome page
D. L. Kienle, C. Korz, B. Hosch, A. Benner, D. Mertens, A. Habermann, A. Krober, U. Jager, P. Lichter, H. Dohner, et al.
Evidence for Distinct Pathomechanisms in Genetic Subgroups of Chronic Lymphocytic Leukemia Revealed by Quantitative Expression Analysis of Cell Cycle, Activation, and Apoptosis-Associated Genes
J. Clin. Oncol., June 1, 2005; 23(16): 3780 - 3792.
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JCOHome page
C. Moreno, N. Villamor, D. Colomer, J. Esteve, R. Martino, J. Nomdedeu, F. Bosch, A. Lopez-Guillermo, E. Campo, J. Sierra, et al.
Allogeneic Stem-Cell Transplantation May Overcome the Adverse Prognosis of Unmutated VH Gene in Patients With Chronic Lymphocytic Leukemia
J. Clin. Oncol., May 20, 2005; 23(15): 3433 - 3438.
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BloodHome page
S. Deaglio, T. Vaisitti, L. Bergui, L. Bonello, A. L. Horenstein, L. Tamagnone, L. Boumsell, and F. Malavasi
CD38 and CD100 lead a network of surface receptors relaying positive signals for B-CLL growth and survival
Blood, April 15, 2005; 105(8): 3042 - 3050.
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NEJMHome page
N. Chiorazzi, K. R. Rai, and M. Ferrarini
Chronic Lymphocytic Leukemia
N. Engl. J. Med., February 24, 2005; 352(8): 804 - 815.
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BloodHome page
H. Nuckel, V. Rebmann, J. Durig, U. Duhrsen, and H. Grosse-Wilde
HLA-G expression is associated with an unfavorable outcome and immunodeficiency in chronic lymphocytic leukemia
Blood, February 15, 2005; 105(4): 1694 - 1698.
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ASH Education BookHome page
G. Dighiero
CLL Biology and Prognosis
Hematology, January 1, 2005; 2005(1): 278 - 284.
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BloodHome page
D. W. Milligan, S. Fernandes, R. Dasgupta, F. E. Davies, E. Matutes, C. D. Fegan, C. McConkey, J. A. Child, D. Cunningham, G. J. Morgan, et al.
Results of the MRC pilot study show autografting for younger patients with chronic lymphocytic leukemia is safe and achieves a high percentage of molecular responses
Blood, January 1, 2005; 105(1): 397 - 404.
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BloodHome page
G. Tobin, U. Thunberg, K. Karlsson, F. Murray, A. Laurell, K. Willander, G. Enblad, M. Merup, J. Vilpo, G. Juliusson, et al.
Subsets with restricted immunoglobulin gene rearrangement features indicate a role for antigen selection in the development of chronic lymphocytic leukemia
Blood, November 1, 2004; 104(9): 2879 - 2885.
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Clin. Cancer Res.Home page
A. Rodriguez, N. Martinez, F. I. Camacho, E. Ruiz-Ballesteros, P. Algara, J.-F. Garcia, J. Menarguez, T. Alvaro, M. F. Fresno, F. Solano, et al.
Variability in the Degree of Expression of Phosphorylated I{kappa}B{alpha} in Chronic Lymphocytic Leukemia Cases With Nodal Involvement
Clin. Cancer Res., October 15, 2004; 10(20): 6796 - 6806.
[Abstract] [Full Text] [PDF]


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BloodHome page
T. Hamblin
CLL: to mend it or be rid of it
Blood, October 15, 2004; 104(8): 2210 - 2210.
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BloodHome page
G. F. Widhopf II, L. Z. Rassenti, T. L. Toy, J. G. Gribben, W. G. Wierda, and T. J. Kipps
Chronic lymphocytic leukemia B cells of more than 1% of patients express virtually identical immunoglobulins
Blood, October 15, 2004; 104(8): 2499 - 2504.
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BloodHome page
M. Ritgen, S. Stilgenbauer, N. von Neuhoff, A. Humpe, M. Bruggemann, C. Pott, T. Raff, A. Krober, D. Bunjes, R. Schlenk, et al.
Graft-versus-leukemia activity may overcome therapeutic resistance of chronic lymphocytic leukemia with unmutated immunoglobulin variable heavy-chain gene status: implications of minimal residual disease measurement with quantitative PCR
Blood, October 15, 2004; 104(8): 2600 - 2602.
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JCOHome page
C. Haslinger, N. Schweifer, S. Stilgenbauer, H. Dohner, P. Lichter, N. Kraut, C. Stratowa, and R. Abseher
Microarray Gene Expression Profiling of B-Cell Chronic Lymphocytic Leukemia Subgroups Defined by Genomic Aberrations and VH Mutation Status
J. Clin. Oncol., October 1, 2004; 22(19): 3937 - 3949.
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NEJMHome page
L. Z. Rassenti, L. Huynh, T. L. Toy, L. Chen, M. J. Keating, J. G. Gribben, D. S. Neuberg, I. W. Flinn, K. R. Rai, J. C. Byrd, et al.
ZAP-70 Compared with Immunoglobulin Heavy-Chain Gene Mutation Status as a Predictor of Disease Progression in Chronic Lymphocytic Leukemia
N. Engl. J. Med., August 26, 2004; 351(9): 893 - 901.
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BloodHome page
H. Kohlhammer, C. Schwaenen, S. Wessendorf, K. Holzmann, H. A. Kestler, D. Kienle, T. F. E. Barth, P. Moller, G. Ott, J. Kalla, et al.
Genomic DNA-chip hybridization in t(11;14)-positive mantle cell lymphomas shows a high frequency of aberrations and allows a refined characterization of consensus regions
Blood, August 1, 2004; 104(3): 795 - 801.
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JNCI J Natl Cancer InstHome page
O. Moshynska, K. Sankaran, P. Pahwa, and A. Saxena
Prognostic Significance of a Short Sequence Insertion in the MCL-1 Promoter in Chronic Lymphocytic Leukemia
J Natl Cancer Inst, May 5, 2004; 96(9): 673 - 682.
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Cancer Res.Home page
L. J. Rush, A. Raval, P. Funchain, A. J. Johnson, L. Smith, D. M. Lucas, M. Bembea, T.-H. Liu, N. A. Heerema, L. Rassenti, et al.
Epigenetic Profiling in Chronic Lymphocytic Leukemia Reveals Novel Methylation Targets
Cancer Res., April 1, 2004; 64(7): 2424 - 2433.
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BloodHome page
P. Dreger, S. Stilgenbauer, A. Benner, M. Ritgen, A. Krober, M. Kneba, N. Schmitz, and H. Dohner
The prognostic impact of autologous stem cell transplantation in patients with chronic lymphocytic leukemia: a risk-matched analysis based on the VH gene mutational status
Blood, April 1, 2004; 103(7): 2850 - 2858.
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Mayo Clin Proc.Home page
T. D. Shanafelt and T. G. Call
Current Approach to Diagnosis and Management of Chronic Lymphocytic Leukemia
Mayo Clin. Proc., March 1, 2004; 79(3): 388 - 398.
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BloodHome page
T. D. Shanafelt, S. M. Geyer, and N. E. Kay
Prognosis at diagnosis: integrating molecular biologic insights into clinical practice for patients with CLL
Blood, February 15, 2004; 103(4): 1202 - 1210.
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Proc. Natl. Acad. Sci. USAHome page
C. Schwaenen, M. Nessling, S. Wessendorf, T. Salvi, G. Wrobel, B. Radlwimmer, H. A. Kestler, C. Haslinger, S. Stilgenbauer, H. Dohner, et al.
Automated array-based genomic profiling in chronic lymphocytic leukemia: Development of a clinical tool and discovery of recurrent genomic alterations
PNAS, January 27, 2004; 101(4): 1039 - 1044.
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ASH Education BookHome page
J. C. Byrd, S. Stilgenbauer, and I. W. Flinn
Chronic Lymphocytic Leukemia
Hematology, January 1, 2004; 2004(1): 163 - 183.
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JCOHome page
Y. Vasconcelos, F. Davi, V. Levy, P. Oppezzo, C. Magnac, A. Michel, M. Yamamoto, O. Pritsch, H. Merle-Beral, K. Maloum, et al.
Binet's Staging System and VH Genes Are Independent but Complementary Prognostic Indicators in Chronic Lymphocytic Leukemia
J. Clin. Oncol., November 1, 2003; 21(21): 3928 - 3932.
[Abstract] [Full Text] [PDF]


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BloodHome page
Z. A. Davis, J. A. Orchard, M. M. Corcoran, and D. G. Oscier
Divergence from the germ-line sequence in unmutated chronic lymphocytic leukemia is due to somatic mutation rather than polymorphisms
Blood, October 15, 2003; 102(8): 3075 - 3075.
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BloodHome page
D. Kienle, A. Krober, T. Katzenberger, G. Ott, E. Leupolt, T. F. E. Barth, P. Moller, A. Benner, A. Habermann, H. K. Muller-Hermelink, et al.
VH mutation status and VDJ rearrangement structure in mantle cell lymphoma: correlation with genomic aberrations, clinical characteristics, and outcome
Blood, October 15, 2003; 102(8): 3003 - 3009.
[Abstract] [Full Text] [PDF]


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Mol. Pathol.Home page
O Moshynska, K Sankaran, and A Saxena
Molecular detection of the G(-248)A BAX promoter nucleotide change in B cell chronic lymphocytic leukaemia
Mol. Pathol., August 1, 2003; 56(4): 205 - 209.
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BloodHome page
A. Guarini, G. Gaidano, F. R. Mauro, D. Capello, F. Mancini, M. S. De Propris, M. Mancini, E. Orsini, M. Gentile, M. Breccia, et al.
Chronic lymphocytic leukemia patients with highly stable and indolent disease show distinctive phenotypic and genotypic features
Blood, August 1, 2003; 102(3): 1035 - 1041.
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BloodHome page
A. Wiestner, A. Rosenwald, T. S. Barry, G. Wright, R. E. Davis, S. E. Henrickson, H. Zhao, R. E. Ibbotson, J. A. Orchard, Z. Davis, et al.
ZAP-70 expression identifies a chronic lymphocytic leukemia subtype with unmutated immunoglobulin genes, inferior clinical outcome, and distinct gene expression profile
Blood, June 15, 2003; 101(12): 4944 - 4951.
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BloodHome page
G. Tobin, U. Thunberg, A. Johnson, I. Eriksson, O. Soderberg, K. Karlsson, M. Merup, G. Juliusson, J. Vilpo, G. Enblad, et al.
Chronic lymphocytic leukemias utilizing the VH3-21 gene display highly restricted V{lambda}2-14 gene use and homologous CDR3s: implicating recognition of a common antigen epitope
Blood, June 15, 2003; 101(12): 4952 - 4957.
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NEJMHome page
L. M. Staudt
Molecular Diagnosis of the Hematologic Cancers
N. Engl. J. Med., May 1, 2003; 348(18): 1777 - 1785.
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NEJMHome page
K. R. Rai and N. Chiorazzi
Determining the Clinical Course and Outcome in Chronic Lymphocytic Leukemia
N. Engl. J. Med., May 1, 2003; 348(18): 1797 - 1799.
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BloodHome page
M. Ritgen, A. Lange, S. Stilgenbauer, H. Dohner, C. Bretscher, H. Bosse, A. Stuhr, M. Kneba, and P. Dreger
Unmutated immunoglobulin variable heavy-chain gene status remains an adverse prognostic factor after autologous stem cell transplantation for chronic lymphocytic leukemia
Blood, March 1, 2003; 101(5): 2049 - 2053.
[Abstract] [Full Text] [PDF]



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